Heart Shaped Box

Before I go any further, PLEASE tell me someone gets the song reference in the title of the post. I'll feel really old if nobody does.

I had my first appointment with my new provider this morning. All-in-all it was as expected. We went over history. She estimated my due date. Based on the u/s that I had in the ER a few weeks back apparently we're looking at October 17th rather than the 15th. A couple of days later than LMP is expected due to my late ovulation (see chart), so whatever. They scheduled me for my first shot at hearing the heartbeat (FINALLY!), and then sent me to the vampires in the lab for blood draws and peeing in a cup.


As of right now, my first chance at seeing a heartbeat won't be until March 31st. I'll be about 11.5 weeks. Ironically, I'll be getting a NT Scan at a different hospital (the u/s tech that does them at the military hospital is deployed) at roughly the same time (11-13 weeks). I'll be waiting what feels like an eternity for an u/s, and then getting two in two weeks time. Figures.



******

Now for the big news of the day. Apparently I have what they are deeming a Bicornate Uterus. I knew at my ER visit at 6 weeks that they were looking at the possibility, but I had no idea it was official. I'm honestly kind of suspecting its the fibroid I've been told is there growing and distorting things, but they are right to be conservative.


For those that don't know, a bicornate uterus is basically one with a partial division down the center. There are two common shapes to a bicornate uterus. Heart-shaped and two horned. I'm the heart-shaped variety. I don't have an image of my own yet, so here is the closest I could find on the internet to what I saw during my u/s.

A three-dimensional image that demonstrates a heart-shaped bicornuate uterus. Fundal indentation is well seen (arrow), as well as the widely divergent horns (asterisks) with a single cervix (arrowhead). (Image and explanation courtesy of: http://tinyurl.com/4gnr7zd)

From what I've been able to find online, the biggest risks are:
*Miscarriage if implantation happens in a region of the uterus where growth would be too restricted.

*Early delivery due to space restrictions.

*Cesarean section due to breech/transverse presentation. Basically the shape of the the uterus can restrict the baby being able to flip into a head-down position for delivery.

I've also found examples on the internet of women going full term and doing natural deliveries, so I'm just taking it as something they'll be watching closely. We'll deal with potential complications as we go. I've already got a list going for questions to ask the doctor. Right now I'm just trying to remind myself that this is the same pregnancy as it was yesterday, I'll just be watched more closely now. I'd be lying if I didn't say I was concerned though. Its scary being told your pregnancy is now deemed risky enough that they are sending you to the Big Dogs to be watched more closely. The same place that you were told just weeks ago was for "high risk" only. *Gulp*

Everything You Never Wanted To Know...

...about my ute.

Since I'm in the midst of the 2ww (7DPO today), I figured this would be a good time to get you all up to speed on a somewhat relevant bit of my history. Plus, I know when I was wondering what was wrong with me it was helpful to hear others stories. Be warned there may be TMI for some.

First the back story:
In December 2007 I was working outside at my job. Woods in Virginia. On an Army base. Just me and 5 guys. It was my time of the month (no biggie, used to that in such situations). This day was different. The bleeding was so heavy I was going through a tampon AND a pad in about 10 minutes. Clots passing that were quarter to palm sized. The guys were asking if I was OK as I was pretty pale (in hindsight, I was probably anemic). Needless to say we did the bare minimum we needed to do that day and then baled. The rest of my period was fine. I figured it was some fluke thing.

Until June 2008. In mid June I started spotting mid-cycle. I was on BCP at the time and figured it was just time to change the type of pill. So we changed the type of pill. Still spotting. Changed pill type again. Still spotting daily, sometimes pretty heavily. In the meantime at each follow-up appointment I'm being screened for everything under the sun that could cause the bleeding. Syndromes. STDs. Cancers. Stuff that really gets the mind racing. Nothing like knowing something is definitely wrong...but not having anyone be able to tell you what that something is.

There was another incident of extremely heavy bleeding in late August 2008. I remember the exact date as it was at my best friends wedding. Awesome Timing. I spent half the event in the ladies room trying to keep up with the bleeding. I got back from my trip to the wedding and got in to see my doctor ASAP. Enough already.

My normal OB/GYN realizes she's in over her head as the issue isn't being resolved and refers me to a specialist. This was in Sept 2008. THREE MONTHS of constant spotting/bleeding later. This specialist, my first male OB/GYN, puts me on a different pill. This pill actually made a difference with the bleeding. Got it down to about 5 days of spotting in the 3 weeks of active pills. Doctor isn't satisfied with the results. Wants it down to 0 days. I get an unexpected uterine tissue sampling done in his office that afternoon. Cervix manually dilated and they scrape out some tissue. No anesthesia. Not Fun. Sample comes back negative for uterine cancer (woo hoo!). Since there are still no answers, its time to go in and take a look around.

The Resolution:
In January 2009 he performed a hysteroscopy and D&C. For those that aren't familiar with what those procedures are, I'll give you a quick description. In a hysteroscopy, they distend the uterus with either a liquid or gas (in my case, saline). They then insert a contraption called a hysteroscope to look inside. In my case he was looking for the source(s) of the bleeding.

(Image Credit: http://tinyurl.com/4fzpoqo)

Once he'd had a look around, and removed the two culprits, he performed a D&C. During a D&C (aka Dilation & Curettage) the cervix is dilated and then the contents of the uterus are removed. Though most commonly associated with miscarriages, D&Cs can also lessen heavy bleeding like I was having.

The Diagnosis:

Submucosal Uterine Fibroids. One of the least common of the types of uterine fibroids, accounting for 5% of all uterine fibroids*. These fibroids grow on the inner side of the uterus and I had two of the classic symptoms: Unusually heavy or prolonged menstrual periods and bleeding between periods.*

(Image Credit: http://tinyurl.com/4gtvw7h)

I want to note that uterine fibroids are very common and rarely cancerous. My doctor said roughly half of the women of childbearing age have them. Most of those women have no idea they are even present. My type was enough of a rarity that I got to be a case study for my doctor (Go Me!). Unfortunately, that meant he needed all the pictures of the inside of my ute (I know, I'm strange in thinking stuff like that is cool...but how often do you get a photo like that???) To my knowledge I have two fibroids in my uterus still. One was left during the D&C as they didn't have the tools to reach it. Its up at the top of my uterus. The other was found via ultrasound during my miscarriage, its on the sidewall. I've only had two minor bouts of spotting since the D&C. Nothing to worry about really. And honestly, just knowing they are there is more than half the battle. The worst part of the whole unexplained bleeding deal was not knowing what was wrong. Finding out was so empowering.

I've had about 5 different doctors swear up and down that my having fibroids should have no bearing on my ability to get and stay pregnant. Crossing my fingers they are right.

So, there ya have it...everything you never wanted to know about my ute.

Take care,



Reference:

* http://tinyurl.com/4fcr8dp

(To any of the Buds reading. Could one of you tell me the trick to get it to say photo credit where I have the links listed under the images? Thanks!)

Surgery was a success!

Went into my RE appointment thinking I was just having a vaginal ultrasound.... wasn't I surprised to find out I was having a hysteroscopy?! All was well though. It wasn't painful or uncomfortable at all so they didn't do the local anesthesia they normally do for it. My RE's words were "It didn't hurt because I did it." He's just a little cocky...

The hysteroscopy showed a beautiful and perfect uterus. Everything has healed up beyond Dr. P's expectations and he said it's looking absolutely wonderful. He held up the "before" pictures from before he started my surgery and compared them to the screen showing what it looks like now. It doesn't even look like the same uterus anymore. It's absolutely clear in there and you can see both tubes wide open. The endometrial tissue has grown tremendously and there is no sign of the scarring from surgery where the fibroid was.

He was beyond impressed and had a huge smile on his face the entire time. This is a man who rarely shows any personality or emotion. When I remarked about it to Debbie, his nurse, she was laughing and said that he's always bursting at the seams when he knows he did an exceptional job.

He said I can stop the Premarin and Provera today and that I am to return for CD3 bloodwork to check my estradiol and FSH levels when I get my next "natural" period. In other words, not this coming period since it will be hormone induced. Then is CD22 bloodwork to test estradiol again and progesterone. I asked him if we were okay to try on our own naturally this month after my period starts and he said without a doubt, absolutely and he strongly encourages it. We'll also try on our own naturally with timed intercourse the following cycle. He said after those 2 cycles, I will come back in 2 weeks after my CD22 blood work and we'll discuss the results and our next steps if I am not pregnant.

I feel MUCH better about that than what he had decided last time (6 months trying on our own starting in October).

No real update so far... my uterus is still on vacation.

Just finished my first completely cycle of hormone therapy. 25 days of meds and 5 days of no meds. Started my period this morning and it's nice and light so far. 27 day cycle is what was normal for me before all the symptoms of the fibroid starting showing up so it's nice to be back to that. Hopefully my period will stay light, which is also what was normal before I had the fibroid.

I've been contemplating whether or not to call the RE and see if I can get in earlier than my July 15th appointment.

My reasoning is that by that appointment, I will have already ovulated. I'm an early ovulator, generally between CD11-13. I'd like for the month to not be out if it doesn't have to be.

Also, from my predictions if my cycles stay on this track, I'll be ovulating in August the week we are out of the country on vacation. Therefore, making any treatment in August impossible. :(

Which means that we wouldn't even be able to begin treatments until September. Which seems like FOREVER from now. Not to mention that I know that once you have fibroids, your chance of them reoccurring is higher so I'm terrified of having another one and needing more surgery.

Survived surgery!

There hasn't been much to update until now. I was on birth control pills to prevent possible hemorrhage from my heavy periods.

Went in for surgery at 8am on Wednesday. The nurses and doctors at the surgery center are VERY nice! One girl was a student and they asked permission for her to watch the procedure and I had no problem letting her watch. Everyone has to learn! And the doctor told her it was going to be a very interesting procedure with all that I had going on. Possible removal of right tube, left ovary and left tube. Definite removal of cysts and fibroid.

The IV hurt really badly going in and I barely remember being knocked out. I remember them putting a mask on my face and telling me to take deep breaths (they did anesthesia via mask AND IV) and next thing I remember is being told to calm down and that everything was okay. I, apparently, was having a hard time coming out of anesthesia. I didn't do well last time I was put under either.

Wheeled into recovery where I was given a shot of Fentanyl which helped the pain (which was pretty severe) for a brief moment and made me very woozy. The pain came back pretty quickly and they gave me another shot of Fentanyl. Again, woozy and brief respite from the pain. After a bit, they had me get up and get dressed. This made me start vomiting and very nauseous so they gave me some Zofran. Another shot of Fentanyl until they could be sure I'd be able to keep down the Percocet pill they had for me.

Finally, my doctor came over to talk to us about the surgery. He found that my uterus had attached to the abdominal wall. He showed us a ton of pictures and that was by far the coolest picture he had. So he separated the uterus from my abdomen and said that was a fairly easy procedure. Drained and removed all the cysts (there were 4 on my left ovary and 1 on my right). Removed the fibroid which was HUGE. The pictures were insane. Dr. P was pretty impressed with the size of the thing as well. That took him most of the time in surgery, which actually ran longer than the 2 hours allotted for it. But he got it ALL. All that is left of it is a black scab which he said endometrial tissue will grow over it.

And on to the tube/ovary news....

My tubes and ovaries were perfectly healthy and fine!!! There was no blockage on my right tube. Just a little flap of tissue that he easily removed. There is no damage to either tube at all. My left ovary was only 1.5 times the size of a normal one so it definitely shrunk a great deal (thank you devil pills!). But he said he had no reason to remove any of them and that they are in great condition and looking very healthy!!!

I literally burst into tears with relief. I was shocked by this news because he had prepared me going into surgery that I could wake up with ONLY my right ovary. Every time, he opened his mouth, I swear it was like heaven and goodness flowed out!

I've had a pretty rough recovery so far. MUCH worse than surgery in February. I've been beyond blessed by Mr. Sunflower Bud. He's being incredible and taking such awesome care of me. He has to help me up and down out of bed and to the bathroom. He's been shooing the cats out of the bedroom (they want to cuddle up ON my stomach for some reason) and keeping Little Sunflower Bud out of the house as much as possible (she's in major Mommy phase and wants to climb all over me).

From the time I got home, I was literally asleep for 2 hours, awake for 20 minutes, asleep for 2 hours, awake for 20 minutes, etc. Woke up a lot during the night Wednesday night because I was itching so badly. Could not get with it at all all day Thursday. I made it down to the couch for about 40 minutes before I was asking to go back to bed. I couldn't look at my laptop because it made me ill for some reason. When I worked up the courage to get in the shower yesterday afternoon, I discovered that I was covered in hives!!! No wonder I was so itchy!

Turns out, I'm allergic to Percocet. What a sad sad allergy that is. Who wants to be allergic to such a wonderful narcotic? :( Called the doctor and he called in Darvocet and told us to flush the rest of the Percocet and that I'd have to note that on all allergies from now on (boooo). Started taking the Darvocet last night around 6pm and holy cow, what a difference!!! Knocked me out at first but when I woke up, I actually felt human. No more itching (thank you Benadryl!) and I was actually lucid and able to sit on the couch long enough to watch a movie and get on the laptop for a little while. I even slept 7 hours straight last night without waking up to itch! And I was able to eat a whole entire meal last night. I could barely nibble on toast throughout the day on the Percocet.

I go back to see Dr. P in 6 weeks to discuss what's next. It's funny... having been faced with IVF being our only option, doing IUI's just seems like pennies and dimes! I'm fairly certain that IUI is on our plate but the only question will be if it's medicated or unmedicated. Either way, the costs are certainly not as daunting now as it was when we were focused on affording IVF.

I'm on a hormone therapy schedule to build up my lining:
25 days on Premarin, 5 days off, 25 more days of Premarin
Days 13-25 of both months, take Provera

Just 2 months of healing and hormone therapy before we can get back to TTC! I am PSYCHED. I'm so getting pregnant this year. Spring 2011 looks like a lovely time to have a baby, don't you think?

Smudge is SO Grounded

I really can’t complain about this pregnancy so far. I’ve had nausea, I’ve been dizzy and I’ve definitely been extremely fatigued. But I can’t complain. If barely being able to hold my head up is the worst of my 1st trimester, then I definitely can’t complain.

More than anything else, I have never spotted. Not once. Not a hint of it.

So this morning, when I saw that blood on the toilet paper, on the last day of my 1st trimester, I just about lost my mind.

First I called my husband, told him I was spotting. Then I called my doctor’s nurse, and was barely able to hold my voice together. I told her what had happened, and that I knew everything was probably fine, but was there any way she could fit me in tomorrow, just to get checked. Thankfully, Nurse M knows about everything we’ve been through. She was mostly worried about me. She told me that she could hear me shaking on the phone. She was going to call Dr Loh (who was at the hospital) and call me back. Meanwhile, I called a good friend who would keep me occupied until Nurse M called me back.

When Nurse M called back, to my surprise, they weren’t going to fit me in for an ultrasound tomorrow. She was sending me immediately to the radiology place they affiliate with for an ultrasound. She faxed a prescription and said they were waiting for me, and would take me as soon as I got there (it was about 40 minutes away).

Our sonographer was Linda, and she was wonderful. Seriously kid gloves. Exactly what I needed. As soon as she put the wand on my belly, we saw a little arm pop up. All I wanted was to see the heartbeat, but Linda kept saying that with all the movement, everything was fine. Then we saw the perfect heartbeat beating away at 173. And then I breathed.

The ultrasound was amazing. 15 minutes of watching baby acrobatics. And Smudge was MOVING. All over the place. Cartwheels, somersaults, the works! Kicking and waving up a storm. It was great to see. And as soon as I saw s/he was okay, I pointed at the monitor and said “you’re grounded”, and the baby promptly raised it’s arm.

I’m fairly certain my child just gave me the finger.

Measurement-wise, we’re ahead in everything. The head is measuring 6 days ahead, abdomen 1 day and femur 3 days. I even got a NT sneak peek… the baby wouldn’t cooperate well, but from what she was able to see, she said she saw no significance to the area at all. So, although highly unofficial, I’ll take it.

Linda did find all three fibroids… so they’re still there, but the largest is hanging off the back of my uterus, so that’s fine. The two smaller ones are embedded in the wall, but not interfering with anything.

Then I saw the little black patch at the bottom of the screen. I’m a nurse. I’m not an idiot. I know what blood looks like on an ultrasound. I pointed it out to Linda and asked her if it was a subchorionic hematoma, and she said that, yes, that’s what she would call it.

Well, now we have our answer.

I’m 100% convinced that the HORRIBLE day I had at work yesterday, where I was on my feet for 12 hours, wasn’t able to sit hardly at all and didn’t drink nearly as much water as I would have wanted to, combined with the SCH is the reason why I spotted today.

Needless to say, I’m not going in tomorrow. I already called out.

So, here I am, sitting on my comfy chair with my nalgene bottle filled with water and the remote. Smudge is waving at me from the ultrasound picture on my right.

Today is the last day of my first trimester, and I absolutely love my baby.

It’s real. I’m pregnant. And I’m going to do whatever I have to in order to assure this baby is born healthy.

Circling in the holding pattern

It's been about a week since I posted. I've needed some time to digest everything I found out.

The day after my appointment with the new RE, he had me come back in for an SHG. What he found was disappointing to say the least.

I have a fibroid. Not just any fibroid, but a HUGE freaking fibroid. It's the same one I was operated on in February. It was submucosal and most of it was embedded in the uterine wall and they could only get what was in the uterus. Since then, it's delivered into the uterus completely and grown. Grown so much that it's actually expanding my uterus and stretching it and distorting it's shape completely. A normal uterus is triangular shaped. Mine is a horizontal oval right now.

My right tube is blocked on the outside by ovarian tissue. He will decide completely once he's inside and can get a better look but he feels that removing it would be the best course of action. He said that when there is a blockage on the outside, there is generally damage inside the tube as well and that it greatly decreases chance of pregnant and increases chance of ectopic.

My left ovary is triple the size of a normal ovary. SHEESH! He has no idea what is going on there but he's hoping that it's overstimulation from Clomid. I'm on birth control pills for another month in the hopes that it will calm down and shrink in size. If it doesn't.... it has to be removed. It's also covered in cysts and he said that he can't safely remove the cysts without risking snapping the ovary off due to it's size and unstable state.

I'm scheduled for another SHG on the 27th of this month to see how that ovary is doing.

My surgery (lap/hysteroscopy) is scheduled for June 2. I won't know what is removed until I wake up from surgery.

I'm praying to God every day that I don't wake up with just a left tube and a right ovary. Because frankly, that would suck.

If I get to keep my left ovary, we have a shot at IUI. If I don't.... our only option is IVF.

But for now... I'm on birth control pills and am actually in a MUCH better place emotionally than I have been in awhile. Knowing 100% that I can not get pregnant is actually a relief for now. There's not stress or wonder or worry. It's nice to live in the moment and enjoy the NOW instead of being completely focused on what's going on.

Amazing what a second opinion can tell you!

We met with the top ranked RE in our state this morning. I was highly impressed immediately when I met him. Dr. P is extremely detail oriented and very thorough. He spent 2 hours with us and had pulled up every single documentation that was in the hospital records system and went through it all with a fine tooth comb.

Dr. P said that he disagrees with everything that Dr. M said.

1. I do not need IVF. At all. He was incredulous that Dr. M even suggested it.
2. It's not a polyp. It's the same fibroid that I had surgery on in February. It's submucosal. Half of it had been embedded in the muscular wall and has now popped out into the uterine cavity and is preventing us from getting pregnant. It does need to be surgically removed especially due to the increasing intensity of my periods. He was concerned when he heard my last period was 9 days long and I was going through super tampons paired with pads and soaking through both in less than an hour.
3. He agrees that the right tube is blocked but disagrees that it can't be removed and he wants to remove it. This would mean I would only get to ovulate out of one tube every other month but it decreases our risk of ectopic pregnancy which is sitting around 10% right now.
4. He disagrees with the diagnosis of diminished ovarian reserve and said that my FSH should never be tested when my ovaries are covered in cysts because they cause increases in your hormone levels. My FSH in September was 7.8 when I had no cysts.
5. Mr. Sunflower Bud has (in the doctor's exact words) amazing and perfect "donor quality" sperm that he doesn't see very often. Naturally, Mr. Sunflower Bud is all puffed up and feeling good about himself right now.

He said that once we get in there and get everything out, we should have no trouble getting pregnant and he would want to do the IUI (artificial insemination) without any fertility drugs until I actually show signs of ovulation problems. He's very conservative about fertility drugs and feels they shouldn't be used if you already ovulate fine on your own.

I feel like we actually have hope now. If we can just get this fibroid out once and for all...

I go back tomorrow for another SHG so he can get a good look at how the fibroid is situated and if there are any others. He also wants a more in depth look for himself at the blockage on the right tube. Dr. M wrote that it was a hydrosalpinx and Dr. P finds it hard to believe that is the case but won't rule it out until he sees it himself.

Afterward, we'll discuss scheduling the surgery. Another surgery... UGH. But at least this time I know it's just a means to an end.

I held a 4 week old baby girl tonight for over an hour. Just the feel of her in my arms and looking at her sweet face gave me restored hope and faith that one day I will be holding one of my own again.

7w1d.... another chance to see smudge....

...and, smudge looks good.

She's 7w1d today. Her heartbeat was 158. She measured 7.9mm, which is almost double last week (4mm), and is measuring at 6w5d. The RE says that's perfectly normal.

My RE said that much like when the baby is born, and gets measured against a growth percentile chart, there's a "growth chart" for in utero as well and the baby has to measure within a week of the actual dates. So we're right on track. He said her heartbeat is perfect.

All told... things look good. He tried to kick me out today - but I suckered one more u/s out of him next week. I told him that he can't tell me the miscarriage risk drops to 5% at 8 weeks and not see me at 8 weeks.

In other news, I also talked to my RE about how an RN would break into the field of IF (i'm miserable at my job, and have been job hunting for quite awhile. Mr. DB and I have been talking about this possibility for about 6 months). He said that he might be looking for a new nurse soon (i know one of his LPNs left suddenly, and they're not thrilled with her replacement) ... i'm not going to hold my breath... but at least I opened a door.

Other news from the u/s: no obvious cysts, so we'll chalk up the weird left sided cramping to growing pains for now. No changes in the fibroid and the second sac is still resolving.

Pregnancy symptoms: I'm still peeing every 5 minutes, which is REALLY cutting into sleeping, but that's okay. At least I know I'm pregnant, right? Occasional nausea, and some dizziness... but I think between the Vitamin B6 that I'm taking and the acu are keeping the worst of the morning sickness at bay.

After all this time....

Almost 2 years of TTC, Countless Cycles, Devastating Diagnosis, Rivers of Tears and Two IVF cycles....

.... Have led me to you....

That's my baby smudge.

We had our 1st ultrasound yesterday at 6w1d. Our baby is measuring perfectly. We saw a perfect heartbeat and were able to hear it.

It was so surreal.

Dr Z saw a second sac, a lost twin. As bittersweet as that should be, i'm okay. I knew somehow, and had even commented to someone the other day that I felt like there had been two, and that one had been lost. It's really weird to be right about that - but I think, however I knew that, it helped me work through it before I even saw the u/s. I think that's why I've been so nervous the past week or so. Why i've been looking up everything I can about blighted ovum and things like that. Because I knew it was happening. And I was able to work through it before I saw it on the u/s.

I also asked Dr Z to check my fibroids. There's now only 1 and it's nowhere near the baby. Dr Z has no concerns about the fibroid affecting the pregnancy at all.

Meanwhile, we're absolutely thrilled about our little smudge... please keep thinking about us. The next 2 weeks are really important. We'll go back for another u/s in one week, and then again the following week.

I love you baby smudge.

There, but for the grace of Tampax, go I.

Ah, to be in the house of Dandelion.

I'd love to say that the road to IVF #2 is fraught with blood, sweat and tears - but mostly, it's just blood.

I've been on my favorite devil pills for 6 weeks now. I just started pack number 3 of the desogen. At least I know I only have to take 5 pills from this pack - because my last devil pill will be this friday. Usually, after you stop taking the devil pills, you expect a period. However, i've already been bleeding for almost 3 weeks. Isn't it just fantastic? Usually, the ONLY benefit to BCPs is NOT bleeding. Not in Dandelion land... not this time, anyway. The good news, is that my IVF nurse says I might not bleed like I did last time i came off the devil pills, since i've been bleeding for so long. But I've been through almost 5 boxes of tampons. So, enough is seriously enough already.

photo credit

I had my baseline ultrasound this past wednesday. The good news: my antral follicle count is 11. So - that's not great - but it certainly doesn't suck. Our only question is how many of those eggs aren't geriatric. I guess time will tell. I found this chart (below) online... explains a little bit more about AFCs. I think my AFC last time was 14 or 15.

Total number of antral follicles	Expected response to injectable stimulating drugs and chances for IVF success
Less than 4	Extremely low count, very poor (or no) response to stimulation and a cancelled cycle expected. Should consider not attempting IVF at all. Rare pregnancies if IVF attempted.
4-7	Low count, we are concerned about a possible/probable poor response to the stimulation drugs. Likely to need high doses of FSH product to stimulate ovaries adequately. Higher than average rate of IVF cycle cancellation. Lower than average pregnancy rates for those cases that make it to egg retrieval. The reduction in success rates is more pronounced beyond age 35.
8-10	Reduced count. Higher than average rate of IVF cycle cancellation. Slightly reduced chances for pregnancy success as a group.
11-14	Normal (but intermediate) count, the response to drug stimulation is sometimes low, but usually adequate. Slight increased risk for IVF cycle cancellation. Pregnancy rates as a group slightly reduced compared to the "best" group.
15-30	Normal (good) antral count, should have an excellent response to ovarian stimulation. Likely to respond well to low doses of FSH product. Very low risk for IVF cycle cancellation. Some risk for ovarian overstimulation. Best pregnancy rates overall as a group.
Over 30	High count, watch for polycystic ovary type of ovarian response. Likely to have a high response to low doses of FSH product. Higher than average risk for overstimulation. Very good pregnancy rate overall as a group, but some cases in the group may have egg quality issues and somewhat lower chances for pregnancy.

photo credit

Okay - so the question on everyone's mind... what the heck is causing the bleeding? .... what about the fibroid? Here are the answers to those questions....

The bleeding, as far as they're concerned is just an unfortunate and messy side effect of the BCPs. They are 100% sure that it is NOT from the fibroid, because the fibroid "has not deviated the uterine cavity". In other words, my lining appears on the ultrasound as a straight line. If the lining were interrupted, because a fibroid had broken through into the uterus, the line would be separated, interrupted or deviated in some way. It is not. So, Dr Z is NOT concerned at all. Therefore, I am not concerned at all. However, there isn't just 1 fibroid anymore. Now there are 3. Nevertheless, as long as they all stay outside of my uterus, where they are now, Dr Z could care less, and isn't even considering taking them out. Totally works for me.

I also discussed another concern with him. It seems that the majority of girls I talk to have an ultrasound guided embryo transfer and all have had a mock embryo transfer prior to their cycle. I hadn't had either - and I was curious as to why. Mr DB told me just to ask, so at my appointment i said, "Dr Z, i'm in a support group (he doesn't like that I go online all the time, so i figured he'd take it better if I told him this all came from a support group), and some of the girls were talking about their transfer experiences. I was wondering why it seems that some doctors do mock transfers and u/s guided transfers, and some don't?" He was SO awesome with his answer. First of all, I DID have a mock transfer... it's just that mine happened during my retrieval while I was unconscious. That works for me! Then we talked about the u/s guided transfers.

Apparently, they did do them for about 4-6 months when they first came in vogue. However, their pregnancy rates dropped by almost 15% during that time. Dr Z said that it is a matter of learning new technique and personal preference. He said that in his experience, you can focus too much on the picture, and even a minor movement can cause you to lose embryos. Furthermore, he felt t he full bladder was very uncomfortable for patients. He said as soon as he stopped doing the u/s guided transfers, his pregnancy rates went right back up, so unless he has a patient with a particularly difficult mock transfer, he prefers to NOT do them.

As his pregnancy rates are already above the national average, without u/s guided transfers, I say, "if it ain't broke, don't fix it".

What 8 grand worth of meds looks like

So, where we are now:

• Last devil pill will be this friday
• Suppression check Friday, March 5th
• Stims start, at max dosages, Friday, March 5th
• 1st monitoring appointment Tuesday, March 9th
• ER/ET will be the week of March 14th

This time it is going to work - POF be damned.

Quick Update

Hey everyone! I just wanted to pop in & let everyone know that I had my CD 2 vaginal u/s & b/w done. Everything looks very normal according to my Dr. & nurse. During the u/s they did find one small fibroid, but the Dr. said that she does not believe that it is effecting my fertility in any way. I talked to the nurse more about it when she called & she basically said that of the Dr. is not worried about it, then I shouldn't be. From what I read about fibroids, she is most likely right, but, I will talk to Dr. G about it more during our followup consultation, which is scheduled for December 18th.

My b/w was also all normal - she told me all the numbers, but I didn't write it down, but my Estrogen, Prolactin, LH & FSH were all at the normal levels they like to see from women at the beginning of their cycles. So, basically so far, so good!

Mr. WB's SA & my HSG is scheduled for this Wednesday, November 18th & I am also hoping for good news! Please pray for normal results for us!! If everything looks normal, then we will still do the followup consultation, but most likely stick with our plan to try for a few more cycles before doing any medicated cycles.

In the mean time, I am keeping busy with my Thanksgiving (my husband's family is coming up to our area this year) & other holiday plans. I can't believe the holidays are already upon us - my how time flies!