Beginning Stimming

After willing and begging AF to arrive, the biatch showed up this morning after I called the RE's to say she didn't arrive. After waiting by the phone all day (I haven't done this since my days trying to find a guy), I just talked to the nurse. I can begin stims on Saturday. This is actually beginning. I actually have a good chance, at least 50%, of being pregnant in a month. This is the best chance that we have had in months. BRING IT ON!

I am very lucky that my friends know about what is going on since I have to take my very first shot during our HP 7 girls' night celebration. Mr. Plannerbud is actually secretly excited that he gets out of one night of helping me with the shot. He will probably be planning lots of events right around my 8 pm shot time.

I will be taking 150iu of Gonal F. From what I have read the side effects are not truly that bad. Many people had harsher side effects with clomid than with the injections. I hope it is the same for me. I am already on edge and snapping at poor Mr. Planner bud and the cycle hasn't really even started.

Fingers crossed that I stim quickly and can get in and out before MCAS testing so my boss doesn't kill me!

Hola from Costa Rica!

Hello Bloomin' Babies readers! I only have time for a quick update, but wanted to let you know that we arrived here in Costa Rica safe and sound. We have had an amazing 3 days, and I can't believe we still have over a week left to explore this beautiful country.



My first appointment was on the 1st, and we drove straight to the clinic from the airport. We met Dr. Perez, discussed my history, did a quick ultrasound which revealed that my ovaries were quiet as expected, and did my first injection of Gonal-F. I'm taking 225iu's a day, and I go back on Wednesday the 7th for my next ultrasound. That will be the big one that gives us an idea of how I am responding and how my follicles are looking. I have been thinking about it and hoping for the best, but we have been able to do some really cool stuff and also relax a LOT, so I'm not stressed or worried at all. Thanks for all the good vibes coming my way, I appreciate it!



Here are two pictures from our stay at Arenal Volcano...the first from a hike we took to a waterfall and the second was the view from our lodge.



Pura Vida!

Starting from the finish line

When Dr Z says we're not starting slow, he means we're NOT starting slow.

I just got home from my suppression check where I had my first official cycle vagcam/follicle check and blood draw. I also got my medication instructions for the next 4 days.

Vagcam/Follicle Check: All is well at this point. Lining is 6mm, homozygous and I have 12 antral follicles. Thats up from 10-11 at my vagcam 2 weeks ago, so I'll take it. Also, the bleeding has S-L-O-W-E-D down... it's still red, but I'm barely spotting at this point, so that makes me happy. If today is my last spotting day, i'll be thrilled. That would make 34 days bleeding all together. I'll be happy to stow the tampax - finally.

Blood draw: shockingly, they're checking my beta level. I laughed when Dr S (the embryologist that drew my blood this AM) told me that they were checking that in addition to my E2 level. Can you imagine if I were pregnant? Ridiculous thinking. But, they have to make sure. I know.

Instructions for the next 4 days: HOLY MEDICATION BATMAN. Dr Z warned me we were starting strong. I'm at maximum doses... for now. That's 2 vials of menopur (which burns like a bitch) and 300 units of gonal-f every day. Tonight the gonal will be in all one dose. Starting tomorrow, the gonal will be in 2 injections daily. We'll see where things are on tuesday. When my follicles hit 14-15mm, they'll add in ganirelex, which will prevent my ovaries from ovulating on their own.

Anyway - there's my update for now. We're starting from the top.... but we're on our way.

IVF #2 starts now.

Lupron Evaluation - Done!

This morning I went in for my Lupron Evaluation, which consists of a blood draw & vaginal ultrasound. I got my blood drawn first & the girl doing it was really nice - it was quick & painless (only 1 vial)! Then, they had me empty my bladder & sit down and wait to be called in for the u/s. I have now had a couple vaginal ultrasounds, so this one was no biggie. My RE did this one & I love it when he does them b/c he shows me what's going on & talks to me while he's doing the check.

He checked my lining first & said it was nice & thin, which is good at this stage. Then he checked my ovaries & said they both looked awesome - no cysts or anything. When he looked at each ovary he said there were about "7 less than 10" on one side & "about 7" on the other ovary. I didn't ask, but I assumed he was referring to the number of antral follicles he observed. He said everything looked great & I should be all ready to get started stimming!! After I got dressed, I met with one of the IVF nurses & she gave me an updated IVF calendar. So, tonight I start stimming with 112.5 IU of Gonal-F & 37.5 IU of Menopur, and then continue the Lupron each morning, but reduce the dosage from 20 units to 5 each morning. I was told to await the call from my nurse after they get the b/w results, but that I should be good to get started with this meds administration schedule. I am so happy that I finally get to start stimming, but time is flying way quicker than I ever expected! I have a follow up appointment on Friday to monitor the follicle development. I'm staying positive & hopeful & continuing to pray that my body continues to cooperate & respond as it should to the drugs. Please Lord, let this be it for us. As always, I want to thank anyone thinking of or praying for us during this time!

On BCPs for IVF now!

Literally hours after my last post AF arrived & the beginning of my IVF journey began! As soon as AF arrived, I called my IVF nurse. She wasn't in that day, so I called the backup nurse & left a message. The other nurse called me back in about an hour & told me everything I need to know to get this cycle started. She instructed me to start BCPs on Friday, January 8th and continue them thru Thursday, January 28th. I also scheduled my mock embryo transfer & injection training course for next Friday, January 22nd. If all goes well at the mock transfer, then I will be accepted into my center's Shared Risk program. That same day, I will plan on applying for the loan to cover the costs of my cycle(s) (after Mr. Worry Bud & I put down about $2K, it'll be just about $20K). Once we get the receipt from our Dr.'s office, we will submit it to our FSA to get reimbursed for the $10K.

Photo Credit

The nurse also sent me my IVF calendar: I start Lupron injections & baby aspirin on January 26th; my estimated Egg Retrieval (ER) is February 13th (the day before Valentines!) & my estimated Egg Transfer (ET) is February 16th (the day after my Mom's birthday & days before Mr. WB's!). I am hoping to have lots of good looking embryos on day 3 & hopefully make it to a 5-day blastocyst transfer. At our IVF consult, we discussed the risks with our RE & he agreed with our desire to transfer two embryos vs. the one he originally recommended! So, hopefully our busy month of February will end in happy birthday news for both my mom & Mr. WB!!

I also got a call from my insurance company regarding the medication prescribed for this cycle, which consists of:

• Lupron
• Menopur
• Gonal-F
• Novarel (HCG trigger)
• Azithromycin
  
• Endometrin

Photo Credit

I had to wait until Monday to get the cost of the meds from my insurance company, but I had the option of going thru another mail order pharmacy that my insurance covers & they were almost $300 cheaper! So, the estimated costs of the meds are going to cost a little under $350 including needles & shipping! I know that is it WAAAY more expensive for many other women undergoing IVF treatment, so I feel very blessed to at least have prescription coverage for the IVF drugs.

Oh & last, but not least, I am seeing an IF counselor for a one-on-one session this Friday, January 15th. I'm not sure exactly everything we will discuss, or even that sure of my expectations for the session, but I am very interested in any coping strategies she can suggest for the roller coaster of emotions that I know my upcoming IVF cycle will bring. My clinic also has a FREE IVF support group meeting next Thursday & I am considering attending that. I just want to make sure that I am emotionally as ready as possible since I believe that the mind-body connection is a very important & often overlooked component of IF treatment. That's all I got for now...thanks for all the thoughts & prayers - please keep 'em coming!

holy crap

I really don't have a more appropriate title for this blog entry.

After all of the roller coaster emotions of the past week - thoughts of being canceled, thoughts of having diminished reserve - I can't believe I was just told what I was told at the RE's office this morning.

I'm triggering tonight.

My lining went from 14 to 16mm overnight! This photo shows what a trilaminar pattern looks like:

photo credit

These are my follicle sizes from the last three visits:

• Monday: 16, 15, 13, 13, 13, 11 (Dr Z only counts the ones above 10)
  
• Wednesday: 19, 18, 15, 14, 14, 13 (6 small - meaning under 10; Dr B counts everything)
• Today: 22, 22, 20, 18, 18, 17, 15, 14, 10

photo credit

Yep - you read that right... 5 mature follicles!!!!!!! And with the way things have been going, I wouldn't be surprised if the 17 and 15 caught up by saturday.

I found this cool website that explains mature follicle sizes (remember, i'm on Gonal-F) and what happens after trigger:

• How big should my lead follicle be before I take my HCG shot?
  

A lead follicle should be at least 16 mm on an hMG like Pergonal, it should be at least 18 mm on a recombinant FSH like Gonal-F, and should be about 22 mm on Clomid. Occasionally Gonal-F can produce mature eggs in smaller follicles, in which case other measurements such as E2 and progesterone should be used to indicate maturity. (The difference in ideal size is due to the difference in mechanisms by which the medications work. For example, the mechanism by which Clomid works often takes a bit longer because it is indirect. Therefore, the follicle has more time to grow before the egg is actually mature).

• How much do follicles grow each day?
  

Follicles grow 1 to 2 mm a day both while taking ovulatory stimulants and after the HCG shot.

• Will smaller follicles "catch up" in time to release eggs?
  

Follicles generally need to be at least 15-16 mm to contain fertilizable eggs (although it is possible in rare cases for follicles to be as small as 14 mm and still contain fertilizable eggs). If the smaller follicles are close in size to the lead, they may "catch up" and release. HCG will usually result in most mature follicles releasing eggs. Otherwise, most likely only the lead follicle will ovulate.

I'm starting to think that sometimes Dr. Z is just TOO cautious. Like last week when he said, "i'm not worried YET". Today he said that tomorrow morning when I go in for blood work (they measure my estrogen again and my HCG levels, to make sure i've gotten enough of the trigger) he wants to see my estrogen go up, stay the same, or not drop more than 20%. He said if it drops more than 20% it's indicative of immature eggs that won't fertilize. I asked him if he expects that to happen. He said, "It shouldn't". Why couldn't he just say "no".

But it's not going to happen. Not with all of these follicles. Not after everything i've been through.

We're triggering tonight.

Retrieval is saturday.

Holy crap.

RE isn't throwing in the towel. Yet.

The bottom line is I'm not responding like he thought i would. There's one reason for that. Despite my stellar blood work, we now know that I have diminished ovarian reserve, at the ripe old age of 34.

I've been crying since we left Dr Z's office.

Today's update:
My estrogen went up yesterday. Thankfully. From 52 to 80. Still nowhere near where he wants it to be. However, there are positive signs. My lining is increased to 9mm and it's trilaminar now (the three layers). That is estrogen driven. So, hopefully, my estrogen today is WELL on it's way to where it needs to be.

On my left ovary, i have 4 measuring follicles: 13x12, 13x12, 14x11, and 10x11.
On the right ovary, i have 5 measuring follicles: 11x11, 8x8, 11x8, 10x8, and 10x6.

The others have stopped growing. I am on stims day 9. He said he's not likely to increase my meds at this point, because more might have adverse effects. I'm currently on Gonal-F 300 units (divided) and Menopur 2 vials. Last night I felt some cramping, and i'm definitely bloated. I am SO hoping that my estrogen is up this morning. I'm anxiously waiting for that phone call. (Since i'm crazy and asked him to call even if they aren't changing my doses... i need to know my E2).

He said the estrogen needs to be 500 to trigger and he would like to see at least 2 follicles measuring 18mm.

Perfect bloodwork. Diminshed Ovarian Reserve.

Dr Z said that he isn't worried, and there's still a good chance. Mr. DB agrees 100% with Dr Z.

The hormonally induced blubbering mess that is me is just trying to get through this day. Come on ovaries. You're only 34 years old. I've never asked anything of you in my life. PLEASE. Start responding to the meds.

Please pray for us.

Update: Follie Check #1

I had my first follicle check this morning.

My lining is at 5mm and is still homogeneous. I was concerned about this, because at my suppression check it was 7mm. I didn't understand why it would get thinner. The RE that did my US this morning (not Dr Z but his associate Dr B) said that since I still had my period at my US and spotted for another 2 days following, that my lining would get smaller because of that and it will likely start growing from here. I'm very comfortable with his explanation, but I'm going to start drinking my pomegranate (pom) juice anyway, to try to fluff up my lining.

My follicles seemed good too... on the right, I had 5 small follicles, unsized, with a lead follicle at 11mm and another at 10mm. On the left I had 5 small follicles. Dr B said that it is okay for now and that today's visit was mostly to make sure I wasn't moving too fast. I also had blood checked today for my estrogen levels (E2).

Well - my follicles might have looked okay for a first US, but we're guessing that my E2 was in the tank. I got the call around 3:30pm.

They're stopping the lupron (the suppressant) and DOUBLING my menopur and gonal-f (the stims). So, of course, I was concerned that they think i'm over suppressed now. However, the great ladies on the infertility forum convinced me that everything is going to be okay - it's probably a reaction to my low E2 (which will rise as my follicles get bigger). The ladies say I probably just need a jump start to get the party started.

So, now my protocol is, 150 units of Gonal-F in the mornings and at night 150 units of Gonal-F and 2 vials of Menopur.

My next US and E2 check will be saturday morning at 7am.

Until then, please keep me in your thoughts and prayers.... follicle wishes and thick lining dreams.

Suppression Check, checked!!

I got to the RE at 7:30am for the monitoring cattle call, where it's first come first served from 7-8:15 for blood work and vagcams. Considering that I didn't get out of there until 9:45, i think next time, i'll be there right at 7. Maybe even a few minutes before. Might be rough, considering it's almost 40 minutes away, but I was almost late for work this time, and don't want to take that chance again.

Anyway - the update.

I took my first shot in my leg today, previously i've been doing them all in my arms. starting monday, i'll be taking 4 injections daily. I needed more options than my arms. And since it seems that my RE is more strict than some others, i can't take them in my abdomen. The leg shot hurt, but at least i'll be able to do them myself.

Bloodwork (bw)
I don't know if I'll even find out the results of the blood work this time, but I really don't care yet. I'll want to know my estrogen (E2) levels and progesterone (P4) levels as time goes on.

Ultrasound (us)
We're very happy about my vagcam results. My IVF Nurse (F) did it this time, rather than Dr. Z, so the eyes on the US were different. She also had a much lighter tough, and wasn't looking for things as aggressively as he does. 10 days ago, Dr Z saw 14 antral follicles. F saw 11. I'm okay with that. She said the most important thing is that there's obvious activity in both ovaries. The other great news is my endometrial lining. It measured 7mm. F said that is a great starting point. Apparently they like to see lining from 8mm-13mm for implantation, and I'm well on my way to that point. It's also homogeneous, which means it's one layer right now. Eventually, they'll want to see it at three layers for implantation to occur.

Stimulation Protocol
So, here we are... i'm ready to start cranking these follies out! Sunday morning, I'll reduce my Lupron dosage by half to 10 units (and hopefully lose these migraines in the process). Then, sunday night, I'll take 150 units of Gonal-F and 1 vial of Menopur.

Monday starts my new schedule:
In the morning:

• Gonal F 75 units
• Lupron 10 units
  

At night:

• Gonal F 75 units
• Menopur 1 vial
  

My next monitoring appointment will be thursday morning. My dosages may be adjusted based on the bloodwork results and the ultrasound that day.

Thanks for all of the continued good wishes and T&P. With your support, I might just get through this.