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.

Having GREAT friends helps + follie check #1!

I had my first follie monitoring appointment this morning, but before I talk about that, can I just AW my dear dear Bud friends for a minute?! Chef Bud & Obsessive Bud. They are literally so.freakin.awesome. And let me tell you why....

First, Chef Bud - she is such a wonderful, sweet person. We met online on one of our favorite TTC message boards back in late June when Mr. Worry Bud & I started TTC. We have been there to root each other on through failed cycle, after failed cycle, but have both tried to remain positive & hopeful! Since we both started seeing RE's for our TTC issues around the same time, we kept in touch via email to support each other. I checked our mail this morning (forgot to last night...had to run to the grocery store to get some essentials before the crazy winter storm expected to hit our area in a few hours) & look what I got:

Lucky penguin Valentines socks, a very sweet card & a rose quartz heart shaped stone. The note with the rose quartz says "RQ represents love & fertility. It is said to help promote pregnancy & to protect the mother & unborn fetus from miscarriage."

Well, I sent a personal note to CB, but I just want to say publicly that you have no clue how much this gesture means to me. It brought tears to my eyes that someone I have never met IRL cares that much about me to put together something so special & send it to me. It makes me feel so good to know that I have such wonderful people out there thinking of me. My rose quartz heart & penguin socks will definitely be accompanying me to my monitoring & other appts. & procedures! Thank you again & again & again Chef Bud - you are truly a wonderful person, friend & are going to make a wonderful mother. I love you girl!

And then, there's Obessive Bud. She is an awesome friend & shortly after she joined the blog, we became close friends that talk pretty much everyday via text, phone or G-Chat. She has been so positive & has been a wonderful support system for me - cheering me on as I go! I just want to say thank you to you as well OB for always being there & for calming me down when I start freaking & WORRYing about everything I have going on. I love you too & you are an awesome friend. I can't wait to "meet" that precious LO you have growing big & strong inside you. I know that you will be an awesome momma!

And while I'm at it...to all the other Buds, followers, friends that have been thinking of us during our IVF cycle & have commented on my posts, leaving us well wishes & hope & prayers & love...I also want to say, again, to each of you: THANK YOU! It truly warms my heart to know how many other women out there care about my story & are thinking of me. Mr. WB & I want to express how much it means to us, but I honestly don't think I can put how much your support means into words. It has helped me to remain positive, upbeat & hopeful about this cycle! I consider each of you my virtual friends & just want you to know that I think about & pray for each you every day & night as well!

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Okay, sorry for the long prelude to this post, but I felt like I needed to express how much everyone's support has meant & continues to mean to me everyday! So, IDK how many of you live on the east coast, but we are expecting a huge winter storm today - many meteorologists are predicting that this could be one of the worst we have had in nearly 10 years! I mean the one in December dropped almost 2 feet of snow & this is supposed to be worse...eeek! Both that December storm & this one are predicted to be in the top 10 worse winter storms for this area! This photo shows the snow on my back deck form December - it was a lot!

Anyways, I say all this to describe my RE office visit this morning. I went in for my first follie monitoring appointment this morning & it was PACKED at my RE's office. I found out that they moved all of their Saturday monitoring appointments to this morning to avoid the craziness that is sure to take over my area in just a few short hours. Despite the office being a bit more packed than usual, I still got in & out in about 30 min. I got my blood drawn (only 1 vial again!), then emptied my bladder & walked back to the ultrasound waiting area. Once I was called in, my RE checked out my lining & ovaries with the "vag cam". He said my lining was getting thicker, just like it should & then he checked out both ovaries after 3 days of stimming with Gonal-F & Menopur. On my left ovary, he said he observed "12 less than 10mm" & on the right I have "10 less than 10mm". He said I appear to be right on track & that after they get my blood results back, then my nurse will give me call with directions on either adjusting or keeping my meds dosages the same. I asked if it started getting bad outside would they possibly not call with directions & they said they'd make every single call before leaving for the night! I love my RE's office staff - everyone is so nice from the financial coordinator - to the girl who draws blood - to all the nurses - and especially my RE. He's a great man & I have have such respect for him & confidence in him that he is doing anything he can to help us get pregnant. It definitely helps me stay positive when I feel so confident in the staff working with us!

While waiting to be called in for my u/s, I got a chance to chat with several other women cycling right now, one was doing an IUI, a couple doing frozen cycles, and one other doing fresh. It always makes me feel better to talk with someone else in a similar situation, or who has gone through the same thing I am going through now. We talked about how everything was going so far. I asked them if any of them were using Menopur & a couple had - we talked about how much that shot stings! It's hard to describe, but the best thing I can think of is that it feels kind of like fire being shot inside of you. Nothing I can't handle, but it definitely doesn't feel that great! So far, that has been the most difficult shot for me. Despite that, I am still remaining positive & hopeful and feeling pretty good so far! I do feel a bit uncomfortable in my ovaries b/c they are getting bigger with all the follies, but that was something I expected to feel, so again, nothing I can't handle! So, that's my update - sorry for such a LONG post, but I had so much to say! Thanks as always for continuing to pray for & think of us...I think about all of you everyday too!

And if you are in the storm area, stay safe this weekend! It just started coming down here!

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!

2nd Follie Scan...

So after 6 nights of stims with Follistim, Menopur and Lovenox I added Ganirelix last night. At my u/s this afternoon I had 10 follies on my left about 11mm and at least 10 on my right around 11mm. So far my RE says we are right on track for an ER over the weekend. He is also watching my E2 levels closely to make sure I don't overstim. I start antibiotics tonight and I go back Wednesday. My IVF girls on the bump/nest were right, once you start the stimulation phase it does fly by...

Photography Credit

Until Next Time,

Follie Scan Friday

First Follie Scan
So Friday 1/29/10 I had my first early Follie check. After 3 nights of stims for IVF #1, there are many small unmeasurable follies on my left and right ovaries. Dr. B expected this since I have PCOS and he expected that I would not have anything measurable yet. Follies become measurable once they reach 10mm.

Photography Credit

So once I got home from Dr. B on Friday night I dropped to 300iu Follistim; added 75iu Menopour and continued 40mg Lovenox. Sunday night I will add 250am of Ganirelix, which will prevent me from ovulating before my Egg Retrieval. I will be on these dosages until Monday when I meet with with Dr. B. again.

Photography Credit

In the Mix With Menopur
Menopur is an LH drug that you have to mix yourself. So far I have been on Follistim only, which is an FSH drug. Mixing the Menopur for the first time was very interesting. Nurse K gave me an instruction packet and I also looked at a Menopur injection video on youtube lol.

Photography Credit

Until Next 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!

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.