Like Clockwork

My period arrived last night. 28 days exactly. My ovaries, my eggs, my tubes, and my ute may all be for shit. But damn if my period isn't the best, most perfect, overachieving, right-on-time period ever. It kind of made me feel good (something works!). Also, it's nice to shed the last remnants of this first IVF. IVF is hard. Harder than I ever imagined. I thought IVF was the ANSWER. The miracle cure that brings the baby. But it was so hard. Physically,  logistically, emotionally, financially. It knocked the wind out of me. I had no idea. I thought it was just this lucky thing that people with insurance or money get to do. For fun! For a baby! But it rips you apart.

In my head, our sweet little embryos are tiny little alka seltzer tablets. I know that sounds weird. But they just fizzled up and died. The official diagnosis is severe fragmentation. On day 1, they were 3 little fertilized eggs. On day 2, they were already fragmenting. On day 3, they were all highly fragmented grade 3 embryos (grade 4 is the worst at our clinic). One was already 7 cells (not good. there was clearly something wrong with that little guy. Always a sucker for the underdog, my heart goes out to that one the most. doomed from the beginning). The other two were 2-4 cells (perfect, as far as cells go). On day 4, they were grade 4 and the fragmenting was just getting worse. On day 5, they arrested. On day 6, they were discarded. I wish I hadn't seen the paperwork. Seeing them coded as arrested and discarded about broke my heart.

My RE was so sweet and she called to check up on us. She feels bad. She got me in on day 6 for a WTF appointment. I wasn't sure if that was a good idea or not. I couldn't talk about it without crying (I hate crying in public). I hadn't processed it all. But it was good. She was so nice and so hopeful. Maybe that's what I needed to hear. I still feel unsure if we should do this again. I think we will. How could we not? My insurance gives us one more chance. My RE thinks that my body is still in shock from the PE in December. She didn't expect these results. I was textbook perfect for someone my age (she says). All my numbers were good, up until the eggs left my body. She didn't expected the fragmentation. She thinks my body is inflamed and we should take a break, take some supplements, and come back and try again with a different protocol. She wants me on DHEA and CoQ10 now. Then metformin in June (I don't have PCOS, nor am I diabetic, she just thinks we should try it). If we do this, I'll start estrogen after I ovulate in June (estrogen priming protocol). Then IVF with my July period, this time with extra ganarelix and human growth hormone. She says, "let's throw the kitchen sink at it."

I don't know. That is so much crap to put in my body. I'm swallowing hand fulls of pills (levothyroxine, CoQ10, DHEA, prenatal vitamins, vit D, special folate for folks with MTHFR, fish oil) and wondering, what the fuck am I putting into my body? I'm reading articles and there are mixed opinions on if some of this stuff will help or harm. But, I started the extra supplements yesterday. Just in case we want to do this come June. I think we will. How could we not?

IVF #1: Cancelled

None of the embryos made it. Devastated. There are a few more details, but I can't write them today. For now, I'm just glad for the xanex I took before I got the call.

IVF #1: Fertilization Report

4 of the 7 eggs were mature. Clearly, my eggs are underachievers.
However, 3 of the 4 eggs fertilized. Apparently we picked some badass sperm.

Here's how it all went down....
By Wednesday night (night before retrieval), I was *so* uncomfortable. I don't even know how people with 10, 20, 30, 40 eggs get through this. The doxycyline made me sick and it turned into a long queasy night.

I felt a bit better Thursday morning and woke up to two epiphanies: 1) damn, I'm a hormonal mess and 2) no way am I wishing for a Sunday transfer, it's PGD and May FET all the way.

All the staff involved with the retrieval were awesome. So nice and comforting and knowledgeable. They definitely put us at ease. On a side note, the anesthesiologist totally grabbed my boob. It was an accident. IVF has given me crazy pregnancy symptoms (huge boobs, nausea [don't even mention chicken to me], the inability to button my pants). So, I was laid out on the OR gurney, large and in charge tatas sneakily hiding under the gown and blankets, when Dr. anesthesiologist, trying to be nice, went to move my blankets and grabbed a fist full of boob instead. It was awkward. We both pretended like it didn't happen.

And then I woke up.

I actually felt better when I woke up than I did before they put me under. My abdomen was noticeably less distended. The RE came in and excitedly told us about our 7 eggs. Lucky 7, she said. Of course, I cried. Just a little. But I had decided that what we really wanted was 10-15 eggs so we could stick with plan A (PGD + FET). 7 meant no PGD.

I went home, ate some soup, and took a nap. Best nap ever. I was tired and crampy, but functional the rest of the day. And chicken sounded good again :)

Today, I had some major cramps in the morning, worse than with a normal period. A few tylenols later, I'm feeling pretty good. Still uncomfortable to button my pants, but not as bad as before retrieval. They called with the fertilization report and I was a little bummed that we're down to 3 embryos. But it only takes one, right? And, Oh. My. Gosh., we have 3 embryos. THREE!! The plan is:

• They call us Sunday morning. If things aren't growing well, we'll do a day 3 transfer at 9:30am. If things are growing well, we'll hold out until Tuesday
• If we make it until Tuesday and things are growing *really* well, we'll consider PGD and freezing. If things are looking more average, we'll go for a day 5 transfer

I feel pretty good about all that. I can't believe how fast all of this goes once you're here. Years and years of waiting and wondering and trying and then it feels like in the blink of an eye you might be getting knocked up next Sunday. Fast but slow. Slow but fast.

7 eggs

Glad it's more than zero. Sad it looks like not enough for PGD and FET. We might be doing this on Sunday. More after I have a little nap....

IVF #1: CD16: stim day 10 - retrieval scheduled (and a day 3 transfer?)

Appointment went well this morning and they've decided I'm ready to trigger. No more stims for me (which is kind of funny, because that means me and my slow growing old lady eggs actually only had 9 days of injections) They didn't provide any estrogen/progesterone stats this time, but I guess it was all good enough. Every time I'm up in the stirrups I try to remember the follie counts and as soon as my feet touch the ground, I forget. Based on my unreliable memory, there are a few too small 10s and 12s on both sides, 4 large-ish follicles on the right ranging from 15mm to 18mm, and 4 to 5 large-ish follicles on the left ranging from about 16 mm to 21 mm.

The plan is, 10pm trigger shot tonight, 9:30am pre-op tomorrow, and 9am retrieval on Thursday. I can't believe it! (but thank goodness as my ovaries hardly fit in my pants anymore)

Then what happens? I have no idea.

• The original plan: retrieval, fertilize, grow to day 5, biopsy, send  for PGD, transfer up to 2 healthy (frozen) embies with my May cycle
• The backup plan: If there are too few embies to biopsy for PGD (I'm not sure what this magic number is), then we just grow to day 3 or day 5 and freeze. Then proceed with FET in May
• The backup to the backup plan: Of course I want to be pregnant yesterday. Well, three years ago, if we're being honest and making wishes. So, I am sort of putting the idea out there that if there are too few embies to warrant PGD, we just do a fresh transfer next week. The major hiccup being that all of my doctors have suggested I wait 6 months from PE diagnosis (Dec 21, 2012), before I get pregnant. But I'm thinking that I'd rather risk the PE (I had a CT the first week in March that showed no clots) versus risking the freeze/thaw on the embryos, especially if there are just a few (or a couple, or one. please let there be more than zero) (*updated: nurse has me tentatively scheduled for a day 3 transfer on Sunday - fertilization report and doctor's orders will have the final say)

This leaves me feeling:

• Incredibly excited and thankful
• Scared an anxious
• Desperate, when I think about what's going to happen
• Calm, when I think that our little peanut(s) are growing big and strong in my bloaty ovaries right now
• Sad, when I think about my grandparents and how much I wanted them to be here for this (it was recently my grandpa's first yhartzeit. I remember my grandparents lighting yhartzeit candles for their parents and/or siblings, whom I never met. It felt so significant, their love for their families that passed, the ritual, the stories they told me about the people they loved and missed. In the same way that only a child can believe the sun rises and sets with herself, it felt strange, how huge their love and their grief was for people that had died before I had even been born. And now I'm going to repeat that. Lighting the candles, telling my children stories, sharing how much I love and miss my grandparents. I know they might be "here" in their own way, but boy do I wish they were *here*.)

IVF #1: CD15: stim day 9 - the ups

Let me tell you part of the best news of all, I am *so* uncomfortable. And I love every second of it. My ovaries are seriously large and in charge in there. I've been walking around with my pants undone all day (thank goodness I work from home). The RE office just called with my afternoon update. Here are the stats for today:
Estrogen - 1,374
Progesterone - 1.0 (thanks to Amanda Raye for pointing out that this is indeed normal)
Lowering my meds back to my regular dose (4 vials bravelle, 2 vials menopur, everything else stays the same).

A few random thoughts for today:

• Even though today is stim day 9, my results are really based on 8 days of meds, since I take my stim shots in the evenings, but have my blood work and ultrasounds in the mornings
• I ran out of bravelle and menopur and had to order more of both. Somehow, my brain keeps thinking "need to order more" = "wasteful". I'm not sure what that's about, but I am very, very, very thankful I even have the option to order more
• It's looking like we'll trigger Tues or Wed and have our retrieval Thur or Fri. I am so nervous and excited
• We're doing PGD (hello, old lady eggs) and have always planned to freeze everything with FET in May (fingers crossed). But now that I actually feel like this IVF is really happening, I'm daydreaming that if there are only a few eggs (one of my fears) then we'll just put them back right away instead of risking the freeze/thaw (but really, I hope there are lots of eggs and, health wise, it would make SO MUCH MORE SENSE to wait until May)
• I am wondering what the calendar/meds look like for an FET. I need to look that up next. For someone who can't take birth control, do they just shoot me up with progestrone and wait until I ovulate?
• And these bullets are the reasons why I've developed IVF-insomnia. (I woke up at 4 this morning and  never did fall back asleep - finally gave up and rolled out of bed at 5:30 to get some work done)

Back to the RE tomorrow morning at 8:30.

IVF #1: CD13: stim day 7 - ups and downs

Let's start with the downs. I had an appointment Saturday morning. Things were not looking so good. I cried. Follies had grown an average of 1mm in 2 days. I can't remember the exact measurements because I was so nervous/upset. Mostly 10s and 12s, I think. There may have been a 13mm. They kept my meds the same and told me to come back in two days. Later that afternoon, they called with my blood results, estrogen: 743 and progesterone: 0.5. The estrogen made me feel a little better...quite a jump from the high 100s at my last visit. I have no idea where my progesterone falls on the "normal" range. If work would stop bugging me with deadlines and conference calls, I'd have time to look it up ;) More later this afternoon with results from this morning's scan.... 

IVF #1: CD11: stim day 5 - it's working! (*updated)

First U/S and blood draw since I started stims on Sunday night. I've been feeling bloaty/crampy but was trying to pass it off on my nightly ice cream indulgence. I was a little afraid I was going to be sent home with no follicles and a diagnosis of gas pains. But things turned out way better than just some mild GI disturbance. Righty, my little under achiever who never quite recovered from the 2010 dermoid surgery, is holding steady with ~5 follicles, all under 10mm. Lefty, my little workhorse, has ~5 follicles, all under 10mm, along with a few at 11mm and a few at 12mm. You go lefty! Lining is at 8mm and estrogen results should come in this afternoon. The only potential issue is what appears to be a functional cyst. A small cyst was noted at my baseline appointment, but since my estrogen was low, I was cleared to cycle. However, the cyst is now bigger and appears cloudy on U/S. I'm hoping this doesn't impact my other little eggs. Next appointment is on Saturday and I can hardly wait!

*Updated
Nurse just called. Estrogen is 176. Doc says to increase my meds (add 150 IU Bravelle) to help some of those smaller follies catch up. New Rx is for 450 IU Bravelle and 150 IU Menopur.

Crap. Does that mean it isn't working? I was all happy this morning (yay! there's eggs!), but now I'm worried they are growing too slow. At least they have a few days to catch up.

IVF #1: CD8: stim day 2

Mixed my first syringe of stims last night. I'm on 300 IU bravelle and 150 IU menopur (for now). S sat at the table biting her nails. My hands were shaking. We were nervous! All went well though (I think). So far no side effects, except maybe with the lupron (10 units twice a day). I always feel a little dizzy after, my injection site burns, and I get a bit of heart burn. That's the easiest injection to give though (compared to stims or enoxaparin).

I feel like I've been waiting years to add a pic of my IVF meds to this blog (pic below includes ganarelix, bravelle, menopur, dexamethasone, doxycycline, and femara - only things missing are levothyroxin, lupron, enoxaparin, and vitamins). I can't believe we're finally here. I am so nervous about Thursday's scan and blood work. I hope my ovaries are getting to work in there. Every time I feel my anxiety getting out of control I try to remind myself that it's not my job to predict the future, it's just my job to try and have a good today.