Monday, September 26, 2011

Gearing up

I spoke to our IVF nurse on Friday. (When you go from IUI to IVF at our clinic you immediately jump to a whole new level of handholding, including having ONE dedicated nurse who coordinates everything about your cycle.) She set up an appointment for us to come in this Wednesday and redo all the bloodwork and paperwork we already did two years ago (when we came thisclose to doing IVF but backed out at the last minute)--infectious disease testing, consent forms, hormone levels and ultrasound for me, SA for my husband. We don't have to take an injection class, since we did it before, but she recommended I go online and watch the videos for mixing up the Menopur and doing the PIO injections just as a refresher. She also went over the cycle in a little bit more detail and we talked about timing. Given that I'd like to have the transfer happen as close to the first week of November as possible, it will look a little something like this:

-Start birth control pill Wed or Thurs (assuming bloodwork and ultrasound show my ovaries are doing nothing on their own). On the pill for 3 weeks, then back in for blood and ultrasound.
-1 week of Letrozole to get things started
-Start Gonal-F injections (starting at 200 IU) to juice up whatever follicles the Letrozole started--target date for this is around 10/27.
-As we near retrieval, add Ganirelix (to suppress ovulation) and Menopur (to keep the Ganirelix from crashing my ovaries). So at this point there will be three injections a day, Gonal-F in the morning, Ganirelix and Menopur in the evening.
-Trigger and retrieval sometime in early November, ideally we have one or two nice embryos that go to day 5. PIO injections through the 2ww, naturally.

My biggest fear is that I'll hyperstimulate (unlikely with this low-stim cycle, but you never know--I had mild hyperstimulation the cycle I got pregnant with Bat Girl) and they'll cancel transfer, and given that we don't want to freeze embryos, we'll be left with NOTHING to show. It's possible my husband might bend on the freezing in that one scenario, though (we've talked about it, it's not just my wishful thinking).

I also talked to my friend, who's a licensed acupuncturist, about supporting the cycle through acupuncture and diet. Remember this? Yeah, not making fun of it so much anymore. Basically I'm going to do acupuncture treatments in the pre-cycle stages, during stim, and the day of and day after transfer, also possibly some moxa. I'm also going to help strengthen my spleen (yeah, I know) by trying to avoid cold and raw foods and drinks. I figure it's fall, I don't like cold stuff that much anyway, and I'm going to throw everything I can at this cycle. My friend will do the acupuncture treatments and I'm very comfortable with her--she'll do them outside normal office hours, in her apartment or mine, so it's super convenient for me.

It's past my bedtime and too late for me to come up with anything profound or clever to wrap this up so I'll just leave it at that. More updates after our Wednesday appointment.

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Tuesday, September 20, 2011

Looking back, looking ahead

"Why is it taking you so long to get pregnant?" Dr. SF complained as he ushered me into his office. "I wish I knew!" I returned.

After taking two months off from reproductive medicine, I was back again. My husband and I had discussed it extensively, and not only were we ready to get back in the game, but he was ready to try IVF...with the stipulation that we freeze no embryos. Dr. SF was a little perplexed by this ("Usually Catholic patients want to freeze everything") but was game. Normally with a patient like me, he said, he would start with 200 IU Follistim, aiming to get about 25 eggs, maybe 10 of which would fertilize and 5 of which would make it to blastocyst--we'd transfer the best one and freeze the rest. But if we wanted to minimize the number of extra embryos produced, we could try a minimal stim cycle as we'd discussed previously, where we'd start with letrozole, then juice it with Follistim (150 IU, I wrote down in my notes). Ganirelix and Menopur would be involved somehow but I'm not quite clear on how.

Dr. SF warned that doing it this way would greatly reduce the odds of success, particularly since we're only doing single-embryo transfer--ironically, in the waiting room the day of my appointment they had on display stacks of copies of an article co-authored by the clinic director about how minimal stimulation cycles have success rates that are "disappointingly low" (8%!). But since I have insurance coverage for three fresh cycles, he's willing to give it a try with one cycle, and then we could reassess if it doesn't work. (Or if, for example, we discover that despite my generally good response to stim, my eggs are actually crap and don't fertilize or my embryos don't grow fast enough.) It's just a matter of getting the right egg, he thinks, since we have no reason to believe that anything else is malfunctioning.

But first, I wanted to try one more IUI...a Hail Mary cycle, I called it. Just one more, one last shot at the "easy" way, and one more to ease back in before leaping into IVF. This was all going on the last week of August. I didn't blog about any of it at the time because...I don't know, I was embarrassed about keeping on doing the same thing and expecting a different result? (I mean, come on, EIGHT IUIs? Who does that?) And, truthfully, I had a tiny bit of hope that I could just surprise you guys one day and say, hey, guess what news I have?

It was not to be. I got my period last Wednesday. The next day I got on a plane to fly cross-country to be in the wedding of my best friend from high school. Who is 12 weeks pregnant. By accident--she was actually on the pill when she conceived. The phone call when she told me the news was hard, I won't lie, even though I can hardly resent someone who has the good fortune of getting pregnant accidentally at 38. I just wish she hadn't said quite so many times how not-ready she was and how terrible the timing was.

I also wish I had remembered to call my clinic and let them know I had gotten my period before I left, so I wouldn't have gotten multiple phone messages over the weekend wondering if I'd gotten my period or if I'd like to come in for a pregnancy test.

Anyway, I'm going to call this week to set up our final consultation before we begin in earnest. I'm thinking we'll aim for a mid-November transfer, which will align well with my work schedule. I wish it could be easier, but since it seems like that's not meant to be, we'll tough out the hard way.

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Sunday, September 11, 2011

Ten years ago today

It's still as vivid as it was then.

Thursday, September 08, 2011

Really? REALLY????

Four pregnancy announcements from friends in the last week. Two second babies, two third babies. Kill me now.