The cat's out of the bag!

Brad and I decided to go ahead and tell pretty much everyone that we're pregnant. We want to celebrate and why not celebrate?!

I'm glad this blog has been short and I hope to never come back for another round. I'll leave it up for now, but for updates on my pregnancy, please see my general blog (which has been badly neglected in the past few months!).

First OB ultrasound scheduled

My first ultrasound is scheduled for Thursday, July 5th. I will be exactly 7 weeks that day. The nurse made me promise that if I scheduled my ultrasound early, I would not panic if they didn't see a heartbeat. It could just be a little bit early. Yeah right. I'm sure I'd panic. But I still want the earlier ultrasound. :)

Beta #4 - I graudated!!!

My beta today was 1545, which is a doubling time of 32.55 hours! That's much higher than I was hoping for! Everything looks great and I have officially graduated from bloodwork and from the ART (assistive reproductive technologies) department at the doctor's office. I was instructed to call my regular RE's nurse to schedule my first OB ultrasound. When I get it scheduled, I'll let you know when it is!

OK, I admit it...

I'll admit it, I'm scared. I feel like tomorrow is a big day. I could "graduate" from the beta stage. If my number is higher than 1000, then I'm done and they'll schedule me for an ultrasound in a couple weeks.

I feel fine... I feel pregnant... and have seen no worrisome signs. But I can't get over the feeling that getting past 5 weeks pregnant with all good signs is not something that can happen to me. That happens to millions of women... billions of women... but not me.

Beta #3

Today's beta (18 dpo) was 556. That's a doubling time of 49.05 hours. The nurse seemed very pleased. I, of course, am a little worried that it slowed down a little. I know that the number is good and the doubling time is good, but I can't help but worry a little.

My progesterone was 52.6, which is good.

Next blood draw is Wednesday. If it's over 1000, that'll be the last one... but if it doesn't quite double, it might not get to 1000 and I'll have to go back again on Friday.

The bills have started rolling in...

I got the bill for the cryopreservation of our 2 extra embryos. For one year of storage, it's $310. We also had to sign a contract that acknowledges that if anything happens to them, it's not the lab's fault.

I'm very glad to have our snowbabies, but the bills are making my head spin.

I also got my first COBRA bill this week (for the insurance that has infertility coverage). That's going to be a tough decision to discontinue that coverage... Discontinuing it would also mean that any costs associated with actually transferring our snowbabies in the future would be all out of pocket (somewhere around $3000/attempt, I believe).

Correction: That was my 2nd COBRA bill. I thought they sent me a duplicate statement, but I had just paid June and now they want the money for July. Ugh.

More stats from the past

My highest ever beta was 422 on 19dpo with my last pregnancy. That number is actually within the range of normal for that day. Betas for that pregnancy were:

8/25/06, 12dpo: 12
8/28/06, 15dpo: 35, double in 46 hrs
8/30/06, 17dpo: 119, double in 27 hrs
9/1/06, 19dpo: 422, double in 26 hours
9/5/06, 23dpo: 122 (and continued to drop from there)

Beta #2

Beta #2 was 201. Doubling time of 35.63 hours. That's wonderful. That's perfectly NORMAL.

My period is due today and...

Nothing is happening. No spotting. Nothing. I feel hot and kinda bloated and my skin & eyes feel very dry.

My clothes have been feeling a little snug for a couple weeks from everything the IVF has done to my body... so this could be a problem. Not that I'm complaining. I think I might go out and buy some stretchy shorts so I can have something comfortable to wear around the house.

Stats from the past

I just looked up my beta numbers from my past pregnancies.

miscarriage #1:
13dpo: 15
15dpo: 26

(#2 was so early I didn't have any betas)

miscarriage #3:
12dpo: 12
15dpo: 35

This one sure is looking better!

Beautifully normal

My beta today was 79. That's wonderful. That's NORMAL.

Betas planned for Friday, Monday, and Wednesday. And if all is well on Wednesday, an ultrasound will be scheduled around 7.5 weeks of pregnancy, somewhere around the 1st or 2nd week of July. I'm going to push for the end of the first week of July so that we can tell people at Brad's reunion that weekend. :) He's already acting like a proud daddy and wants to tell everyone.

By the way, on Friday, we'll be looking for a number around 150-160. The minimum "ok" level would be 130, but with how high I started, the nurse said that she wouldn't be suprised if my level more than doubled and I had a nice high number on Friday.

Betas

My beta tests (blood pregnancy tests) were scheduled for Thursday and Monday. They always do 2 after IVF, even if it's negative, just to make sure. But, as many of you probably know, what's important about beta tests is whether they double in 2 days or not. So, if I stuck with those test dates, I wouldn't really know anything until Monday afternoon. That's just not acceptable. :)

So, I called and asked if I can change them to Wednesdsay and Friday and the nurse agreed. She said that they don't like to trust tests done before 14 days past egg retrieval (Thursday) but if it would make me feel better, they'll do it.

So, tomorrow will be my first beta. The rule is that they want it to be over 50 on 14dpo but this will only be 13dpo... so I guess anything over 25 or so is ok. Here's a chart of normal betas for 13dpo.

While I was away...

I've been doing a little bit of obsessing, as you can imagine. I took a home pregnancy test for the first time on Saturday, which was only 9 days past egg retrival (equlivalent to 9 days past ovulation or 9dpo in fertility lingo). It *should* have been negative, because it should have been long enough for the trigger shot to clear out of my system but a little too early for a new pregnancy to be producing enough hormone to show up on a test...

Well, it was positive. So, what does a girl do, but test again of course? Well, they've been getting darker... Dark enough to convince me that they're for real:


If you don't like squinking, here's a picture darkened using Photoshop:


And if you're still not convinced, check out what I got yesterday:

Progesterone test results

I had my progesterone test today. They just need to check that my level is high enough (above 15). Progesterone helps to support a pregnancy and is very important, but since I'm on progesterone-in-oil injections (given faithfully every night by Brad), there's not much worry that it's too low.

My level was... drum roll... 70.8. That's through the roof, so that's good. Higher is better.

We have 2 snowbabies!

Our other 2 embryos were able to be frozen! Yay!

Update from the couch

Mittsy won't stop staring at me... she wants to go outside so she can lay in the sunshine or chase some birds around. When I let her out at lunchtime, she just banged on the door to be let back in 30 minutes later. She doesn't get why if I'm on the couch, I can't get up to satisfy her every need.

An early blastocyst

Unlike a lot of IVF labs, mine does not take pictures of the embryos because they feel it's just one more time disturbing the embryos that is not necessary. I was a little bummed to learn that, so take a look at a blastocyst I found on the net. :) Click on it to see a larger version and read the labels.

The big day - embryo transfer!

We had 3 early blasts left today (everything else was degenerating). But the good news is that all 3 were Grade 1 (perfect). So, since the doctors seemed confident that the other 2 would make it to freeze (giving us a 2nd shot with a future frozen transfer if this fails), we went ahead with a single blast transfer. I had imagined we'd have a lot more embryos to pick from at this stage, but I can't complain about 3 perfect blasts. I'll find out tomorrow afternoon if my other 2 made it to freeze.

I got to talk to the embryologist and he was pretty happy with how everything went. The only slight problem was that he felt I had too many immature eggs (6 out of 18) and so if we ever did another fresh cycle, he would recommend adjusting the stimulation phase (different meds/dosage/timing) to help with that.

I asked him if anything he saw would help to explain our losses and he said no, that everything was pretty normal and average. He talked about a couple of things that he could have observed (like a large percentage of improper fertilization, etc) but he didn't see any of those red flags.

So, now I just spend 2 days on the couch and the wait begins...

No updates today

The nurse called me today to let me know that my transfer is going to be at 11am tomorrow. I asked about the status of my embryos and she said to call the lab... so I did. The lab told me that they don't check on embryos on day 4 because they're difficult to evaluate at the morula stage (where they should be at this point) so they just leave them alone in the incubator until day 5.

So, tomorrow is the big day. Thankfully, my main doctor will be doing my transfer (also did my egg retrieval) and I'm glad about that. I've heard that he has the "golden touch" and there are higher success rates with his transfers than with the other doctors in the practice. I hope that works for us!

Just kidding!

This is getting crazy! At the dr's office, they put us into an office (not an exam room) and the dr came in to talk to us. As she walked in the room, she smiled and said, "You know how we changed your transfer day?"

I laughed and replied, "You're going to change it again, aren't you?"

Yep, I'm back to a 5-day transfer on Tuesday. Our embryos did REALLY well overnight and since I have so many strong ones, we can do a 5-day transfer. And since our goal was to do a single blast transfer, we may still be able to do that.

We even had a couple embryos start growing that weren't growing before! Here are our stats (I think - I may have gotten them confused in the surprise):

2 8-cell grade 1 (PERFECT)
2 8-cell grade 2 (really good)
2 8-cell grade 4
2 6-cell
1 2-cell

The dr said that my embryos are doing well but since they had some surprising results overnight, it would be hard to be sure that they're choosing the best ones today, so it would be best to wait for a 5-day transfer to give them time to show us which ones are the best.

I told her that I hadn't called my boss yet to change my days off... and she said that I must have had a premonition.

Now I'm not sure what to do with myself today. :)

Well, I guess that answers some questions...

My embryos did surprisingly poorly overnight. Out of 11 fertilized eggs, only 7 divided.

All 7 growing embryos are 2-4 cells, which is what they should be at this stage. On a scale of 1-5 (1 being best):

• 2 are grade 1
• 3 are grade 2
• 2 are grade 4

They're moving my transfer to tomorrow. They explained to me that the only reason to wait to do a 5-day transfer is to pick out the best embryos and if we already know which ones are the best, there is no point in waiting longer.

We'll see how they're doing tomorrow and decide how many to transfer (or possibly push off transfer to day 5, if we wanted to stick to our plan of transferring 1 day-5 blast to reduce our risk of twins... but there's no guarentee that we'll get a blast).

This is not the way I hoped things would go, but it could be much worse. I still have 2 perfect embryos and 3 pretty good ones.

Pictures of embryos at various stages

If you're curious about what embryos look like at various stages, here are some good photos: http://www.ivf.net/content/index.php?page=out&id=2591

So, according to Dr. Google, I should be hoping for my embryos to be 2 or 4-celled tomorrow.

Fertilization report

Well, good news! We have ELEVEN EMBRYOS! YAY! Out of the 18 eggs retrieved, 12 were mature, and 11 of those fertilized.

The lab will call daily with updates but for now, we are to expect a 5-day transfer (when the embryos are 5 days old) on Tuesday. Then I will rest on Tuesday and Wednesday and go back to work on Thursday.

Egg Retrieval

Egg retrieval was today. The good news is that the doctor got 18 eggs! Yay! That's a great number. The nurse told me that they hope for 10 and any more is just bonus.

The bad news is that it didn't go smoothly and it was very painful. And I'm still feeling like poo. You know how the saying goes, "there's no such thing as minor surgery when it's being done to you." Anyway, I won't go into the details, but I'm going to be fine. I just need some time to rest and recover.

Tomorrow, I'll find out how many eggs fertilized and how many little embryos are growing in the lab!

Follicle Check #2 & #3

Yesterday was my 2nd follicle check. Everything was looking good - follicles were growing on schedule with the biggest around 15mm. My estrogen was 1561, which is quite a large rise from last time, but not dangerously high.

Today was my 3rd follicle check and I am *almost* ready for trigger, but they want to see the follicles just a *tiny* bit bigger, so I'm going to do one last dose of stims tonight and trigger tomorrow (Tuesday) for egg retrieval on Thursday. I can't believe it's already happening!

The timing works out pretty well because I have a training at work on Wednesday and a special event at work on Friday and I'll be able to make it to both.

Friday, I'll get a call to tell us how many eggs fertilized and let me know which day they recommend we do the embryo transfer. Most likely, it'll be Sunday if we have a 3-day transfer or Tuesday if we're doing a 5-day transfer. We're hoping for Tuesday (which would mean we have plenty of nice-growing embryos).

On the ultrasound today, it appeared that I had about 14 follicles that could produce eggs, and that's a great number. Not too few, not too many. Fingers and toes crossed!

Follicle Check #1

Today's follicle check went really well. On the ultrasound, the doctor saw around 12 follicles that are in the 10mm range (normal size for this stage). There were also a number of smaller ones that might catch up, though. It's hard to tell how many we'll end up with at this point.

My uterine lining was already at 11mm and just needs to be over 6mm by the time of trigger, so it's already ready.

My estrogen was 350, which is good. It's rising but not too fast and that's what we're going for.

The dr wants me to continue on the same dose of meds and return for follicle check #2 on Saturday morning.

To give you a frame of reference, estrogen levels (aka e2 levels) should continue to rise as the follicles develop. At the time of trigger, it should be around 200-600 per mature follicle (follicles over 18mm). BUT, we don't want it to go too far over 3,000 (the danger zone for hyper-stimulation) and definitely not over 5000 (the potential for hyper-stimulation requiring hospitalization).

Ah, that feels better!

I started stims on Saturday (Bravelle & Menupur, which are the hormones LH & FSH). And wow, do I feel better. I feel like a normal person right now... This feeling will last approximately a week, until my ovaries start swelling up to the size of grapefruits. But I'm not going to think about that right now... Right now, I'm going to enjoy feeling normal.

Next appointment is Wednesday. They will take a look at my follicles to see how many are growing and check my estrogen level. They'll use that info to decide if they want to adjust my medication dosage.

All systems go!

My estrogen level was 29, which is QUITE low. That's great - better for stimming (but also probably the reason I'm feeling very "blah" and continue to get some awful headaches). Anyway, that means I'm set to go on Saturday!

All quiet...

My baseline ultrasound went really well. All is quiet in there, as I had hoped. And in other good news, I have lots of antral follicles (potential follicles) in there (around 30 or so)... so hopefully we'll have plenty of eggs to work with this cycle. They took blood to check my estrogen and as long as it comes back at less than 80, I'll start my stim meds on Saturday. Here we go!

Big day tomorrow!

Tomorrow morning is my baseline ultrasound / suppression check. It's when the doctor decides if I get the green light to start stim meds this Saturday. He (or she) will be looking for a thin uterine lining, quiet ovaries (with no major cysts), and a low estrogen level. I can guarantee that my estrogen is low cause I feel very "blah" and I've been getting awful headaches the last few days.

Oh yeah?

Who knew?

I learned something new about myself this weekend. I learned that I can now do injections in my sleep.

Lupron is rather time-sensitive, so I've been trying to take it as close to 7am each morning as possible. On the weekend, that meant setting my alarm, even though I would prefer to sleep in.

I got up at 7am, went to the bathroom (with the light off and my eyes shut), walked downstairs, got the lupron out of the fridge, opened a alcohol wiped, wiped the bottle and my belly, opened a clean syringe, jabbed the bottle, pulled up exactly 10 units, put the bottle back in the fridge, pinched my belly, jabbed my belly, pulled out the needle, put a cotton ball on it while walking back upstairs...

And climbed right back into bed and went immediately back to sleep. Zzzzzzz...

Fun with needles begins

I started Lupron about a week ago. It's taken by little sub-cutaneous needles (that aren't too scary). The purpose of it is to suppress the ovaries and make things nice and quiet in there. It produces a kind of peri-menopause, but so far I have been lucky with the side effects. I feel a little "blah" and I've had some annoying acne, but other than that, I've been fine. Knock on wood that I don't get any hot flashes or headaches like I've heard about from other women. I figure if I've made it a week, I'm probably fine, though.

Tomorrow is also my last birth control pill, so I should expect to get my period around the end of this week, so then we can get this show on the road!

My baseline ultrasound is scheduled for Tuesday, May 15th. That's when they'll check that I'm sufficiently suppressed (and don't have any cysts) and they'll decide if I'm ready to start stimulants. If I "pass", I'll start stims on Saturday, May 19th, while I'll be away from home at sorority convention. While it's not ideal to start my meds while away from home, I'm very glad that I don't have to drive home in the middle of convetion for a doctor's appointment.

I'll write a little list of dates on the sidebar so that you can keep track of when things are happening.

So, this is the boring part

I starting taking the birth control pills on Tuesday. Both Brad and I started the antibiotics on Tuesday too. After some phonetag with the nurses, I finally got my next appointment scheduled for next Thursday. I'll be going for my protocol review (find out what the heck I'm actually doing) and my uterine sounding (where they just poke me with a tube and have me tell them when they're hitting something - fun times).

I also ordered my medications today from the mail-order specialty pharmacy. I don't even know what all I ordered... I do know that my stimulant medications are going to be Bravelle and Menupur, which is pretty normal. I'm getting a truckload of drugs and I only had to pay $200 in co-pays (as opposed to many thousands of dollars that I would have to pay if I didn't have my wonderful insurance coverage).

I also found out that the pharmacy can ship my meds to the local Fedex location (instead of my house) and I can pick them up in the evening. I wish someone would have told me that before when I got drug deliveries and had to run around like a nut trying to find someone who could sign for the package during the day (and put the drugs in the fridge). So that'll make life a little easier and I can pick up my meds at Fedex (nearby) on Tuesday.

And so it begins

Oh, the irony is killing me. Sheryl Crow never sang about taking birth control pills in order to conceive. After our IVF orientation session today, we picked up our prescriptions. And to add more humor to the situation, the pharmacist-in-training advised me that the antibiotic I'm taking may interfere with the effectiveness of birth control pills. I'm sure she wondered why I snorted.

Tomorrow is the official start of this fun ride. Cycle day 3. In the morning, I will be going for my FSH (follicle stimulating hormone) test. A cycle day 3 FSH test is an indicator of ovarian reserve (ie. how old your eggs are). It helps the doctor to determine your IVF protocol (what doses of meds to start you on, etc).

Brad and I also both start antibiotics tomorrow. We have to take them twice daily and the nurse warned that they're killer on your stomach, so they should be taken with a full meal. Should be fun times.

Basic Overview of IVF

Here is a basic overview of how a cycle of IVF (in vitro fertilization) goes. It's actually 2 menstrual cycles long.

• Cycle 1 consists of suppression of the ovaries and preparation for the actual IVF process. Generally this involves ovarian suppression drugs (sometimes birth control pills, sometimes lupron which causes a kind of menopause). Antibiotics are also recommended to clear out any possible infections in both the man and woman.
• Cycle 2 is where the real action happens. First 2 weeks are ovarian stimulant drugs, which require ultrasound and blood test monitoring every few days. The doctor checks for follicle growth and adjusts the medications accordingly. It's a tight balance between getting lots of eggs and overstimulating (causing serious side effects).
• When the follicles are mature, an injection of hcg (pregnancy hormone) is given which matures the eggs (and causes ovulation if no action is taken). Exactly 36 hours after the hcg, the eggs are retrieved through a surgical office procedure.
• Then the eggs are mixed in a dish with sperm and hopefully fertilize.
• The woman starts and pregnancy support drugs (progesterone and others).
• 2-6 days later, the embryos are transferred back into the woman (painless office procedure). My doctor advises 2 days of "lounge rest" (laying on the couch) after transfer.
• About 10 days later, a blood pregnancy test is done. If it's positive, the pregnancy support drugs are continued until 12 weeks of pregnancy.

Starting at the beginning...

If you're reading this blog, it's probably because I invited you here to follow our journey through IVF. But in case you stumbled here, I'll give you a quick recap of what's happened so far. My husband, Brad, and I have been trying to have our first child for about 3 years now. In those 3 years, I've been pregnant 3 times. I lost one very early and the other two at around 6 weeks. We have no explanations as to why it's so difficult for us to get pregnant and stay pregnant. Other than my slightly whacky cycles, we're both perfectly healthy and normal. My last pregnancy was in late summer of 2006 and I would have been due next month.

And that brings us here. To IVF. This is our last shot. We have insurance that covers $25k of infertility treatment and drugs. We plan to exhaust that benefit and then get off this crazy roller coaster and move on with our lives. Hopefully, this works and we'll have a baby next spring. If not, we will pursue adoption. One way or another, this is going to be over soon.

The purpose of this blog is to keep everyone informed. I know I have a lot of people rooting for me and I don't want to leave you all in the dark. But I also don't want to deal with daily phone calls asking for updates. If I can write it down, you all can read it at your leisure. Comment if you want, but don't feel obligated to.