Ever see an overstimulated ovary on an ultrasound? It reminds me of an opening flower. Imagine the petals slightly folded, curving - arched and rounded. Imagine 8 petals on one flower, 10 on another - because that's what's going on. I'm up to 18 follicles!
Or, for those of you who are hungry, you could imagine each ovary as a piece of popcorn, but I doubt you want to associate that yumminess with an organ. You'll never munch down in a theater the same way again.
Or, for you nerds out there, it looks a lot like some crazy molecule model in 3D.
It's crazy. I'm not sure I'm developing as fast as I should, but I am developing a great quantity. Let's hope at least part of it is quality. I'm concerned because 4 are completely immature - under 10mm, and probably 8-10 are around 14-15mm, and only 4 - 6 are over 16mm.
Think about that size - it's approximately a fingernail and a half in width. Now multiply that by seven, all over an ovary which is usually the size of a teaspoon . That's now the size of each of my ovaries. No wonder I'm feeling a wee bloated. I'm in pajama pants because they are the only ones that fit me comfortably right now. I'll wear dresses the next couple of days so I don't have anything against my belly.
I am scheduled for egg retrieval on Wednesday morning at 9am. I'll trigger tonight with the help of a friend. I'll probably be sleeping on and off that afternoon like last time, coming off anesthesia but on painkillers. I'll know number of eggs when I wake up. I'm still surprised that I had the presence of mind to ask how many eggs as soon as I was cognizant last time. I had this memory of being told but the nurse swore up and down that I hadn't been told because they hadn't known yet. I swear someone must have said something in the OR when I was under and I was so desperate to know that I retained it!
More acupuncture tomorrow, and then we ER and wait. I've learned to fill my days up to get the time to pass as quickly as possible. It's the only way to stay sane. Now watch me be lazy and sit my butt on the sofa. Oh, yeah, I guess I kinda have to do that anyway because of recovery and bedrest. Nice excuse!
Monday, July 30, 2012
Sunday, July 29, 2012
Attitudes
I told a friend recently that it was all about attitude. On day 5, I was ecstatic to discover that I had ten follicles with 9 leading as potential eggs. Last round on that day, I was crushed because I only had ten follicles and 4 leading. (bloodwork E2 119 D5). Still taking it one day at a time, just following the process.
Day 8, twelve follicles with 11 leading. (E2 479). Tentative hope.
And today, Day 10, I have fourteen follicles that we can find with all 14 leading. holy cow! We're going to allow them to continue to grow for another day. Maybe even two. I do think some of them are rather small for day 10 - 12mm. This tells me that either they have developed as quickly or these are some of the tinier ones the tech thought she might see but didn't want to count since she couldn't see behind my left ovary.
I've been doing my acupuncture, my bodywork. I've added in some talk therapy to manage stress as well as guided relaxation. And then there's the usual set of blood draws, ultrasounds, summer camp pick ups and drop offs, and some OT for my girl. I was going to add in yoga for fertility, but, after speaking with the teacher, we decided that to add in one more thing might totally stress me out!
She did teach me the feet up the wall pose, where you lie on your back on the floor and put your legs straight up against the wall to allow the blood flow to come back to your reproductive organs. I felt so silly, lying in the hallway with my head in the bathroom door way. I told her I felt like I was doing everything but sacrificing a chicken to make this happen. It occurred to me a moment later that I might have insulted her, so I quickly stated how yoga and acupuncture obviously affected circulation and chi and that of course that didn't fall into the whole "sacrificing a chicken" mindset.
One thought that has been stressing me out - TWINS. I thought I was okay with our plan to transfer two embryos on Day 3 with assisted hatching. And then my talk therapist FREAKED ME OUT with her talk of hospital bedrest and NICU and probable soft neuro-developmental delays and pre-eclampsia and gestational diabetes and needing not just a few afternoons a week of extra help but needing a full time nanny even with my being home and how would we pay for that or could someone move in who could help for either a few months or a few years. HOLY CRAP. So her negative attitude (she worked in high risk obstetrics and a fertility clinic) has now given me a negative attitude. I called my RE (that's reproductive endocrinologist aka fertility doctor) to discuss.
One factor in this is also the discovery of a sharp change in my anti mullerian hormone (AMH). In January, I had a 1.1, which is actually a little better than normal for a woman of my age. Between that and the kicking FSH 6.54 (follicle stimulating hormone), egg quality was looking quite good. I think this is evidenced as well by our having six embryos even on day 3 last round. You want FSH to be low and AMH to be high to show good egg quality, or egg reserves. As of May, my FSH was even lower (odd!) at 5.71, but my AMH had plummeted to .39. That's not a tiny fluctation!! That puts me at very low egg quality, which can certainly affect the number of eggs which mature and which will fertilize. So, even with almost twice as many follicles, I could end up with the same amount of embryos or even fewer.
The doc and I sat down this morning and "hatched" out a new plan. (Oh, ha ha, I am so funny after a blood draw and no food. Coffee first.) If we only have two or three embryos on day 3, we'll insert two. There are greater chances at my age that there could be genetic issues which would prevent development, so it's best to hedge our bets on that. They don't have the data about SET (single embryo transfer) that they do for younger patients, showing that the odds are about the same to implant one vs. the other. Although it was from those studies that it was decided we'd do a SET with the last one on day 5.
If we have many growing and doing well, then we will go out to Day 5 and see. If we have a few that we could transfer, we may still opt to do a SET and then grow the others out one more day and have some for freezing. I'm feeling optimistic about that since we're seeing 14 follicles. Last time we had 8 follicles with 7 eggs and 6 fertilized. If we can even get 12 eggs and 10 fertilized, we are so much more ahead of the game!!
As I mentioned, though, my hormone numbers are very different than we thought. Still, these draws were done within weeks of the last IVF cycle, so I'm guessing these numbers were about the same during cycle number 1? (the one which didn't result in a pregnancy - hmmmmmm....)
Looks like that microdose lupron protocol is working very well for me. I've had far more headaches than last time, beginning from the birth control pills to even yesterday. They are starting to wane, though, as my follicles increase production of whatever hormones are going on. Although I have more follies and I'm swollen in the belly, I'm not as swollen in the belly and I've not gotten to the point of feeling like I have rocks in my stomach, sitting on my organs. That's always been my least favorite part of the clomid rounds, but I gotta say that the headaches tie it. I appreciate pain killers and my body work specialists for helping with these.
I return tomorrow for yet another blood draw and ultrasound to see if we trigger tomorrow night (that means we'll do another hormone shot to get the eggs to start releasing to make for easier retrieval). I've got the Bud in summer camp all week because of this crazy scheduling. And now it looks like some of this has to be done before camp even starts and some procedures over the weekend or even into early next week.
Anybody want a kid for a few hours? Juggling childcare has been a big part of this stress but it's gotten better with discovering an online coupon for a preschool camp near my home. I thought I'd be in more pain than this, so I feel guilty for sending Bud off when I can still move. Last time, I could barely get off the sofa. I suppose that time will come, though! It's surprising to me that this saps my energy so much, and yet it can make me so irritable I could enter a prize fight and win.
I suppose that's my attitude right now - working hard, optimistic, yet irritable and tired. I wonder if they make an emoticon for that. It's a pretty normal feeling for someone going through fertility treatments. I could sign all my online writings with it. Maybe a hormonal woman sacrificing a chicken?
Day 8, twelve follicles with 11 leading. (E2 479). Tentative hope.
And today, Day 10, I have fourteen follicles that we can find with all 14 leading. holy cow! We're going to allow them to continue to grow for another day. Maybe even two. I do think some of them are rather small for day 10 - 12mm. This tells me that either they have developed as quickly or these are some of the tinier ones the tech thought she might see but didn't want to count since she couldn't see behind my left ovary.
I've been doing my acupuncture, my bodywork. I've added in some talk therapy to manage stress as well as guided relaxation. And then there's the usual set of blood draws, ultrasounds, summer camp pick ups and drop offs, and some OT for my girl. I was going to add in yoga for fertility, but, after speaking with the teacher, we decided that to add in one more thing might totally stress me out!
She did teach me the feet up the wall pose, where you lie on your back on the floor and put your legs straight up against the wall to allow the blood flow to come back to your reproductive organs. I felt so silly, lying in the hallway with my head in the bathroom door way. I told her I felt like I was doing everything but sacrificing a chicken to make this happen. It occurred to me a moment later that I might have insulted her, so I quickly stated how yoga and acupuncture obviously affected circulation and chi and that of course that didn't fall into the whole "sacrificing a chicken" mindset.
One thought that has been stressing me out - TWINS. I thought I was okay with our plan to transfer two embryos on Day 3 with assisted hatching. And then my talk therapist FREAKED ME OUT with her talk of hospital bedrest and NICU and probable soft neuro-developmental delays and pre-eclampsia and gestational diabetes and needing not just a few afternoons a week of extra help but needing a full time nanny even with my being home and how would we pay for that or could someone move in who could help for either a few months or a few years. HOLY CRAP. So her negative attitude (she worked in high risk obstetrics and a fertility clinic) has now given me a negative attitude. I called my RE (that's reproductive endocrinologist aka fertility doctor) to discuss.
One factor in this is also the discovery of a sharp change in my anti mullerian hormone (AMH). In January, I had a 1.1, which is actually a little better than normal for a woman of my age. Between that and the kicking FSH 6.54 (follicle stimulating hormone), egg quality was looking quite good. I think this is evidenced as well by our having six embryos even on day 3 last round. You want FSH to be low and AMH to be high to show good egg quality, or egg reserves. As of May, my FSH was even lower (odd!) at 5.71, but my AMH had plummeted to .39. That's not a tiny fluctation!! That puts me at very low egg quality, which can certainly affect the number of eggs which mature and which will fertilize. So, even with almost twice as many follicles, I could end up with the same amount of embryos or even fewer.
The doc and I sat down this morning and "hatched" out a new plan. (Oh, ha ha, I am so funny after a blood draw and no food. Coffee first.) If we only have two or three embryos on day 3, we'll insert two. There are greater chances at my age that there could be genetic issues which would prevent development, so it's best to hedge our bets on that. They don't have the data about SET (single embryo transfer) that they do for younger patients, showing that the odds are about the same to implant one vs. the other. Although it was from those studies that it was decided we'd do a SET with the last one on day 5.
If we have many growing and doing well, then we will go out to Day 5 and see. If we have a few that we could transfer, we may still opt to do a SET and then grow the others out one more day and have some for freezing. I'm feeling optimistic about that since we're seeing 14 follicles. Last time we had 8 follicles with 7 eggs and 6 fertilized. If we can even get 12 eggs and 10 fertilized, we are so much more ahead of the game!!
As I mentioned, though, my hormone numbers are very different than we thought. Still, these draws were done within weeks of the last IVF cycle, so I'm guessing these numbers were about the same during cycle number 1? (the one which didn't result in a pregnancy - hmmmmmm....)
Looks like that microdose lupron protocol is working very well for me. I've had far more headaches than last time, beginning from the birth control pills to even yesterday. They are starting to wane, though, as my follicles increase production of whatever hormones are going on. Although I have more follies and I'm swollen in the belly, I'm not as swollen in the belly and I've not gotten to the point of feeling like I have rocks in my stomach, sitting on my organs. That's always been my least favorite part of the clomid rounds, but I gotta say that the headaches tie it. I appreciate pain killers and my body work specialists for helping with these.
I return tomorrow for yet another blood draw and ultrasound to see if we trigger tomorrow night (that means we'll do another hormone shot to get the eggs to start releasing to make for easier retrieval). I've got the Bud in summer camp all week because of this crazy scheduling. And now it looks like some of this has to be done before camp even starts and some procedures over the weekend or even into early next week.
Anybody want a kid for a few hours? Juggling childcare has been a big part of this stress but it's gotten better with discovering an online coupon for a preschool camp near my home. I thought I'd be in more pain than this, so I feel guilty for sending Bud off when I can still move. Last time, I could barely get off the sofa. I suppose that time will come, though! It's surprising to me that this saps my energy so much, and yet it can make me so irritable I could enter a prize fight and win.
I suppose that's my attitude right now - working hard, optimistic, yet irritable and tired. I wonder if they make an emoticon for that. It's a pretty normal feeling for someone going through fertility treatments. I could sign all my online writings with it. Maybe a hormonal woman sacrificing a chicken?
Tuesday, July 17, 2012
FRI the 13th and IVF the 2nd
Yes, we're doing it again.
I'm sitting here with naproxen and hydrocodone in my system as I wait for the suppression headache to abate. And that's just from the birth control pills! I'd forgotten how sick they could make me. I believe now that the lupron headaches last time may have been worsened by the bc pills.
I begin a new protocol tomorrow. I had an appointment on Friday for the suppression check. While there, they decided to check my vitals. Holy hell, I gained five pounds on vacation! The nurses flipped their lids! Suddenly, despite a great ultrasound showing 13 antral follicles (that's potential egg homes), I'm being told that we may have to postpone the cycle! and they don't say for how long! They checked my blood pressure - high - no duh! I have it flashing through my head from the December anesthesia consult that if I put on any weight we'd have to find a different place for my hysteroscopy. And now, I'm seeing that I gained weight.
I tried to joke about it with the nurse - mom's southern cooking and all that. She said my weight was lower than the last BMI in December, although I remember differently. But, because my blood pressure was up, she then says she's not allowed to release me. I'm in a half hour zone, no lunch, a sick husband waiting on me at home to drive him on an errand, and a kid expecting to go to Red Robin as a special lunch treat. But no, I have to wait. We decide to take it again after all of this flashes through my mind with the vision of staying there for hours washes through my head. Yup, higher. ggrrrrrreat.
They scramble for someone to speak with me. Folks are on the phone, now I'm getting multiple warnings that we may have to postpone the cycle, and I'm feeling ill on a number of levels. I'm told i'll receive a phone call later to determine if i'll have to come in yet again and have a face to face with an anesthesiologist because of this grave matter.
A nurse walks out from the procedure area. She's seen me for my egg retrieval and for my embryo transfer. "oh, it's you! you're fine. I know you run a little high, but I do think you should talk to your primary care doctor: You're free to go once you check out". whoo! what a relief, because what else could go wrong?
oh, yes, there is more.
I go to clear out with finance, knowing I don't owe anything. "oh, good, D, we wanted to talk to you about something in your contract. We've just learned it doesn't cover cryopreservation of embryos so you'll need to prepay an additional $900 in case you have any embryos to freeze". Say whaaaa??? We've paid how many thousands of dollars and now we owe another $900? The contract covers a fresh cycle and the retrieval, covers a frozen cycle and the defrosting and implantation, but not the in-between part where you freeze the embryo? not cool, Attain, not cool. We went round and round as I tried to understand. We left it that if we do have embryos to freeze, they have my card on file and will charge then.
I scheduled further blood draws and ultrasounds, and left - much later, hungrier, far more stressed, but without a parking ticket. My Friday the 13th was not going so well, but there was that.
And then.
I received a call from yet another nurse speaking warningly about postponing my cycle. my meds are here! they are in the fridge! postpone?? I've got reserves shriveling up as the seconds tick down each day, and you think postponing is good? Over five pounds? When it's the same weight as I was at egg retrieval?
The anesthesiologist called Monday. I queried about the astonishing alarm a five pound weight gain had wrought. Were they concerned it was in my neck and that's why they had to re-examine me in person? Was it because I weighed less than the first anesthesia in January? He was laughing, a LOT, over it. He explained that the nurses were following protocol, but because I'd had anesthesia (gosh, I'm finally learning to spell that word!) three times there and it was such a minimal weight gain, he'd approve me immediately over the phone. Postponement cancelled.
No meds on Monday, no meds today. I wake up tomorrow morning with a different protocol than last cycle and will take 10 units of microdose lupron before my morning coffee. It's some kind of flare protocol. My understanding is that they hope a tiny little bit of lupron just before I start stimulation meds on Friday will create a hormone flare, and they can capitalize on it with the stimulation medication and I'll have even more follicles. I'm already excited that I have 13. I had, what, 8? last cycle?
So, we're off and running again. Wish us luck.
I'm sitting here with naproxen and hydrocodone in my system as I wait for the suppression headache to abate. And that's just from the birth control pills! I'd forgotten how sick they could make me. I believe now that the lupron headaches last time may have been worsened by the bc pills.
I begin a new protocol tomorrow. I had an appointment on Friday for the suppression check. While there, they decided to check my vitals. Holy hell, I gained five pounds on vacation! The nurses flipped their lids! Suddenly, despite a great ultrasound showing 13 antral follicles (that's potential egg homes), I'm being told that we may have to postpone the cycle! and they don't say for how long! They checked my blood pressure - high - no duh! I have it flashing through my head from the December anesthesia consult that if I put on any weight we'd have to find a different place for my hysteroscopy. And now, I'm seeing that I gained weight.
I tried to joke about it with the nurse - mom's southern cooking and all that. She said my weight was lower than the last BMI in December, although I remember differently. But, because my blood pressure was up, she then says she's not allowed to release me. I'm in a half hour zone, no lunch, a sick husband waiting on me at home to drive him on an errand, and a kid expecting to go to Red Robin as a special lunch treat. But no, I have to wait. We decide to take it again after all of this flashes through my mind with the vision of staying there for hours washes through my head. Yup, higher. ggrrrrrreat.
They scramble for someone to speak with me. Folks are on the phone, now I'm getting multiple warnings that we may have to postpone the cycle, and I'm feeling ill on a number of levels. I'm told i'll receive a phone call later to determine if i'll have to come in yet again and have a face to face with an anesthesiologist because of this grave matter.
A nurse walks out from the procedure area. She's seen me for my egg retrieval and for my embryo transfer. "oh, it's you! you're fine. I know you run a little high, but I do think you should talk to your primary care doctor: You're free to go once you check out". whoo! what a relief, because what else could go wrong?
oh, yes, there is more.
I go to clear out with finance, knowing I don't owe anything. "oh, good, D, we wanted to talk to you about something in your contract. We've just learned it doesn't cover cryopreservation of embryos so you'll need to prepay an additional $900 in case you have any embryos to freeze". Say whaaaa??? We've paid how many thousands of dollars and now we owe another $900? The contract covers a fresh cycle and the retrieval, covers a frozen cycle and the defrosting and implantation, but not the in-between part where you freeze the embryo? not cool, Attain, not cool. We went round and round as I tried to understand. We left it that if we do have embryos to freeze, they have my card on file and will charge then.
I scheduled further blood draws and ultrasounds, and left - much later, hungrier, far more stressed, but without a parking ticket. My Friday the 13th was not going so well, but there was that.
And then.
I received a call from yet another nurse speaking warningly about postponing my cycle. my meds are here! they are in the fridge! postpone?? I've got reserves shriveling up as the seconds tick down each day, and you think postponing is good? Over five pounds? When it's the same weight as I was at egg retrieval?
The anesthesiologist called Monday. I queried about the astonishing alarm a five pound weight gain had wrought. Were they concerned it was in my neck and that's why they had to re-examine me in person? Was it because I weighed less than the first anesthesia in January? He was laughing, a LOT, over it. He explained that the nurses were following protocol, but because I'd had anesthesia (gosh, I'm finally learning to spell that word!) three times there and it was such a minimal weight gain, he'd approve me immediately over the phone. Postponement cancelled.
No meds on Monday, no meds today. I wake up tomorrow morning with a different protocol than last cycle and will take 10 units of microdose lupron before my morning coffee. It's some kind of flare protocol. My understanding is that they hope a tiny little bit of lupron just before I start stimulation meds on Friday will create a hormone flare, and they can capitalize on it with the stimulation medication and I'll have even more follicles. I'm already excited that I have 13. I had, what, 8? last cycle?
So, we're off and running again. Wish us luck.
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