cryo report and peeing on sticks

I know it will shock you all to hear this, but... none of my little buggers made it to the freezer.

I'm ... well, I suppose on one level I am upset that I can't seem to make decent embryos (though I do know that my clinic has really high standards for freezing embryos). But on the other hand, I'm incredibly relieved that I'm not being faced with a $1300 cryopreservation bill that I really don't have the money for right now.

Well, you know? I suppose there's always the possibility that George, Jr. will just stick around and this will all be a moot point, right?

Um. Yeah.

My buddy Barren asked when I start peeing on sticks. I hope I don't. I'm just not sure I can deal with the neurosis, the hope, the devastation, the rationalizing, the maybes (maybe it's too early, maybe it's a dud stick, maybe I should try another brand, maybe, maybe, maybe).

I'm sure I'll cave. I have, after all, a pile of the internet EPTs in the bathroom cabinet. How could a girl truly resist?

It's Like DeJaVu All Over Again

The phone call from SuperDoc on Day 4 explaining the outlook and the options. The apologetic tone in his voice. The determination to push forward. The sense that maybe things aren't quite as perfect as he'd like them to be. I feel like I've lived this life before. I've been down this path, I know where it leads, and it doesn't lead to the perfect single embryo transfer on Day 5.

In fact, that's pretty much what SuperDoc told me this morning. Things looked "great" on Day 2, but apparently not so great on Day 3, and even less so on Day 4 (today).

Embryo #:	Day 2 Report:	Day 3 Report:	Day 4 Report:
1	2 cell, no fragmentation	4 cell, no fragmentation	6 cell
2	2 cell, no fragmentation	4 cell, no fragmentation	4 cell, no change
3	2 cell, no fragmentation	4 cell, no fragmentation	6 cell
4	2 cell, no fragmentation	3 cell, 15% fragmentation	8 cell
5	4 cell, no fragmenation	4 cell, no change	4 cell, no change
6	4 cell, no fragmentation	4 cell, no change	7 cell
7	4 cell, no fragmentation	4 cell, no change	4 cell, no change
8	4 cell, no fragmentation	6 cell, uneven growth	compacting embryo

Note, SuperDoc gave me no information about fragmentation - but said that the embryo quality today wasn't nearly as promising as he'd hoped. He believes that we'll likely have a [singular] good quality blastocyst to transfer - but he thinks it is unlikely that we will have it by tomorrow and that I'll more likely be pushed to a Day 6 transfer.

This seems to be a chronic problem of mine - the slow growing embryos. This is the same thing that happened to me last time, essentially. By Day 4, I should pretty much be looking at morulas. I should have had 6-8 cells on Day 3. The reason that clinics don't do Day 4 transfers (usually) is that it's difficult to differentiate quality between morulas, so they let the morulas mature to blastocysts by Day 5. But it's unlikely that my almost-morula (Embryo #8) is going to be a blast by tomorrow (Day 5). It'll need the extra day. This is the same thing that happened last time. I did end up with two blasts on Day 6 (none on Day 5), but one was clearly the winner. None of my 9 embryos in IVF#1 made it to freeze. None. It is unlikely that any of these 8 will either.

So what do you do about slow-growing embryos? Not much. According to Dr. Licciardi, from NYU Fertility Center, they really don't know what to do about it. They'll try different things in the protocol to see if it fixes anything, but they never know whether it was the change in protocol that fixed the slow growth issue, or whether it was just luck. Probably just luck.

Since we've always known that PCOS isn't my sole issue with getting (and staying) pregnant, it makes me wonder whether my slow-growing embryos contribute to the issue. But then again, maybe they're only slow growing in a lab. This is one of those places where the science is simply too immature to help answer these questions. We just don't know. So we keep trying.

I have long said that I am grateful to live in a time when the science and the medicine have reached a point that I know, with a reasonable degree of certainty that I can get pregnant with assistance. I went through five years of infertility, countless monitored cycles, 11 medicated cycles, 6 IUIS, and a late miscarriage before having my beautiful babies. But a hundred years ago, even fifty years ago, I wouldn't have been able to push through all of that knowing that there was always a next step available to me. There just wouldn't have been options (regarding getting pregnant, that is), period.

I am incredibly grateful that I live in a time where the science and medicine are so advanced. But I think it bears noting that we are still in the (pardon the pun) infant stages of this research. We have so far to go before we really understand how a lot of the embryo development works. How and why certain embryos are more likely to implant than others. Why, in the absence of chromosomal abnormalities, killer cells, a clotting disorder, etc., recurrent miscarriages occur. It is important to recognize and appreciate how far we have come ... but also to recognize how far we have to go to ensure that our sons and daughters, grandsons and grandaughters, friends and families have less heartache and more hope.

I have hope that we'll have a little George, Jr. on Day 6 this cycle. And that George, Jr. will want to cozy on up and stick around until 40 weeks gestation and make his or her appearance into the world. I have hope that this will be the case.

But I am also making plans. A girl needs to make plans, you know. I'm making plans to start my next cycle in August. It will be my last covered at YOFC. I wonder whether I'll need to use the category, "IVF#3" in my blog posts. I hope not, but I'm making my plans, just in case, because that's what I do.

Details on the Demise of IVF #2, Take 2

Thanks to all for all your kind thoughts and well wishes. I'm fine. The decision to cancel this cycle was a mutual decision between my doctor and myself. He would have been okay with pushing forward if that's what I had insisted upon, but that's not a position I want to be in, especially with coverage running out with my insurance.

Several of you said it seemed so sudden given how well things seemed to be going... but that seems... odd to me, because the thing is that nothing had gone quite right yet. My Lupron Evaluation wasn't where they really would have wanted it, with my estrogen nearly double what it should be (mine was 89 vs. optimal should be under 50), but they let me go ahead anyway because it just seems to be what I do these days.

Sunday's monitoring appointment was... okay, but not brilliant. Four measurable follicles? (and a bunch of others that weren't measurable yet.)When supposedly the greatest risk for me with IVF is OHSS? Last cycle after a few monitoring appointments, I had what looked to be four, maybe five follicles that were promising (but also a definite lead follicle that they were going to let fall off) and several others that had some possibility of catching up. We ended up with 10 in the end, but nothing to freeze after an eSET. The goal with this cycle was to have increased the medications such that I would have a much more significant response with the stim cycle and have 14-15 follicles growing from the start (no more than that). That would have given us more to work with.

So when I went in on Tuesday for more monitoring, I had 5 measurable follicles, and while they were definitely growing - there weren't any others to be seen. Five. And while I tried to push my anxiety aside, knowing that I'm not the doctor and I didn't have all the information in front of me... five isn't... what we were looking for. I usually had more than that at this point in an IUI cycle and this is usually where they started talking about whether or not some were going to behave and drop off or whether I was going to have to cancel my IUI cycles. And that was on 1/3 of the doses of Follistim (but no Lupron).

I typed a long, long, long, long post to finish this all off.... and lost it. As I highlighted the post to copy it to the clipboard before posting it (just in case), it disappeared. This was as far as blogger saved it. I frickin' hate blogger. I'm not going to try and reconstruct the whole thing. I'll give you the cliffs notes version.

SuperDoc called me in the afternoon. Never a good sign when it's the doctor that calls rather than my nurse. I told him so and he agreed. He said that he'd been hoping some of the smaller follicles from Sunday would have caught up, but they've disappeared, and we're left with 4, maybe 5, if we're lucky. Last time we had the same thing at this point and we got 10, but he said last time was a slightly different situation where we were seeing 4-5 plus a bunch of smaller ones and I had a definite lead follicle that they just let fall away. This time I have a maybe lead follicle, but possibly not, and no smaller follicles anymore. Odds aren't looking so good that I'd have another 10 follicle retrieval in this case. Plus, the goal had been to get a 14-15 follicle growth cycle this time, and we're not there.

That being said, SuperDoc wasn't jumping to cancel. Yet. He said with this cycle, he'd give me a 30% chance of pregnancy. If we'd gotten the optimal cycle he'd been hoping for, he'd give me closer to 50% chance, and he didn't think that differential necessarily warranted cancelling in and of itself. He said he didn't want to test my patience by cancelling again after having already had one failed IVF and one cancelled cycle. But... to me, that's not a good enough reason to move forward. So although he was leaving it up to me, I ultimately left the decision up to him. I wanted him to make whatever decision he felt was the right decision, medically. And he said that if I was giving him a mandate to maximize the possiblity of success, particularly given that I have only two cycles covered under my insurance left, he felt that the best thing to do would be to cancel. So that's what we did.

As for moving forward....

I took the hCG trigger Tuesday night with dire warnings not to have unprotected intercourse, lest I end up with twins (or worse). Got it. I should expect my period in 2 weeks or so. I will start a 21 course of birth control pills (whoopie). I will start 20 units of Lupron on Day 19 and will continue with 20 units of Lupron after I start stims. I'll take 225 units of Follistim and 75 units of Luveris.

I told him I wasn't trying to play "back seat patient" but wanted to know whether there would be any advantage to trying the antagonist protocol.. He said no. He would use Ganirelex if he absolutely had to, but that in my case he believed that it would, in fact, put me at a disadvantage. He believes it would produce a worse cohort of follicles and would give far less control over the cycle. Though it may be testing everyone's patience, he assured me that they are learning more and more with each cycle that passes with me. The problem is that they are walking a very fine line with my "goldilocks ovaries"... too much and I'll hyperstim, too little and... well, I get cancelled, because it's just not worth doing all this for so little again. But hyperstimming isn't anyone's goal - the last thing anyone wants is to see me in the hospital getting liters of fluid removed from my abdomen, right? Of course right. So caution is good in this case.

By the way, he took me being a back seat patient really well. I prefaced my question with a big huge caveat about not questioning his knowledge and that I would NEVER bring it up if ... well, anyway, so he said to please feel comfortable asking anything I wanted and I did ask about the antagonist protocol and he gave me his very thorough answer (which I've only paraphrased here). And I told him that was totally fine and I reiterated that I was NOT trying to be a back seat patient and he said, "It's absolutely fine. When I'm 0 for 2, it's a perfectly justifiable time to ask if a different approach would be appropriate. But I do think that as long as you think that your patience isn't being tested to much and you think you can hang in there for a bit, we are getting there."

And I believe him.

I just.

You know, this IVF thing was supposed to be "easy." I was supposed to be doing the IVF thing not because nothing else worked, but because IUI worked.... too well. And... now I've had one failed cycle in which not a whole lot went right aside from a retrieval that went a million times better than we expected. I've had one cycle that got cancelled before I even got to stims. And one cycle that got cancelled after stims, but before retrieval. This was supposed to be "bada-bing, bada-boom, you're pregnant."

But now? Now I'm the interesting patient he uses as an illustration to his interns and fellows (no, really! I'm serious!). I don't want to be interesting. I want to be textbook boring.

Since I started my original IVF#2, nearly all of my original cycle buddies on cyclesista have finished their cycles and gotten their results (many of them BFPs!). And in that space of time... I've had two cancelled cycles. Heh. Well, just time to move on to the next one, right? In about five weeks.

Now what to call the next IVF... IVF #2 (take 3)? Or just scrap it all together and call the next one IVF#3?

It's Like Deja Vu All Over Again

Left Ovary: 12mm and 11mm
Right Ovary: 14mm and 11mm

Do I sense the possibility of a lead follicle in the making? Does this sound familiar??

Yeah.

Edit: Results from clinic are in. E2 = 145. Endometrium = 8.1. Stay on same doses of medications and return to office on Tuesday. This gives me absolutely no information upon which to base my feelings one way or another, and I didn't see a doctor today, so who knows.

Closer to Cancelled

Not to be confused with "Closer to Fine".

My lining, she is not wafer thin - she is 10.1mm and I have a lovely 18.6 follicle. Or maybe it's a cyst. But it's probably a beautiful follicle. We'll see what my estrogen is, but either way, it probably means triggering tonight and starting Lupron again in 9 days.

Dr. C. was covering monitoring today. I told him that the last time I saw him was when he was standing there, mouth agape while M (sonographer extraordinaire) was telling me there were three in there. "Oh my, was I the one who gave you that news?" Yep. Well, no. It was actually M. But yeah. He was the doc that day. And actually, I've seen him since, but I think only in passing. We had a lovely little chat and I showed off pictures of my kids.

And, of course, I delivered sour cream chocolate chip poundcake. Because I rock.

Stupid Body

Yeah, um, hello? Stupid body. Per SuperDoc, "Sometimes on Lupron you get the opposite effect that you're hoping for... What I was afraid of last time was that you're ovulating on your own despite the Lupron." Meanwhile, M (Sonographer Extraordinaire) was frowning. "She's thickening..." (referring to my endometrium, damn that endometrium!)

Seriously, how does this happen? I can't manage to ovulate on my own without the ovary-suppressing Lupron. Now I'm using Lupron to beat my perky ovaries into submission and what happens?? Goodness!

So instead of my endometrium staying wafer thin, it has thickened by .4mm. That may not seem like a lot to you, but it's enough to make my doctor frown and the student that was with him shrugged her shoulders in exasperation also. Oh, and my beaten-into-submission-non-perky-ovaries?

Riiiiiiiiggghhhhhtttt!!!

Two, count 'em, Two perfectly formed, gorgeous follicles. 12.4 and 14.7 mm follicles.

No numbers back on the estrogen level yet, but odds are good that it's gone up, not down. So the answer is to trigger with the hCG shot and then re-start Lupron 9 days later and then I'll come back for a re-check 2 weeks later. So we're looking at about a 3 week delay. Whee!

On the other hand, did I really want another summer pregnancy anyway?

About that Assisted Hatching

By the way, it turns out the reason I had assisted hatching was because I had a Day Six transfer. Apparently, they do Assisted Hatching on all day six transfers. Standard Operating Procedure.

So... no dramarama. Nothing particularly wrong with George, other than he was a slow grower who, well, wasn't particularly userful in the end. But that's okay - his siblings weren't particularly useful either, were they? Sorry, George. Not trying to diss you or anything, but you really didn't hold up your end of the bargain, did you?

Assisted What?

So I found out today that in IVF#1, Ye Olde Fertility Clinic did Assisted Hatching on George. Who knew?

Well, my financial services coordinator knew. My nurse didn't know, though.

I had called to find out the status of my account, make sure I didn't owe any more money (because based on the EOB's I've gotten from my insurance company, it looks to me like I should owe another couple hundred dollars in addition to the deposit I gave them last month), and to find out what my deposit for IVF#2 should be. The financial services coordinator said that they're just waiting for the insurance company to pay for the transfer and the assisted hatching.

I'm sorry, the... the what?

The assisted hatching.

Um. What assisted hatching? Yeah. So apparently George had a little extra assistance. Which is fine and all. I'm just sayin'. A girl should have been told. And maybe I would have been told if I hadn't had my huge FREAK OUT over SuperDoc's little joke about transferring eight embryos they might have told me. But probably it got lost in the shuffle of my panic attack. So I'm not assigning blame here. But seriously. Assisted Hatching? Why?

A girl needs to know! So you can be darned skippy sure I'll be asking that question next week!

And, I mean, no big deal, right? Except, um, there's the small little detail of assisted hatching increases the risk of monozygotic twinning. And I get that it's still a minute little tiny itty bitty risk. But any little itty bitty increase in that risk, I want to know about! Just sayin'!

(All this being said, one of the things I agreed to in my consent forms ahead of time was that if the doctor and embryologist believed it was necessary, they could go forth with assisted hatching without seeking additional consent from me, based on their medical opinion, knowing that there may be additional expense to me. So no one did anything wrong here.)

Meanwhile, I may still owe a little extra money for IVF#1, but the total amount is unknown as they're still waiting for the insurance company to pay up, but I did pay my deposit for IVF#2 today. Gah. Like I needed to spend more money today.

The Very Definition of Insanity

Do you know the definition of insanity? Doing the same action over and over again, expecting a different result.

Why, then, do I continue to POAS? Is it insanity? Or, as Jody suggests, simply ritual?

Truthfully, though I don't deny that I'm crazy, I don't expect a different result, so I imagine there's simply some comfort in the morning ritual, just as there is in the evening ritual of drawing up the PIO injection. At least I'm doing something.

It certainly won't change tomorrow's beta, that's for sure. But after tomorrow, there won't be anything to do for at least a few weeks. That time is interminable to me. I remember after my miscarriage in 2006 I had to wait a couple of months for my hCG to zero out, and then they still made me wait another month before starting a cycle.* That was absolutely the worst three months of TTC for me, ever.

I suppose I'll use my break this time to make random drop ins at YOFC to check and see if that mobile has been hung yet. AHEM. What do you think, J - has it been hung yet?? Don't think I've forgotten about it! I'll cut off the cookie supply if it doesn't get hung!

Just kidding. I'd never cut off the cookie supply. I'm too nice. Snickerdoodles tomorrow. They're already made.




*Note, there are no scientific studies (that I can find) that support a need for a month off after the beta bottoms out (my OB/GYN supported my theory on this) - most doctors admit that this is purely because they believe it will help a patient emotionally. However, I believe that the 2 months it took my beta to bottom out was a sufficient break. Furthermore, my completely unscientific survey with a sample size of, oh, 6 or so, showed that being forced to take an additional month break without being consulted as to whether this month was emotionally necessary was, in fact, perceived as patronizing and was more emotionally harmful than helpful.

And for all those lingering optimists out there...

Just in case you were thinking that just *maybe* 14dpo might *just* be a little too early still and there *might* just still be a miracle waiting... let's just assume that 15 and 16dpo is quite definitive, shall we?

I'm still bringing J and Co. Snickerdoodles on Wednesday (beta day). It's not their fault my body sucks, right?

Reading Between the Lines

Get it? Reading between the lines? Like, if I had two lines and you had to rea... oh forget it, they always say that it's not funny if you have to explain the joke. Onward and upward...

ANYWHOZIT: The point, for those still reading (and I wouldn't blame you if you'd stopped bothering after that lame-assed joke), is that I recognize that I've obscured the facts somewhat in the last few posts. So let me clear it up for those who have emailed me (though, to be fair, most of you HAD seemed to understand where I was going with it all)...

Yes, I have POAS'd. No, there were not two lines. Well, I mean, if you took TWO of the tests and put them together, you'd get two lines, but I doubt that's what any of you meant. Yes, this was a direct violation of my doctor's orders. But it's not like it was going to change the end result. Wednesday's beta will still be whatever Wednesday's beta is going to be. Plus, SuperNurse said I could pee on anything I wanted, so long as I was going to be sane about it (e.g. not call her every five minutes with the latest test results freaking out).

I'm very uncomfortable, both because of the giant lumps on my, ahem, posterior, and because I am extraordinarily crampy. I have little question in my mind that if it weren't for the blasted PIO, I'd be on CD-something right now based on how I'm feeling. Yes, I've tried a heating pad for both pains. No, it's not helping. Thanks for the suggestion. The warm heating pad sure is snuggly, even if it doesn't help. And the cats like it, too (bonus).

And now I get to hang out until Wednesday when I have my beta and can ask what my next steps are. I might call on Monday to schedule an appointment for a consult with SuperDoc, preemptively. I know it'll take a while to get an appointment with him, so I may as well get it on the books. I could always cancel it if (hah!) today's test results were somehow mistaken.

To answer Lori's comments....

I know my clinic did not allow back-to-back cycles. Your body needs a little downtime after all that.

Different clinics have different protocols. And some are satisfied that the month on BCPs = sufficient downtime before starting over. That isn't the same as going straight into another stim cycle, which is what back-to-back IVFs would actually be. A month of BCPs IS actually time off between cycles. I just don't know if that's sufficient for my clinic because in my efforts to be more "go-with-the-flow" than I naturally want to be, I just forgot to ask.

If your beta is negative do you have a consult before the next cycle? My clinic did. You should SO push for a cycle without Lupron.

They don't require a consult between cycles - that's really my call. I don't currently have a consult scheduled, but I might schedule one. I haven't really decided what to do. As for pushing for a cycle without Lupron... to be honest, I'm tired of pushing. I pushed and pushed through my first round of infertility treatment, and I'm really done with that. I have full faith and confidence in my doctor and his expertise. I don't have the emotional energy or the mental capacity left to play back-seat-patient. Certainly, I will ask what he thinks of doing an antagonist protocol instead, but I will not push for it. If he has a reason he doesn't think that's the answer, I'm not going to rock the boat. The headaches from Lupron suck mightily. There's NO question. I would love to be without them. But the fact of the matter is that if the protocol ultimately works and I get to hold a baby in my arms sometime in the next year or two... I won't give two hoots about the headaches (though I reserve the right to complain about them here, while I'm going through the process).

Finally, I know it ain't over 'til it's over, and the fat lady hasn't sung yet (wait, I *did* sing bedtime songs to my kids tonight...), but I know that the reality is that this isn't going anywhere. Many of you have emailed me directly to express your sympathy for this (and boy, will *I* feel stupid if I end up with a positive beta on Wednesday! Hah!), and I do appreciate it. I'm okay, though. I'm sad about the lost time and the lost chance and the fact that only 2 opportunities remain without some seriously creative financing, but I'm really okay with giving this another go. I'm eager, in fact, to keep moving. And like I've said all along - the good news is I love SuperDoc, SuperNurse, M (sonographer extraordinaire), J (Marketing Supervisor Extraordinaire)*, and everyone at my clinic. So is it really so bad to have to spend some more time with them?


----------------------------
*Er, not that J has anything to do with my treatment cycles or anything, because of course he does NOT. But at least I get to barge into his office now and again and drop random boxes of cookies on his desk and harass him. That part is fun for me. :)

Too Late to Say it's Too Early

I will now postulate that at 8dp6dt, aka 14dpo, it is now too late to say it's too early to tell anything.

No news. I don't expect this to change come beta time. Still don't know what the plan is - whether I have to take off a month before rolling in to BCPs or whether the month of BCPs IS my month off. Different clinics have different policies, and I don't know what my clinic's policy is. I do remember back in 2007 when I had my original IVF consult with SuperDoc he had said that I wouldn't be able to do back-to-back IVF cycles, but that could still be that he was referring to the BCP month in between.

I don't love not having a plan.

Frankly, I don't even know how we're going to pay for another set of coinsurances/copays again right now anyway - we just had a major huge crisis in our house which will likely involve digging up our entire yard to fix a broken water pipe to the tune of several thousand dollars, so it may be out of my hands for a while regardless, but I'm hoping not. We'll just have to see.

Anywhozit, we'll just see what happens. Wish I could just stop taking the PIO, but I'd probably get yelled at by SuperNurse on behalf of SuperDoc if I did that before beta day. So stick it out (pun intended), I shall.




I do not like not knowing the plan.

I don't care if it only takes one

Yes, people, I know it only takes one. I get that. But the cliche isn't helping me right now. I have a right to wallow for a few hours in my less-than-stellar news, and that's precisely what I'm going to do now, because today's news was even less promising than yesterday's news.

Let's Review:

Going into Retrieval: We were expecting 4-6 eggs (not stellar news, but at least we were expecting not stellar news)

Retrieval Day: 10 eggs retrieved! (Double what we expected! A great number, all things considered)

Day 1 Fert. Report: Of the 10 eggs retrieved, 9 were mature (1 post mature) and all 9 fertilized and were 2 celled embryos (unbelievably good news! I was stunned and overjoyed by this news!)

Day 2 Embryology Report: 1 didn't make it at all, 6 2-celled embryos still (1 with no change; not a good sign), 2 6-celled embryos (with 10-15% fragmentation, not good). Not a good enough report to warrant a 5 day transfer. Transfer scheduled for day 3 at 2pm. Disappointing news at best as with Single Embryo Transfers, they always try to go to blast in order to find the cream of the crop when possible.

Day 3 ... (Today):

I'm on my way in to work and the weather is crappy, my head is pounding, my tushie is sore from the PIO shots, I'm cranky. You get it, right?

I'm walking out of my parking garage on my way into my office juggling my keys, my briefcase, a couple shopping bags (I bought candy to re-fill the candy jar I keep for people to snack on in my office), and my phone rings. I'm fumbling for it, but I have to pull off my glove (did I mention it's snowing?) to get it open and turn it on; I almost miss the call. It's my nurse at Ye Olde Fertility Clinic.

"Hi Perky One*, it's NurseAwesome*. SuperDoc wants to talk to you."
"Yeah? All right," I sighed.
"You okay??"
"Yeah. Yeah, I'm fine." I said, knowing that this just wasn't going to bode well.
"Okay, hang on, here he is."

Why the man couldn't have just dialed the phone himself is beyond me. Because that introduction is exactly what gave me the anxiety I had, you know. But whatever. I do love him, and I know he has my best interests at heart. And for all I know it was NurseAwesome that wanted to make the call to me so that she could guage how I was doing, since she knows how pissy I've been all cycle. (Update: It turns out that SuperDoc did call me directly himself - but he called me at home and left a message at 8:45. Of course, I wasn't home - I was on my way to work. NurseAmazing knows better, and she knows me well enough to know that I probably wouldn't have been okay with just hearing a voicemail on my home number ... which I may or may not have checked before I went in for my appointment this afternoon, by the way ... so she probably said, "Yeah, no, we're going to call her cell phone now." That's why I love her.)

So he said he took a look at the embryos with the embryologist this morning and what I've got is a 7-cell, a 6-cell, a 5-cell, and 2 four cells. If I were any other patient, with their normal criteria, he'd be recommending a two-embryo transfer today (day 3), but he does NOT recommend that with my history. With HOMs at home, and with my pregnancy history (e.g. not good) and with my need to ensure I do not get pregnant with twins (unless, you know, they're monozygotic, in which case, we just had no way of controlling that risk), he is wholly opposed to a 2-embryo transfer. Which is good, because I am also opposed to it. My exact words were "absolutely not." And he responded, "We are on the exact same page, don't worry, I'm not recommending it - I would caution against it."

My embryos look pretty crappy. They do not meet the criteria to go to a 5 day blast, but given the choice between picking a crappy single embryo for transfer today as planned or trying to grow one to blast by Thursday or Friday, he thinks our chances are better if we wait. He believes we are likely to have one at the blast stage if we wait.

So what happens if we don't have any blasts by Thurs/Fri? We transfer whatever the best we've got is. And what if there's nothing? We scrap the whole thing and start over. After all, we were all set to cancel this cycle last week before we got to retrieval, remember? It's really no different, except that now we've been through a lot more hell than if we'd canceled ahead of time. But at least now we've got more information, right? What I don't know is whether this would count as a full IVF cycle for insurance purposes if we don't make it to transfer. My guess? Once you get to retrieval, it counts. That being said, my doctor is confident that we'll have something to transfer either Thursday afternoon or Friday morning, it's just a question of quality.

And so it goes.


*Note, she did actually use our real names... she doesn't refer to herself as "NurseAwesome" though she'd be perfectly justified in doing so.

Change in Plan

Update from SuperDoc - raise Follistim dose to 150IU. Back on Wednesday for monitoring. Wednesday is the worst possible day for me to deal with monitoring. My husband is going to work at 6:30am and I'm on duty at home until 7:30 and then have a myriad of other things to do. Dammit.

My nurse thinks we'll get 7, not 4. I guess we'll just see. I'm inclined to scrap the whole thing, frankly. This just hasn't been going as expected, but I guess - when has it ever?

Frick.

Calling all Assvice

Right: 19.6, 12.1
Left: 14.8, 13.1, 13.9, 13.4, 9.9, 9.8

Basically, my doctor is hoping that 19.6 just floats away and that MAYBE we'll get the others to grow enough by tomorrow to trigger. That would mean retrieval on Thursday, my 33rd birthday. And maybe get four eggs.

Four.

Originally, we were really worried about hyperstimming me. Don't get me wrong - I'm extremely happy that didn't happen. But... Four? Now, if I were forty, I'd take four joyfully. If I had premature ovarian failure, or even unexplained infertility, I'd take four. But I have frickin' PCOS, for crying out loud. Four?

What if we go through all this, retrieve four, at best, and then only 3 actually fertilize, and only one makes it to blast? Or what if none make it? Gah. There are too many "what ifs" involved here. I don't know what to do.

My doctor is inclined to go ahead with just four. But his original prediction of a 40-45% chance of pregnancy with an elective single embryo transfer (their normal rate of pregnancy with elective single embryo transfers is 67%) is now down to 30%. Me? I'm inclined to cancel. It just seems like an awful lot of work, time, money wasted for ... four.

I have three IVF cycles covered per live birth. If we cancel before retrieval, this doesn't count against my three. I get that I'm "only" on my first, but if that fails, I'm down to two. That's 30% down.

Oh, there was another option. We could have triggered today and converted to an IUI. Over my dead body. I would have been risking quadruplets if I'd agreed to that.

SuperDoc had students with him today, and while they were poking around at my ovaries I was being as lighthearted and joking away as I could. As he reviewed my previous cycle with them to see what they would think retrospectively, I mocked him a little "Oh no, this cycle will never work. We'll trigger you early, blow this cycle off - we know you're moving on next cycle anyway. No possibility you'll even get pregnant let alone with HOMs!" He said if I weren't back for more he might pay attention to me. A fair point. I apologized later to one of the students for being such a pain in the ass, but she said it was great comic relief.

SuperDoc was jovial and calming as always, but once I sat up, I got more serious and so did he. I wasn't happy. He was calm and seems comfortable with proceeding, but I feel like I'm being followed by a shadow. He did note that if we cancel and start over, we'll start my Follistim at 220 IUs and we'll be much more likely to see the 15 follicles we expected. Still, like I said, he's comfortable proceeding as is. Me? I'm not so sure.

I waffle. The Lupron sucks so badly I'd hate to think I took it for two weeks just to cancel.

Sigh.

Update: Thanks, Bean, for noting that I should double check my insurance - I did just that on my way out of the clinic this morning... I checked in with the financial counselor to find out what the financial implications of canceling would be and whether it would count against the three, and the long and the short of it is that each of the monitoring appointments would get billed separately to my insurance and I'd have my copayment for those and coinsurance for all the labwork. I had her double check to make sure that the cancelation would not count against the three cycles and it will not.

Another Update: the 19.6 is not the one. By Thursday, it'll be gone. Definitely good points for moving forward, but it's a lot of money I stand to lose.

Sigh *Update*

Not great news this morning. When I was doing IUI I never could get a dominant follicle to grow at the right time. Now I'm doing IVF and I don't want a dominant follicle and guess what I've got? Yep. That sucker is still growing and coming out on top. Lots of good medium ones, though, so maybe they'll just let that one go. I didn't like the looks of it and neither did the sonographer extraordinaire, M. No doctor in monitoring again today. I'm feeling the love, let me tell you.

Probably have to go back tomorrow, but will update more later when I hear from my nurse. But for now, not feeling the warm fuzzies.

Right: 17.0, 10.5, 8.1
Left: 12.5, 12.0, 10.9, 10.0, 7.7, 7.6

Yeah, not looking so hot. Possible they'll just let that 17 go and hope the others take over. But the risk with any dominant follicle is that it'll take over and suppress the others. Doesn't seem to be happening so far, but who knows. I suppose anything goes at this point. I also don't love the fact that I'm still not looking at a lot of follicles - considering my typical antral follicle counts, this is suprising (My typical antral follicle counts are in the thirties). I know it only takes one to work, but seriously, I have to have something to worry about, right?

Meanwhile, headaches still suck (possible sign that my estrogen is still in the crapper - typical for me), and my ovaries feel like they're the size of baseballs, though from the looks of today's monitoring that's probably not the case.

Update: My estrogen level is 226 (not great, but good rise from Thursday when it was 99). Meds stay the same, back tomorrow morning. Unfortunately, the only appointment time they had available meant canceling two meetings. Not good. Sigh.

I am not expecting great news tomorrow. Am hoping a doctor actually shows his or her face in monitoring, at least.