Follow Up With Dr. B

Thursday was our follow-up appointment with Dr. Br.averman. Our appointment was at 2:30 in the afternoon and we had planned to both work on Wednesday and head down after to stay with my cousin in NYC. Well, they had predicted about 9 inches of snow so we ended up leaving early to avoid it. We got into Manhattan around four and my cousin wasn't going to be free until quite a bit later. We parked our car and walked around Ti.mes Sq.uare, Br.oadway, and Ro.ckefeller Cen.ter. The weather was pretty awful and within a short amount of time we were ready to head back to the car. We were both soaked and cold. 

From there we decided to do the driving tour of Manhattan. We saw the Empire State Building, the Freedom Tower, 5th Avenue, and Greenwich Village. It was so much better from the warmth of the car. W only triggered one episode of road rage from another driver, so, all in all it was successful and much more enjoyable. 

We met up with my cousin and her husband and had dinner delivered to his Muay Thai boxing gym in Manhattan. They were doing some maintenance since they were closed for the holidays. After a bit we headed back to Queens to their apartment. 

W and I slept on their fold out couch which wasn't the most comfortable, but was most definitely free. We woke on Thursday morning, showered, got some breakfast, and hung out for a bit before we headed to Long Island for our appointment. I had my list of questions and was ready to meet with Dr. B. 

We didn't wait long to see him and there weren't many people in the office. It was such a different feel from my current RE's office where you wonder if there is going to be enough seats for everyone. One woman came out and was talking with the receptionist. Then Dr. B came out and gave her a big hug and chatted with her for a bit. I'm pretty sure she was pregnant, although I tried not to eavesdrop. 

When we headed back to Dr. B's office he greeted us warmly and mentioned something about how much easier this appointment was than the last one. He first asked how many frozen embyros we had left. When I told him five he started to make a plan for that. Then I told him we were more interested in doing a fresh cycle at his clinic than using those frozen embryos right now. 

He thinks our past failures are more linked to the lab than either eggs or sperm. I can't deny the success rates are really low at my current clinic for fresh cycles. Their frozen success rates are abysmal. That's not to say it doesn't work for some people. I know lots of people who got pregnant there. I just don't appear to be an easy case. 

Dr. B thinks we should do a similar protocol to last time with a Lupron trigger, so that means no Lupron to suppress. I've been on birth control pills for around two weeks now so will stop that soon. At that time we will start stims. I haven't received a calendar yet, but I have an idea of what it will look like. We will use Gonal-F and Menopur and I'm also guessing Ganirelix. In addition, we will increase the Neupogen dose a bit. We will wait until the day before the transfer to add in the Neupogen since I guess it has been linked to higher estradiol levels when added sooner. We don't need any help in that department. 

I asked about doing an endometrial biopsy again and he said studies aren't conclusive enough to do it at this point so it's probably not worth it. I asked about repeating the HSG since I've only ever had that done once and he said he sees too many false positives with it and that it's not a great test. The best way to look at everything is with a lap surgery which I have had, twice. I asked about PIO vs. Crinone and he said that at least initially he prefers to use PIO. I asked whether our chemical pregnancies were likely the result of chromosomal abnormalities or the HLA matching. He said it could be a combination of both and that it's hard to know. 

I asked at what point implantation is reduced with high estradiol levels and he said around 4000. He agreed to aim for a fresh transfer and said that, "maybe there's something there" since I've only ever had implantation with fresh cycles. 

He was super positive and said we will have a baby. Even if it's not a guarantee, it was really nice to hear. He even said that if we aren't successful this cycle (frozen embryos included) that he will give us another cycle for free. He's not going to leave us hanging. 

He said his lab is able to mature eggs and that if it means triggering me a day sooner to keep my estradiol a little lower, it's not a big deal. At that point we would likely have some mature eggs so it would just mean some would have to undergo in-vitro maturation.

 Once our conversation appeared to be at a near end I asked if I was going to get an ultrasound. He said yes and called his tech down. 

We went into the ultrasound room and started. The tech didn't say much but I knew a doppler blood flow portion would be performed. The ultrasound took a really long time as she was super thorough. I had no idea what she was looking for with the doppler so I lost interest quickly. When she finished she told me not to get dressed and to wait for Dr. B to come in the room.

When he came back he told me a number of things, all new to me. He told me I had a fibroid that was about an inch. It was making my uterine cavity appear curved. I asked whether this was something that grew slowly and he said it had likely been there for a while. This pissed me off a bit that I had never been told about it at all. I'm wondering if my current clinic ever even saw it. He said he wanted to perform a hysteroscopy to take a look at it to be sure it wasn't in my uterus. If it was we were looking at surgery to remove it. He joked that he could do it that day but that the machine wasn't sterilized so he could give me a half off deal on it. I asked whether it could be done the following day and he said fine. 

He then told me I had reduced blood flow to both sides of my uterus. He recommended I use Viagra vaginally to help with blood flow as well as Vitamin E daily. In addition, he said they would double my dosage of Lovenox next cycle to twice a day. Hopefully this will all help with the blood flow issue. I'm really glad I went and had this done because it obviously gave us new information and changed our treatment a bit. When the tech was performing the doppler portion I asked her why more clinics don't do it. She said it's because they likely don't understand the importance. 

We returned the next morning for the hysteroscopy. We waited a bit in the procedure room this time but when Dr. B came in he joked about reading the cliff notes for how to perform the procedure. When I asked the previous day whether I would be conscious for the procedure he said I would but he would not. The hysteropscopy itself was short and showed the fibroid wasn't going to interfere in any way so that was really great news. From there he turned to W and said he was sorry he didn't find his watch in there. 

I talked with his nurse for a bit and we talked about meds for this upcoming cycle, my calendar, and supplements Dr. B recommended. These were: Omega 3 Fish oil 2x's/day, Vitamin C 1000-2000 mg/day, Vitamin D 4000 units/day, Pycnogenol 100 mg/day, Vitamin E 500 mg/day, and Vitamin B complex. In addition, she gave me a sample of something called Preg.nitude which contains Folic acid and Myo-inositol and instructed me to take in twice a day. They also wrote me a script for Mentanx which is to help with the MTHFR. The nurse also said Dr. B is going to want to see me around day eight of my stims to perform the ultrasound and take a look for himself. This is going to make things a lot more complicated and I don't think W will join me for that appointment. We will see at what time it falls and see who I can rope into coming with me. 

All in all, I'm really glad we went. Talking with someone face-to-face is so much better than over the phone. We regained some confidence and feel positive moving forward with Dr. B. We also received some new information that changes things a bit. I'm not holding my breath that IVF #5 (holy crap) is going to be the one, but it's nice to have some hope again that it may work out in the end. 

Glad It's Over (Christmas 2012)

Our tree sits proudly, taking up a quarter of our living room. Our lights outside are well hung and look awesome. The cookies were baked, frosted, and quickly eaten. The presents have all been opened and we are back home together. 

Christmas is over and I can't lie, I'm pretty glad it is. We made the best of what we could this year, but it was especially tough. 

Pepper Claus

Can you find the kitty in the tree? His new favorite skill

The front of our house

Our tree in the living room

The garage

I don't have the fondest childhood memories from Christmas. My parents got divorced when I was seven so I don't have any Christmas memories with my Dad at home. From as early as I can remember, I dealt with my sister unintentionally trying to ruin Christmas for us. She hated surprises (and honestly still does) so she made it her life's work each December to find our presents and show them to me. 

One year my mom hid them in the trunk of her car. When my mom went running my sister brought me outside and we played with our toys in the driveway. She got a Game Boy that year that got lots of use before Christmas. I remember I got a stroller for my dolls. 

Another year she showed me how to unwrap the presents from the corners to peek and see what was inside. 

Then there was the year that I had heard rumors that there wasn't a Santa (probably from my sis) so I wrote him a note and asked him to sign on the line if he was real. In my excitement I brought it to my sister to show her and she prompted replied with, "That's moms handwriting." 

As we got older my mom gave us money a few weeks before Christmas and took us shopping. We were able to pick out what we wanted and then she wrapped them for us for Christmas. 

I know it's not my sister or mom's fault that I don't love Christmas. It always just felt like such a let down. 

For Christmas Eve this year we went to my in-law's house. This was the first year my mom and step dad were in town for Christmas in about ten years so they were there as well with my brother. In addition, our friends C, J, and their little girl E came over. It was nice to spend time with everyone. The tough part came when I overheard W's aunt talking about how she was going to be a grandmother again. Her son and his wife are pregnant and due in May. 

Yeah, that wedding we attended in June? They're pregnant already. Not to mention the fact that she left him for about a month within a few weeks of them getting married. Yeah, they're pregnant. 

From the point that I heard that news on I struggled. I knew we would be seeing W's cousin and pregnant wife for Christmas dinner and I started to dread it. We managed to arrive as late as possible, both tearing up a bit on the ride over.  I didn't converse with her at all tonight. I didn't tell either of them congratulations. I was a jerk and I don't care. I'm not handling pregnancy announcements particularly well these days. 

I just don't get how it's possible that she is in her upper 30's and got pregnant within a few short months of them getting married. It's really starting to hit us hard that for every wedding we attended since our own, the couples are either pregnant or already have already had a baby. Couples that are way older than us. One of my co-workers who was expecting at the same time as we were supposed to be the first time told me recently that they are expecting their second child this spring. They started trying late this summer. 

To be completely honest, I just don't get it. I don't understand why I'm still in my 20's (for eight more months) and unable to get pregnant. Unable despite trying everything we can. Unable despite all of the money we have thrown at the situation. 

 I'm okay with babies, but pregnancy is really starting to rub me the wrong way. It's probably because I'm coming to terms with the fact that it may never be me. 

Things have been ok lately. Last week brought some serious work drama that had me crying in bed at midnight that night. It's hard to feel the stress of infertility and then pair it with work stress. It just feels like too much sometimes. Everything is fine now, but it didn't feel that way for a bit. 

On Thursday we meet with Dr. Br.averman again. I'm not sure how I feel about things. Going through another IVF cycle does not sound like fun. I'm curious to see what he has to say and to see whether he can re-inflate our hope balloon. 

Then next Thursday we have an appointment with an adoption attorney to talk. I'm not sure what our plans are exactly with that, but it will be nice to talk to someone about things. 

Christmas wasn't easy this year. We both struggled to put on a happy face and to focus on the positives We have so many things to be happy and grateful for but it's hard not to feel like something's missing. 

The Dark Clouds are Parting

Things are looking up. The dark clouds that were hanging around us last week seem to be moving aside and allowing for some bright light. We are feeling happier, smiling more, and moving on from the sadness. It took a lot longer this time, but it also changed some of our perspectives on things.

The orientation at the adoption agency Tuesday night really helped. We drove about two hours west and arrived early. It was a good thing we did because finding the office was incredibly confusing. I guess they had just moved so it wasn't marked as their office and we spent almost 25 minutes looking for the place, driving up and down the road. The orientation itself was informative and helped to explain the whole process really well. They had a bunch of sample profiles to look at and it was nice to see what people share about themselves. The agency also had a family come in with their four month old son to share their experience. They had waited thirteen months to be matched, but their little guy was adorable. The process sounds difficult and expensive, but totally worth it. I'm sure it's incredibly hard to wait for "the call." It seems to different from doing treatments.

After the orientation we went for dinner. The food was horrible but we laughed and had a good time. We had some great conversations in the car during our two hour ride home. It was fun to talk about and we both felt so positive.

We aren't jumping up and down to start registering with them. I thought it would be a good idea to speak to an adoption attorney first to get some reviews of this agency and possible other options before moving forward. If we do choose this agency they believe in open adoptions. When I first asked W about it we were on the fence. The more we thought about it the more it seemed fine. W said, "It's just another person we get to brag to about our kid." I thought that was funny.

When I looked up local adoption attorneys yesterday I found a good family friend of my MiL and FiL listed. W called him today and he said although he does deal with some adoptions, he had a good friend who primarily does them. He gave us his number and W left a message yesterday afternoon.

In other news Aunt Flo finally decided to show her face a full eight days after stopping my meds. It was the longest I have ever waited and I was honestly started to get concerned. I emailed the nurse at Dr. B's office on Wednesday and by Thursday morning things had started. I also got a call from Dr. B's office saying they had an appointment available for the 27th. I called back and we are scheduled for 2:30. We are planning to take Thursday and Friday off from work and spend some time in NYC. He isn't doing office visits in the city anymore (Hurricaine Sandy maybe?), but it's so close and a great excuse to spend some time in the city. I'm pretty sure the tree will still be up in Rockefeller center so I'm pretty excited to see that. W has two cousins that live in the city, I have one, and his aunt and uncle live in northern NJ. I'm sure we can find someone to stay with.

I have to call my local clinic to schedule a baseline appointment before starting birth control pills. I'm a little nervous about it because they always ask what kind of cycle I will be doing. I know they won't like the idea of me going somewhere else, but I think it's time to move on from them. 

It's somewhat alarming how much cheaper my current clinic's prices are. It has to be for some reason, right? I can't believe it's just because the RE who owns it has a good heart. We were able to buy three cycles for a little over $7,000. That included ICSI, assisted hatching, anesthesia, and all frozen cycles involved. It didn't include meds and monitoring. Doesn't that seems bit too cheap? My first IVF cycle was at a publicly funded state university clinic. They still charged us about $6,000 for the cycle we did there. 

 I'm sure my current clinic is a great clinic if you are a straightforward case and the one-size-fits-all approach works. Unfortunately, I'm not that person. I would have loved nothing more than for our first cycle to work with them. Three fresh cycles (one with a freeze all) and three frozen cycles later it still didn't worked. I shouldn't feel bad going somewhere else, we need to do what is best for us. At this point though I'm still not completely convinced what is best is doing a cycle with Dr. B. It may just be pursuing adoption, but I think I'd like some closure on treatments. The thing about that is as long as we have five frozen embyros, we won't have closure. I'd really like to make a decision by the end of the year so that if we pay for another cycle we can deduct it on our taxes. With all of our medical expenses this year it would help us to get some of it back. The prices at Dr. B's office certainly aren't as cheap as where I am now. 

None of this is easy, but now we have some plans in place. We are hoping to speak with a lawyer soon and at least register with an agency. We will meet with Dr. B and make a plan moving forward with him most likely. It's been a bumpy ride, but hopefully there will be fewer potholes in the future. Either that, or I should buckle up and hang on tight.

Moving Forward

Estsy: MeganMatsuoka

Maybe it's because we invested so much more into this cycle, but this negative has been one of the hardest hits in a long time. W and I are definitely still really sad about it. There are times each day where I find my eyes welling up with tears thinking about it. We're taking care of ourselves and allowing ourselves to be sad. 

I have exchanged a bunch of emails with Dr. Br.averman since Friday. He generally responds quickly, but I can tell isn't comfortable answering all of my questions. I understand that. I really should sit down with him and pay him for his time. I just needed some immediate answers to feel better. 

When I asked what the biggest factors are in determining FET success he said, "I looked over your records. I think your treatment for the HLA issues is complete. We need to look at both embryo quality and other issues such as your uterine lining at the time of the transfer." When I explained to him that my lining was almost 9 mm a week before the transfer and that I've done both a sonohysterogram and endometrial biopsy recently, all signs pointed to our embryos.

His words: "I agree, most likely a quality issue." I don't find that hard to believe since we have transferred a lot of embryos without success. What frustrates me the most is that we don't have an answer to why our embryos aren't great quality. The last time I met with my local RE he told me my eggs look fine and the sperm is great. The first clinic we went to for only one IVF cycle told me the outer shell of my embryos was hard to penetrate. When we did ICSI on half and allowed the other half to fertilize naturally, only one fertilized naturally. They also triggered me too soon so I'm not sure if my eggs were immature and that was part of it. The clinic I currently go to where we have done three cycles is the one that told me my eggs look fine.

 Our embyros also get decent grades each time and we always have some left to freeze. They make it to day five and we've gotten really high graded embryos in the past. Those were the ones that resulted in chemical pregnancies. 

We've only ever had success with fresh transfers. I'm not sure if it's the lab, vitrification process, or our embyros that result in no implantation with frozen cycles. 

I know this is a bit of a moot point, but my HCG came back at 0.8. In the past with each negative HCG it measured <0.5. I've gotten that result at least five times between baseline appointments and negative cycles. I'm wondering if this slight elevation means a little something did happen. I wish I had tested earlier. Not that it matters though. When I test before the beta I wish I hadn't. When I don't test I wish I did. The grass is always greener. 

The morning after our negative result W hugged me as I cried and said I didn't think it would ever work for us. I thought it was time to move forward with adoption. We talked about how we knew we could love any baby but how it's hard to mourn the loss of our own. I wasn't sure how much more heartbreak I could take. We've talked about adoption a lot in the past. Originally we had talked about having two children and then adopting one. My mom, dad, brother, brother in law, and two of my cousins are all adopted. It's something we're totally comfortable with. 

I looked online and called around a bit on Friday and found a local-ish agency that happens to have an orientation this coming Tuesday night. W and I are planning to attend despite the drive. I've also signed up to receive registration packets from a few other agencies. It's incredibly overwhelming knowing which agency to pick so that's why I've requested information from a few. I think we will start moving forward with adoption. I'm looking forward to learning more on Tuesday night. For those who have adopted, how did you choose an agency?

When I first emailed Dr. B and discussed my frustration with the process he said, "You certainly have to try one more time with treatment to be sure that this won't work." Enter doubt. When we talked about it we realized we didn't give Dr. B a full chance. We used our own clinic and had him make the decisions. When we first met with him he told us that he can't control the lab or speak for the lab at our particular clinic. That may be part of the equation. I'm not putting everything on that but it's certainly something to think about. We went through the process of getting all of the blood work done with him and we found out some new information. From there, we've haven't given it much of a shot. It's just so hard to continue doing treatments with the stress of the costs and emotional tolls it all takes. I know we don't have to do another cycle just because Dr. B recommends it but I never want to look back and feel like we should have tried harder. 

When I called Dr. B's office last week to try to book a follow-up/WTF appointment I was told there's nothing available until the second week in January. I emailed him and told him this and he said he'll get me an appointment sooner. 

So, I'll wait to hear when I can follow-up with Dr. B. I have a list of questions started and we'll determine then whether we are going to do another cycle. There is no huge rush to use our frozen embryos, they're not going anywhere. We will attend the orientation on Tuesday and find out more about adoption. I may call and talk with the embryologist at our local clinic and try to find out more information regarding our embryos, my eggs, and W's swimmers. It will help to be armed with that information going into the appointment with Dr. B.  

We're still picking up the pieces and feeling really sad about this most recent cycle. We are taking time to mourn this loss and trying to determine whether we want to continue with treatments or not. Either way, I know we are going to be parents, and awesome parents at that. Our child (wherever he or she is) is so wanted.

Another Negative

There's not a whole lot to say. I was surprised we didn't get a positive this time. I really, really thought this was going to be the one. I feel lost. I don't know what to do moving forward. 

W and I tested the morning of my beta. I was so surprised a second line didn't pop up. We are so disappointed. Yet again. 

We have five frozen embryos left. I'm not sure whether we will use Br.averman for this next cycle. He definitely used a different protocol but I'm not sure it made much of a difference. The biggest differences were Lupron, antibiotics, and Neupogen. He wants me to get a few tests repeated as the nurse said it may help explain why we got a negative. I don't think anyone ever knows why it doesn't work. I just doesn't. 

I'm so tired of this. I just want a baby. 

As I've realized already, life goes on. Even when you feel like you are standing still you look around and realize nothing else is.

 I will be okay and so will W, but it doesn't make it suck any less. 

6DP5DT and Keeping the Positivity

It has been six days since my embryo transfer. Earlier in the week I handed over all of my HPT's to W and asked him to hide them. This has kept me from testing too early and has allowed me to keep the positivity. I want to know, but I guess I can continue to hold out. We've agreed that we will test together before my beta so I don't get the news when I am by myself at work. Not testing early also makes the IM shots more bearable. I'm doing 2 cc's of progesterone every night and then on Tuesday and Friday we also do an estradial valerate shot that is IM. Nothing like two IM shots in one night, let me tell you! 

I'm still taking Lovenox and Neupogen. The bruising has gotten much better so that's good. In addition, each night I have a "crotch rocket" AKA estradiol/progesterone suppository that I use. I had never heard of such a concoction, but I guess you learn something new every time. It's all so much fun!

In the past I've written that I don't believe in symptoms since the hormones mimic so many of them. It's hard not to be on symptom watch, but I've been trying not to read into them too much. OK, that's me lying because I've been spending WAY too much time on Google in the morning. I still don't know what to think but I like feeling positive. I guess in a way I like not knowing yet.  

This weekend was busy. We had our friends C, J and their little girl E over on Saturday. We hung out, ate some crepes, ate some soup, and played some Scattergories while their little one took a nap in our king sized bed. Once she woke up we headed out to cut down our Christmas trees. We went to the same place two years ago and had a great time. We brought the dogs and rode in the back of a pickup truck with them. E thought it was hilarious. On the way back our dog Pepper made a friend with some lady and was all snuggled up on her lap. Good thing she was a dog person. 

We picked a concolor fir tree which I honestly know nothing about. The needles are much longer than usual and W said it was super easy to cut down. The people at the tree farm said it was the most fragrant kind and they were right. Our house smells amazing! We haven't decorated it yet but we have tons of time. 

Today W hung lights outside on the house and garage while I did some work. After, we went out to lunch for gyros and then we went shopping for a new couch. We didn't find anything we loved and our current couch is fine. 

This evening I finally finished the binding on my first quilt. I have a deadline as my friend's baby shower is next Saturday. I'm dropping it off tomorrow to get machine quilted. I will be sure to take a picture when it's totally done, but I love it. I'm really impressed that I was able to teach myself how to quilt so well. I'm no pro or anything, but it really does look great. I know my friend is going to love it. 

I'm glad to be going back to work tomorrow since I won't have the urge to test as much. I'm not going to lie, I did hunt for the tests for a while today and W did a damn good job hiding them. I know I can buy more but I'm not there...yet. I really hope this is the one!