Follow-Up Chat/WTF Appointment

My appointment didn't go exactly as I had hoped, but it was pretty good overall. My plan was to let my RE (Dr. Greene) tell me what he thought before asking any questions. Well, he came into the room, introduced himself (even though I've met him 3 times already), and immediately asked me what questions I had. 

So first I asked why he thought I was having chemical pregnancies. He said that he thought it was likely genetic. He explained that at the point that we transfer the embryos they have only made simple determinations as to what type of cells they are going to be (placenta, fetus, etc.) but it's not very complicated. The cells are multiplying and dividing, but not getting too detailed. He made an analogy to a book. It is as if the embryo copied all of the chapter titles of the book, but didn't yet get any words. He said that as things progress the embryo needs to make more complicated divisions and the cells determine exactly what everything will be (liver, brain, blood vessels, etc.) This is where there appears to be a problem. 

He didn't recommend donor eggs, donor sperm, or PGD at this time. He recommended we just keep trying. This I found somewhat frustrating. It's not that I want to do any of these things, but I wish we had more concrete answers. 

His recommendation was to do the FET before moving on to another fresh cycle. He said the quality isn't great for the ones we have, but it is best to focus on this as our next step. When the embryos were frozen both were graded 4CC. 

He then said grading is just a beauty contest. It's not that he doesn't give the embryologists credit for the amazing job they do, but he and the other doctors at the practice don't care as much about the grade. He said it probably means more to me than it does to him. Dr. G told me a story about a woman who had only 1 embryo to transfer that the embryologists graded as so poor they didn't even recommend transferring. This woman got pregnant and her son now speaks 3 languages and plays 2 instruments. He said even though our embryos didn't get a great grade on their report card there's no reason to believe they can't turn out to be perfect babies. The grading plays no part on what the child ends up as, it's just a simple way of judging them when they are at such an early stage. Once they implant there is no reason to believe they will be inferior or imperfect. 

He also said he did a study which compared embryos with PGD. He said often the best looking ones were the ones that were the most abnormal. His theory was that the ones that don't look as great could have had a simple problem during division and they already corrected themselves, giving them a less than perfect appearance. 

Dr .G didn't seem to think the coasting had much of an effect on my eggs. He said the HCG trigger is what is responsible for the final maturation and not the other meds. He did say that one option is to do a staggered cycle. This is when you don't coast at all but you freeze all embryos and transfer them in a subsequent cycle. 

He didn't see any problems with egg quality, sperm quality, or embryo quality. This is pretty good because I was worried about my eggs and embryos. My last clinic told me that all of our embryos were slow to develop. He said this wasn't the case with my past 2 cycles. He compared it to puberty. Just because people go through it at slightly different times doesn't mean either are better or worse off. 

I asked about my thyroid since my levels vary a bit. Since they are always (more or less) within the normal range he didn't think any further testing was necessary. He said TSH levels can affect a person's ability to get pregnant, but don't typically unless they are grossly abnormal. 

I asked about doing a panel for RPL but he said it wasn't going to change anything we are doing. It is just more testing and more money, but it won't change our current protocol. He was skeptical about Lovenox, but said the other doctor in the clinic highly believed in it. He said there weren't any specific studies to prove it is effective. He seemed to be on board with intralipids and Metformin to help reduce miscarriage rates. 

I really wanted a plan for our next IVF, but he was more focused on the upcoming FET. He said he could sit down and look specifically at my past cycles and make a new plan, but he didn't feel like we should focus on that yet. He said I could email him any time and I plan to (if necessary) about this rather than booking another appointment if our FET doesn't work.

The dialogue part of the appointment was pretty short and a nurse popped her head into a room at one point and I heard something about someone being ready for an HSG. He pretty much wrapped things up and said to stay positive and focus on our next FET rather than trying to plan for our next IVF. 

I then asked if I was going to get an ultrasound. He said I could if I wanted one. I explained that I was wondering if this cycle was ovulatory or not and wanted to get a prescription for progesterone if it wasn't. 

They brought me into another room and I waited a bit. I'm guessing he did the HSG in that time. Then he came in and did the ultrasound. First was my lining. It was a bit thin for me at 7.5. He then went to my right ovary (the one with a tube) and there was a great looking follicle which measured about 17 mm. On my left ovary (the one without a tube) there was another one which was larger and a little bigger than 20. I asked about a natural FET and he asked when my HCG came back negative. I think how recent that was paired with my thin lining made him say it wouldn't be a good cycle to do it. He said I should pick up ovulation tests and start using them. He then said we should definitely try on our own this month.

To find out I was actually ovulating was pretty great. There are some perks to going to a fertility clinic, such as getting a peak inside even when you are not actively cycling. In total, W and I only tried on our own 3 months. One was the first month before we saw a RE, and 2 cycles were post D&C so I don't even know if they were ovulatory. Sometimes I wonder if we could do this on our own, but it's hard to have faith in my body at this point. Dr. Greene did say that often women get pregnant in the cycles immediately following an IVF cycle. This is because the eggs are exposed to a more favorable environment preceding final maturation and ovulation. I would certainly take a natural pregnancy at this point!

I know this post is thorough and I may have bored the crap out of you, but I wanted to document and remember as much from the appointment as possible. I'm a seeker of information and always try to understand as much of this process as I can. 

I've been peeing on OPK's for a few days now. Since I have so many and they are cheap, there is no concern with using more than 1 per day. This afternoon the line was darker than it has been and there has been an abundance of EWCM. I'm hoping I get a positive soon and I will keep you posted. 

Tick Tock

The clock is not moving fast enough. This whole "month off" thing feels like it is taking forever! I guess I didn't realize how bad I still was feeling about things until this morning. I haven't wanted to work any day this week. Time seems to be dragging, especially without anything too great to look forward to.

BigBadWolf etsy shop

 I have my list of questions ready for my appointment tomorrow, so we shall see what transpires from it all. I also will have an ultrasound so can get an idea as to whether this cycle will be ovulatory or not. If not, I think I will ask for a prescription for progesterone so I can start that within a reasonable time frame and not have to wait forever for AF to show up again.

I bought a bunch of OPK's but I'm not holding my breath. I started using them this morning and the second line was pretty darn faint. I have a whole bunch and can pee on things with reckless abandon so that should help pass the time.

I've been looking at the profiles of women who donate their eggs for my clinic and have been feeling more comfortable about going that route if need be. It's not ideal, but heck, I can pick someone smarter than me! There is so much information in the profile including what they got on the SAT's, educational background, family history, previous cycle history, pictures, etc. I have to laugh that there is more information available about their families than we know about my own. Both of my parents were adopted and neither of them know their birth parents. My dad is in contact with two sisters, but thats all. It seemed like all of the good looking ones were already matched and it felt a little like online dating, but it's interesting to look at the profiles if nothing else. My clinic just introduced a new egg donor program and the prices are pretty good, much better than what I thought they would be. I'm more comfortable with donated eggs than adoption at this point, especially because as far as anyone else would be concerned it would be our child. I'd like to experience pregnancy so this is the next best option.

I guess I'm expecting my RE to tell me my eggs are crap tomorrow. I'm prepared at least. We have our frozen embryos and another fresh IVF already paid for, so I guess the most productive thing at this point is to look towards those with a positive mind frame.

I do know my face is breaking out, I feel super fat and crappy about my body (big surprise after another failed cycle), and I've been extra moody. I feel like I'm going through rehab and am detoxing. The headaches have been pretty darn consistent as well.

Oh yeah, my HCG level was negative at under 5 this week. Yay, right?!?

Have you ever considered.....

Being your own RE? I joke with my hubby all the time about how I am going to become my own RE. I mean, I've talked to Dr.S enough and have a good enough grasp of this all, right? I mean, I do have a fridge full of all the meds I need. I have an idea of the dosage and at what time I ovulate, I should just go ahead, right? Who needs to pay big bucks for ultrasounds and blood work?

I am honestly just kidding. I have considered this before, but never very seriously. I guess all of our chats about OHSS did their job. This month I am off from cycling. I haven't had an active cycle since July when the transfer was cancelled. I have not had a legitimate chance of getting pregnant since May!! But I had a D&C on October 5th and my body needs time to heal and recover.

If you recall, I ovulated on Lupron during an IVF cycle (last January) and became pregnant. Forget IUI's and Clomid, apparently all I need is a little Lupron. And by a little I mean 1 shot. When we figured out how far along I was in my pregnancy we were able to figure out that I ovulated the day I started Lupron, day 21 of that cycle. Lupron triggered ovulation for me. So.... that makes me think. Would a little Lupron get me to ovulate and give me a shot this month at getting pregnant on my own (*sort of.) I'm not talking about injecting myself with Gonal-F at high doses for a few weeks, we're talking about a single shot of Lupron.

BTW, these were my thoughts last week leading up to day 14 of my cycle.

We came up with a plan at my appointment on Friday. I had been hoping Dr. S would give me the go-ahead to start oral progesterone on day 21 of this cycle so that I could have a 28-ish day cycle and get started of the FET. Well, he wants me to wait 28 days to see if I get AF on my own (yeah, I've never had a 28 day cycle). He wrote me a prescription and told me if I haven't gotten my period my Nov 1 I should start it.

Flash forward to Saturday (CD 17). We had a mellow day and were just hanging out. I decided to take a bath and saw the OPK's sitting on the vanity. I had one left and decided to take it. Well, what do you know, FIRST EVER TRUE POSITIVE on an OPK. I have always found them to be frustrating and difficult to read, but not this time. It was a clear positive. I couldn't wipe the smile off of my face the rest of the day. So the question is... should you call me Dr. Liz?

Vacation

So we are home and it's Sunday night which means I have to go back to work tomorrow. Don't get me wrong, I love my job, but the end of vacation is always a bummer.

We had a great trip full of lots of sunning, swimming, reading, drinking, eating, relaxing, and enjoying each other. Our room was great and the weather was fantastic. The food and drinks were both consistently great and I had my first bahama mamma (it was absolutely delicious!)

The resort was about an hour and a half away from the airport in Santo Domingo and we had a shuttle arranged. It was interesting to see more of the country and it didn't seem overwhelmingly poor. Unlike Costa Rica there wasn't much wealth either. The biggest thing I noticed was that the street and sides of the streets were covered in garbage. One of the coolest things was that the red lights had a timer to let you know how much time you had left. It seemed like red lights were optional and the driver of our van was very "horny" in that he tapped the horn quite often.

The resort was pretty far back from the road and was very nicely manicured. The beach area was a bit small, but had chairs to sit in. There were a lot of topless women on the beach (not me), and my hubby and I would give out our own award to the best set seen. The waiters even came to the beach to get drink orders and I drank a good amount of frozen alcoholic beverages.

The last day I called MSED (maximum sun exposure day) and am peeling as a result. I got a little burned here and there, but nothing too bad by the last day.

Here are some pictures from the trip:

In other news I started my Metformin last night. I haven't had any extreme side effects, just minor disturbances. I am hoping it stays this way. I had a pretty bad headache all day but so did W, so I'm thinking it was more out of withdrawal from beverages.

Of course I couldn't complete ignore the issue of our trying to start a family on the trip. We had some conversations (less than usual) and I brought ovulation prediction tests with me (of course). I wasn't counting on ovulating this month, but was given the green light to try if I did. I am so confused and frustrated by the test strips since it looks like I got a positive, but in reality I don't think it was. The test strip is darker, but only a portion of the line. When I looked online it said it had to be 50% or more of the line to be positive, so I don't think it counts. What do you think? I'm pretty sure it doesn't count as a positive.

The thing is, even when this test appeared positive, I didn't feel like I was ovulating. I did have some increase in CM the week before but hadn't bought the OPK by then. I really don't think I stood much of a chance ovulating this month, but I may ask my RE to run progesterone levels in order to see since I have to get blood work anyway. 

I am supposed to call me RE this Thursday to tell him whether or not I have gotten my period. It's not that I don't think I would get it if I just waited, but I'm not feeling particularly patient these days. If I haven't gotten it by Thursday (4 weeks post D&C) then he will prescribe Provera to induce it. I don't feel like my period is close as all, but if I did ovulate then I would want to know for sure whether I was pregnant or not before taking it. I'm not feeling like this is very likely, but you never know, right?

 Any experiences with Provera? I've never taken it before. I will probably schedule an appointment for this week to talk about Clomid and I still have to go back for more blood work to check HCG levels and testosterone levels. Ahh, back to reality!