Retrieval Keeps Things Interesting

My retrieval was scheduled for yesterday (Monday) at 1:30 P.M. I've never had a retrieval that late in the day, so I figured I would be very hungry and thirsty leading up to it. The cutoff for food and drink was midnight Sunday night. 

On Sunday afternoon we headed to Queens to stay at an empty apartment owned by our friends. They are in the process of selling it but are waiting to close. We arrived around 9:00 and found the place easily. The apartment was really nice and spacious, but quite empty. Apart from the bed there wasn't much else. Unfortunately, we weren't able to pick up on any wireless networks so watched Net.flix from W's i.Phone. Not the biggest screen ever, but it worked. 

We slept in Monday morning and took our time as we showered and got ready. We left the apartment around 11:00 to head into Manhattan where the retrieval would take place. We found a cheap parking garage nearby and left our car for a few hours. 

From there we had over an hour to kill so decided to walk around some. I do not recommend walking around Manhattan around lunch time when you haven't eaten in twelve hours and are super hungry. I have to say though that the good and bad smells would waver from one step to the next, and one block to the next. There were certainly tons of restaurants to admire as we walked. There was even a guy who stood outside a place and offered free hot soup samples. Soup is my absolute favorite so it was a bit torturous to walk past and not take a delicious sample. 

We went into a few stores and made a few small purchases to kill the time. We then headed to the clinic with plenty of time to spare.  The staff was not overly communicative about anything. There was another couple there scheduled to go before me and the husband was not being cooperative. He refused to sign any consents without things being thoroughly explained to him. He also came to the front desk to complain that it was 1:05 and his wife's procedure time was supposed to be 1:00. I'm not sure if it was their first time or what, but they were making things much more difficult than they needed to be. 

Dr. Br.averman has a contract with this office. They only perform procedures and don't actually treat any patients. I would not see Dr. B during this procedure. 

I got changed and waited in the smallest recovery room ever. As I changed the other woman was taken into the procedure room. The recovery room I waited in contained three beds with a curtain between each one. They had me wait in the bed closest to the wall with the procedure room on the other side of that wall. There was a sliding door between the rooms.

As I waited a nurse came in and told me W had gone to give his sample. At one point the RE came in to explain the procedure and risks to me. He asked me if I had any questions and I asked about what kind of anesthesia would be used. For my last retrieval there was a shortage of Pro.pofol and I was in a lot of pain and remembered most of the procedure. Luckily the RE said they had Pro.pofol and joked I had done my last retrieval in Mexico. 

After what seemed like a little while the sliding door opened and I heard hysterical crying. I guess the woman who went before me did not wake up in a good place. They wheeled a bed from the recovery room into the procedure room and I heard them giving her instructions to transfer into that bed. The whole time she was hysterical and I heard it all. I'm not going to lie, this definitely made my heart start to beat a bit faster. 

After they wheeled her into the recovery room and had her cry in the bed next to me they told me it was my turn. I walked into the adjacent room and was immediately asked by the nurse if it was my first retrieval. When I told her it wasn't she was relieved because she didn't want the other patient to freak me out. 

The next bit was a complete whirlwind. The RE came in and instructed me to scoot down the bed while lots of other people moved around the room. I guessed who the anesthesiologist was and finally asked. He started the IV and asked me literally three questions, two of which were the same. It wasn't exactly the confidence I desired. Next things I knew I looked up to see am empty syringe in the anesthesiologists hand and heard him say, "things are underway." I felt a slight burning in my throat and was asleep quickly. 

I woke up and the nurses asked me to walk back to the recovery room. I was super lightheaded and felt  lots of cramps. They had me lie in the same bed I was in previously and all I wanted to do was curl up into a ball and sleep a little more. 

I guess they had other plans for me. They continued to bother me as I just wanted to be left alone to nap. The one nurse offered me a drink and I had zero interest in it. The anesthesiologist and RE came in numerous times. They put a blood pressure cuff on each of my arms. The anesthesiologist at one point lifted my legs and held them in the air for a few minutes. He kept straightening my arm for the IV and asked me to lie on my back rather than my side. They asked me if I was in pain to which I replied yes. They gave me something for the pain but it didn't really help. Most of this time was mostly a blur. 

Eventually I realized they were concerned about my blood pressure. When they asked me what my systolic pressure typically ran I said around 120-130. I then asked what it was. They replied that it was in the 70's! 

I remember seeing W as he hung back a bit and that I felt really cold. The RE came back (apparently he had left) and grabbed my hand to talk to me. I told him his hand was really cold. He decided he wanted to do an ultrasound since my blood pressure was so low and I was in pain. 

They wheeled me back into the room and did a trans-abdominal ultrasound. There wasn't any fluid there so they just continued to pump fluids into me through my IV and brought me back into the recovery room. 

Slowly my blood pressure came back up. The RE said he didn't want us to leave that night and told us it would be best to stay another night. He gave W his cell phone number, his secretary's number, and the hospital info for the one he had rights to. He said he thought I would be fine but it was just good to have that info and keep and eye on things. He said my blood pressure likely got so low due to the fact that I was so dehydrated. I guess that's what happens when you can't have anything to eat or drink for 13 hours. 

Once things were under control and I was more conscious I asked about how many eggs we got. The nurses disappeared for a few minutes and came back to give me some seriously disappointing news. 

They retrieved twelve eggs, only twelve. I know I had at least twenty follicles and felt a bit blindsided by this information. I started to ask questions and they brought in the embryologist. She explained that many of the follicles did not contain eggs. I was completely heartbroken. I am used to egg counts in the high teens or twenties and I knew we had a LOT of follicles. 

I know a lot of people would be thrilled with that many eggs but I was just caught off guard. I really had expected a much higher number. 

I had been instructed by Dr. B's office to take a HCG booster shot of 1,500 IU's after retrieval. I was completely confused about how to do this, so called his office to speak to a nurse. She talked me through it and then I asked about the empty follicles. She said she would ask Dr. B and put me on hold. 

Then Dr. B got on the phone and asked me what was up. I told him what I was told and how disappointed I was. He listened and replied with true concern and compassion. He said no one really knows why empty follicles occur but they likely aren't really empty. The eggs instead stick to the wall of the follicle and then the egg does not come free easily. He said likely it was an egg quality issue with those eggs but that it said nothing about the eggs that were retrieved. He told me it was way too early to get disappointed and that anything over 10 eggs was still good.  He said it could have been the stimulation protocol but there was no way to know that at the time. I honestly felt on the verge of tears. I was glad I was able to talk to Dr. B, and he seemed so positive, but I still felt pretty low. 

W tried to reassure me that we still got a bunch of eggs and that the embryologist said the eggs we got looked really great. 

We left around 4:30 and headed to get some food. My friend had recommended a mac & cheese restaurant so we ate there. As we sat and ate I wanted to cry multiple times. Between the blood pressure fiasco and empty follicles I was feeling really low. W continued to try to reassure me, but I just needed to process everything. From there we headed to a frozen yogurt place a few blocks away and I treated myself to as many delicious toppings as appealed to me. 

We headed back to the apartment in Queens and I napped for a bit in bed. After an hour or two I woke up and wanted to get some fresh air and go for a walk. I was a little hungry so we decided to look for a place to eat. We stopped at some kind of South American restaurant and had some delicious homemade soup. W and I both joked after we left that being in that restaurant was like being in another country. I was convinced I wanted to take the train into Manhattan to see a late night movie, but W was a little more guarded. He didn't think it was a good idea and I realized he was probably right when the cramping returned. 

We went back and watched a little more Net.flix on the i.Phone before we fell asleep. We did my PIO shot and I slapped some estrogen patches on my stomach. I still felt pretty sore and had a lot of cramps. 

I dreamt last night that I was looking for a place to hide and bawl my eyes out. I didn't want W to be there, so found some place and curled up in a chair with one of my dogs. I'm sure it reflects the disappointment I felt. 

I woke up this morning and felt much better. My stomach seemed to have gone done in size and I had gotten up a few times in the night to pee out some of the fluid they pumped me full of. 

We walked to get some breakfast and had another foreign country-like experience. After, we got back in the car ready to head home and I felt SO bloated and full. I reclined for most of the ride and things were quite uneventful as we drove. 

Around 3:00 I emailed Dr. B to get the fertilization report. He responded in literally two minutes to tell me of the twelve eggs retrieved 8 were mature. They performed ICSI on all 8 and... ALL EIGHT FERTILIZED!! This really helped to perk me up a lot.  Our first IVF we had a 55% fertilization rate, #2 we had 80%, #3 we had 61%, and #4 we had 68%. 100% really is great! I asked about In-Virto Maturation and he said they would try with the other 3 eggs. 

So, as much as I was disappointed by the number of eggs retrieved and overwhelmed by the whole blood pressure thing, I was happy to hear about the fertilization. 

We got home this evening around 5:00 and my MiL brought our dogs home to us and joined us for dinner. I still feel pretty full and uncomfortable and am sure I have at least a little OHSS, but I am okay. I'm going to try to work tomorrow but will see how I feel when I get up/as the day progresses. I really need to make some money and work since I have taken off so much time lately. 

I joked to W that I've had two near death experiences (sliding off the road in the snow and really low blood pressure after retrieval) already this cycle. Hopefully everything else will be smooth sailing from this point forward.

My transfer is still scheduled for Saturday at this point and we will head down Friday night and possibility stay the weekend in the city now that we have our own apartment to stay in. 

Tomorrow I will hear again how things are progressing and hopefully it will be more good news. Things have definitely been crazy this time, but I know it will all be worth it if we end up pregnant. Either way, there nothing else we can do but hold on and try to enjoy the ride. 

Not Surprised

Today was my beta. I tested yesterday and it was negative so I wasn't surprised when I received the call. 

When I went in this morning I didn't share my negativity. The receptionist was so positive and wished me good luck. I smiled back. Then the nurse commented on my D.O.B and the fact that my birthday is tomorrow. She said that a positive would be such a great birthday present. I just agreed. 

When she called later she sounded so disappointed. I could tell by the tone when she said hello that she was dreading the call. I think she sounded more upset than me. 

I'm fine with the results. Sure a positive would have been amazing, but I'm not going to feel too bad about things. My birthday is tomorrow so I'm going to put it behind me and focus on the now. 

Not Sure

I have an appointment tomorrow for an ultrasound to check my thyroid. I've been trying to get my doctor to order a full panel for thyroid testing, but he wasn't in today so it hasn't happened yet. I will call the office again tomorrow morning and request it again. 

My TSH levels were 1.07. I've found anything between .3 and 3.0 to be within the normal range. I just don't get it. Smack dab in the middle. I know I had them tested previously and they were normal as well. 

I called my fertility clinic today to ask them about the thyroid thing. They told me it probably wouldn't be the best to do an IVF cycle if my thyroid is all out of whack. I'm supposed to start Lupron on Monday and I have a suppression check in 11 days. I asked if they were to put me on Synthroid how long it would take to work. They said at least 6 weeks. This means potentially delaying another IVF cycle. Delays are not something I have dealt with well in the past, I'm not gonna lie. 

I'm so frustrated! I really need to be able to make an informed decision about whether to continue with this cycle or not before Monday, but I'm not sure that is going to happen. I can't make a decision based on my emotions alone. 

I don't understand how I've been to 2 RE's and neither of them have mentioned my thyroid. I've already done an IVF cycle and don't think my thyroid has anything to do with it failing. Yes, I've had a miscarriage, but I'm pretty sure that was due to low progesterone levels and not my thyroid. 

I've done some (understatement) research and found that the most likely thing is Hashimoto's Thyroiditis. I don't really have any of the symptoms and found that treatment is controversial. Some think if your TSH isn't elevated there is no reason to treat it. Others show that treatment helps. 

I just feel lost and not prepared to handle another delay. I know if there is a problem that needs to be dealt with it is best to do before cycling again. It's just hard to accept that and wait another couple of months. Hopefully I can get some kind of answers tomorrow regarding the ultrasound. 

Roadblock

I'm glad I went for another ultrasound before doing the transfer. Yesterday afternoon I had another ultrasound followed by an appointment with Dr. S. The ultrasound revealed the same amount of fluid plus traces of additional fluid next to it. 

I then met with Dr. S. He pointed out the trace fluid and gave me three options. 1) Go ahead with the transfer despite there being more fluid 2) Cancel the transfer and do an endometrial biopsy, 3) Cancel the transfer and do nothing. 

We talked for a while and I asked for his best recommendation. He said none of those situations are ideal, but since we know a FET is less successful than a fresh transfer, it would be best to eliminate any other variables that may reduce the chances of implantation. He also said he would hate for it to not work and look back and say we should have waited. He looked at the ultrasound and my trial transfer and tried to determine if he could avoid the fluid. It was possible, but not the ideal placement for them. He was planning to place the embryos where the new fluid appeared. He doesn't know why the fluid keeps reappearing since I don't have a hydrosalpinx and there is no possible reason at this time. He recently rechecked my testosterone levels and they were normal (thanks Metformin!)  He's not sure we will be able to avoid this happening in the future, but it is probably best to wait and see what happens in subsequent cycles. It's not a problem I had doing IUI's or on anything ultrasound until last month. 

I opted for choice number 2. He did the biopsy right then and it was not fun. I wasn't able to take anything prior so there was a lot of cramping, but nothing horrible. It felt similar to an IUI but with much more cramping. I saw the tissue he removed and it was a decent amount. 

After the biopsy I went back into his office to get my prescription and paperwork to bring to the receptionist. At first he wrote me a prescription for oral progesterone and told me to take it for a week and then would start the protocol for the FET once I get my period. He then informed me that he is going to be out of town from Sep 1-11. We looked at a calendar and determined that if I took the progesterone and we started another cycle, the next time we would do the transfer would fall during that time he was away. He offered that the other RE in the office could do it, but I've never even met the guy. So, after some discussing with the nurse he decided to put me on birth control pills and keep me on them until he is back. That way he will be there to make any decisions and not have to communicate over the phone with the office during my cycle. 

In a sense I feel relief. I know this is the best decision and gives me the best chances for the future. I'm not sure why this fluid started appearing and has now become a chronic problem. I'm hoping giving my body a break for a month will help and the fluid won't reoccur in the future. 

I had the cyst and surgery and wasn't able to start trying until January. Once January hit we did the IVF that got cancelled because I got pregnant, a miscarriage in Feb followed by a D&C and laparopscopy #2. March was spent waiting for my cycle to start again after the miscarriage, I tried Clomid + IUI in April, injectables + IUI in May, Lupron started for IVF in June, IVF cycle in July was cancelled at the time of the transfer due to fluid, and a cancelled FET cycle in August. I need to step away and take a month off, forced or not. 

At the same time I am disappointed. Disappointed that this has been so difficult, disappointed that my body won't cooperate, and disappointed that I will be in limbo for another month. I need to step back from infertility and distract myself. I need to live life outside of trying to get pregnant and just be. This is going to be hard, but it is something I know I have to do. At this point I don't know how to not focus on TTC. We shall see how the next month pans out. As I left the office my RE apologized that we had to cancel the transfer again. My response, "I'm learning how to be patient." 

Hello again disappointment

The nurse called today and said we will not be able to do the FET this cycle. My RE wants me to come in for another ultrasound when I stop bleeding. He wants to be sure the fluid is gone. I guess if I were to start the estrogen and start building up my lining it could mask the fluid. If the fluid is still there he wants to do a biopsy.

The ultrasound tech is on vacation next week and I don't have an appointment until August 8th.

 I am frustrated to say the least.

Now the debate is whether to wait another 7+ weeks to do the FET (my cycles unmedicated are about 35 days), or whether to start another fresh IVF. I was willing to do the FET this cycle because it would give me closure on our cycle. I didn't have a ton of hope in the fact that the embryos that were frozen were as follows: 1 6-celled embryo graded 4+, 3 4-celled embryos graded 4, and one fertilized egg that hadn't started to divide. It was always very clear they were slow to develop.

So I'm working on a pro's and con's list of IVF and FET.

FET

Pros:

The only cost is the meds (estrogen)

It may work and we could get pregnant for the cost of one IVF cycle

It gives me closure on our cycle and allows me to say we completed an IVF cycle

Cons:

The chances of success aren't great

Our embryos are not as many cells as they should be for day 3 embryos

We have to wait 7+ weeks

The best embryo may not survive the thaw and we would be left with only 4-celled embryos to transfer

IVF

Pros: Doing one cycle prior lets us know that we need to ICSI all eggs and may result in more embryos

We could be transferring fresh embryos in about 7 weeks

The chances of success are higher

We have all the meds we need

We can start this cycle (I think)

Cons:

$$$$

Our embryos could be slow to develop again

Fluid could return since we didn't know what caused it

I really can't make any decisions until the ultrasound to know whether the fluid is gone. Today W and I had a conversation about where to go from here, how much disappointment this has all been, how far we are willing to go with fertility treatments, and how this will all (hopefully) be worth it. Needless to say, the disappointment continues.

Discouraged

Well, I finally talked to the nurse at my clinic after playing phone tag for the past two days. Let me tell you, waiting 2 days to get ultrasound results sucks. I haven't been able to focus at work and have been feeling down. I had an idea about what the news would be, but it was confirmed today. 

The news sucks. On the left I had a dominant follicle that measured 18x17. On the right I had two bigger ones measuring 14x10, 12x8 and a tiny one at 10x8. The nurse reiterated we were planning to trigger on Wednesday until I asked her/reminded her about not having a tube on the left side. Well, she forgot, as did my RE. Come on guy, you removed the tube a little over a month ago!!! She then paused and said she would have to talk with him tomorrow and call me back then. 

I asked whether it was possible to ovulate on my own before the trigger and she said it could happen. I then asked if I should use OPK's and she said no. I asked if there was any chance the ones on the right would catch up, and she said they were counting on the one on the left being the best, if not the only one. It is unlikely they will catch up. 

Needless to say, it sucks to be out for this cycle before it ever really started. I am so disappointed that the dominant follicle is on the left and that I have no tube there. The reality of only having one tube is starting to hit hard. So is the reality of dealing with side effects for essentially nothing.  I'm also disappoited with my clinic. I can't belive they didn't remember that I am missing my left tube. It seems like everyone forgets this but me. This is the first time I have been disappointed by my clinic, but it seems like something you would remember. I have been feeling like they don't really care about doing IUI's and that I haven't really been on the radar. 

My hubby and I went for a walk after receiving the news and talked about our next cycle. It's not that we won't try this cycle, and it hasn't been confirmed the IUI will be cancelled, but I don't want to waste it if it isn't likely to work. There's always that theory of transmigration, but I'm sure as hell not betting on it. 

W previously said that doing an IUI was like rolling a dice, and that eventually your number comes up. What happens if you don't even get the roll the dice? I don't like the odds of IUI to begin with (20-25% success), but not even getting to the IUI puts those odds even lower. 

 My RE said that on average you ovulate 50/50 from each ovary over the course of a year. That doesn't mean that each month you alternate, it just means that over time they both average half of the year. Next month the exact same thing could happen again. 

I want to try something that will give me more than one dominant follicle. I'm not sure what my RE's response will be, but I feel like they will say call on us CD1 and we will prescribe more Clomid.  

I am so disappointed that this cycle was over before it even started : (

Can I get some Provera? ....... JK