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. 

The DJ Better Put On a Slow Song

I had another appointment this afternoon for intralipid therapy, blood work, and an ultrasound. The NP and I joked about how many more follicles have joined the party and that they're really growing up. I guess they aren't grown up enough yet, and it's time to slow this party down a bit. 

Due to the afternoon appointment, I don't know what my estradiol levels are. Shannon anticipated they would be higher than the 4691 that they were on Saturday. So, she gave me Cetrotide and told me to do that alone tonight. No Lupron, no Gonal-F, no Luveris. 

I've been feeling a lot of action in my ovaries and I swear they were pissed after I did the Cetrotide. They were like, who the hell put on a slow song, this party was just getting started!

There were a LOT of follicles today. I had 20 measurable ones but I'm sure there were some more. Whether those will all make it to be eggs or not, who the heck knows. A bunch were still a bit small and immature so I guess we are cutting the underage ones off from any more of the good stuff in hopes they leave the party and don't cause issues for everyone. 

I'm a bit disappointed that my retrieval has been pushed back and that I have to go in SUPER early tomorrow, but I just do what they tell me like the good little patient that I am. I think I'm bummed about two more days of work more than anything else. 

I'm not worrying about everything like the past and it feels good to relinquish some control. Not that I ever was in control anyway! I'm just riding the wave of IVF fun.

Intralipids

Today was my appointment at the clinic. All week I was thinking it was Thursday and then woke up today and realized I wasn't going to make it to a meeting for work. I felt badly canceling the morning of the meeting, but oh well. It was going to drawn out and I wasn't going to get paid for it. 

I did an evaluation with my boss this morning and the mom cried when we told her the results. I hate it when the parents cry, it's so hard.

I met W on the way to the appointment so we could ride together. We got there and the office was empty. It's amazing the difference between 7 AM and 1 PM. They called me back to the procedure side of the clinic. I asked if I was going to get an ultrasound as I entered the room and saw a bed in an upright position with wandy close by. The nurse said I was going to get one and I realized it was going to be at the same time as the I.V. Fun! She had me undress from the waist down and put on a hospital gown. Then they gave me a heated blanket. 

The nurse went over the information, had me sign consents and got me all set up. She stuck something on my forehead, a blood pressure cuff on my arm, and a pulse oximeter on my finger. I've realized the combination of colors in the gown and heated blanket just don't look good on me. They're not my best colors. The nurse put in the IV and took blood before starting the intralipids. The intralipids came in a little bag and were white like milk. Finally I asked her what she put on my forehead. I guess it was a thermometer, but by that point I was really looking good. When they brought W in he practically laughed at me. 

The intralipids took about 1 1/2-2 hours total. It was pretty boring but the nurse came in often to check my vitals and see how I was doing. W and I watched some of The Office with the Netflix app on my phone, but that got old. Midway through I had to pee so I got to bring the IV with me and that was exciting. Well, as exciting as it got.  

The NP came in to do the ultrasound. Everything looked good and my lining was 10.8. She asked when I wanted to do the FET and we decided on Monday. She then asked how many we wanted to thaw. Since 1 is good quality and 3 are fair, it is a tough decision. Part of the package deal we bought says that you have to use all frozen embryos before moving on to another fresh cycle. We haven't completely decided the number yet, but we gave them a tentative number. I start progesterone tomorrow and stay on everything else. The transfer is scheduled for 10:45 on Monday and I'm starting to get excited. Time is really dragging between being excited for the FET and vacation. 

I asked about flying with Lovenox and had to get a note so that they won't give me any problems in the airport traveling with it on my carry-on. I'm not sure if I need to bring a sharps bin or not, but we have time to figure that out. Anyone ever travel with syringes? 

The told me the intralipids last for 28 days. If I get pregnant I will repeat it in 4 weeks. The information they gave me was pretty vague and said it's totally experimental. I guess the only thing I have to lose is my time and $55.00. Let's hope it makes a difference.

Here is the handout they gave me:

Will it Make a Difference?

I got my newest batch of meds in the mail today. More Lovenox and the intralipids. My next appointment is Wednesday to check my lining and to administer the intralipids. I did Lovenox with my last cycle but it was for OHSS. I guess with the risk of OHSS being so high, the risk of blood clots was also high. It was preventative, but I stayed on it until I got the bad news. The intralipids are new to me. It was something that was recommended to me by my clinic and I figured it might help. Does anyone have any pearls of wisdom regarding intralipids?

I'm not sure how I feel about this cycle. I don't want to get my hopes up too high and then be disappointed. I've been there before. I also know that frozen transfers are less successful. 

I'm having a hard time remembering to take my second estrogen pill of the day. I finally asked Siri to remind me to take it so that I am a little more consistent. Let's hope it helps. 

The weather has been beautiful and unseasonably warm. I know 60 degrees may not sound too warm to you, but it sure as heck is around here. On Sunday we spent quite a few hours outside gardening. We have daffodils, irises, hyacinth, and some unknown bulbs (maybe Crocus) littered around the yard. We decided to dig them all up in order to put them in one place. 

Trip #1:Hyacinth and Daffodils

Trip #2: Irises and mystery bulbs

I also had purchased some tulips from the local drugstore when I went to pick up some prescription. They were super cheap ($1.50 for each box), and I figured I didn't have much to lose. We also planted these in the same area. 

All I know is that my legs and back are incredibly sore today from all of the digging and squatting. You should have seen me plop down on the floor for the first time today, it was pretty amusing.

Back Up and Ready for More Punches

Remember those punching bag inflatable things from when you were a kid? The bottom was filled with sand and the rest with air. I remember getting one for Easter one year. I think it was a bunny and I remember feeling bad hitting it too hard. I'm sure you can figure where I'm going with this. That punching bag that quickly pops back up? Yeah, that's what I feel like.

I've recently taken some harder hits than I threw as a kid. But, I'm back up and ready for some more abuse. I'm just hoping I don't pop anytime soon.

Today was an insanely long day. My appointment was at 7:30 and after I had to drop off paperwork at my boss' house. From there I saw 8 kids for therapy. There was a meeting thrown in there as well and a cancellation I wasn't informed of, so I still drove all the way to the daycare. I came home and took a nice nap on the couch.

My appointment was fine today. They drew blood and checked all of my levels: progesterone (0.6), estrogen (<20), LH (.47), TSH (2.45) FSH (4.1), and HCG (4.1). I asked about polyps and that being a possible factor in a chemical pregnancy. The NP said she didn't see any on ultrasound. I then informed her that I had them in the past and that they were only visible with the hysterosonogram. She asked if that was something I was interested in repeating and I said it was. 

I was given the all clear to start estrogen today since my HCG level was low enough. I am supposed to take it 3x's/day. With my last frozen transfer I took it once a day and remember it made me pretty nauseous. I hope it is better this time around. I also start back up on baby aspirin and dexamethasone. It was a nice 4 days off. 

I have another appointment this Thursday to recheck my HCG levels and to do the hysterosonogram. I am hoping I don't have any polyps, but I need to do this for my own peace of mind. I have another appointment for the following Wednesday where they will check my lining and I will do intralipids. It is an IV and takes about an hour and a half. W is requesting the afternoon off from work so he can be there to keep me company. From there, as long as everything looks good we can schedule the transfer. The NP today a possible day could be the 19th. Looks like I will be spending some of my 2WW in Mexico. Yes please!