Good News!

I emailed Dr. Br.averman to get the update today on things. He responded very quickly with some great news. He first said that with the use of In Vitro Maturation (IVM) they were able to mature and fertilize two more eggs. This brought us up to 10 fertilized eggs out of the 12 that were retrieved. 

Of the 8 that fertilized, 5 were at 4 cells and graded A. 2 others were 4 cells and graded B, and then there was 1 that was 3 celled and graded D. The one that was graded D he said they were going to perform embryo plasty on tomorrow. I'm not exactly sure what this is, but I think it is defragmentation. The definition of the word plasty is: to repair, restore, or replace. I'm guessing they are going to alter it in some way to try to help the quality. 

The other 2 eggs that had fertilized were at the 2PN (two pro-nucleate) stage and he said he would have their grades tomorrow. 

Dr. B said based on this information we would do a 5 day transfer on Saturday. He told me to email him again tomorrow for more information. 

I'm still not feeling great. I was able to work a half day today before I became super uncomfortable and headed home to the couch. It's not easy to work sitting on the floor with little ones when your abdomen is uncomfortable. I think I did a bit too much bending and reaching and needed some time to rest. I napped for a few hours and woke up feeling better. I'm hoping I can work a full day tomorrow. 

I'm so happy to hear the news that more eggs fertilized and that we have a good handful of embryos growing away. Hoping for more great news tomorrow.

On another note, Amber from Old Lady and No Baby got the devastating news today that her little one "Bob" no longer had a heartbeat today. Please stop by her blog and send her some love during this tough time. My heart is breaking for her. No one deserves to go through something like that, especially without the love and support of others. 

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. 

We Like to Keep Things Interesting

After my monitoring appointment last Wednesday I heard from the nurses at Dr. Br.averman's office and they said they wanted to see me in Wood.bury Friday for more monitoring. I had expected that and was somewhat happy to not have to work another day last week. On Thursday I was super uncomfortable as I sat in toddler sized chairs. They were not my friend. 

When I called Dr. B's office Thursday around noon to book my Friday appointment the latest option they had was 11 AM. An appointment that early and that far away (5 hours) meant we were in for an early morning.

We packed enough stuff as we expected Dr. B would want to see me Saturday and then we would stay until retrieval. We dropped the dogs off with my MiL on Thursday night and headed home to bed.

We woke up around 5:00 A.M and aimed to leave around 5:30. It had snowed about an inch the night before but we decided to take W's little Ho.nda as it is better on gas and we try to keep the miles off of my Sub.aru. We made it about five minutes down the road when I questioned our car choice. W said it would be fine and that he didn't want to go back to switch the cars.

As W drove I was a bit nervous about his speed. At times he is overly confident when he drives in the snow. 

Fifteen minutes later he lost control of the car. He slipped and turned in one directed and then corrected to slide in the opposite direction. We were headed off the road at about 50 MPH with my side first. 

We came to a stop in a snowy field and took a minute or two or collect ourselves. W realized he could probably drive the car out of the field and successfully did so fairly easily. 

I can't believe how lucky we got that the place we went off the road had no telephone poles, fence posts, animals, big ditches, etc. We were so incredibly lucky to be able to continue on our travels, slightly shaken, but fine otherwise. 

W then drove slowly on the snowy roads. We reached the highway and from that point on the roads were fine. About an hour later I had started to doze off and I heard W say, "Oh, shit!" for the second time that morning. He ended up getting pulled over and got a speeding ticket. All of these things happened before seven thirty. 

From that point on the trip was mostly uneventful. When we hit the George Washington Bridge 2 out of the 4 lanes were closed and we ended up sitting in traffic for about 45 minutes. All in all, we were only about 10 minutes late for our appointment. 

The appointment was fine. When Dr. B came in he said (as I suspected) that we would wait another day to trigger. The follicles weren't quite as large as he would have liked to see them. I know the tech measured twenty follicles on my left ovary and fifteen on the right of all varying sizes. It was be interesting to see how many eggs we end up with. 

Dr. Br.averman told me we would talk the day after retrieval for the fertilization report and then again the next day. By then (day 3) we should have a good idea about quality based on cell division and fragmentation. 

He said he didn't need to see me Saturday so we headed home. We sat in a bunch of traffic but made it home by about 9:15 last night. 

Retrival is scheduled for Monday at 1:30 in Manhattan. I'm a bit nervous about never meeting the RE who will do the retrieval and not knowing any of the nurses. A retrieval in Manhattan will definitely be a new experience too. I'm also a bit nervous about OHSS, as always. We are going to trigger again with Lupron but will also add in an HCG booster shot the day of retrieval. 

A 1:30 PM retrieval means a 3 AM trigger shot tonight. What fun!

I haven't been feeling great the past few days. I tend to get super nauseous close to retrieval and am super uncomfortable. I'm full, nauseous, and have a very small appetite. I'm trying to do my best but feel pretty crappy overall. 

My good friend T who conceived with IVF after 5 years of trying had her baby last night. We actually had plans to hang out with them today and I got a text last night that they were being admitted to the hospital. 

We went to the hospital to hang out for a few hours this evening and got to meet her little guy. He's so ridiculously cute and precious and both T and her hubby B seemed so happy. It really seems like it's all worth it in the end. 

So... trigger tonight and retrieval Monday. I'm so ready to get these eggs out! 

We are headed down to the city tomorrow to stay at T and B's apartment in Queens. If I never have to look at another Menopur box again I will be so happy!

Baby Shower and Progress

My sister's baby shower is over and I'm so glad! I pretty much said good-bye to my weekend as it was entirely centered around the shower. It was a stressful weekend that I'm glad to have behind me. 

On Friday night my friend H surprised me with a text saying she made me a banner for the shower. I had ordered one off of Et.sy, but the seller backed out at the last minute saying it wouldn't be ready in time to ship. I didn't read the listing all that well, so it was partially my fault as well. So, Saturday morning we swung by my friend's house and picked up the banner. She did a really awesome job with it and I got to play with her French bulldog puppy. I wish I took a better picture of the banner but it was hard with the window behind it. 

W and I headed out to Al.bany on Saturday morning in separate cars. Since my mom was not feeling very well psychologically and emotionally, she hitched a ride with me. I got to listen to her talk my ear off for the three hour drive out, lucky me! Saturday was spent driving, chopping and cooking food, decorating the house, and shopping for the things my mom failed to get. It was super stressful and I felt like I didn't stop all day.

Sunday morning we had to run back over to the house to drop off drinks and do some last minute preparing. The shower started at 1:00 and people showed up early! I guess I always show up at least ten minutes late to parties, but not these ladies. We rushed to get everything finished and the party was underway.

Punch bunch and mimosa bowl

My sister's mother in law loves her jell-o molds!

Cocoa cone favors. K's friend made the favors and my friend H helped me make the tags. 

The quilt I made her to match the nursery

My mom wasn't helpful at all during the shower and with preparation, and it almost just made things more difficult. She was supposed to be in charge of the drinks but did nothing other that give us money for them. Mid-way through the party everyone starting freaking out about coffee so I had to leave and go buy some.

My Mom has been diagnosed as bi-polar. She gets into "moods" where she is really bad and it just happened that this weekend she was in one of her moods. She, my step-father, and brother are all going to Costa Rica in a week to stay for a sabbatical semester for my step-dad's work. My mom is totally freaked out about it. Originally, she was going to come home for the birth of her grandson, but now she is thinking she won't be able to travel by herself. It looks like I am going to have to help more when K has the baby. I'm pretty sure I convinced her this weekend to let me be in the room for the birth. I want to be there to help and support her, but also to witness the birth of my little nephew. 

My sister K got a ton of really great presents and survived the shower. Her in-law's family and friends are super intense. It was really nice to spend time with her this weekend and on Sunday night, as just the two of us sat on the couch talking, I got to feel little kicks from my nephew. K doesn't really like anyone touching her belly so it was nice that she was inviting me to do it. I hadn't seen her since Thanksgiving and it was really nice to spend some time together. I really wish we lived closer. 

My sister was very grateful for everything W and I did for the shower and repeatedly thanked us. She hung the banner in the baby's room and loves the quilt so much. I'm really glad I didn't give her any sneak peaks while I was making it. 

Resistance

I started stimulation on Sunday night and had my first monitoring appointment on Wednesday. I'm doing my monitoring locally but will be headed down to Long Island on Monday.

When I checked in at the front desk another woman was also checking in. I looked up to see Dr. K (RE and owner of the clinic) as he was saying hi to the other woman. I was so thrown by seeing him I didn't respond at all. That's just an indication of how frequently I see him around the office. I usually only see him at retrieval and transfer. The nurses serve as the buffer between patients and the RE and there's even minimal contact there. I guess that's what happens when your clinic does close to 3000 cycles a year. 

 I decided not to request any specific NP, but got stuck with Mrs. Bitch-Face anyway. I was so glad W came with me because as she had her back to us and was complaining or being ridiculous, W was making faces. it was good that I was able to smile about it rather than get pissed off. She obviously just doesn't like it when she's not able to make the decisions. 

The scan was fine and there were lots of tiny little follicles. I later got an email from the nurse Sandra at Dr. B's saying they were changing my protocol, completely taking me off Gonal-F. The plan switched me from 150 Gonal-F and 75 Menopur each night to just Menopur 225 nightly. 

As a result  of my being slightly concerned,  I emailed both the nurse and Dr. B to ask the reason for the switch. Dr. B quickly responded saying "It was due to the low LH levels that respond better to pure Menopur cycles." I then asked him the importance of LH during an IVF cycle and what the levels should ideally be and he said, "We like to see it over 2 and it is a necessary building block for estrogen production and follicular growth. We see this commonly when there is some resistance to FSH only stimulation."

I know at my last appointment with Dr. B the nurse mentioned something about resistance to Gonal-F. I didn't understand it at that point but I guess it makes more sense now. I wonder if it's from taking it so much, similar to antibiotic resistance. 

It gives me so much more confidence to have contact with my doctor. Regardless of how busy he is, he takes the time to respond to my questions. The nurse has also been much better about responding to my questions and emails. Last night Dr. B responded at 11:15, long past the point that I was in bed.    Things definitely feel different this time around, but only time will tell if there is a true difference. 

Beyond Frustrated (Rant)

Today was not a great day. Going back to work after lots of time off is never easy. With how busy I am right now it's been particularly hard. There are some days where I go home and wonder if I really want kids. They are exhausting and can really drain all of your patience quickly. I hear it's different with your own kids and I really hope that's true. 

I'm also in the process of planning/hosting my sister's baby shower. She's always said her MiL was crazy, but now I fully believe it. We are doing the shower at her in-law's house and her MiL had only offered to do the cake. I assumed that's all she wanted to do and didn't feel comfortable asking her to do much more. I guess she was complaining that she wasn't feeling involved so I sent her an email. I then found out that my very friendly and nice email made her even more upset. In the end we got it all smoothed out, but it required an hour and a half conversation on the phone. Sometimes I just don't understand why adults can't act their age. I'm not really interested in making things more complicated and difficult than they already are going to be. This isn't the easiest thing for me to do to begin with. 

The biggest thing that has been bothering me this week is the nurse at Dr. B's. When I was in the office last Friday she told me she would send me a calendar that afternoon. By Monday I still hadn't received it. When I called Monday to pay my balance I asked the receptionist about it. Later that day I finally received the calendar. With the calendar was a message asking me to inventory my meds and then let her know what I would be needing. Tuesday morning I responded with my list of meds and also had a list of pertinent questions. When I still hadn't gotten any kind of reply this morning I emailed her again. I again told her my list of meds, asked her to call the others into the pharmacy, and asked my questions. I got zero reply today. I'm willing to be patient and I don't always expect an immediate response, but I don't think I'm being unreasonable in feeling annoyed by it all. We are paying a lot of money and I expect a reply in a somewhat timely fashion. I'm relying on her to call in my meds in order to start this cycle and I'm supposed to start on Monday. I plan to call the office tomorrow morning and am considering asking to be assigned to the nurse I had last cycle. She was much more responsive. I don't want to feel like I have to do someone's job for them. I shouldn't have to try so hard to get some answers to my questions and my prescriptions called in. 

I was hungry this afternoon when I was out running errands. I decided I would buy some pickles to eat since they looked delicious. When I got into the car I really wanted one so opened up the jar. It then spilled everywhere, so now my car smells like dill pickles, yummy!

Sorry for all the bitching, I just needed to get it all out. Okay, I think I'm done. 

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.