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. 

Feeling Craptastic

This week has not been a fun one. I don't remember my last chemical being this bad. The part I really don't understand is that my hormone levels never got very high this time. So why do I feel so bad?

I started bleeding on Tuesday and am still going strong. It started really heavy and I had a lot of cramps. I've been feeling nauseous and my appetite is off. The worst part though has been the headaches. Nothing can touch them and it feels like I am on day 3 of a migraine. I haven't been able to work full days and have had to cancel some therapy sessions. I am just limping through this week trying to survive. The other thing I feel is overwhelmingly tired. I can't believe how exhausted I am. By 1:00 today I was ready to pass out. I came home early and slept for almost 3 hours and woke up with my headache still lingering. 

I'm coming to terms more with taking a month off. I know I need it and am planning a trip to Albany to visit my sister and dad and possibly go to my old college town to go skydiving. I've always wanted to go and now seems like a pretty good time. We also have 2 weddings this month so it will be nice to be able to drink and not have to worry. Weddings are SO MUCH more fun when alcohol is involved. 

I've been feeling pretty sad about everything. I'm trying to stay positive, but it's been hard. As I was driving home on Monday I passed the Memorial Day parade traffic. I saw all of these families walking down the street. I started to wonder whether I would have a little hand to hold someday. I get to hold little hands all of the time at work, but none of them are my own child's. I actually started to cry as I thought of the gaping hole I have in my heart that I want so badly to fill with a child. I really hope that I can make W a daddy because it breaks my heart to think of us childless. 

Stepping back a little bit makes me wonder how and why I continue to do this. I know the answer, but it doesn't make it any easier. I am just so ready to be past this point in my life and moving on to the next chapter. 

A Forced but Badly Needed Break

When I woke up this morning I felt awful. I was nauseous and had a headache. I had to be at my clinic early for beta #2.  

I started spotting in the morning and had pretty bad cramps last night, so I knew I wasn't going to see an increase in my levels. I waited almost all day before calling them. There were some severe storms in the area and I guess their system was down most of the day.

by 11:00 I was bleeding full force so when I first talked to the nurse I told her it was CD 1. She scheduled me an appointment for Thursday as a baseline so that I could start a FET and told me she would call me with the test results once they came in. 

My HCG level dropped to 14. That's only down 5.5 points in 5 days, WTF??!! I had also requested my TSH levels be checked again and they were fine. When she told me my HCG number she said I wasn't going to be able to do the FET this month. We need to wait until my levels go below 5 to be considered negative. I have a repeat beta scheduled for next Monday and my follow-up (WTF) appointment with my RE that Friday.

I'm not sure how I feel about a break. Part of me wants to just keep going, but I realize I probably need a break. We have done 4 transfers (2 fresh and 2 frozen) since December. I've been on some kind of hormone for over a year.... isn't that crazy?! I have either been cycling, trying to cycle and getting cancelled, or on BCP's. I don't even know what a unmedicated cycle would look like for me at this point. I guess there's only one way to find out.

Here Today, Gone Tomorrow

I bought some FRER tests on Thursday. When I got home I used one of those and a wondfo test. Both had faint lines. I waited 24 hours and then did the same thing. The FRER no longer had a faint line and the wondfo was a little lighter. This showed me my levels were not climbing but instead likely falling. I made the executive decision to stop my meds. 

I know a lot of people commented that I should stay on them, but it didn't seem to make any sense. My HCG levels were obviously not increasing and my butt has enough lumps from the PIO already. 

I've had some bad moments and I've also still been able to laugh with W. I have a friend I met through the yoga for fertility class last summer who has also had a few chemical pregnancies and we've been talking. It's nice to have someone else who has been through the same thing. She recently had a follow-up talk with the same RE so I can get an idea of what he is going to say and build my list of questions. 

On Thursday night we were asked to pick up my brother from his after school program. My brother is 10 and was adopted from China 5 years ago. W had gotten us lobster to lift our moods since it is my favorite food. We got one for Sean and W coached him the entire time on how to eat it and do most of it himself. It was really sweet to watch him being so patient and encouraging. 

A few hours later after Sean left W came to me and said that he knows it doesn't matter how we get our kids. Sean is pretty awesome and he loves him the same.

Obviously we are going to use our frozen embryos and the last IVF cycle that we have before talking about our next steps. From there I'm not sure where we are going to go. 

This weekend we are planning on finishing planting our garden and continuing to work on our bathroom. We picked out a paint color and ordered light fixtures so we are getting close. We are still waiting for our vanity to come in. I'm looking forward to being able to use a toilet upstairs again.  

IVF #3 Beta Results

I mentioned earlier my fear of another chemical pregnancy. I'm pretty sure my fear is becoming a reality. My beta HCG levels came back at 19.5 today. Yeah, that's less than half of what it was last chemical pregnancy at this point (43). I'm not alluding myself at all. I'll return on Tuesday (closed Monday for the holiday) and have my blood drawn again, but I may stop my meds before then. I bought some FRER tests and I'm going to watch the progression in the next few days. I used a FRER and a cheapy test this afternoon. On the cheapy test today the second line really wasn't any darker than it was 2 days ago. 

I did find out we have 2 frozen embryos and I booked a follow-up appointment with Dr. Greene for June 8th, so we have a backup plan for now. Honestly though, I don't think FET's work for me. It's just part of the contract we are in that we have to use them before moving on to another fresh cycle. 

Speaking of fresh cycles, we only have one more paid for. I feel like we need to change something. What we are doing does not seem to be working.

I'm going to ask about PGD. I know it's expensive, but so are repeated rounds of IVF. I feel like it was stupid to expect a different result with the same (more or less) protocol for IVF #2 and #3. 

I wish I had better news to share today and I hate the disappointment of another (likely) failed IVF cycle. This process is starting to become really disheartening. 

Not Good

Today was my first ultrasound. From the title of this post, I'm sure you can tell it didn't go well. I was shaking like crazy and my pulse was super high. They first drew blood and then we started the ultrasound. W was there, holding my hand watching along with me. 

 I knew what we were looking for. After a few seconds, the technician turned the screen more towards herself. She looked and looked, and didn't find anything. There was a small spot that she said could be a gestational sac, but it was really small. We talked about dates, and then she agreed there should at least be a larger gestational sac as well as a fetal pole. None of those things were present. 

She said she couldn't say for sure what was going on and that we had to wait for my HCG results. If my levels continued to rise I would have to return for another scan. There was still a chance for an ectopic pregnancy as well. 

 We talked about whether I had frozen embryos and agreed that things weren't looking good based on the fact that I was supposed to be 6w1d. 

W's face dropped and as he walked out he looked so sad. I felt awful. We sat in the car and said nothing for a while. It definitely wasn't the way we wanted things to go today. 

We went out for breakfast and talked about everything. I had a call from the clinic while we were there and I listened to the voicemail. On the message she said my HCG levels had dropped and for me to call her back. I was honestly glad we weren't going to be stuck in more beta hell and have to repeat the ultrasound. 

I called back and talked to the NP. She said my HCG levels had dropped to 16.8 and to stop all of my meds. She said I should get a period within 1-2 weeks, but perhaps sooner. I have to go back monday to get my HCG levels checked again. I asked about a RPL (Recurrent Pregnancy Loss) panel, but since this pregnancy is considered chemical, she didn't think insurance would cover the cost. She welcomed me to call the financial advisor to find out. She then said we could treat the next cycle as if I do have RPL issues. We will use Lovenox and probably add IV intralipids. Apparently these help to suppress the immune system. 

We then talked about a FET. I guess I can go ahead the next cycle, but with our vacation (last week of March), I'm not sure how the timing will work out. She said once I get my period and my HCG is negative, I could start estrogen. 

 I can't say I'm extremely surprised. When my initial levels were low and didn't double Dr. Google did not give me promising news. Apparently only about 15% of pregnancies that don't double in a timely fashion turn out OK. Big surprise I fall into the 85%. 

Bring on the hot baths, wine, and sushi.