Moving Forward

Estsy: MeganMatsuoka

Maybe it's because we invested so much more into this cycle, but this negative has been one of the hardest hits in a long time. W and I are definitely still really sad about it. There are times each day where I find my eyes welling up with tears thinking about it. We're taking care of ourselves and allowing ourselves to be sad. 

I have exchanged a bunch of emails with Dr. Br.averman since Friday. He generally responds quickly, but I can tell isn't comfortable answering all of my questions. I understand that. I really should sit down with him and pay him for his time. I just needed some immediate answers to feel better. 

When I asked what the biggest factors are in determining FET success he said, "I looked over your records. I think your treatment for the HLA issues is complete. We need to look at both embryo quality and other issues such as your uterine lining at the time of the transfer." When I explained to him that my lining was almost 9 mm a week before the transfer and that I've done both a sonohysterogram and endometrial biopsy recently, all signs pointed to our embryos.

His words: "I agree, most likely a quality issue." I don't find that hard to believe since we have transferred a lot of embryos without success. What frustrates me the most is that we don't have an answer to why our embryos aren't great quality. The last time I met with my local RE he told me my eggs look fine and the sperm is great. The first clinic we went to for only one IVF cycle told me the outer shell of my embryos was hard to penetrate. When we did ICSI on half and allowed the other half to fertilize naturally, only one fertilized naturally. They also triggered me too soon so I'm not sure if my eggs were immature and that was part of it. The clinic I currently go to where we have done three cycles is the one that told me my eggs look fine.

 Our embyros also get decent grades each time and we always have some left to freeze. They make it to day five and we've gotten really high graded embryos in the past. Those were the ones that resulted in chemical pregnancies. 

We've only ever had success with fresh transfers. I'm not sure if it's the lab, vitrification process, or our embyros that result in no implantation with frozen cycles. 

I know this is a bit of a moot point, but my HCG came back at 0.8. In the past with each negative HCG it measured <0.5. I've gotten that result at least five times between baseline appointments and negative cycles. I'm wondering if this slight elevation means a little something did happen. I wish I had tested earlier. Not that it matters though. When I test before the beta I wish I hadn't. When I don't test I wish I did. The grass is always greener. 

The morning after our negative result W hugged me as I cried and said I didn't think it would ever work for us. I thought it was time to move forward with adoption. We talked about how we knew we could love any baby but how it's hard to mourn the loss of our own. I wasn't sure how much more heartbreak I could take. We've talked about adoption a lot in the past. Originally we had talked about having two children and then adopting one. My mom, dad, brother, brother in law, and two of my cousins are all adopted. It's something we're totally comfortable with. 

I looked online and called around a bit on Friday and found a local-ish agency that happens to have an orientation this coming Tuesday night. W and I are planning to attend despite the drive. I've also signed up to receive registration packets from a few other agencies. It's incredibly overwhelming knowing which agency to pick so that's why I've requested information from a few. I think we will start moving forward with adoption. I'm looking forward to learning more on Tuesday night. For those who have adopted, how did you choose an agency?

When I first emailed Dr. B and discussed my frustration with the process he said, "You certainly have to try one more time with treatment to be sure that this won't work." Enter doubt. When we talked about it we realized we didn't give Dr. B a full chance. We used our own clinic and had him make the decisions. When we first met with him he told us that he can't control the lab or speak for the lab at our particular clinic. That may be part of the equation. I'm not putting everything on that but it's certainly something to think about. We went through the process of getting all of the blood work done with him and we found out some new information. From there, we've haven't given it much of a shot. It's just so hard to continue doing treatments with the stress of the costs and emotional tolls it all takes. I know we don't have to do another cycle just because Dr. B recommends it but I never want to look back and feel like we should have tried harder. 

When I called Dr. B's office last week to try to book a follow-up/WTF appointment I was told there's nothing available until the second week in January. I emailed him and told him this and he said he'll get me an appointment sooner. 

So, I'll wait to hear when I can follow-up with Dr. B. I have a list of questions started and we'll determine then whether we are going to do another cycle. There is no huge rush to use our frozen embryos, they're not going anywhere. We will attend the orientation on Tuesday and find out more about adoption. I may call and talk with the embryologist at our local clinic and try to find out more information regarding our embryos, my eggs, and W's swimmers. It will help to be armed with that information going into the appointment with Dr. B.  

We're still picking up the pieces and feeling really sad about this most recent cycle. We are taking time to mourn this loss and trying to determine whether we want to continue with treatments or not. Either way, I know we are going to be parents, and awesome parents at that. Our child (wherever he or she is) is so wanted.

Consult

Tuesday, July 31st was our long awaited appointment with Dr. Br.averman. We live in Upstate NY and planned to make the drive down for the appointment. I scheduled it a few months ago and then the weekend prior I got an email confirmation about it. I thought I had scheduled the appointment for the NYC office, but the email said it would be on Long Island. No biggie, it was actually good for us because it meant we wouldn't have to navigate around the city and leave our car at some bus or train station as was our plan.

The appointment was at 5:45 so we left really early in order to have some time on the beach. We spent about 3 hours on Jo.nes Beach and had a great time. It was totally surreal to be sitting on the beach on a Tuesday of a work week. It's a really beautiful beach and it wasn't busy at all. 

We left the beach with lots of time to get to our appointment in case there was traffic. We arrived at the office at about 5:30 and walked in.

All of the lights were shut off. I called the number and it rang and rang. Finally we saw a receptionist in the office despite it definitely being closed. W and I knocked on the door repeatedly and she came over.

I showed her the email and she told me that Dr. Br.averman was in the NYC office on that day. She suggested she call over and see if we could still make it on time to see him since he was running a bit behind.

It took her a while but she finally came back and said she didn't think he would be there by the time we got there. She gave me his cell phone number and we said we were going to try to make it since we had come so far to see him.

So, at 6:00 we were heading from Long Island into NYC with crazy traffic. We never intended to drive into Manhattan so we were both a little overwhelmed. On the way, Dr. B called me himself and told me he would wait for me so not to kill ourselves trying to get there.

We got into midtown Manhattan with the use the map on my phone and W dropped me on some random corner in order to go find parking. I power walked a few blocks and made it to the second floor. I poked my head in a random office and they said his office was down the hall. I went down the hall and wandered around some random office that has no signs of being open.

At that point I pulled out his cell phone number and called him. Somewhat annoyed he asked me how I got that address since it was an old one. I told him it was on my iphone and I just followed what it said. At that point it was about 7:10 and he said he would wait for me but probably not be able to stay for long. He said, "It's not your day, is it?"

I called W frantically and he was just about to pay $25 for parking. Luckily it was just in time and he was able to pull out of the garage and head towards where I was. He picked me up and we headed to the correct address.

He once again dropped me at the corner and I hustled a few blocks to the office. Finally, around 7:30 I arrived in the right place.

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. 

Answers and a plan

Dr. S called on monday evening. He started to talk about protcols for the FET and I immediately interrupted him and said, "I think we might have a different problem." When I told him the spotting never turned into bleeding he wasn't really concerned. Here I was, stressing the f*&% out and he is all casual and says it's no biggie. He said with the D&C only being about 5 weeks prior he wouldn't have expected my lining to build up that much. He wanted to call my spotting on Friday as CD1 and start the frozen cycle.

He presented two option for the protcol. The first being estrogen only like I did previously. The other option involved suppressing me first with Lupron and then using the estrogen. He spent more time talking about the Lupron one. He told me when they discussed my case in conference that the Lupron seemed like the best idea. He then started to look at the calendar and count out the days only to find with the Lupron the transfer would fall the week after Christmas when there is a "skeleton crew" working.

I then asked if we could do the protocol without Lupron. He wasn't completely pleased at first but finally talked himself into it. By the end of the conversation he was in agreement that if we do the FET right now the estrogen protocol is the best one. He warned me that the fluid could return and that we could be in the same situation again, but I realize this can happen with or without Lupron.

So Monday night he called in oral estrogen to my pharmacy and I started. We chatted briefly yesterday and I received a call later in the day that I have an ultrasound scheduled for next Wednesday at 9:00. Transfer is tentatively scheduled for Dec 5th!!!!!

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." 

The 2WW is good for something

Well, the 2ww officially ends on Friday, but I'm pretty sure my period will be paying me a visit any day now. People say that PMS symptoms are very similar to pregnancy symptoms, but I think I can tell the subtle differences. Sure, my boobs are sore, but more in a I'm getting my period kind of way that huge and pregnant kind of way. I feel moody, but don't even remember feeling that way when I was pregnant. My sense of smell is within the normal range and I haven't been stopping to use the bathroom much at all. When I look back at the time before I knew I was pregnant last time, the things that stand out the most were SUPER sore boobs and getting up in the middle of the night to pee. I always sleep through the night and have been doing so all week. 

That being said, I have an appointment with my RE for Friday to discuss our future options. This was an appointment I voluntary scheduled today since I feel like we need to sit down and talk. I haven't actually talked to him since before we even started the Clomid. I was starting to feel like I was being treated by a nurse and wasn't comfortable with this. Maybe this is just the part of me who was about to do a cycle of IVF and am now doing IUI's. I know they aren't as involved, but it is hard to go from one treatment to the other with the same expectations. My hubby and I were talking about it the other day and we said it's like I went from point A to point C and am now back at point B. It has been an interesting and confusing journey and we're not even to our destination yet. 

 I tried to call my RE on Monday to ask a few questions and called a different number he had given me. Since I go to a University clinic, he also has an "academic" number. I know this number leads directly to voicemail and that I could leave a message that he would receive. Well, he called back at 6:25 on Monday night (I left my phone in the car as we were at calling hours). I was disappointed to see he had called back and I didn't expect it, but his message made me think this wasn't a number to call with general questions. He basically said I could get ahold of him the following day through the clinic if it were an emergency, or call the nurse at the clinic with questions. I don't feel like she can answer some of my questions and she isn't the most thorough. She tends to be brief and almost always seems annoyed with me. I will let you know how the appointment goes and the answers to some of the questions that have been bothering me. 

Since I have given you the update on IF, I decided to update you on what I kept myself busy with over the past two weeks. Some of the projects were started a little before, but here is what we did:

Painted our office:

Before (a dark green). These pictures were taken before we moved in an had furniture in the room. 

It's not that we didn't like the color, it was more that it was dark for the space and I wanted to do STRIPES. Here were go!

First we pained it all a lighter color:

Then we measured and taped (my hubby was ready to kill me during this process):

Then we painted the darker color and pulled off the tape. The touch ups were done courtesy of my hubby and I think it looks pretty fantastic. 

 That's probably enough looking at my house pictures, so I will spare you other projects until I update again (Ok I lied, here are some pretty spring pictures I took today). Hope everyone is having a great week and that spring is visiting them too! ICLW has been great and I've been enjoying reading some new blogs and having new visitors. Thanks for stopping by!

Mind over matter

My hubby and I have been talking a lot the past few days about my mood and attitude towards this cycle. This week I was feeling SO down and couldn't figure out why. It was worse than after the miscarriage; I was feeling so depressed. I know it sucks to have follicles on the wrong side, but really Liz? I was tired all the time, struggling to make it through each work day, feeling somewhat anxious and unable to focus on anything, and crying a lot. Each day as the week went on all I wanted to do was come home and curl up on the couch or in bed and cry. It was bad. Well, last night we were talking and it all started to come together. I started feeling my mood change as soon as I started the Clomid. My hubby agreed that I haven't been myself since starting it (the past 2 or so weeks). It started as moodiness and feeling short tempered and evolved into depression. It is hard to think that something so small could affect you so much, but I'm pretty sure that is the culprit. I'm not prone to getting depressed and have dealt pretty well with all of this infertility crap. I try to keep a positive mind frame and not dwell on the things I cannot control. This was definitely the worst I have felt during the past 9 months in dealing with everything. I was starting to wonder whether it had all built up to this point, but now I'm starting to doubt that. I blame it on the Clomid. 

Having said that I am able to feel much better. I consulted Google last night and found SO MANY entries on forums and boards where people said that Clomid made them depressed. My mind and body were telling me not to repeat the IUI and give up because I was subconsciously aware that it was the Clomid and I didn't want to repeat the process. I found faults with every avenue of my treatment this cycle and was ready to switch RE's. I have had great experiences with my clinic up until this month where my judgment was clouded, and therefore, so were my feelings about everything. 

Having said all of that I plan to make a call to my RE and raise some questions and concerns about this cycle and future ones. I'm not sure what his opinion will be about repeating Clomid, especially given the fact that it made me super depressed. In all fairness, my ovaries responded well, just not my brain. I would love to try something that will give me more than one dominant follicle, even if that means risking more than one baby. 

I am feeling SO MUCH better after realizing that my mood has been affected by Clomid. I was starting to wonder what was wrong with me and why I was feeling so terrible about everything. Starting last night I adopted the attitude of mind over matter and I know that I can control my mood and be more positive. 

My hubby smiled at me this morning and said it was good to have me back. 

An answer to my burning question

I got pregnant in January (and miscarried in February). My RE was convinced I ovulated a result of the Lupron I was put on in preparation for an IVF cycle, but the dates never matched (on Feb 4th the embryo measured about 6 weeks). This was something that bothered me because I've been told I don't ovulate on my own.

I have been told by others that doesn't matter how I got pregnant, just that it happened at all. Unfortunately I don't agree. I am the type of person who seeks out answers and wants to completely understand everything I can. I want to know whether my body is functioning properly or not.

Today my RE returned my call and I finally got the opportunity to bring this up. He looked at a pregnancy calendar and determined that from the 6 week ultrasound on Feb 4th, I would have conceived on Jan 7th. I started Lupron on January 5th.

He then went on to say that Lupron may have caused a surge in LH and caused the release of a mature egg. Did you catch that?? Mature egg...

He said that Dec/Jan was probably was an ovulatory cycle for me because there was an egg to release. Lupron didn't help me to grow an egg in two days, it just helped trigger a surge of LH.

I am happy to get some closure on this issue and know that I was growing a follicle that month and that the Lupron didn't cause me to ovulate, it may have just helped. I could have ovulated on my own that month had I not taken the Lupron.

I mentioned that I may have ovulated this month but am not completely sure. He said the OPK's are pretty black and white, but I don't see them that way! He agreed to test my Progesterone this month to see whether I not I ovulated.  He doesn't want to prescribe Provera if there is a chance I did ovulate and could be pregnant (I highly doubt it, but I guess you never know). He said from an academic standpoint, he is always interested in hormone levels as long as I am willing to get stuck with a needle (sign me up, I've done it enough by now). Remember, I'm the one who elected for surgery?

 He also told me I am "not a textbook case"... great. Last time I was there he made a comment about how thick my file at the clinic was... fantastic. Do I get some kind of award for that?

My RE also gave me the news that I am not insulin resistant. My results from the fasting insulin and glucose finally came back and the ratio looked good. It is good news, but doesn't help explain why I have PCOS.

My HCG levels were negative from this past Monday. I have an appointment scheduled with him for Friday at 2:00 where we will discuss my upcoming Clomid/IUI cycle. He briefly mentioned something about gonadotropins in addition to the Clomid, but says he hasn't decided yet. We will see...

ICLW numero dos

In sticking with my Dominican Republic Spanish skills, I am impressing you all with the title of this entry. My spanish skills are quite limited (cerveza, bano, and simple things I learned in high school Spanish). I laughed when my hubby got off the plane in Syracuse and said "Adios" to the pilot.

This is my second time doing ICLW and I had a great experience last time. I am hoping to find some new blogs and snag some new followers.

To catch everyone up, my name is Liz and I am married to a great guy, W. We live outside Syracuse, NY and bought our first house in October. If you are interested in our TTC history, check it out: History

 Currently I am waiting for me AF to arrive, although I don't think she is anywhere nearby. I usually have about 35-40 day cycles (thanks PCOS) and am only at day 25 today. I will call my RE on Thursday to report whether or not it has arrived, but I highly doubt it. If not, he is planning to give me Provera. Our plan for this next cycle is to do Clomid and back to back IUI's. The problem is, the main nurse had back surgery and has been out of the office. It is a bit of a disaster trying to get any answers or problems solved at this point. They are hoping she will be back next week and so am I.

Here's where I need your help: I may have ovulated this cycle on my own, but I'm not completely sure. See post Vacation and take a look at my OPK and please share your opinion on whether you think it looks positive. I don't really think it is (since the test line is so thin), but I would love some more feedback.

The next few months are exciting for us since my hubby will FINALLY graduate with his DPT (Doctorate in Physical Therapy) in May and we will have 2 INCOMES!!! Needless to say, I cannot wait!! We plan to celebrate by hosting a graduation/housewarming party in June and then I will ship his butt off to work (jk). The great part about our fields (I am a speech-language pathologist who works in early intervention) is that employment is easy to find. I am hoping for some pregnancy success in the next few months as well, so wish me luck! I am looking forward to getting to know some new people this month and finding some new blogs. Happy ICLW!

RE appointment 3/11

Today was my follow-up appointment for my D&C and laparoscopy with my RE. I was annoyed because they hadn't gotten my blood work results from the lab, but they were able to call over and get them faxed. The downside was that the insulin levels weren't included. They had the glucose and HCG levels, but no insulin results. My HCG was 10 on Wednesday and my fasting glucose levels were well in the average range (83). My RE checked the incision and everything is healing well. I find it pretty funny I didn't think anything of it or flinch when he moved my underwear down to check the smaller incisions. 

We talked about a timeframe and I am supposed to call the clinic on March 24th (4 weeks post D&C) and tell whether or not I have gotten a period. At first he talked about waiting 6-8 weeks after surgery to see if I got a period, but he changed his tune. If I haven't gotten my period in another 2 weeks he will put me on Provera to induce it. I am hoping it comes before then so that I won't have to use anything, but who knows. He first talked about Clomid alone and using OPK's to monitor, but as soon as I asked about IUI's, he was totally willing and said it wasn't a bad idea. Often times, Clomid changes your cervical mucus, so the IUI would bypass that problem. 

I reminded him of the meds I have from our IVF cycle that never happened, and he then said that we could try two months of Clomid with IUI's and then move on to injectables if we don't get a great response. He reiterated that OHSS is not something I want and is very dangerous. Women with PCOS are very prone to it and that risk would be increased with injectables. I guess you can even get it with Clomid, but it is rare. 

He then wrote me a script for Metformin. I don't have to green light to start taking it until he gets the insulin levels, and he doubted I would demonstrate insulin resistance. I also don't want to start taking it before going on vacation. I signed a waver about using the drug "off label" and will start when we get back. I am supposed to call the clinic when I get back to be sure.  

The pro's of this visit/good news:  

If I were to ovulate this month we can try and don't have to use birth control. I'm not really counting on it, but good to know.  

The full pathology report from the tumor/cyst was fine. Although what I had was rare, it was completely benign. 

Even with one tube it is possible to ovulate from the other ovary and get pregnant. Something about          transmigration (he explained it and I understood, but I can't repeat it). My RE treated a woman who had one ovary on one side and one tube on the other and was able to get pregnant. 

We will do an IUI the first cycle and don't have to just try Clomid. My insurance covers IUI's which is great. Also, we will do 2 IUI's per cycle.

We won't be looking at the same "game plan" as previously and could move on to injectables after 2 months of trying Clomid. 

My RE is as confident as I have seen him about me getting pregnant. He seems to think we will be successful quickly, but never gives percentages or absolutes. 

The cons/bad news:

I will be going on Metformin and am terrified of the side effects and how it will affect me. 

More blood work: HCG repeat (until it is below 5), testosterone, and DHEAS levels. 

IVF is still a possibility in the future. 

Time is dragging

Maybe it is the fact that were are leaving for vacation in a few days, or that fact that our next cycle trying seems so far off, but it just feels like time is going by slowly lately.

We have our next appointment with the RE tomorrow and I am SO nervous. It must be because every time I go there, I seem to get more bad news. I think about my last appointment there, when I found out I had miscarried and had to make decisions about what I wanted to do. It always makes me nervous to go, and I am worried about my blood work results. I never have high blood pressure except when I am at my RE's office.

I went for more blood work on Wednesday morning to check my HCG and fasting insulin and glucose levels. I am so nervous about the results of the insulin and glucose. I did take a pregnancy test this afternoon (2 weeks post D & C) and it was negative! I will be curious to find out what the actual level is tomorrow. When I took a pregnancy test a week ago and it was still positive, it was like a @*$% you, but this week I was a little sad to just see one line. There is no telling when I will see two lines again.

I am planning to go to my appointment armed with questions and a plan. I don't want to do the 3 month (just Clomid), 3 month (Clomid and IUI's), 3 month plan (injectables and IUI's) my RE had suggested. I want to be more aggressive and optimize our chances of getting pregnant. My worst case scenario is that we are looking at IVF 9 months from now (exactly 1 year after our first planned IVF). I don't want to wait forever to end up in the same spot we were this past January. When I read about other people's IUI cycles, they never seem all that successful. Only having one good tube makes me even more nervous about failure since our chances will be reduced.

In other news, we are leaving for the Dominican Republic on Sunday. It is daylight savings and our flight is supposed to leave at 6 AM. This will make is feel more like 5 AM. It is going to be so nice to get away and enjoy some sunshine and warm weather. It will also be great to focus on our relationship and each other without the usual distractions of life.

We had a couple over for dinner on Saturday night. The girl is my co-worker and just entered her third trimester. We have been walking for a few months together at the gym and I really like her. We asked them to bring a salad and as we sat down to eat I looked at her and said, "What kind of soft cheese is in the salad?" She proceeded to tell me it was feta and that she doesn't "always follow all the rules." It's hard to hear this from someone who is so far along is her pregnancy without a hitch. I am forever kicking myself for not following all the rules completely. This whole infertility thing takes the fun out of everything. I have to admit though, I have been loving eating soft cheeses, drinking coffee, eating sushi, and drinking wine. Better live it up while I can. I plan to eat seafood every day on my vacation, perhaps more than once a day!

Recovery

So the surgery went as well as surgery can go. We got to the hospital at 6 AM and were admitted right away. By 7:15 they came to wheel me down to the operating room. I saw my RE before and he talked to me about his plan and I gave my hubby a kiss. They gave me something before I got to the operating room and it started to work quickly. I remember moving from one bed to the next and seeing a HUGE round light above my head. The next thing I knew I was waking up in the recovery room at it was 12:15. I was shivering and my teeth were chattering, but they brought me about 4 warmed blankets which seemed to help. I felt OK and witnessed this guy "Frank" in the bed next to me waking up in a bad place. I heard one of the nurses say they hadn't seen someone waking like this in 21 years. He was trying to get out of the bed, sit up, and pull the oxygen out of his nose. He had about 6 nurses around him and this made me feel like a good patient. I didn't throw up either!! That was pretty great. That ended up coming later unfortunately. 

About 12:45 they brought me back up to my room. I felt much better this time and napped for a bit. My hubby and mother-in-law were in the room and were willing to help in any way possible. They brought my a bagel and some juice. The juice ended up being a bad thing and when they brought me the wheelchair as it was time to leave I got really nauseous. I throw up most of the juice but felt fine after and haven't gotten sick since. The nurse said OJ probably wasn't the best idea, but it was delicious. It was a Nantucket Nectar Orange Mango and I really enjoyed it on the way down. I guess I got a little over zealous and drank too much. 

The pain wasn't too bad but I was bleeding quite a bit. My hubby gave me a short run-down of what the doctor told him after, but I did eventually talk to my doctor about it all. He didn't really say much about the D&C, just that it went fine. He talked more about the laparoscopy and how that went. He said when he went in he tried to just remove the cyst but once he got in open he saw there was more growth into my tube that looked like "cauliflower". He said he was initially very concerned and called it a tumor (this was a bit surprising). They sent it to pathology and got the results as I was still in surgery. Everything was benign, but he did remove it all. I ended up losing my left tube, but it wasn't really functional before. He said the right tube looked healthy and clear and that both ovaries looked great. He said I have everything I need to get pregnant and he is confident I will get pregnant. 

He then talked about where we will proceed in the future. Since my remaining tube is open and my ovaries are fine he said it is similar to an engine needing a jump start in the winter. He seemed to think the Lupron has a flare effect initially and that is what made me ovulate. I was a bit disappointed to find out it hadn't just happened on its own. Oh well, I knew we would need help and I didn't want to just try on our own anyway. I knew I wasn't ovulating regularly, so it is no surprise we will need help to ovulate in the future. 

He wants to do a 3 month plan. First, he was saying we could just do Clomid and see how that worked for 3 months. He then said we would do Clomid and IUI for another 3 months to see how that goes. After that we could try 3 months of injectables and IUI. Injectables are more risky because they pose a higher risk for multiples. I feel like with only one good tube, that risk has got to be decreased. I'm not sure exactly how I feel about this and I think I would rather be more aggressive about things. We go back for a post-op appointment in about 2 weeks, so I will be able to talk to him more about my feelings then. 

He said he will probably put me on Metformin. He wants to do the fasting glucose test, but regardless of the results will probably lean towards putting me on it. Does anyone have any advice or experiences with Metformin? I am not thrilled about this prospect, but know it reduces the risk for miscarriage. 

I have been feeling OK. We got home around 6 PM last night and I immediately went to bed. My hubby brought me some soup and I slept most of the night. I got up a few times to use the bathroom and was in a lot of pain once the pain killers wore off. It is worse than last time because I have two additional incisions and they removed my tube and the cyst rather than just draining it like last time. I am a little bummed about losing my tube and being so young, but am looking forward to trying again. My RE said I will get my period soon to shed the lining of my uterus and will probably get another one in either 4 to 6 or 6 to 8 weeks (I don't completely remember.) If that doesn't happen, he can give me something to induce it. I haven't ever had a problem getting my period, so I am hopeful it will happen naturally. 

Otherwise we are just hanging out and have 6 movies we rented as well as Netflix so we are planning to take it easy. It is snowing and looks pretty crappy outside so I am glad to have an excuse to do nothing and stay inside. 

Feeling better

If Friday afternoon sucked, Friday night sucked even more. I wasn't able to fall asleep until 3AM after I finally took something to help me sleep. I cried and cried and felt terrible. Yesterday was a little better, but I was still feeling pretty down. Today I feel a little better, but have shed my share of tears. 

When I look back on the past month I realize things never looked great. I never had a good feeling about things and was constantly worried. Even after I saw the heart beat I still worried. My beta levels never rose as high as they should have, and my symptoms dropped off. I didn't feel as tired, I never felt nauseous, my boobs stopped hurting as much, etc. I actually took a third pregnancy test the day before my appointment at around 5 and 1/2 weeks. The second line was still there, but it was lighter than the initial tests. There are so many things that point to an impending miscarriage, but I didn't accept them at the time.

We can look at the timeframe and know that the embryo stopped growing around 6 weeks, probably the day of or after my last ultrasound. The week following that was the worst one I had. I woke up several mornings in tears (I didn't know why) and had AWFUL headaches. I was so stressed I realized I had been clenching my teeth in my sleep and ended up getting a night guard from my dentist to help prevent this. He looked at me and said, "You're young, what do you have to be stressed about?" 

I feel badly that I am looking forward to Thursday, but I just want to have this past me. 

My conversation with my RE on Friday made me feel slightly better, but it was still hard. He said that there was likely something wrong with the embryo and that after he saw my last beta levels, he suspected a miscarriage. He never said anything to me because he didn't want me to worry. He also said his wife had a miscarriage a few weeks ago at 6 weeks gestation. 

He was very kind and our appointment lasted about 2 1/2 hours. He talked to me about my options (D&C or just passing the embryo) and the cyst. I had the option to just aspirate it like previously but this time under ultrasound, or I could repeat the laparoscopy and just remove it all together. Initially I decided I would do the D&C and aspirate the cyst, but upon further discussion we all agreed the cyst would probably just return like last time. It is hard to elect to have surgery, but I just want to be rid of the cyst all together. The hardest was when he initially asked me what I wanted to do and I realized he and my husband were both looking at me. This wasn't a decision I wanted to have to make, and it was extremely difficult. I think the D&C will allow me to have more closure and will hopefully help my beta levels to lower more quickly. Especially knowing that growth had stopped two weeks ago, and I never bled at all. 

He said it would probably too early to really talk about it, but my options for the future probably don't include IVF as the best one since we were able to get pregnant on our own. He said the best would be to do a medicated IUI. When I think about it more and realize I have the Gonal-F in the refrigerator, I wonder whether he would let us do an injectable IUI cycle. I have done some research and know these tend to me more successful. I didn't ask him at the time, but I wonder how long we will have to wait before we can start trying again. Although I don't feel like I have mourned this loss completely, I also want to be able to look to the future and be hopeful again. 

I am SO glad we booked a vacation and will be going away somewhere tropical in 3 weeks. I think this will help me to heal and feel better. 

This weekend I indulged in sushi, wine, cold cuts, feta cheese, caffeinated coffee, and everything else I have been missing the past month. I took more hot baths than I can count and was able to stay for as long as I wanted each time. 

My RE doesn't make promises or absolute statements, but he looked at me as I was leaving and said "We will get you pregnant." I looked back at him thinking I just was pregnant and he responded "It will be a good one."

Although I am starting to accept that this wasn't meant to be, I still miss feeling optimistic and pregnant. We had started talking about everything in terms of being pregnant and my due-date, and now I have to shift back to not being pregnant again. I feel stupid for letting myself get so far ahead of things, but realize my optimism was important.   

I honestly feel like we will get pregnant again, but I don't want to wait another 7 months for it to happen. This journey has been incredibly hard and painful and I know it's not over yet. 

Sonohystogram and trial transfer

So I went to my RE yesterday to start the testing processing for IVF. They took me right into an ultrasound room with my hubby and first made me sign a consent for the testing and HIV test. My hubby also had to sign a consent to get tested for HIV. They say this is a precaution because the instrumentation can cause infections to spread if there are any. They then told me to empty my bladder and then undress from the bottom down. I was pretty nervous but had taken a 600 mg Motrin prior. I was hoping this would reduce any cramping and make me more relaxed.

So the doc came in with his nurse and started an ultrasound first. He immediately said, "Didn't you just empty your bladder?" It was at this point that I realized something may be wrong. I have been getting twinges from my lower left side and was thinking maybe the cyst had returned. Well... it has. It isn't as large this time (about 3 cm x 4 cm), but it's back. The doctor said that when he did the laparoscopy he drained the cyst and debated with his resident as to whether to remove the tissue or not. Well, at the time I guess he figured that was the least invasive thing to do. Immediately following the surgery I remember asking what happens if it comes back, and he seemed pretty sure that was unlikely.

Well, the cyst is back and I'm not completely pleased. The doctor thought for a few minutes and then kinda just moved on. He looked at my ovaries and uterus under ultrasound and then did the trial transfer. The good news is that my cervix was really easy to get past (I just hope not too easy) and that the transfer will most likely be easy. Once the catheter was in for the trial transfer he used it to insert saline and then used the ultrasound in addition to make sure my uterus looked it. The other good news is that there weren't any polyps or abnormalities there.

The doctor is planning to drain the cyst when I have my egg retrieval. He will first retrieve the eggs and then he will drain the cyst. He seems to think this is the best plan since I will already be under anesthesia at the time. He said it is midline and since he knows it is a simple fluid filled cyst, there is no problem doing this.

The bad news is that we can't continue to drain this thing every few months. I will probably have to have another laparopscopy to get it removed completely in the future. I wasn't too happy about that, but really happy we don't have to cancel or IVF cycle or change anything. They gave us our big 'ole box of meds.

The doctor is not prescribing progesterone injections, but instead a pill that is inserted vaginally. The woman I know and talk to about IVF said she didn't like that. She said it is messy and the last thing you want when you are going through an IVF cycle is the be "leaking". The doctor said the shots "get old fast" and that I will probably be on the progesterone for a few weeks at least. The nurse said she will call it into the pharmacy and I should check on the price. If it is OK, then that is what we will do. If not, then we should call her and we can do the shots. The shots are cheaper, but not the preferred way according to my doctor.

 When we left I had to go downstairs to the lab to get blood work done. I was initially nervous about all this blood work, but I was feeling pretty positive about things at the time. My husband didn't get his done because he wants to call the insurance company and see where they might cover it.  They also wrote a script for him to get a semen analysis. They don't want any "surprises" the day of the egg retrieval.

All in all we are feeling really positive and excited. It really stinks that the cyst has returned, but it isn't going to change much. It means future surgery down the road, but the doctor is really optimistic about our chances for IVF success. I am young and there isn't any known reason to believe an embryo will have a hard time implanting. I think I am handing stress well now, but we will see when the transfer gets closer. I am really hoping for success and for a 2011 baby!!

Taking Action

I finally called the doctor's office. I called on Friday around 2, but didn't get a call back. I wasn't exactly sure what to say, but it went a little like this "Hi, I'm a patient of Dr. ___ and we have decided we want to do IVF. We aren't sure exactly whether we should meet with the doctor now or not because we were thinking the beginning of the year..." I rambled on to the receptionist. When she got a chance to speak she said, "I will put you through to the nurse and you can talk to her." I felt a little embarrassed, but this is why I have been putting this phone call off. I have been scared of what to say and how to say it. Well I was only able to leave a message for the nurse, and am waiting to hear back.

My period did end up coming the following day. It is just about gone now, but I was glad to see it to be honest. I have a birth control prescription that I can get filled, so I think I might do that today.

I got a few books about IVF this week. I only read a majority of one of them so far, but it seems I have also read on the internet that most doctors place their patients on a birth control pill a month or more before starting IVF. In addition, with the PCOS, it makes me less likely to form any new cysts.

I started feeling really optimistic about the IVF yesterday. I think it if probably the book I am reading, but I need to feel a little more optimistic about it. I have been spending so much time being so worried it won't work. I need to feel more optimistic. It is hard to put a price tag on having a child, but that is exactly what we are doing. It seems so unfair that people get pregnant without even trying.

Lately it seems like every time I log onto Facebook another friend of mine is announcing their pregnancy. This week there were two days in a row where I saw this. I told myself I was going to stay off Facebook, but I obviously didn't.

Back to the RE Post-Op

I had my appointment on Friday with the RE. The nurse recognized me in the waiting room and asked how I was doing on my way to the receptionist. The receptionist also asked how I was doing. They then took me right into the office. 

They weighed me first. I'm not too happy with my weight these days and am really looking forward to getting back into better shape now that this cyst is gone. Because the cyst was so large and the doctor wasn't sure what it was, he advised me to not do too much vigorous exercise until I got in removed. 


They took me into an exam room and the doctor checked the stitches. He said they looked good and that I was healing well. He then said to meet him in his office. 

This appointment was a little different from the past ones. For starters, I no longer had the cyst that was always a concern in the past. Also, we were talking about taking our next steps towards pregnancy during this meeting. He said we had two options: to take Lupron for 3-6 months and see whether is clears my tubes. He said we would do it for 3 months and then run the HSG again. 

The other option is to go ahead with IVF. Since I am young and my tubes are blocked, this is our course where we will likely have the most success. When I asked the doctor what the success rates are at that clinic, he said he has only been there since July and that since they are a University, that they get the trickier cases. He says their odds don't look as good as other clinics for that reason. He also said that other IVF doctors would "kill" for a patient like me. I appear to be an easier case than he is used to. 


The doctor started talking about pricing and insurance for IVF. He said that since it is through the University, that it is more affordable (around $6,000). He said my insurance may cover it, but it also may not. I was told to call their billing person on Monday to discuss my insurance and what is covered. 

This leaves us with the decision as to what to do next. Do we take the Lupron that insurance covers and hope for the best with my tubes, or do we not waste time and get to the IVF? I have enough money in my bank account to cover one round, but what if we aren't successful? Choices, choices.....