Another WTF appointment at Large Fertility Operation

Time to pick apart my cycle: WTF went wrong and WTF did we learn from it.

I have come to enjoy the WTF appointment.  It is like the big game.  I prep and get all my business in order.  My stomach is a little nervous going in to the match.  I want to perform my best because there is just so goddamn much at stake.

Please remember I am not an RE.  Hell, I can barely keep my job in IT.  I am not a reliable source of information.  I do my best to transcribe things here, but there are much better bloggers you should use as a learning source. 

I want to suggest the following reading is not for everyone.  I learned some scary shit today.  (Yes, Rosie, N, Lisa, Lut, Stacie... Bunny - you too young, but don't get any ideas... I am speaking to you.)  This info is from MY RE and about MY body, so don't get worried it will apply to you.  I am older than all you bitches put together.

Look at all you pregnant mother fuckers.  Awesome.

If your name is not in that list and after reading this you think, "I am doomed", then you have misread this post.  Remember, individuals are all or nothing.  It works or it doesn't.  There is no half way point.  Don't let stats scare you.  Understand?

Anyhow. 

** UPDATED  **
A note to the weary, attempting to make sense out of this post: don't try it.  This is a core dump so I can recall all the information and try to confirm a decision.
 

Short Version

If I had a money tree, we would have another IVF cycle at CCRM.  They cost about $20k more, but RE admits they have something.  Donor eggs would always wait for us.

Extended version:

Semen stories, too bad, so sad
Curve ball in our last round.  Rocco has had crap SA after crap SA.  The semen sample for IUI wants to see at least 20 million.  We had low everything for all our SA and IUI.  Guess who rubbed out 134.5 million and 90% motility on our most recent IUI?  Rocco was calling out to all the ladies on the way from our last IUI - we were giddy.

I asked RE if now we could be considered IUI candidates?  No go.  This semen achievement thing can come and go.  Plus my eggs.  I have learned they are of questionable quality and approaching few and far between.  We used AZH in our successful IVF.  If the sperm found an egg, not sure they could bust their way inside this time. 

What plan offers us the best chance for a healthy baby?

• Donor eggs - she used the words:
• "slam dunk", 
• "ideal DE candidate", and 
• "pregnant in 3-4 months"
  
• More IVF with DHEA, etc.
• Large Fertility Operation doesn't have the magic bullet CCRM offers and admits my chances of success are best there to address poor egg quality;
• the chance of miscarriage at my age is 40%;
• holy shit, 40%.

Is there an indication of poor quality eggs?
Ha.  Turns out the problem is both quality and quantity.  Okay, didn't expect that answer to come that easily to my RE.

My miscarriage was likely due to a chromosomal problem.  Our beta tests looked good, but something wasn't right.  No heartbeat ever developed.  Perhaps isolated, but likely a sign of the state of my eggs.  My first RE suggested DE way back when, at the end of cycle one.  We always knew something was a little off. 

How does this relate to AMH?
It doesn't.  AMH is an indicator how I would respond to stims.  RE expects my AMH would be low, less than 0.5. 

What advantages do DE offer us?
I worried about Down's.  I would love my Down's baby as any mother would.  I was relieved to hear the risk of Down's was less than 1%.  Not a worry I needed to have - this is nice to know. 

Where should we cycle based on success rates?

• Large Fertility Operation (LFO)  53.8%
• Awesome Fertility (AF)             78.7%
• CCRM                                     81.6%

Numbers games.  It sounds like only the elite are accepted into the DE program at AF.  Good news is, I would qualify.  LFO takes anyone, including my Sisters of the Fibroid.  The way LFO looks at it, you just might get pregnant with DE, so let's try it.  AF doesn't want you to fuck up their stats.  I love LFO for this. 

Why weren't we offered a retrieval like last canceled IVF?
I was confused that RE offered to get our 2 follicles in our last cancellation, but didn't advise it this round.  It turns out my progesterone levels were on the rise - premature luteinization - with a definite impact on egg quality.  Only my evil friend Lupron can prevent this.  Or being young.  Whatever.

I can twist this into good news.  I messed up my meds, but if anything it might have helped.  Go figure.  Estrogen is the uterine padding and progesterone is the glue.  I already had too much glue with the premature luteinization.

What about embryo classifications and grades?
I sadly confirm this cannot this serve as an indicator for chromosomal abnormalities or genetic abnormalities.  My FET blast was gorgeous, but it didnt make it to a heartbeat.

Only 25% of retrieved eggs make it to blast.  We hope to see our donor retrieve 15-20 eggs, worst case getting us 4 blasts?  Getting way ahead of myself here. 

How many do we transfer?
Depends on the blasts.  I like this answer. One or two, TBD.

Could I be any more boring.

We have our phone consult with CCRM at the end of September.  Our RE plans to pull some strings to get us jumped up in line.

I love looking at donors.

The Shit Show that came looking for me

We are not pregnant.

I had a positive pregnancy test yesterday.  What.  I don't know.  I got up to pee in the middle of the night.  I figured the trigger shot was gone (14 days) and it had been 12 days since the IUI.  Why not just take a test and get the monkey off my back?

Jesus, Mary and Joseph, there is a line.  I carry it around all day with me.  It was very, very faint.  In fact, if you looked at it from the side it showed up better.  It was there.  I know only you people will trust me when I say I know what a negative looks like and this was not one of them.

I took the test again this morning.  It was negative.  No hope of the line.  What.  I turn around and Aunt Flo, that miserable bitch, is staining my toilet.  She has done that to me twice now.

It is 4 am.  Rocco and I look at each other, there isn't much to say.  We eventually go back to sleep, but when I roll over God knows how much later, he is still awake with me.  We are alone in our bed with each other.

I go to work today.  They pay me if I show up and I have a $25k - $45k cycle to pay in the coming months.  I don't know how, but I don't cry.  I am late for work, so I hit the Starbuck's drive through to get a coffee.  Decaf, as I am stupidly ever hopeful.  This is my rebellion.  I haven't had decaf in a long time.  

Rocco takes me to lunch.  I want to talk about how to choose a donor but instead I obsess over the money we don't have to pay for the next cycle.  I feel worse after lunch.  Poor Rocco, I don't tell him this.

I get back to work.  Pandora, a spreadsheet, and I forget about things for a while.  I change into a new tampon.  Wow, that is a lot.  I get a real coffee even though it is 2pm.

I jump when someone says PSSST so loudly I hear it through Pandora.  I turn around and you won't believe who the fuck is in my face....

The pregnant fertile bitch from work.

She is actually holding her belly and says to me that she hasn't seen me around (you clueless fuck, I sit in the cube catty corner to yours - did you ever stop to wonder why).  She then says (with this voice), "Look at my bump.  I am getting so fat."

Welcome to Shit Show II.

Yeah, I cried.  I tried to listen to her.  I heard something about food makes her sick and goes right to her belly.  She asked what was wrong.  Was work getting to me?  A lot of deadlines?  Are you sure you don't want to talk about it?  You sure you're ok?

Get me the fuck out of here.  

I am home with my dogs.

My decision

I hope it makes sense to move the thoughts from my head to paper.  I fear much will get lost in translation.  I will do my best to capture it.  I want to be able to refer back to it and reset myself if needed.  I feel positive.  I get it now.  The Shit Show has concluded.

I have been thinking about donor eggs since our first IVF failure.  My RE repeatedly told me "we are not there yet", but then one day, she did.  I felt prepared to discuss donor eggs back then.  It was when the choice wasn't mine that I had the problem.

The last few weeks I have been chewing razors, fearing what the almighty practitioners at CCRM would tell us.  Would they increase our odds to make it to retrieval?  Would they let us go ahead and try again?  How can they change the preparation, the stim, the fertilization, the development, the transfer and the outcome with a BFP?

They really can't.  I have come to realize taking me from a 10% chance to make retrieval to a 50% chance isn't enough.  What if they promise a 75% chance to retrieval?  Is that enough?  What number is enough?  If we had to pull teeth from our long term RE to get a low number, what new RE is going to risk a guarantee of success?  No RE in his or her right mind would do this.

Short of a miracle written on butterfly parchment and wax-sealed shut for accuracy by the horn of a unicorn by faeries, we are done.  My battery is beyond low and I don't have the energy to recharge it for another round with my eggs.

This decision became clear and silence fell all around me.  I think all the chaos I was feeling was from trying to fight my deep seated knowledge of myself.  I believe when you follow your true path everything falls into place.  Once I decided donor eggs were for us and made it MY decision, not one handed down by an RE, I felt at peace.  It is the craziest thing I have ever experienced.  Total peace once I made the decision.

Will there be a Shit Show II at the end of this week after my pregnancy test?  Maybe, but I doubt it.  I know getting pregnant from IUI and with my slightly expired eggs is a long shot.  I am, however, ever hopeful.

Welcome to my shit show

So, I cry at work.  Poor bastards.  I try to listen to what they are saying and focus on whatever trivial bullshit they want from me.  But I start to cry.  And they hate it, I hate it, we all get uncomfortable together.  I did it twice last week and a couple times this week.

This is my shit show.

I am getting a little under it all.  I fucked up my meds this week.  Don't ask me how, but I confused endometrin with estrace for 3 days and this will haunt me.  Should this not result in a BFP, I will have this monster in my head.  TMI.  Sorry, but this post is all about my shit show.

I get a lot of heat from my family when I talk like this.  "You have a beautiful daughter", "Don't let this ruin everything", and my favorite, "Other things that make me feel bad for not being happy".  I get it.  Doesn't mean I can do it, but I understand.

I can get past it all when I am with the little one.  She is a powerful creature.  I watch her find joy in picking dog hair off her hands.  Everything makes her happy.

I lose my way at work.  I am there to pay the RE bills, the pharmacy, the acupuncturist and the witch doctor at the health food store.  What a catch - don't stress, go deep into debt and oh, by the way, no crazy meds for you.

I try not to talk baby as I know we share many losses.  I hope you will indulge me during my shit show.  We can get there.  We just don't know how it all works.  We will only believe it when it happens.  I know it will happen for us.

Tie a knot and hang on.

I feel like that kitten swinging on a rope.  The poster very likely hung from my bedroom wall back when I was young (and more fertile).

The IVF retrieval was canceled due to poor response.  We were not advised to consider the option to retrieve the single egg.  My progesterone was on the rise and waiting on the other egg wasn't going to work.

I was sort of lying to myself when I said this was the last IVF before donor.  I always knew I had the option to fall back on DHEA.  The cancer link scared me, but I knew deep down it must not match the hype or my RE wouldn't offer it.  It was like a safety net.  One last Last Chance should this cycle not turn out.

Rocco and I were on the phone with the RE when she called it.  We had a mini WTF appointment.  We talked about what would change for the next round: back to microdose Lupron; the DHEA and a handful of other meds; 2-3 months to let the supplements (Royal Jelly, CoQ10, Melatonin, etc.) kick in.  

My RE talked me down off my worries on DHEA.  She explained the DHEA was only taken for 5 days and the studies linked to cancer were for over 3-4 years of continuous use.  We were building a plan.  I was smiling and pulling my calendar, already doing to date math for a due date.  God help me.

The tide started to change on me.  I wasn't getting the whole story.  I sensed trouble.  I asked if she thought I had diminished ovarian reserve. I didn't think so, I had some bad ass FSH.  "Oh, it is definitely DOR."  She said something about getting closer to donor eggs.  

Gulp.  What.  The rest is a blur. 

My RE was referring me to CCRM, the Mayo of the Fertically Challenged.  The Large Fertility Operation had nothing else to offer me.  A fresh set of eyes and a second opinion was the best recommendation she could give me.

I don't understand.  We just sketched out the next cycle, didn't we?  Didn't we?  I pressed my RE for her thoughts.  I have come to trust her and like her very much.  I make the conversation sound horrible (it was), but she was very kind in delivering the message.

"I would only be guessing.  But if I had to give you a percentage of success, there is about a 10% chance you would make it to retrieval."

All that time, energy and money.  For a 10% chance to make it to retrieval.

A 10% chance to make it to see if we succeed with a 17% chance to get pregnant.

What about all the other hurdles?  POAS?  Beta 1, beta 2, beta 3?  The heartbeat?  The level II ultrasound?  Viability at 3x weeks?  Avoiding still birth?  What about all of those?

My RE took my Secret Weapon of Hope and smashed it into a million pieces.

My sorrow doesn't revolve around the use of a donor egg.  I think I am there.  I just need to reset.  Learn how to change away from a feeling of hopelessness.

I am scared.  I know IVF.  I even learned IUI because my body was dragging through the cycles, spitting out all she could.  I know the rules, the players and the measurements to track success.

I don't know donor.  How do I know what to do?  Who to pick?  Where to pick?  Who to trust?  I don't even know the right questions to ask.

Rollercoaster shitballs

Ah, fuck, we talked about IUI at the office today.

We also enjoy MFI so IUI is a waste of time, energy and money I just don't fucking have anymore.

Mother father.

Friday 06-Aug, day 5

• Left 9, 8, 8 , 7
• Right 6, 5
• Not measured    7-8

Monday 09-Aug, day 8

• Left 11, 11, 6, 5, 4
• Right 10, 7, 7
• Not measured 6-8 

Based on 2mm growth per day, this gets me 3 by Saturday.  The rest are useless, I guess.  They are on a different schedule.  Maybe this is the risk with no BCP and no Lupron?  Mother father.

The nurse reminded me the RE wants a minimum of 3 for retrieval.  They want a 20 for retrieval.  I saw over at Lisa's house her RE will do a 14.  (Thank you, thank you for posting that today and congratulations.  Can you please come to my house and rub yourself all over my abdomen for good luck?)

Obviously, I panicked a bit.  Nurse back tracked a little and said things look much better than last time, but it didn’t go over very well.  I don’t know if she was just careless or has presented a real threat to our success.  My sister had a great point.  We may have three eggs this time which is 50% more than the amount last time.  High percentages are easy when your numbers suck ass like mine.

I am waiting for the call from RE today.  Sounds like meds will go up and retrieval on Monday, if we make it.  I am back in the office on Wednesday.

ps - I don’t know why some would actually reduce in size, see the left side.

pps - I am totally and completely full of shit for anything I have said about being ready for donor eggs.

First IVF baby becomes a mother

Did she really need to say her own conception was normal?

I could have picked a million better words than normal.

A follicle inventory and Tidbit follow up

Things are looking good. We have two follicles measuring at a 5, three measuring at 7 and an 8. An additional nine are small and not measurable at this point, but are expected to step up and deliver. That is a total of 15, my highest number in all four cycles.

A little concerned that the growth might be a little slow. They expect 2mm growth per day. They may jack up my meds. Considering I am 450 F.ollistim and 150 M.enopur already, this is impressive. We are going balls out for eggs. Back to the office on Monday.

A couple follow ups on my Tidbits. I was asked some valid questions I couldn't answer. I asked about it again yesterday at my acupuncture session.

I know I won't do it justice. I get so caught up in my acupuncturist's stories, I let it wash over me and forget to take notes. She weaves these great trips of health, communication and peace - all the while talking about farm stands, go figure.

I confirmed the eat local was a big benefit in her opinion to fertility treatments. She told me the local foods had a stronger life force (italics mine) in them.

I don't know exactly what life force means but it sure sounds like it needs to have a special font.  She talked about energy and connection to the earth. It was riveting.

My acupuncturist referenced a book by Barbara Kingsolver, who happens to be one of my favorite authors. (It was published during The Dark Ages, so I totally missed it.) This book captures the benefits of eating local.

I was in some pain a couple days ago. I was sure I could feel my ovary. How awkward. Turns out, er, I had some sluggish bowels. The descending colon passes on your left and gets a little crowded from all the follicles. A little something to file away so you don't worry as I did.

Poop, ladies, remember to poop.

All stims, no antagonist - like riding a motorcycle without a helmet

I love it.

If you are calling about that $5570.18 I owe you, then I will have to pay you back later as that check went to my friends at Freedom Pharmacy.  (What a stupid name for a fertility pharmacy.  "Free" is the last word I would choose for my subliminal positive association.  Free, my ass.)

We are a go.  No AF and RE doest care to wait around for her.  The meds are here and I am shooting.  Looks like we have 12 follicles total.  This is a bitchin' number for me.  5 we can measure and 7 waiting in the wings.  One is a big mofo, but no one talked about it sucking the life out of the others.

I am giddy and know exactly where my ovaries are inside my body.  This cycle is pretty intense now that I think about it.  There is very little suppression.  I had 3 shots of Ganirelix, but that was over a week ago.

No BCP, no Lupron.  Just stims.

I am not very comfortable, but I feel like a hen house filled with eggs.  I hope to all hell this isn't a bad sign.  I mean, I know precisely where my left ovary is situated.  So weird.

PS - Marry who you love.  Nice one, CA.

Estrogen nonsense

I am wrapping up the estrogen priming phase of My Last Cycle with My Eggs.

I head into the RE tomorrow to see where the hell AF got lost.  She should have been here by now.  Probably not an issue, but it is an opportunity to drop $350 for unplanned additional vag cam work.

I have been wearing an estrogen patch for 11 days straight.  It looks nasty, but that thing is fused to me like second skin.  I always used to fret about my patches, worried the water would leak in them and render them less powerful.  I was careful to time the *new* patches right after a shower where I needed extra time (shaving, shampoo/condition, more shaving for the u/s tech).

Pointless worry.  This thing isn't coming off the remainder of this calendar year.

Probably no one else worried about them but me, but just in case, a word to the worried:  Estrogen patches are the new IVF tattoo.  They might get a little ragged around the edges, but they aren't going anywhere until you intervene.

We went to Oak Park today to check out Frank Lloyd Wright homes.  I didn't get to tour the house as I was on baby duty.  I asked Mr. Rocco what the deal was with all the pelicans on the outside of one of them.

They weren't pelicans.  They were fertility symbols.  Storks.

Holy cow.