June 22, 2009
My visit started off with almost getting hit by a couple of cars in my rear. Reason - This dumb (probably preggo) women not knowing how to back up a freakin huge SUV from the small parking lot. I was held up in the middle of a very busy 4 lane road because of her and was praying that I didn’t have to deal with some car bumping in to me since I was unexpectedly (completely) stopped in the middle of the road.
After parking the car I marched in hoping not to see any bellies. Fortunately, there were only 2 MEN there. One was snoring away to glory and the other was waiting to speak with the receptionist. The women I could hear inside was supposedly 40+ and excited about how she weighed less today than when she was a teenager! I was very happy for her (cause I didn’t have to deal with hearing some preggo lady). This doctor’s office is completely covered with pictures of babies he has delivered and the happy families he has created. He has tons of albums of these folks as well. For the last 3 years I have enjoyed looking at them and dreaming! Today, I was too busy playing a game on my phone, I didn’t want to look up!
Finally I got called in. I didn’t want to get weighed. I know what my weight is, but I hate to be reminded of how I have yo-yo’ed with all these medication. Next came the pee cup. I didn’t need another reminder that I was not pregnant a year after my last visit (which consisted of a beta test, cause I was sure I was preggers and the darn pee stick didn’t want to recognize it… fun-fun)! The nurse also had to ask me and reconfirm that I was there for just an annual checkup! So finally I went in to the examination room... was hoping that the doctor would arrive right away so I could get out of this place. The doctor came and asked me “What’s new?”… my answer: “Nothing and everything”. That is I am not pregnant right now… I have had 3 IUI’s so far, the last one resulted in to a chemical pregnancy at 5 weeks and I am currently on an IVF cycle! As he was doing his deeds, he started telling me stories of how some of his other patients have been directed towards an IVF and turned out pregnant right before the IVF cycle. I didn’t want to hear stories (I had started tearing up already) and I wanted to get out of there ASAP! I had to tell him that unless my chemical pregnancy has made this miraculous change to my “system”, I am probably not ovulating (on my own)… and also I am on BCP… so it’s highly unlikely. He is a very sweet old guy and I know he was trying to help me… but I was in no mood to be given false hopes. On top of it as I said, my goal was to see no pregnant bellies, and no baby and happy family pictures… so that meant I had to get out of their as quickly as I possibly could. I would say I was pretty successful, I just saw one (not so pregnant) belly in the passing. Was such a relief to get out of there!
May be I just made a big deal out of it! Though, I did reconfirm myself that I am very happy to see other slightly pregnant bellies at my RE, because that’s a positive reinforcement that it can happen… and I know those ladies have struggled… and they deserve it! It’s sad that I have developed this phobia for non-IF pregnant bellies… I hope this anxiety easies (I know it will never completely disappear) as I move along in life (hopefully with a kid or two). I am glad I don’t have to deal with this kind of a visit for another year… I will know my pap went well (hopefully) and I can go on with my IVF!
June 21, 2009
- See my complete IF journey here: ICLW May 2009 post and/or the sidebar (IF Timeline)
- IVF # 1 Timeline: IVF - Cycle # 1 ...and more post and/or the sidebar (IVF # 1 Details)
June 18, 2009
High BMI & IVF
Having a high BMI, in simple words, being overweight/obese can cause fat deposition in abdomen area… supposedly this can distance your ovaries from the vagi.na. So, during the ER, when they try to reach the ovaries, sometimes they have trouble retrieving the eggs. Hence, there is a cut of limit for BMI for a person to qualify for IVF (varies from clinic to clinic).
Now, I have never been skinny, but I am not obese either (as per the BMI). My right ovary, which is the one which seems to do most of the work… seems to go high up in my abdominal cavity (especially when hyperstimulated) towards the end of a cycle… the RE somehow has to make it come down (by pushing on my abdomen area) for it to be visible in the u/s. My left ovary is never ever a problem. I hope this is not going to be a major issue during ER! I need to work out a little in the next 3 weeks before I turn in to a zombie (with the medications)… may be that will help? I don’t know… but at least I will be satisfied that I tried to help my ovaries… and of course not being lazy and working out is always good!
I knew Estrogen (E2) levels are pretty important in any cycle, but I never seemed to have registered them in my brain during the CD3 b/w. My FSH has consistently been around 3’ish at CD3. Which supposedly indicates good egg quality and quantity (ovarian reserve)! Similarly, having a very high E2 level on CD3 could indicate poor ovarian reserve or an active cyst (active ovarian cyst secrete Estrogen). Higher E2 at the start of the cycle might also indicate a shorter stimulated cycle and hence poorer follicle/egg quality (not enough time for the eggs to mature). Dr. Google also informed me that a very high E2 during an IVF (ER/ET) could lead to a cycle cancellation, because it could indicate a severe OHSS in the making or some studies even seem to show that E2 levels above 4000-6000 units seem to reduce the chances of implantation. I have read blogs where in spite of good embryos (and good ET), it was a BFN and RE (possibly) attributed it to high E2 at the wtf meet! For more information see the following links: estrogen affects fertility window, poor egg quality and E2 levels, E2 levels, estrogen and progesterone levels for ivf.
This piece of info sent a chill through my spine! What are my E2 levels!? I have been “assuming” that my ovarian reserve is (supposedly) “good”… but maybe E2? I emailed my nurse and it seems that my E2 levels ranged from 50 to 75 at CD3 (during the last 6 cycles). Higher levels (relatively) were noted whenever cysts were identified in the ovaries (or so I would like to believe… I am sure if there are super active cysts, they probably give out tons of Estrogen and not just 10 and 15 units more). The lab cut off for my clinic is 100 units (FertilityPlus says 75 is upper limit in the normal range)… so I guess I am okay (had it not been okay, I would have probably already heard about it from my RE). E2 levels rise as follicles grow… the more the follicles, higher the E2 levels. My nurse mentioned that they do not cancel a cycle for high E2 levels (she didn’t reconfirm the piece of information that I gathered – that very high E2 reduces chances of implantation), however if they are very high, it could lead to severe OHSS (thus cancelling a cycle).
So, I still have "hope"… my FSH is good and E2 is not high-high. I have stopped believing in luck… everything seems to be random and coincidental… or else if luck really existed, I would have already been pregnant (and carried it through) after so many tries! We are doing all we can to shape our future, our destiny… so hopefully we will never have to say that we never tried!
For the last 1.5 years I have been taking the prenatals that my OBGYN had prescribed (sigh, it’s been that long)! However, the prescription ran out and I had requested my RE to refill it. When I went to pick up the prenatals, I noticed that my nurse had asked for the same prenatals that I had been taking all this while, but with an additional tablet of DHA. Now, I had vaguely heard about DHA, but never really researched about it (every time I come across something new, I realize that there is still so much that I don’t know and there is still so much I could do). So now that I am going to be adding DHA (supplement) to my diet, I decided to look it up. General information about DHA can be found here: Docosahexaenoic Acid (DHA). The DHA prescribed to me is algae/plant based. Now, this is not really an IVF related entry, but I am just trying to summarize all the information I am gathering (so here it is)!
Some of the facts about DHA:
- Current research suggests adequate levels of DHA may help increase a developing baby's cognitive functioning, reduce the risk of pre-term labor and decrease the risk of postpartum depression. (DHA Intake During Pregnancy and Breastfeeding)
- DHA can be found in seafood, nuts, meat (organ) products, but is generally not adequately consumed by pregnant women. Average American diet is known to be low in DHA.
- DHA can lower triglycerides (PCOS women tend to have high tryglycerides).
- Fish based DHA could have ocean borne contaminants – mercury etc.
- Low levels of DHA have been correlated with memory loss, mood swings and other mental and visual conditions.
SCSA, HBA and PICSI
I recently came across Murgdan’s post about abnormal sperms and some of the diagnostic and procedures associated with it! (You might already know her and might have read this already.) She has done an absolutely fantastic job in describing SCSA, HBA and PICSI. I am not going to try to steal the show from her... here are the links for her posts (if you haven’t checked it out already): SCSA and PICSI
Just a brief background:
Sperm Chromatin Structure Assay (SCSA): Research indicates that sperm with high-levels of DNA fragmentation have a lower probability of producing a successful pregnancy. SCSA is able to identify DNA fragmentation in sperms.
Hyaluronan Binding Assay (HBA): HBA is a qualitative assay proposed to determine the maturity of sperm in a fresh semen sample. The assay is based on the ability of mature sperm to bind to the substance hyaluronan (a major component of the external coating of female ova (eggs)) necessary for proper sperm function.
PICSI: In ICSI, an individual sperm is selected and injected into an oocyte to achieve fertilization. The PICSI device makes it possible to select a functionally competent sperm (mature, with less DNA damage and fewer chromosomal aneuploidies), indicated by its ability to bind to hyaluronan. Preliminary clinical trials suggest that sperm selected by PICSI may improve clinical pregnancy rates and reduce miscarriage rates.
June 15, 2009
Thanks to my Grandma’s visit… I have been busy with her and relatively sane post the end of my slightly P cycle! However, I have been miserable in the evenings (at times). I have felt lost and lonely… insecure and scared… feelings I can’t really define! Honestly, the low HCG kinda helped… cause it did not get me too excited… I was more cautious. In one of my insanity spells, it just occurred to me that if there is nothing to lose (as of now) then there is nothing I can lose… sounds stupid I know, but it made me feel a little better.
My AF started middle of last week… that was a relief… that I could move on – specially to the next step (IVF). During AF I noticed a few clots and I couldn’t let go of them (sorry, TMI)… it seemed like they would be a part of this baby in some form or the other! I just calculated the due date and it would have been Feb 7, 2010… I had dared not to calculate it all this while!
Anyways, I went in for b/w over the weekend and I have now officially started my IVF cycle… yay!!! :) I started my BCPs and my IVF schedule has arrived in my inbox! The schedule as of now is:
* 6/13/09 – Start BCP
* 7/2/09 – Start Lupron (20 units)
* 7/6/09 – Stop BCP (may or may not get a period)
* 7/13/09 – First b/w & u/s, Start Follistim (300 IU) and continue with Lupron (10 units), DH starts Doxycycline
* 7/16/09 – Second b/w and u/s (medication could change post 7/16)
* Possible retrieval (ER) 7/23 – 7/25 (Ovidrel to trigger, Doxycycline & Medrol start on the day of retrieval, PIO starts the day after retrieval)
* Possible transfer (ET) 7/26 – 7/30
I have my annual gynaec visit scheduled for 7/21. My (IF) nurse wants me to reschedule it since it will be so close to the IVF (ER/ET)… also I will probably not be my own self (physically) during this phase (for pelvic and bre.ast examination). Now there is a catch here… I am trying to change my OBGYN! The one I go to (as I mentioned before), I dearly love… though I am not very comfy with the hospital he is associated with… so if/when I get pregnant I want to change my OBGYN! I have kinda figured out which OBGYN I would like to go to… but getting an appointment with him is a pain in the rear! I can’t get one prior to 7/13… and it seems that it’s okay to have a pap smear et. al. once you are pregnant. Though, I would just like to get it out of the way and know that everything is okay before I deal with the IVF. I might just schedule an appointment with my old OBGYN!
June 8, 2009
June 5, 2009
June 4, 2009
I almost started crying at my local pharmacy today! I went in to pick up my Prometrium and Metformin and I was told that I cannot get my Prometrium till June 12th. I was like what the heck (I almost felt like they were taking "this" away from me), I really need it now! The pharmacist mentioned that my Prometrium quota for the month had been met and the insurance wouldn’t cover anything more. So, I asked how much it would cost to pay out of pocket. 600+ freaking $$$ for 50 something pills! I explained that I take the medication 4 times a day (Rx’ed by my RE) and there is no way 50 pills would last me a month. So she decided to look in to it. It seems my insurance will cover 2 Prometrium per day… she asked me to call my doctor, who would then communicate with my insurance. In the interim, I decided to pick up at least 3 days worth of supply for $85… just in case this was going to take some time. After leaving the pharmacy, I called my nurse and left her a message. After exchanging a few phone calls (between the nurse, insurance and myself), the nurse told me that she has taken care of the issue and it would take 3-5 days for the approval for the increased dosage! She mentioned that I could stop by and pick up some different brand of progesterone supplement that they have at the clinic. I might do that on Monday or just go buy some more out of pocket for continuity sake!
While I was talking with the nurse, she was not negative, but I could sense that she was trying to tell me that lets pull through this coming Tuesday (when I have my b/w and u/s) and then see how things go with the insurance and Prometrium… as in I might not need the Prometrium after Tuesday!!! I have been doing okay for the last 4 days (trying to stay strong, positive and hopeful)… but this just hit me below the belt! I know my HCG is low (though it has tripled once) and we are still not sure about the viability… but I want this baby, I really want this child of ours! I hope I can stay P! I want time to fly by and want Tuesday to be here right now. I hope I can stay strong on Tuesday! My weekend is supposed to be super busy, so hopefully I will pull though this extended 2ww!
June 2, 2009
The lady reading this is beautiful, classy and strong, and I love her. Help her live her life to the fullest. Please promote her and cause her to excel above her expectations. Help her shine in the darkest places where it is impossible to love. Protect her at all times, lift her up when she needs you the most, and let her know when she walks with you, She will always be safe.
Love you Girl!!!
June 1, 2009
Do we need to do a Clomid Challenge Test and Basal Antral Follicle Count?
No! My day 3 FSH has been < 5 for the last 5 tests (indicating good quality/quantity). I seem to have tons of eggs during every scan and they have had to watch out to make sure that they did not over stimulate me during IUI. So quality and quantity should not be a problem and we do not need to do any more diagnostic as of now.
What are the chances of me having endometriosis? How can we confirm?
Minimal, nothing (cyst/scars) seen in u/s and I do not have any pains and aches.
What are the standard IVF protocol (lupron/long, flare, antagonist) used at the clinic? Which one suits me best and why?
Lupron, since that seems to suit the best for PCOS patients.
How many minimum mature eggs required to continue with IVF (egg retrieval)?
Will we be doing a Mock Transfer?
Mock transfer was already performed prior to IUI and it’s an all clear.
What is the optimum lining of the uterus for implantation? Have I had triple stripe lining?
Optimum lining is 6 mm. I have had at least 8-9 each time. I have had triple stripe lining (also called as Type A) during the pre ovulation u/s.
Should we be doing a PGS/PGD?
PGS/PGD is not recommended unless there is a genetic disorder identified in the family or if there are multiple miscarriages. RE will not recommend this now. When all chromosomes are screened there is 97% reliability in the screening results.
Do I qualify for the clinic’s Embryo Quality Study?
I do not, since I have PCOS.
What are the success rates for IVF and FET?
IVF success rate in my case is approximately 60% and FET success rates is approximately 50%.
For IVF - ICSI or Assisted Hatching? GIFT/ZIFT an option?
GIFT and ZIFT are rarely used since the success rates are very low. ICSI is the way to go. Assisted Hatching is performed when a day 3 transfer is done, this helps in implantation.
My progesterone level 4DP-IUI has been around 6 units? Is it something to be worried about?
Progesterone level of 5 is required for implantation (which is also supposed to be the level indicating that ovulation has occurred). With IF treatment the RE’s like to see a 9. Since I am taking Prometrium, I should not be concerned about low progesterone and lack of implantation.
Should I be concerned about OHSS during IVF? How is that monitored/controlled? Does OHSS lead to IVF cancellation?
During egg retrieval (ER), all the follicles (mature or not) are emptied, therefore the chances of hyperstimulation post retrieval is very low. There will be some discomfort since the ovaries are large, but severe OHSS is probably not a concern. Regular u/s and b/w will help in monitoring the ovaries.
Day 3 or 5/6 Egg Transfer (ET)?
RE recommends transferring 2 embryos in my case (assuming 2 good embryos are identified). Day 3 transfer will be performed if two really-really good embryos are identified (remaining will keep growing in the lab for a possible FET). It’s quite obvious that uterus is the better incubator (as compared to the lab), so transferring the really-really good embryos in the better incubator early makes sense than leaving them out (in the lab) for the next 2-3 days. If there are several embryos doing well and it’s hard to tell which ones are the really-really good embryos, we will be waiting till day 5/6. This will give a chance for the really-really good embryos to stand out… these two will then be chosen and transferred (remaining will keep growing in the lab for a possible FET).
Is Baby Aspirin recommended?
RE’s clinic prescribed Baby Aspirin to patients for two years (after studies showing increased successful pregnancy rates). However the clinic did not see any increase in pregnancies, where as they noticed increased bleeding and bruising in patients. They no longer recommend Baby Aspirin.