It's over (for now)!

Thank you all for your prayers and support! As mentioned before, I started spotting on Friday... I ended up calling my nurse and she rescheduled the b/w from Tuesday to Monday (and not earlier since I was out of town this weekend... all I did this weekend was laze around). I went in today (Monday) morning to be surprised with an u/s appointment as well. I was a nervous wreck. Didn't see anything in the u/s... the doc mentioned that it might be too early. The final call came in at around 0530 pm... my beta for today was 25 (not different from last Monday). This cycle is officially over... I stopped my Prometrium and my IUI journey ends here!

Answers to IVF Questions

We meet with our RE last week for an IVF consult. The RE explained in detail what the IVF procedure would be like. He also answered several questions that I had come up with (see post Q for IVF for background information). Below is a summary of all the questions he answered:

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)?
4 minimum

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.

Just a little...

After the IVF consult on Friday, my nurse decided to reschedule the beta test from Sunday to Saturday! I guess she wanted to lessen my anxiety of waiting for beta (after BFN @ HPT).

So, I went in this morning for b/w... and got a call back this afternoon. The test is not negative! The HCG value is 8.6 and they normally like to see at least a 50 by this time in the cycle! So, I am just a little pregnant!!! I am supposed to go in again on Monday for another beta test. Not sure how viable this pregnancy is. But I am very happy that we at least reached this far! I see some hope for the future! :) For now, we are hoping and praying for the best and I am continuing the Prometrium suppository. I feel more cautious than excited!

For the symptoms this cycle: Besides the regular bloating, twinges etc (during/after medication)… My boo.bs have been super soar (like never before), I have had a consistent head ache and leg pain. Two days ago, nerves on my boo.bs started showing (just a little bit… something I had never noticed before). Last Monday, I had severe cramping twice in my uterus which lasted for a minute or two… the pain started from my uterus and went all the way down to my groin area. The pain/cramp was so sharp that I was breathless and felt disoriented. This had never happened to me before!

Is 3 a charm? ...BFN

I got up at 5 am this morning for my prometrium suppository and couldn't stop myself fom POAS. So I do my deed and I wait and wait, squint and squint some more, move my head around - rotate the pee stick! ZILCH - BFN! Yes, may be the pee stick didn't recognize the small amount of HCG... though I doubt thats the case. I was 2 days away from beta when I POAS... more than likely the beta is gonna be BFN too!


I had several dreams last night that I had a BFP! In one of the dreams (right before I woke up) my FIL comes and tells me I had a baby boy! Why would I not know what I had? Anyhow, I have learnt that dreams dont dictate reality! I somehow ended up going back to sleep w/o being much dissapointed. As soon as my DH got up in the morning I updated him. My dissapointment was curbed because I had something to look forward too - our IVF consult. I am happy with our discussion with the doctors. I will put up another post with all the information we gathered during the consultation. We signed our consent forms as well. And oh yeah... my RE thinks that if POAS was BFN (so close to beta), then more thank likely, beta will be BFN too.


IVF here we come!

What next?

So, I am just a few days away from my beta and I have refrained myself from doing a HPT or googling too much… and hence not much of an update! I have “several” symptoms (some similar to IUI # 1 and IUI # 2… and some totally new (which I don’t want to blurt out till I see the BFP/BFN))… but I am not trying to link them to pregnancy (in the back of my mind I am… though I am trying hard to shoo them off... it is getting harder to refrain from looking things up as I get closer to the end of 2ww)! I see my RE for the IVF consult on Friday, and I think I am going to take the HPT before I go see him! If it’s not a BFP, we at least will know what our next step will be for sure (?)… that way we won’t talk vaguely (at the meeting), like “if IUI # 3 doesn’t work...” or “if we have to go on to IVF...”!

I absolutely loved ICLW. I have come across such fabulous blogs and bloggers during ICLW, and it gives me so much hope! Thank you Mel for starting it and thank you all for the support. :)

IcomLeaveWe - May 2009

I am new to the IcomLeaveWe (ICLW)... this is my first time! I was going through a few blogs to leave my comments and realized that some of the bloggers had a summary of their journey for ICLW... and it was a little easier to figure out what was going on in their journey. So here is mine:

• 2000 - PCOS diagnosed (symptoms under control)
• 2004 - PCOS on a high (symptoms: acne, mood swings, weight gain, male pattern baldness, excessive hair growth)
• Mar 2005 - Start BCP (Yasmin)
• 2007 to 2008 - Try to loose weight (lost 20 lbs)
• Apr 2008 - Off BCP (TTC)
• May to Sept 2008 - Return of the PCOS (symptoms: acne, mood swings, male pattern baldness, excessive hair growth)
• Oct 2008 - Start seeing RE
• Oct to Jan 2009 - Diagnostic (HSG, saline u/s, b/w, s/a), result: of course PCOS, some morphology issues (great sperm count, motility)
• Jan 2009 - Start Acupuncture
• Feb 2009 - IUI # 1 (w/ injectables - BFN), OHSS like symptoms
• Mar 2009 - Cyst (cycle cancelled)
• Apr 2009 - IUI # 2 (w/ injectables - BFN)
• May 2009 - IUI # 3 (in progress - 2WW), preping for a possible IVF
  

Hope to connect with a lot more IF bloggers through the ICLW. Good luck to everybody!

IUI # 3 - Progesterone Check

I went to the clinic this morning for my progesterone b/w and just got a call back from the nurse. It is 7.9 (Atleast I know I O'ed since its above 5)! The last two cycles it has been 6 (at 3-4 DPO). I start Prometrium suppository today (4 times a day) untill beta. So what does this mean? Am I doing better than before or it is an insignificant increase? Is it just higher because I had more follicles this time as compared to IUI # 1 & 2? Is there something wrong (quality?) with me (my eggs/follicles) which is leading to the lower numbers, which in turn is also leading to BFNs? How does my progesterone level impact a future IVF? My progesterone levels during beta for IUI # 1 (with Ovidrel) was 6 and for IUI # 2 (with Prometrium) was 9... how much progesterore is required for implantation (I have read anything above 9) and for sustaining a pregnancy? Do I need to increase my dose?

I guess, I need to discuss this with the RE/nurse... or am I just making a big issue out of it!? I just don't feel very positive about this thing! :(

---

Update: I guess I was just having a panic attack because I was seeing the same pattern that I have had for the past two failed IUIs. I felt like I knew what the answers were to most of my questions, but just needed some reassurance! Though any new detailed information is always welcome!

I spoke to the nurse later on and she said... progesterone level up from 6 to 7.9 is not a significant change, they like to see a 9; she has seen BFPs for women have had progesterone levels as low as 4-5; progesterone levels do not indicate quality of the egg; Prometrium should help with implantation (if pregnancy occurs), since its still early in the DPO. She encouraged me to discuss this issues with the RE when I meet him next week.

Dr. Google mentioned that progesterone levels can fluctuate from day to day and is not always the best indicator... though the doctors prefer giving you supplement if it appears low. It seems checking progesterone 3-4 DPO is also not the norm... but thats what my RE does!

Three posts in a day? (IUI # 3 Update)

Well, I am just trying to stay positive… honestly, half the time I forget that I am on an IUI cycle (specially with no injections right now ;)). I so want this (cycle) to work, but the last two failures have numbed me and I seem to be focused on to a (future) IVF!

The insemination went well… it felt like just another day… I was not anxious at all, like I have been the last two times. Since I had more follicles this time (than IUI # 2), my current symptoms match IUI # 1 (with multiple follicles). I am bloated and my ovaries hurt… though I am trying not to think much about it! I go in for progesterone check tomorrow… (going by the progesterone level the last 2 times) the RE will probably put me on Prometrium (like IUI # 2… since that worked better than a second Ovidrel shot for IUI # 1)! Hooray for 2ww!

IUI - Cycle # 3 Progress

IUI # 3 insemination 1 & 2 happens this weekend. I was on 75, 75, 75, 100, 100, 100, 125, 125, 125, 125 IU of Follistim for the last 10 days. I will be taking Ovidril tonight and going to the other clinic location which operates on the weekend (different and farther off from my regular one) tomorrow. During today's u/s, I had 2 follicles in my right ovary (18 & 13 mm) and a couple of 11-12 mm in the left ovary. My RE prefers going low and slow on the dose because of (my) PCOS. However, that resulted in to just 1 follcile during second IUI. I guess, technically you just need 1 "good" egg to do the trick, but it sucks when you have already had 2 failed IUIs. So I ended up speaking with my RE to see if we could be a little bit more (of course reasonably) aggressive this time... last time I took 75 IU of Follistim every single day except for the last 2 days, when I took 125 IU! The increased dose for IUI # 3 did not really shorten the cycle (I have been on Follistim for 10 days starting at CD3 the last 2 cycles as well), it seems to have slightly increased the number of potential babies. My Estrogen was 787.

The u/s was performed by a different RE (from group of docs at the clinic)... he is one of the founding members of the practice and I had never really interacted with him before. So, I was a little curious to see how things went.... He entered w/o knocking the door (I could hear him outside and of course I was ready... so I wasn't really startled!)... exchanged a few pleasantries and then swiftly moved my cover/paper blanket (or whatever it is called) up (I was a little startled then), the probe went in equally fast as well! With his quick actions... I actually lost track of the follicles (hence the "couple" of follicles in left ovary (mentioned above)). He started asking me as to why I am not going for an IVF. During our conversation he also went on to say that with the number of potential follicles I have, there is a great risk of multiples with IUI, and as much less "torture" (yes, he used that word to imply IVF) as they would want me to go through, I would probably produce a lot of eggs for IVF (which has approximately 80% chances of success at my age at this clinic (assuming other things are okay besides PCOS) as compared to 20% with IUI). He also mentioned that at my age probably 50% of the eggs are probably already bad... which adds up to the BFNs for IUI!!! I mentioned to him that I have an appointment with my RE to discuss IVF and that is probably going to be our next option if this IUI doesn't work!

I was not very pleased with his bed side manners, however I was very impressed with the amount of time he spent with me and the way he answered my questions! Gives me lots of hope for IVF! :) So for now... IUI # 3... here we come! Will this be the lucky cycle!?!

Q for IVF

My 3rd IUI will officially end by the end of this month (unless cycle is cancelled). Around the same time we are supposed to be meeting up with my RE to discuss IVF (in case IUI # 3 fails…. Which I hope it doesn’t! As much as I don't want to think of a failed IUI, I need to mentally prep myself for an IVF). My RE has an online course discussing most of the aspects of the IVF. However, I have noticed that there is a lot more beyond what is listed in his notes. So I am doing my own research of possible things that the RE would bring up (so that I am not dumbstruck) or I would like to ask in case he doesn’t discuss it. Below is a summary of all the literature I have gathered followed by the questions I have. This is an ongoing entry, which I will update as I come up with more questions & answers. I thought that I would do this now while I am sane enough (and not all psyched up during the 2WW... you can probably also tell that I am a planner, though I am learning fast that all the plans (hint: baby) don't materialize as per your plan/wish)! Please note that I have just copied and pasted the definitions of the procedures/terminology, you can find more information in the embeded hyperlinks. Some guidance can be found at the RESOLVE Questions to Ask series.

• Basal Antral Follicle Count - Antral follicles are small follicles (about 2-8 mm in diameter) that we can see - and measure and count - with ultrasound. Antral follicles are also referred to as resting follicles. Antral follicle counts are a good predictor of the number of mature follicles that we will be able to stimulate in the woman's ovaries when we give injectable FSH medications that are used for in vitro fertilization. The higher the number of Antral follicle, the higher the number of eggs retrieved, which in turn correlates with IVF success rate.
• Clomid Challenge Test - The test is an evaluation of female pituitary hormone levels. The test utilizes the fertility medication Clomid (clomiphene citrate) to increase the accuracy of finding women with decreased ovarian reserve. Day 3 and 10 FSH levels are monitored and if either the Day 3 FSH level or the Day 10 FSH level in a clomid challenge test is elevated, it is considered abnormal. A high FSH level is a sign of poor ovarian reserve.

Question: How good is my ovarian reserve? I know I have tons of dormant follicles during u/s, but then, I am also not ovulating on my own! Should we be checking it before we proceed to an IVF?

---

• Pre-implantation genetic screening/diagnosis (PGS/PGD) is used as an alternative to prenatal diagnosis and possible termination of pregnancy of an affected fetus for couples who are at risk of passing on serious genetic diseases to their children. The DNA fingerprinting provides information about the quality of the embryo, and thus the chances of implantation and a successful pregnancy. PGS consists of: FISH (Fluorescent In-Situ Hybridization), CGH (Comparative Genome Hybridization) or Microarray (MA). Reference: Preimplantation Genetic Diagnosis (PGD), DNA Fingerprinting Identifies Viable IVF Embryos.

Question: Should we be doing a PGS? (I suspect that my RE will recommend it only if we have at least 1 failed IVF). How many embryos (minimum) are required for PGS to be performed? I suppose if more than 1 embryo (with certain criteria) is required, and thats not available... then PGS gets cancelled? In this case, if one does not do PGS on IVF # 1, # 2 fails, and insurance covers only 2 IVFs... then we are on our own after the second IVF! (I know, I might be sounding pessimistic thinking about 2 BFN IVFs, but I want all my answers before I start!)

---

• My RE’s clinic is performing an “Embryo Quality Study”. There are certain criterias one has to fit in (including 1 failed IVF). The study provides you with a free of cost IVF and the associated medication.

Question: Do I qualify for the study? Is this study the same thing as the PGS?

---

• Mock Embryo Transfer: Before the first cycle a physician performs a trial or mock embryo transfer. This involves passing a catheter through the cervix into the uterus to determine its path through the cervix and to measure the distance to the top of the uterine cavity.

Question: Will I be undergoing a mock embryo transfer?

---

Other IF procedures:

• Gamete Intrafallopian Transfer (GIFT) - In this ART procedure fertilization takes place in the fallopian tube. GIFT should only be performed when sperm level is adequate and at least one fallopian tube is open and functional. The steps involved in GIFT are similar to IVF up to the point of egg retrieval. Egg retrieval is usually performed under general anesthesia, and the eggs and sperm are immediately transferred into a catheter that is used to place the eggs and sperm into the fallopian tube during a laparoscopy. Unlike IVF, there is no ability to document fertilization or to evaluate embryo quality in a GIFT procedure.
• Zygote Intrafallopian Transfer (ZIFT) - ZIFT is a combination of IVF and GIFT: A fertilized egg is transferred into the fallopian tubes. Fertilization takes place in a laboratory, and the zygotes (newly fertilized eggs) are transferred into the fallopian tubes at the time of laparoscopy. With ZIFT, fertilization is documented, but evaluation of the dividing embryo is not possible.
  

Question/Comment: Having had 2 failed IUI and a possible third one if we do end up going on for IVF, I highly doubt that ZIFT or GIFT would be an option. I don’t think the doctors would let the sperms and eggs do their job on their own and we would probably be doing an assisted hatching or Intracytoplasmic Sperm Injection (ICSI)!

---

Other questions/concerns:

• How many mature eggs (minimum) do you expect to be present to continue with IVF (egg retrieval)? (i.e. not all eggs will fertilize, not all embryos will survive... the lower the number of eggs retrieved, the lower the chances of success, so I presume if there are just 2 eggs ready, the cycle would probably be cancelled?)
• What are your standard IVF protocols (lupron/long, flare, antagonist)? Which one suits me best and why?
• What are the chances of me having endometriosis? How can we confirm?
• My progesterone level 4DP-IUI has been around 6 units? Is it normal to be in that range during that time period? If not, is that implying something?
• Should I be concerned about OHSS during IVF? How is that monitored/controlled? Does OHSS lead to IVF cancellation?
• What is the optimum lining of the uterus for implantation? What is triple stripe ovarian lining… how important is it for implantation?
• My low progesterone DP IUI... is that an indicator of issues with egg (quality)? How can this affect my IVF?
• What are the success rates for FET?
• I am considering taking a break of month or two and trying Chinese Herbal Medicine! I have come across a few experiences where folks have had repeated failed IVFs... they went on to take a break from IVF and starting these alternative medicines and then going back to a successful IVF. It seems the herbal meds cleanse and stabilize your system. Though I am unable to find any scientific literature... and most of the info is pretty vague. Would be great to hear more about such experiences! I am also not sure if my RE will be happy with this option!

IUI - Cycle # 3

Got a go ahead from the RE for IUI cycle # 3. The last IUI cycle that our insurance covers. No cysts thus far, uterine lining is low and hormones are good. Will be starting with Follistim tonight! Yet another roller coaster ride. Will this be the one? Time will tell!

Birthday Gift or Not?

So finally, I decided not to take the HPT! I was sick of wasting money on those pee-sticks which always turned BFN… I had to anyways pay the freakin $30 copay (which adds up to 100s in any active cycle months) at the RE’s for bw. I had started convincing myself that I am not so lucky, as to have the "best’est" ever birthday present of my life! I could not be declared pregnant a day before my birthday. How could I? I have never had it easy… I wasn’t meant to go through IF so that I could get a fancy birthday present! My idea was… if I was pregnant, then yes, it would be the most cherishable present I have ever given to myself… but if I wasn’t, I was not going to be very disappointed (with the mental prep). Also, it was going to be another year down the drain for my biological clock.

On the day of the bw, I waited and waited… and the nurse finally called at around 3:30 pm or so that afternoon… of course the news wasn’t good… I didn’t seem disappointed! Progesterone was 9 and HCG was less than 1. I also asked about my Estrogen level before my trigger (since I had forgotten to ask that), it was 216 (probably just 1 follicle). We started talking about the next step. I have 1 more IUI left on my insurance (exhausted 2) after which we would have to go on to an IVF. I have read stories where an IVF cycle gets converted into an IUI cycle due to poor response, and I was concerned that if we exhausted all our IUI’s, I wouldn’t have a backup (insurance paid) IUI cycle. My nurse mentioned that with my PCOS, it is highly unlikely that I wouldn’t have enough eggs for IVF… she wanted us to think about it and get back to her when I called her with my AF day 1. After I hung up, I called my husband and informed him about the not so great news! He wanted to make sure I was okay… which I guess I was… he said we would discuss this once we both got home.

Think and discuss was something I didn’t wanna do – my brain was fried! For the last freakin 9 months, I had refrained myself from consuming anything that is not really required by/for my body. I probably have had 1 beer, 1 small wine, no coffee, no tea and may be a little bit of sprite in the last 9 months! I was ready to get sloshed tonight!!! If being nice for 9 months didn’t help, getting drunk 1 night was not going to make things worse. We opened my favorite wine – it’s from a small winery (Messinahof) in Texas, but I think they have the best Port wine (http://www.messinahof.com/Spec%20Sheets/Port_PR_2003_TX.pdf). My husband did get some cake for my birthday. Honestly, I was not expecting anything and didn’t really wanna do anything either (I wanted to keep it low key)! I was thinking of not picking up any birthday calls that I received the next day! However, I felt like a sob ignoring the calls and I did answer them – they cheered me up momentarily! Birthday evening we decided to go and pray! …And I couldn’t hold my tears back! What wrong had I done to be going through what I am going through? If this is a test, how many times do I fail before *God* gets happy and grants me a wish? What are Blessings? What is Luck? What is Karma? Should I really believe in those things? The next few days passed! I still don’t wanna think of what next? I am blindly accepting my husband’s decision that we will be doing a 3rd IUI. Honestly, I don’t think I am mentally prepared to start a different routine (IVF) this cycle… all the planning, the timing, the newness, the uncertainty! If the 3rd IUI fails, I have no option but to go on for an IVF – so I guess I will be mentally prepping myself this month!

My AF has arrived and I will be going in for my day 3 check up tomorrow. Not sure if this will be an active cycle or if I am going to have cyst issues like last time. I didn’t feel over-stimulated this time, though who knows what my ovaries have to say?!

I do realize this is just the beginning, and even if I get pregnant, carrying a healthy baby to full term is another challenge! And I hope I can ultimately succeed.

Weight Gain/Loss during IUI Cycles

I had gained almost 4-5 lbs during IUI # 1. I was afraid that I was going to be like 100 lbs heavier by the time I finished all my cycles/got pregnant. But to my surprise, I lost that gained weight and I lost additional 4 lbs during the rest cycle (total -8 lbs). I looked slimmer too! :) May be it’s the medication (Follistim, Ovidrel), may be it’s my insulin/sugar in control (due to Metformin), may be it’s the Acupuncture… or may be its just me! :)

With IUI # 2, I was afraid that I was going to gain weight again… though till now, I might have gained 2-3 lbs… in spite of me getting hungry every now and then and hogging so much! Though, I do feel heavier and bloated. Only time will tell the final outcome!

IUI – Cycle # 2

…And so, day 35 came (of the break cycle) and I decided to go to the RE’s office and get my bw & us done to see what’s going on! Guess what, just like January end/February beginning, my lining was thin and hormones were low enough for it to be considered day 3 (without AF). So here we go… IUI # 2! I was still afraid that my cyst would pop up again and we would have to cancel the cycle. I wasn’t at peace till my day 7 us (which is when they found the big cyst during the previous cancelled cycle). Day 7 arrived and things looked okay. In fact, one of my follicles had already started growing in my right ovary (by day 7 us) and was 12 mm and estrogen was 63 units. That was a quickie as compared to the first IUI cycle! It had taken me almost over 8 days to respond last time. During this cycle, I took 75 IU Follistim for 8 days followed by 150 IU for the next 2 days. I triggered on day 13 (of the so called non AF cycle) using Ovidrel. The “big follicle” kept growing up to 18 mm before I triggered. Only 2 more follicles in my right ovary were around 12 mm before I triggered (none >10 mm in left ovary). I forgot to ask about estrogen on the day of the trigger. I know things can be very different every cycle, but I still asked my RE as to why I had such less follicles… he mentioned that this is normally what they expect (& not the "n" number follicles I had last time). I was ready to deal with all the side effect of Ovidrel (with last IUI cycle experience). But fortunately (?) things were much better this time. Slight tiredness, slight cramping and the rest was smooth sailing. I had mentioned to my nurse about my OHSS like symptoms from last time and had asked if I could take an Ovidrel alternative for my progesterone boost if required. I was told that I could take Prometrium (http://www.drugs.com/pdr/prometrium.html) vaginally if the progesterone was not as per the standard requirement (of 9 units or higher).

IUI (insemination 1 & 2) went well. Sperm count was great and it looked like I had one healthy egg (for sure)! With the (minor?) aches and pains that keep coming with all the medication, I wasn’t very successful in telling if I had ovulated (couldn’t identify ovulation symptoms). 5 Days past first insemination, I went in for my progesterone check… level was 6 units (just like IUI # 1). I was prescribed Prometrium vaginally 4 times a day till my next bw (pregnancy test). So, currently I am at the 2WW!

This progesterone suppositories– Prometrium is supposed to help with implantation (progesterone > 9 units for implantation). It’s very easy! Just that it can be messy. Progesterone from the pill is supposed to be absorbed by the vagina/uterus, though some of the ingredients leak out. (Sorry, if it’s TMI!) A panty liner is a must.

I am hopeful, yet even more cautious this time. I am trying hard to not look up every symptom online… trying harder to not look at online (baby) shopping websites… and trying even harder to not be disappointed, frustrated and bitchy! My ovaries have not cramped much this time, though I have felt some twinges once in a while around my uterine area. I feel a little something in my chest/throat… may be heart burn… I am too scared to call it nausea. My inner thigh (mainly right) feels strained. I am hungry a lot and get tired very easily. Approx 7 days past ovulation (DPO), my cervix is soft & low, and my body feels warm. I think my brain is on an overdrive... it’s probably all the medication! May be the next time I will learn to ignore these new symptoms as well (though I truly hope that this is the lucky cycle)!

My Acupuncture routine is the same as IUI cycle # 1. Twice a week while on Follistim; followed by day before and of the insemination; and once a week during 2ww.

IUI – Almost Cycle # 2

I went in for day 3 b/w and u/s for this new cycle (early February 2009). I was positive and hopeful! There was 1 cyst on my left ovary. The doctor mentioned that if the cyst is not secreting any hormone (which would be detected in the b/w), we should be okay with starting a new cycle. The b/w was good; we could start the 2nd IUI cycle!!!

I started off with 75 IU of Follistim again (for the next 4 days). I had started to feel a little discomfort during these 4 days. I went in for day 7 b/w and u/s. I had more than 5 cysts each greater than 50 mm in my right ovary and a few small ones in my left ovary! My ovaries were almost double the size. The cycle had to be cancelled! I was disheartened!

Currently, I am towards the end of this “waiting” cycle. My ovaries have cramped once in a while and I have been tired at times… no other pains in this month! I am going for acupuncture once a week and have not really done any yoga this month (I am too afraid that my ovaries are the size of a football). Hopefully, I will get my AF naturally and the ovaries will be fine.

IUI – Cycle # 1

I started my IUI cycle towards the end of January 2009. The cycle medication normally starts with b/w and u/s on day 3. I was towards the end of my menstrual cycle and was hoping that my AF would start soon (so that I could start my IUI cycle)… though nothing seemed to happen till day 35! So I went in for u/s and b/w to see if I could be induced. Surprisingly, I had not developed any lining on my uterus (to shed during a period), so even if I had been induced, it would not work. The b/w it seems turned out such that… my hormones were at a level that one would have during day 3 of a new cycle. So my RE decided to start my medication.

I administered Follistim (http://www.follistim.com) every night (75 IU for 4 days, 100 IU for 4 days and 150 IU for 2 days) at home starting on day 3 of the cycle. I was scared big time to poke myself in the belly the first night, but honestly it wasn’t bad at all. Though I did realize that I had different sensation every night (from no pain to sharp pain to tingling sensation)! I guess things changed as my body hormone level went up/down. Follistim made me bloated, tired, my boobs were sore, nipples were extremely sore, I was a lot more thirsty, had an increased appetite. My follicles went from too small (less than 10 mm) to 15 mm + as soon as I up’ed my dose to 150. With PCOS (excessive follicles in the ovaries), the doctors do not want to stimulate you to quick, because it could cause a severe hyperstimulation (OHSS: http://en.wikipedia.org/wiki/OHSS). I was monitored (b/w and vaginal u/s) on day 3, 7, 9, 11 and 13. On the 13th day of the cycle (3 follicles > 18mm @ right ovary and 1 follicle > 15 mm @ left ovary), I administered myself the prefilled syringe of Ovidrel (http://www.drugs.com/mtm/ovidrel-injectable.html)! We were supposed to go to the RE on day 14 for the 1st insemination and day 15 for the 2nd insemination (My RE does 2 insemination to increase the chances of catching the ovulation post induction).

Insemination went well! Husbands sperms were collected (both days – good count) and were washed (Sperm Washing: http://en.wikipedia.org/wiki/Sperm_washing). The insemination procedure did not take very long (approx 10 mins) and there was no pain or cramping or bleeding involved. I rested both the days after IUI. The Ovidrel did make me bloated and soar. My ovaries cramped, my feet hurt bad, caused headaches and I was very thirsty… it was manageable and it all subsided within 3-4 days. I went in for progesterone check 4 days past first insemination. Progesterone level was 6.4 units, the doctor recommended taking an Ovidrel shot to up the levels (10 or above is required for implantation to occur). I had similar symptoms to my first Ovidrel shot, though the intensity of all the pain was higher! My ovaries were cramping badly and I couldn’t move much, had some chest pain and had difficulty urinating! I was afraid it was OHSS! I ended up calling the emergency line at the RE’s office and spoke to a nurse. According to her, as long as I had not stopped passing fluids (urinating), I should be okay. She scheduled an u/s and b/w appointment for the following morning. The u/s revealed a few cysts in the right ovary (not very big). Cysts normally subside by the end of the cycle. Sometimes they can persist through pregnancy. If they don’t subside a cycle might have to be skipped (if not pregnant)! My RE mentioned that bloating and pain normally increases towards the end of the day (because of physical activity throughout the day). He also mentioned that since the Progesterone levels were above 3 units (during the progesterone check 4 days past insemination), ovulation had occurred and these cysts were not just left over eggs.

My OHSS symptoms subsided in the next week or so. I was perfectly fine initially during the 2 weeks waiting (2ww). With all the medication I had had thus far, it was hard to tell if all the changes/symptoms were pregnancy symptoms or medication. My August 2008 experience had taught me not to read too much into these symptoms. Though it did not stop me from looking up information online… it just made me a little cautious and less anxious! However as the 2ww almost came to an end, I couldn’t stop myself from trying an EPT! I used the Walgreens brand (I had spent enough $$ last yr to realize that the brand name didn’t make much of a difference) 2 days prior to going to the RE’s office for b/w! It was slightly positive, though it could have been the Ovidrel (HCG)! I tested again the day before (b/w) and the line was much lighter than the previous day! I was kind of mentally prepared for a BFN at the RE’s!

Never ever has this treatment not surprised me (till date)! My b/w results were indeterminate. My HCG level (pregnancy hormone) was 3’ish. If one is not pregnant, the levels are below 2 units. Progesterone levels were 6’ish (not suggesting pregnancy). I was asked to come again 2 days later for another round of b/w. Even though I had anticipated this (after my EPT), I was frustrated and angry! Why me!?! I cried a lot that day, didn’t want to speak with anyone. Though I calmed down after speaking with my husband at night and I was pretty normal from the next day. The second round of b/w was definitely a very BFN for sure! My AF started the following day. I cramped like never before… I could hardly move during the first half of the first day!

Treatment – IUI / IVF

After approximately 4 months of diagnostic work (between two doctors and all the tests), the RE finally suggested that IUI (Intra-Uterine Insemination: http://en.wikipedia.org/wiki/Intrauterine_insemination) with injectables made better sense in our case (to start off with). In lay mans language, since there was a sperm morphology issue, it would be better to assist the sperms in getting to the egg without them having to go through the vagina and the cervix. Plus, instead of Clomid (which is what most people start off with for ovulation induction) (http://www.webmd.com/drugs/drug-11204-Clomid.aspx?drugid=11204&drugname=Clomid), my RE wanted me to start with the injectables, which would help in creating more eggs, thus increasing the chances of conception (higher success rate)! Hopefully IUI will work, if it doesn’t work, we would have to go towards IVF (In Vitro Fertilization: http://en.wikipedia.org/wiki/IVF)!