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?

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• 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!)

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• 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?

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• 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?

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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)!

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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!

New symptoms/side effects every cycle…

I have gotten used to getting new symptoms/side effects every cycle. I have been on mental over drives of (over) analyzing each symptom/side effect, and figuring out what it means and how it could impact my success rate that cycle, several times thus far… and I think I am now reaching a point where I seem to be kind of ignoring them and just doing my usual stuff. However, some of the occurrences are absolutely unexpected and new.

The other day, I got up in the middle of the night to pee (Sorry if TMI)… and I felt very uncomfortable. Within a few seconds I felt dizzy and weak, and then felt flushed… I guess I experienced a hot flash! I felt extremely hot and started sweating. In a matter of minute or so, that turned into extreme chill (I guess sweat is supposed to cool you down)… this feeling passed away in a few minutes. I got in to the bed and drank a ton of water (I had to send DH to the kitchen to get me some more). This has never happened to me before. It seems that this is a side effect of Follistim.

The day following the night sweat, I had muscle spasm in my left hip. It continued for 2-3 hours and then disappeared, again to reappear the next day in my left hip, back of the left thigh and close to my left big toe. This continued for some time and again disappeared! I have never had such repetitive and long muscle spasms before. I mentioned this to my Acupuncturist. She added a few points to the routine to help ease that and asked me to let her know if this repeats. I did feel a few spasms in both my legs during the acupuncture session, but I was too dazed to really register it well.

I wonder what lies ahead!

Mother's Day!

Happy Mothers Day to all the Mothers &Wannabe Mothers!

IF Buddy

I just spoke to my first IF buddy today! :) My excitement seems silly, but it just makes me feel like IF is for real (not just virtual - besides the IFs I see at the RE) and I am really not the only one going through it! She is a friend of a friend (Our common friend is 7 months pregnant! :))... has been riding the wagon for over a year. She has PCOS too, has had a couple of failed IUI's and a successful IVF which resulted in to a miscarriage at 5 weeks! Baby dust to her! After a really really long time, I found some one who spoke my (IF) lingo! :P Hopefully we will get across this soon!

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!

SS Rice Cooker - A Healthier Choice?

Lets say we are pretty regular on our rice consumption. Fortunately, we like brown rice and that's what we eat! I have always made my rice in the microwave, its quick and comes out perfect. However, in an attempt to get healthy, I decided to reduce my microwave consumption. One can find gazillion article on the web about how bad microwave can be for ones health. True or not, microwave is not the "natural" means of cooking food and hence I started looking for an alternate means - rice cooker. Now, unfortunately all the rice cookers available in the market have non-stick coating on them... which is again supposed to be bad for you health (and if not, at least un-natural - more so than steel as per what we humans have figured out thus far). So in my quest to find a rice cooker with a stainless steel container, I came across: Miracle ME81 (http://wize.com/rice-cookers-and-steamers/p58461-miracle-me81#t=64824). It can be found for the cheapest price at Amazon (http://www.amazon.com/Stainless-Steel-Cooker-Model-Formerly/dp/B000PC3G7M). I am pleased with it!

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.

Life goes on…

I haven’t really blogged about anything but the baby to be. This entry is probably different – its more about me – unfortunately bitching!

I broke down the other night! Something trivial happened and I could almost feel my nerves popping and I started crying! My husband tried to console me, and every word he spoke was just like a reality check! It was like, everything he said was something I knew but just didn’t want to hear. The biggest blow was when he said, “I feel hurt too when friends and other folks tell me that they are pregnant!” My heart broke; he has born so much for and from me! And yet, there is not much I can do, I feel helpless! Somehow I cooled down after a big bowl of vanilla ice cream and hot fudge, and some sleep! We discussed about my breakdown the next day. He asked how he could help me help us… and all I could say was that we are doing all we can and I don’t expect him to do anything more - it is what it is ...and eventually I was back to my current normalcy(?)!

I have always dreamt of babies and today my dream is still a dream where as the world seems to have moved on. A few things that flashbacked at me when I heard the last pregnancy news…
-We moved into our house approximately 2 years ago and I had dreamt that soon we would have a cute little baby and our neighbor’s would coo over him/her! One of our neighbors now has a 4 month old adorable baby girl!
-We went to one of the local spring fest’s a few weekends ago… we had been there last year too with a pregnant friend of ours… and I had hoped I would go with a pregnant belly this year… that friends baby is now almost a year old!
-At a baby shower last summer, I won most of the games we played and everybody teased me that it’s a sign and I would probably be the next mommy in the group, and here I am typing away almost a years since then.
-One of my neighbors who I grew up with got married a year after us, and I was surprised that I hadn’t heard that she was pregnant yet (since the whole world seems to be popping kids), and the day of my IUI, my father had to tell me that she was 4 months pregnant with twins!
-One of the non-IF blogs I follow, the female has a 3 year old son, they decided to take an EU trip last fall before they could start planning for a sibling for their son, and now she is already pregnant - with twins!

Even before we started riding the IF highway, we have always tried to keep ourselves busy over the weekends, either with small house projects or entertaining friends at home or going out somewhere. Weeks just fly by, and it helps to not have free time on weekends to build demons in my head. Last to last weekend we had two families over for dinner. Both the ladies have babies (who are two months apart), and they couldn’t stop discussing their infants… I guess I am going to have to be smart enough to not bring “mother” friends home! Though what do I do if/when everybody I know is almost into their motherhood?

I sound like a mean old b#$%* who can’t stop whining! I am not jealous (as yet), but I can’t fathom the idea that it’s so easy for some… the suspense in my life kills me!

The IF ride is so over powering, that I have realized that I am willing to let go of a lot of hang ups and insecurities I have had before. I am (more) willing to accept that time changes everything; things and relations don’t remain the same. No relation is indispensable, yet cherishable! Every person has the right to be irrational, insensitive and stupid… and I should not be getting hurt! Life is too short and anything could happen to anybody at any time.

I debated if I should have taken the HPT before I went to the RE’s office for bw (during the 2ww). I knew the HPT’s could be wrong or could possibly not detect the hormones in the blood… but, I was trying to figure out if I should give myself a relatively sober birthday (if it’s a BFN) by knowing in advance or wait for the bw a day before my birthday! I have had all new symptoms this time (pregnancy?), though it could be the progesterone suppositories I was taking! As optimistic as I wanted to be, I am already sick of getting hurt and betrayed. This wait is annoying!