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! :(

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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!

My Hero!

My Grandmother is supposed to be visiting me (us) for a month… I am so excited!!! She doesn’t live close by and as a result never really visited me since I started college… graduated… started working… got married and settled down. However, I visited her often, so it wasn’t like we have not seen each other for ever! Though, her visiting me and the time we will spend together is a very special period in my life!

A little bit about my Grandma: She is in her (very) late 70’s, has seen poverty and injustice and has struggled to successfully overcome that. She lost her eldest son (my uncle) three decades ago to some illness (unfortunately, it’s never discussed in our family and I am not very aware of the happenings!). Her second son (my uncle) was disabled after an accident when he was a child and things just worsened with time. He passed away last year after being bed ridden for several years. This was another reason why she chose to not travel much (and come see me) for several years. In the interim her husband (my grandpa) passed away of a heart attack (he was 80).

One is not supposed to bury their own children… in her case 2 grown up kids! Things have never been easy for her. Yet, she has coped, survived and grown stronger! She started off as a house-wife and eventually started working at a social organization (to support the family), where they helped women with integrated health care, education, and women’s empowerment. She has risen the ladders at that organization and is now a part of the managing committee at the top. She still works full time (not for money but for the cause) and is not willing to take too much time off work.

Now, she has two daughters (one of them is my Mom) and three grandkids (including me). Besides her work, she is spending time with her daughters and is visiting us this summer. She is full of life, loves to cook and travel. She is the strongest, caring and daring person I have ever known in my life. She gives me hope and strength in this difficult journey of ours (which is probably not very significant as compared to her life story). She is my inspiration, my HERO!

I had hoped that I would be able to give her the good news about her (first) great grandchild, but that still remains a dream. Life is full of obstacle, though it doesn’t end with a failure and she keeps me motivated to keep trying harder! I want to make the best of whatever time I have with her.

What do I think God meant when he gave me infertility?

Couples experiencing infertility often receive well-meaning but extremely insensitive "advice." We can all list the most popular ones: "Just relax and you'll get pregnant," or "adopt and you'll get pregnant," or "things happen for a reason", of the most painful from those who think they've got the goods on God's plan, "Maybe God never meant for you to have children." The sheer audacity of making a statement like that never fails to amaze me.

"These same people would never walk up to someone seeking treatment for cancer and say, "Maybe God never meant for you to live." However, because I am infertile, I'm supposed to get on with my life. It's hard to understand that people can not see infertility for what it is, a disease for which I have to seek treatment. What if Jonas Salk had said to the parents of polio victims, "Maybe God meant for thousands of our children to be cripples, live in an iron lung or die." What if he'd never tried to find a cure? Who could think for one minute that that was God's plan?

"What do I think God meant when he gave me infertility?"

I think he meant for my husband and I to grow closer, become stronger, love deeper. I think God meant for us to find the fortitude within ourselves to get up every time infertility knocks us down. I think God meant for our medical community to discover medicines, invent medical equipment, create procedures and protocols. I think God meant for us to find a cure for infertility.

No, God never meant for me not to have children. That's not my destiny; that's just a fork in the road I'm on. I've been placed on the road less traveled, and, like it or not, I'm a better person for it. Clearly, God meant for me to develop more compassion, deeper courage, and greater inner strength on this journey to resolution, and I haven't let him down.

Frankly, if the truth be known, I think God has singled me out for a special treatment. I think God meant for me to build a thirst for a child so strong and so deep that when that baby is finally placed in my arms, it will be the longest, coolest, most refreshing drink I've ever known.

While I would never choose infertility, I can not deny that a fertile woman could never know the joy that awaits me. Yes, one way or another, I will have a baby of my own. And the next time someone wants to offer me unsolicited advice I'll say, Don't tell me what God meant when he handed me infertility. I already know.

-author unknown

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!