Monday, April 27, 2015

FET #2 and on to CCRM

I keep trying to write this post, but then can't, because it's too discouraging. But finally the pain from the BFN it starting to subside, at least temporarily (before it likely roars its ugly head again,) and now that I'm filling out all the paperwork for our next consult, I know it is so helpful to have all my IVF information on here. So here is what happened with the FET:

March 8th - last day of bcps (had been on for 2 months prior)
March 11th - started period
March 13th - baseline ultrasound - lining thin, no cysts, start estradiol 2 mg tid
March 14th - 20th - awesome vacation with my husband, sister, and brother in law. Do develop hives on March 16, likely secondary to wet suits from scuba diving and start Claritin.
March 23rd - bloodwork estrogen 260
March 24th - hives gone, stop Claritin
March 26th - bloodwork estrogen 374, lining 8.5 mm but not trilaminar throughout. Start Viagra suppositories tid.
April 2nd - lining 9.5 and trilaminar. Start PIO 1 mL at 11 am.
April 7th - Lining looks great, transfer goes smoothly. However, counseled that our genetically normal embryo was rated as poor prior to freezing and is still only rated as poor now.
April 13th - 6dp6dt HPT negative, call CCRM to schedule consult
April 17th - 10dp6dt beta negative.

Today we had our consult with CCRM. We talked with Dr. S, but the less famous Dr. S at CCRM. He was very friendly and positive. He wants to investigate a few things before moving forward (me getting a karyotype and checking K's sperm fragmentation) but he thinks with the right protocol (undecided at this point) and their awesome lab, we have a good chance. He said it would be very unlikely for someone my age to have no normal eggs, but he also thinks something else might be going on with K, since he does not think the translocation is the source of his 0% morphology. We are planning to go out to CCRM in early June. Maybe if we are lucky we can do our day 3 labs that same cycle... I'm not sure if that is possible before I've been seen in person. In the meantime my RE here can order my karyotype.

Thursday, February 5, 2015

Retrieval, Fertilization, and Biopsy Results

Sorry for the delay but here is how things went:

Retrieval went well. It was on a Tuesday. Kevin said it only took half the amount of time it took last time and Dr. V said that my ovaries "felt" healthy based on the resistance she had while retrieving the eggs. I woke up to great news - 23 eggs retrieved! She was worried about OHSS however and had me take my one leftover Ganirelix when I got home and start Cabergoline for 8 days. I felt crampy (but less than last time.) However, I think Thursday was the roughest because I went back to work Wednesday and by Thursday I was barely waddling. K went out of town for a marathon and thankfully my aunt came from out of town to take care of me and E, since he was too heavy for me to lift. We had a great time.

The day after retrieval I got an email saying that of the 23 eggs 16 were mature, 3 were immature, and 4 were empty zonas. They attempted ICSI on all of the 16 mature eggs. 12 fertilized to a 2 PN which is the normal first stage of fertilization, 2 fertilized abnormally to a 3 PN stage, and 2 did not fertilize. So we had pretty good maturity and fertilization rates. On day 6 I hadn't heard from the clinic, but I saw a charge go through on my credit card from Genesis Genetics so I was pretty hopeful that that meant there was something to biopsy. I called the clinic and finally got a call back a few hours later that 2 embryos made it to biopsy. We elected for a batching option with instant results through Genesis that is a set price for as many cycles as it takes to get a normal embryo. I was very nervous with only 2 embryos, but one of my good IVF buddies kept my spirits up. I was told results would take 7 days, but after only 2 days I had a message while at work that my results were in. I had to wait a few hours to get in touch with the geneticist at my RE, but I finally got a call back. The first embryo had an unbalanced translocation that is consistent with K's balanced translocation :( but the second embryo is genetically normal! It was the best news in months!

We couldn't do a transfer right away because my clinic requires 1 month of birth control prior to transfer. We also have plans to go out of the country on an adults only trip in March, so we decided to wait until after our trip for the transfer. I started birth control with my period after IVF and will stay on birth control till March 8th, when I will stop it. I go in for labs and an ultrasound to make sure things are good to go on March 13th. If things are good I will start oral estrogen. We are planning for a regimen similar to the FET that I got pregnant with E. Then I will go in for a lining check on March 23rd. If things look good I will start progesterone in oil when appropriate for a transfer on March 31.

They gave me the option of any day March 31-April 3 for the transfer, pending things going as panned. If we did April 3rd it would mean a due date of 12/25, which was my due date for my first pregnancy/miscarriage. If things worked out it would feel like a good redemption, but if things went badly I think Christmas would become even more painful, so I decided to avoid that day.

Saturday, January 10, 2015

Monitoring appointment 3

1/9: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
1/10: 1 vial Menopur bid, 75 Follistim am only, and 10 units micro dose Lupron bid
Ultrasound 10 measured follicles on right 13-20 mm + several smaller, 6 measured on left 13-19 mm. Estrogen 3249.

I had my monitoring ultrasound and the doctor said the follicles looked packed in! (I believe in a good way, as in there were many.) She said I might be ready to trigger tonight, but was also willing to let me stim one more day based on my estrogen result. I saw quite a few 13 mm sized follicles on my ultrasound today, and I want to give them a chance to reach 15 mm - the minimum size for maturity - so I asked to stim for one more day. Since follicles grow about 2 mm per day one more day should be perfect for us to hopefully get a few extra eggs. The largest follicle was only 20, so it would only reach 22, and follicles don't get over mature till over 24 mm, so we should still be safe there. I voiced this to the doctor, who agreed. Even though my Estrogen ended up coming back at 3249, she said it's ok to stim one more day, but we will hold Follistim tonight and tomorrow and just do Menopur. She thinks that's enough hormone not to deprive the follicles, but decrease my chances of OHSS. My estrogen will likely be above 4000 at trigger tomorrow, which they like to keep it below due to OHSS, but she is ok with that since we are not doing a fresh transfer (getting pregnant with a fresh transfer worsens OHSS due to beta-hcg.) So our plan for the next few days is:

1/11: 1 vial Menopur and 10 units micro dose Lupron in am, HCG trigger at 7 pm
1/12: Blood draw to check HCG level to ensure adequate level
1/13: Retrieval. Show up at 6 am.

Thursday, January 8, 2015

Monitoring appointments 1 & 2

1/2: 10 units micro dose Lupron bid
1/3: 150 Follistim bid and 10 units micro dose Lupron bid
1/4: 150 Follistim bid and 10 units micro dose Lupron bid
1/5: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
1/6: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
First monitoring ultrasound: lining 2.5 (was just finishing my period), all follicles under 10 mm, ~30 on right, ~20 on left. Estrogen 411.
1/7: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid + Humira in pm
1/8: 1 vial Menopur bid, 75 Follistim bid, and 10 units micro dose Lupron bid
Second monitoring ultrasound: lining 9, R ovary: 13, 12, 12, 11, 11, 10, many under 10, L ovary: 10, 10, 10, 10, several under 10. Estrogen 1338.

It looks like things are going well this round. I'm much happier with my estrogen. I think it might get pretty high by retrieval, but hopeful that will be in indication of many follicles, and many mature follicles. I am going to continue the same dose of meds and return for an ultrasound on Saturday. The follicles are still small but they all are growing, so hopefully it will be a nice, slow, steady increase. There is still time for those under 10 to catch up.

On Estrogen levels I've done a bit of reading, since I was worried with my low levels last cycle. From what I've read the goal is for Estrogen to reach 2000-4000 before retrieval (though I'm not sure if that is the level on day of trigger vs day of actual retrieval). Also there is a handy dandy equation that reflects expected Estrogen levels and number and size of follicles:

E2 = 291 pg/ml + 180 (x) + 64 (y) + 18.7 (z) 
where x, y and z represent follicles measuring >17 mm, 15 to 16 mm, and <14 mm respectively

I've also heard on average a mature follicle will produce ~200 pg/ml of estrogen. So far I'm just feeling a little uncomfortable in my lower abdomen already and had a little GI upset today. Otherwise, I'm feeling pretty happy and hopeful today.

Sunday, January 4, 2015

Trying again

I went in for my baseline ultrasound last Friday and everything looked good (lining ~4 mm, 30 antral follicles on R, 20 on L) so I started microdose Lupron that morning (10 units bid). Saturday morning I added in Follistim 150 mg bid, and tomorrow I add in 1 vial or Menopur bid and reduce Follistim to 75 mg bid. I go in for my first ultrasound to check how things are going on Tuesday morning. The main changes this cycle are doing microdose Lupron instead of antagonist, and doing just Follistim for two days before adding Menopur, which is what I did for my first IVF cycle.

I feel hopeful but also like there is so much standing between me and another baby. In my head I will do this round and if we can at least get to the point of having blasts to test, I would be willing to do it again if there aren't any that are normal. If we don't get any blasts then we will have to seriously think about what to do next. We would likely try going to a clinic that is well known for PGD, which would include traveling... but I know I'm getting ahead of myself. I need to give this cycle a full try, I just feel better having a contingency plan. I was hopeful enough (or more likely concerned about finances enough) that I had them send me the FET meds with my fresh IVF meds all before 1/1/15, since I had met my deducible last year and by some miracle my current plan covered my medications. So hopefully I will get a chance to use those FET meds in the next few months.

Tuesday, November 11, 2014

Well that was a complete failure

Of the 13 eggs (or a baker's dozen as K called it), 10 were mature, 2 were immature, and 1 was clearly abnormal. Of the 10 mature, 8 fertilized. There were doing ok on day 3: 3 or 4 grade B and 3 or 4 grade C (I can't remember if each was 3 or 4 because I was so upset because I only heard this after they told me everything had failed). However, on day 5 none were blastocysts. When they rechecked on day 6 they all had died except one very poor quality blastocyst which "fell apart" when they touched it to try to biopsy. I am devastated. I was worried we might not have any genetically normal embryos on PGS, but I never thought we wouldn't even have any embryos to test. I am 26 and K is 28. His morphology increased from 0% to 4% and he has been taking supplements.

The clinic says they aren't sure what went wrong. I talked to both doctors and heard slightly different information. The first said that they sometimes see embryos go downhill after 4-5 days if it is a sperm problem. The second was worried my UC might have effected my egg quality.

There are only a few differences between this cycle and last:

1. UC
After E was born I was diagnosed with Ulcerative Colitis. My symptoms weren't horrible, but they weren't under control until about 2 weeks before starting IVF. I am taking Hum.ira. Maybe my UC effected my egg quality. Hopefully, now that my symptoms are under control my egg quality might improve. I am going to start taking supplements for egg quality. I searched the CCRM supplement list and am going to take:

DHEA – 25mg x 3/day
Myo Inositol 2gm (twice a day)
Melatonin 3mg (at bedtime)
Co Enzyme Q10 (200 mg x 2/day)
Omega-3 fatty acid 1000mg (once daily)
Vitamin C 500mg (once daily in the AM)
Vitamin E 200IU (once daily)
L-arginine 1000mg (twice a day)
Pycnogenol 100mg (once daily)

2. Met.formin
My last IVF cycle I had been on 1500 mg met.formin for ~4 months. This time I was only taking it inconsistently few 2-3 weeks. I was really really nauseous on the bcp for IVF, and I thought the met.formin might be contributing so I didn't take it as often. I had my hormones checked and they did not show a typical PCOS pattern, so I figured I didn't really need the met.formin. However, now I am back on the 1500 mg and will take it everyday.

3. Medications
The main difference in medications was 1st cycle I did follistim only for 3 days then added menopur. I took them both together at night. This time I started menopur and follistim on the same day and took menopur in the morning and follistim at night. I also took about twice the total amount of injections this time (150 follistim vs 75 per dose and used 11 total vials of menopur vs 5), since we were trying to get more eggs. We got 13 vs 11 last time. Also, I used 4 vials of ganirelix vs only 1. I felt they were on the fence on having me trigger on Friday vs Saturday. They had me wait (I think in hopes of having my estrogen rise more, since it still was only 800), where my first Drs had me trigger at a similar stage - part of me wonders if we waited one day too long to trigger (I forgot to ask the Dr this)? I asked the doctor if we used too much drug, and she said no because we still had a healthy total number of eggs and my estrogen was not too high. She says that I required more medications for only slightly more eggs may be a sign of decreasing egg quality, but still my overall dose isn't as high as some women use/need. However, one concern is that my estrogen was never very high and was somewhat low considering my follicle size. Because of this she wants to try a micro dose Lupron flare protocol to cause higher FSH/LH/estrogen and hopefully recruit more follicles and have healthier follicles.

Based on all these things my plan is to give my UC more time in remission before we try again and give the supplements and met.formin time to improve my egg quality. I have heard you need about 3 months. At this point based on my schedule I could work in another IVF try in between January 12 - February 8th (which would give me only 2- 2.5 months) or March 9 - May 3rd (which would give me 4-4.5 months.) The only problem till waiting till March is if we do have success in creating blastocysts that we can biopsy and freeze, based on K's translocation they estimate only 20% will be normal. We could have no normal embryos and would need to cycle again. However, we move out of state again at the end of June and my May schedule is not really amenable to another IVF cycle. We could possibly squeeze in another cycle in June, but then would have to return to the clinic at a later date to do the FET or have the embryos transferred to a different lab closer to where we move for the FET. I'm not really sure on what to do at this point. Do you think I can improve my egg quality enough in 2 - 2.5 months or should I wait 4 - 4.5 months?

Another thing to question is if we should do anymore testing on K. One doctor suggested testing for sperm DNA fragmentation, but even if it is fragmented there isn't much was can do. They can do a testicular aspiration to get sperm, but there is not much evidence on this improving outcomes. Plus, we were told that many of K's sperm with unbalanced mutations probably don't make it out of the testicle (this his lower concentration), so if we aspirate we could get an even higher percentage of abnormal sperm. If it was super fragmented I would still want to try again with his sperm, since we know it worked once. It's hard to give up on his sperm or my eggs at this point since our first IVF was successful. I hope we can figure things out.

We also have considered talking to our original clinic, but it would be incredibly difficult to get back there to cycle (as it is 6 hours away.) The only way it would work is if I could do monitoring here, which I'm not sure they would agree to, and only go back for retrieval. At this point I am willing to give this clinic one more try. If we have complete failure again we would not try at this clinic a third time. There is no other clinic other than the one I am at for several hundred miles, so we don't have another close option.

Any suggestions or opinions on what we should do?


Monday, November 3, 2014


Retrieval was this morning at 7 am. They retrieved 13 eggs, which I am happy with (but doesn't everyone wish for more.) We will find out tomorrow how many were mature and fertilized.

The bad part is that I don't feel the best. I already had a sore throat and cough before retrieval. Now I am also very crampy and when I cough my shoulder kills me - I'm not sure if it is referred pain or what. I'm definitely more uncomfortable than I recall being after my last retrieval. The doctor today had to push the retrieval needle through part of my cervix, which caused bleeding, and she had to put a stitch in my cervix.

I'm trying not to stress too much. It's hard not to start doing math. I have 13 eggs but not all are mature, not all will fertilize, not all will make it to day 5 to be biopsied, and not all will be genetically normal. I hope in the end I will have a few healthy, genetically normal embryos to transfer.