CANCELED!

We've decided to cancel our IVF. I went in this morning for my last ultrasound monitoring appointment and what started as 6 good looking follicles during ultrasound #1 and then turned into 3 o-kay follicles during ultrasound #2 is now only 2 follicles with a smaller one at 14.5 mm that MIGHT grow a little and release with the trigger shot but that's a big maybe. So, 2 follicles is not worth the almost $10,000 that we would have to pay to go forward with an IVF. Oh yeah, and the uterine lining has shrunk ... it was 8.3 mm on Wed and only 7.8 mm today. Yes, there can be some variability due to operator error but I could tell right away that it just didn't look as full and vibrant on the screen as it did on Wednesday and my doc remeasured it 3 times to be sure and all 3 times it was b/w 7.6 - 7.9. I'm completely baffled at this point.

It's a total bummer, obviously, but strangely, I'm kind of numb to it. I was pretty down on Wednesday when it was obvious that this IVF wasn't progressing as we had hoped but since then I've just kind of lost any emotion I had (and this with an extraordinarily high estrogen level). I can't explain it but I think I'm just so done with all of this BS that I no longer have the capacity to care. I've dealt with so many curve balls and frustration over the years that I'm just DONE. 

Dr. K had me go ahead and get one more blood test to check my current E2 and P4 levels. If they are o-kay, we are going to go ahead and convert this cycle to an IUI instead, since I do have 2 good follies (a 27 mm and a 19 mm) and a decent lining. Who knows, 3 of them have resulted in conception in the past ... maybe we'll get another (preferably one that sticks around).

If, however, the IUI doesn't happen or doesn't work, we are going to wait until after we go to Bali later in the year to try the microdose lupron protocol. That will give us some time to recover a bit from what we have already spent and replenish my supply of fertility drugs. {SIGH}

Oh, I do have to give kudos to my honey though, he's been so sweet and attentive during all of this and willing to do WHATEVER was asked of him! This morning, when I called him with the results, he was really compassionate and he said he's really proud of me and thinks I've been doing a really good job and that with all of the appointments and shots (not to mention the horrible bruises that are all over my stomach!) he is really impressed with how well I've handled everything. That choked me up more than anything!

Pretty Lame When No-one Shows Up to the Party

You know that feeling when you've spent a ton of time and money cleaning your house, decorating and cooking and you get a lame turn out for the party you were preparing for? Well, that's kind of how I feel right now! Remember that party I was supposed to be having in my recently remodeled uterus? Yeah ... that's not really happening!

I went back today for my 2nd ultrasound monitoring appointment and only the 2 largest follicles have grown much and the 2 smaller ones have actually gotten smaller (grrrrr)!! it's looking like, at the very best, we may only be able to hope for 4 eggs (and that's assuming they're all mature/viable), MAYBE 5, but that's doubtful! I just don't know if it's worth moving forward with this cycle or not (for IVF).

Dr. K said we might consider cancelling this cycle and trying a different protocol. Although, he did admit that he just doesn't know if we can expect another cycle to turn out any differently! The pattern of one follicle growing quickly and really outpacing the others is very consistent for me, so I really don't know that I trust that anything will be different with a different protocol. The really frustrating thing is there is nothing, to date, in any of my tests or bloodwork results, to suggest that I should be such a poor responder to ovarian stimulation, so what the heck is the deal?!?

While typing this Dr. K called with the results of my blood work from today's appointment. The estrogen (E2) results were nice and high and the progesterone (P4) results were nice and low. He said he's happy with the results and that he's encouraged that my estrogen is high, because, typically, there is a positive correlation with high estrogen and egg quality. So, in general, that means that although there aren't many eggs, they seem to be producing good estrogen. Since my P4 is still well within pre-ovulatory range the plan is to continue with the meds tonight and tomorrow, with a follow-up P4 test tomorrow to make sure it's still on the low side, and then go back in on Friday for another ultrasound to see if any of the smaller follicles catch up.

Dr. K did say that he doesn't feel this cycle is bleak and that although the response isn't what we had hoped for, there is still a good chance for success, although the likelihood of having anything to freeze is very, very low.

Friday is the crossroads: if there are 4 follicles or less we have to make the decision whether to go forward with the egg retrieval (low numbers) or cancel and sacrifice the $1000 in u/s and office visit fees + a week's worth of stims (~$2500) that we've already spent.

IVF = Bad Gas Mileage

IVF is not very gas efficient, that's for sure! Once the meds start there are ultrasound appointments and blood draws, typically, every couple of days. With my Dr's office being located in far south Austin (off of Ben White Blvd) and my office being located in far northwest Austin (Parmer and RR 620), I'm definitely putting a few miles on my car running back and forth to appointments and spending far more time than I prefer in Austin traffic as I traverse the city, often times during rush hour.

At my first u/s monitoring appointment (Monday, 7/11) there were 6 actively growing follicles, which measured: 16.5, 12.8 and 9.8 on the left and 15.5, 16.8 and 11.7 on the right (they are considered "mature" and possibly ready to go when they reach 17+).

I'm not thrilled with the response so far but I'm trying to remain optimistic. There were 8 follicles during my initial antral follicle count so I was hoping to get at least that many mature follicles and maybe a couple more but so far it appears there are only 3 on each ovary actively growing.

Since there are a couple of follicles outpacing the others in the cohort (i.e. the 16.5 and 16.8), Dr. K had me go ahead and start my Ganirelix shots as well, which will hold the larger follicles at bay while the smaller ones catch up. I'm hopeful that the Ganirelix may also allow the recruitment of another couple of follicles, but we'll just have to wait and see. With the addition of the Ganirelix that makes a total of 5 shots in the belly every.day. Fun times!

I am, however, pleased with the endometrial lining, which was 7.4 mm. I've had trouble in the past even getting the lining to grow to 7 mm, so to be at 7.4 mm after only 3 days of meds is pretty exciting! Dr. K was really pleased with that as well, he also said the overall shape and look of the lining was a lot better than in the past, so hopefully the delay for the hysteroscopy is going to pay off!!

Next appointment is Wednesday (7/13).

Let the Party in My Ovaries Begin!

The results of my repeat estrogen tests on Tuesday (7/5) and Thursday (7/7) were both less than 50 so I started taking my IVF fertility meds this morning! The goal is to stimulate multiple follicles to grow simultaneously so that we will, hopefully, have a good number of mature eggs available for retrieval. I uploaded a picture of my stimulation meds to give an idea of how many drugs are involved in this process.  I will inject all of this (2 injections in the belly twice daily) in 7 - 10 days, pretty staggering!

I'm Good With Perfect

Well, it wouldn't be me if there weren't a few curve balls. I went in Friday 7/1 for my baseline ultrasound and bloodwork, with the anticipation of starting medical stimulation the following day. Everything looked great on the u/s but my  b/w results revealed an elevated estrogen level. Dr. K wants to see it below 50 and it came back at 70. So, instead of starting stims on Saturday, I went back on birth control pills for a few more days of additional suppression.

Needless to say, I had a bit of a freak out when I got his phone message b/c I felt like I had JUST gotten myself into a really positive frame of mind and then I was delayed again! 

However, I talked to my Dr the next day and he made me feel a ton better! He said this is not out of the ordinary at all and that I shouldn't feel like something has gone wrong, rather I should just think of it as the first step in the tweaking process to make sure everything is perfect. As I said to him, "I'm good with perfect". He said he even thought about going ahead and starting me b/c my levels were not that elevated but he didn't want to look back and wish he had done anything differently.  

So, I'm back on BCPs for the next several days then I'll have my estrogen level checked again. If the results are at an acceptable level we will move forward with stims, likely by the end of the week, but if not I'll stay on BCPs for a while longer. I guess this is another test in just "trusting" my doc!

All Systems Go!

The seemingly never ending month of healing after the hysteroscopy procedure finally ended and I went in yesterday for a follow-up saline infused sonogram to make sure everything healed properly. I was sooo nervous b/c the last SIS was so incredibly painful that I kept going back and forth between feeling like I was going to vomit and being on the verge of passing out. However, yesterday's exam went great, with very minor cramping, and everything looked "perfect" (in the words of my Dr). He said they like to see a nice paisley shape with no scar tissue and sure enough mine was a smooth, picture perfect paisley! HOORAY!!

So it looks like we are "All systems Go" for IVF #1 Take 2! I will continue to take birth control pills for another 2 weeks (this is to "quiet" the ovaries and help them to respond better to medical stimulation) and then my baseline bloodwork and sonogram is scheduled for 7/1. I'll start medical stimualtion a couple of days later for 8 - 10 days and then the egg retrieval and egg transfer will likely be sometime during the 2nd week of July.

I'm equal parts excited and nervous, which I know is normal. However, I've actually been having some second thoughts. Lately, I've been able to really step away from the pressures of trying to conceive and I honestly feel like the "fever" has passed a bit and I've been sooo much happier. As busy as I've been recently, I've also been having a lot of fun and really enjoying my freedom and independence. I've been exercising more again and generally feeling much more like my old self. Sadly, I haven't felt that way in a very long time.

In hindsight, I now realize what a horrible grip infertility had on me and how truly depressed I was. I DO NOT WANT TO GO BACK THERE!!! I'm absolutely terrified that this process is going to cause me to stumble and relapse and I have no interest in going back into that deep, dark hole that I was in previously. I'm just hoping and praying that I can take this "detached" attitude that I've developed with me through the process and, come what may, just keep going when it's all over and done with.

Frankenuterus

Last Friday I went in for my post-op appointment and to have the uterine balloon/stint removed and, as always, it was ... interesting.

When my Dr tried to remove the saline from the balloon he wasn't able to get anything out of it, so he went ahead and removed it (which hurt like a {fill in your favorite explitive here}) and it was completely empty! Obviously, I was a bit frustrated that I suffered with mild cramping and other unpleasantries throughout the week, basically for nothing, since the balloon wasn't fully inflated while the lining was healing/regrowing. 

Perplexed, Dr. K filled the balloon with saline to see if he could identify the leak and we finally determined that it was the valve at the end of the catheter; each time it got bumped a drop or two of saline came out. However, Dr. K did say he felt like the balloon still helped, even though it wasn't fully inflated b/c it created a physical barrier to keep the uterine walls from touching while they healed. We are going to do another SIS in a few weeks to make sure everything healed up properly. Yay (said with dripping sarcasm). 

We also reviewed the pictures that he took during the procedure where he identified and removed some scar tissue that was creating a "wall like" structure at the top of the uterus near the opening to the right fallopian tube. We looked back at the pics from my previous hysteroscopy in Jan 2010 and an SIS I had done in July 2010 and nothing like that appeared, so it is baffling as to where the tissue came from. He told me that he can't explain it and if he hadn't seen it with his own eyes he would think it was two different uteruses! OF COURSE it would be my luck to have the most unique uterus known to modern science. As I told the Dr, apparently I have a Frankenuterus! Grrrr. For what it's worth, Dr. K. didn't agree that it is a Frankenuterus but he did admit that what he found was strange.

Oh well, onward and upward, hopefully this is just the remodeling my uterus needed to create the perfect habitat for a thriving embryo!

IVF Here We Come ... Not so Fast!

In April 2011 I began taking birth control pills (BCPs), which is the first step in the IVF protocol that Dr. K prescribed for me. There's also a variety of blood tests and exams that have to be conducted as part of the IVF checklist prior to starting fertility drugs. One of these procedures is a saline infused sonogram (SIS) to check the uterine cavity and make sure everything looks alright prior to doing the IVF. I had the requisite SIS done a few weeks ago and, surprise, surprise an "unidentified" uterine mass of some sort was discovered and much to both my and Dr. K's chagrin, I had to have yet another hysteroscopy (this is hysteroscopy number 4, for those who are counting).

This past Friday (May 6) was the procedure and we were anticipating that it would be pretty simple. I was even expecting to be able to attend a friend's birthday celebration later that evening. Since it was "just" a hysteroscopy I anticipated that I shouldn't have too much discomfort. I guess that's what I get for making assumptions!

What was supposed to be a fairly simple, routine 30 - 45 minute procedure turned into an almost 2 hour, extensive, uterine "cleaning". Dr. K ended up finding a lot of polyps (he said there were many more than what he was expecting based on the SIS) as well as some more scar tissue at the top of my uterus (similar location to where it had previously been removed during the June 2009 procedure)! He said he probably went a bit above and beyond what was necessary but he wanted to be sure that he got everything and that the uterine environment will be as clean and hospitable as possible. Also, since the procedure was so much more extensive than expected, he went ahead and inserted a stint/balloon to allow the lining to re-grow and the uterine walls to heal without touching and hopefully avoid any opportunity for additional scar tissue to develop. Needless to say, I ended up spending the rest of that day and night laying on the couch, catching up on the shows I have been DVRing over the past several months!

We now have to wait for the uterine lining to heal and re-grow and then I start BCPs again.

2011 Re-Cap

It is now clear to us that conception will not be achieved through conventional methods and the less invasive, less costly forms of fertility treatment will not get us to the goal of parenthood. Therefore, we have both maxed out our health/flex savings accounts for 2011 in order to come up with the approximately $12,000 it is going to cost to do IVF. This is the last option for having a child of our own and given the expense, realistically we only have one shot at it!

2010 Re-Cap

In January 2010 my new RE, Dr. Shar Kavoussi, performed another laprascopy and hysteroscopy. The results revealed some additional, minor, endometriosis and, more significantly, quite a number of uterine polyps (again!). It was now clear that I had an issue with polyps and we needed to try and get pregnant as quickly as possible before any more developed.

Dr. K switched me from clomid to Femara because my uterine lining had become very thin and we were concerned it was a side effect of the clomid (which is fairly common). I responded well to Femara but unfortunately I continued to have trouble growing a lining that was thick enough to support a pregnancy. I also began to see a mayan abdominal masage therapist and consulted with a couple of midwives/doulas. Despite our best efforts, the year 2010, four more IUIs (eventually graduating to injectable fertility drugs to assist with ovarian stimulation and lining growth) and several thousand dollars slipped away, still with no success.

2009 Re-Cap

The next step was to try ovarian stimulation via clomid and IUI, to the tune of approximately $700/cycle (all out of pocket since insurance does not cover fertility treatments).  We tried our first IUI cycle in February 2009 with no luck but our second attempt, in March 2009, resulted in the faintest possible positive line on a home pregnancy test. We were cautiously hopeful that this might be it!

My first beta HCG (blood pregnancy test) came back later that day at 19 but it should have been around 100. Immediately, my Dr's nurse was warning me that things didn't look good. I continued to get betas taken every other day or every 3-4 days and, surprisingly, the levels continued to rise at a good rate but they were still well below where they "should" be. However, we were trying to stay positive and starting to get excited b/c the numbers were increasing really well and there are plenty of stories of perfectly healthy babies that had low rising beta numbers to begin with.

At 6 wks 2 days we had our first ultrasound (u/s) but there was nothing in the uterus. So, the Dr. determined that it was most likely ectopic. I was devastated ... I just couldn't wrap my brain around the idea. I had no risk factors what so ever and had absolutely NO typical symptoms. I went in for a second opinion u/s the following day at an independent imaging center but it showed the same thing, an empty uterus. However, they did not see anything in the tubes either. This was strange because my beta numbers were high enough at this point that a mass should have been visible SOMEWHERE. Two days later we went in for another follow-up u/s with the Dr. I was expecting/prepared (but not happy about it) to receive a methotrexate shot to terminate the, presumably, ectopic pregnancy. Shockingly though, during the u/s not one but TWO gestational sacs showed up in the uterus. It was a miracle (just happened to be Good Friday)! So we were back in the hope boat.

The following week my beta numbers started to really slow down but they were well in the 20,000s range so that's not totally out of the ordinary. That week's u/s showed that both sacs had grown in size but it appeared there was still nothing in them. So, we had to wait another week wondering if we were really "preggers" (it's amazing how LOOOOOONG a week can seem). The next u/s appt finally rolled around (I was 8 wks 3 days at this point) and sadly the results showed that the larger sac had barely grown at all and the smaller one was getting smaller and they were both still empty. The Dr informed us that it was not a viable pregnancy and I ended up having a D&C two days later, which was Friday, April 24, 2009.  It was an incredibly hard month of waiting and not knowing, being handed a spoonful of hope and then a bucket full of disappointment.

Unfortunatley, as if we hadn't already been through enough, the universe was not finished toying with us. On May 28 I had a follow-up appointment  b/c the hormone (hcg) levels in my body were not decreasing as rapidly as they should have been. The Dr. did another u/s and found a mass of pregnancy tissue ("remnants" is the lovely term they use to describe this) still remaining. Therefore, I had to have yet another D&C, making me the lucky recipient of not ONE but TWO D&Cs for the same failed pregnancy! It was a pretty awesome couple of months to be sure (note sarcasm and eye rolls)!

My Dr. called the day after the procedure to discuss what he found. It turned out, I had an 'atypical' shaped uterus (we already knew this from the previous HSG), which is shaped more like a "T" than an upside down triangle (normal shape). As it turns out, there were these two small 'pockets' on the outer edges of my uterus (i.e. at the ends of the top cross bar on the "T") and the residual tissue mass was lodged in one of those pockets. The Dr said it was also 'unusually adherent' tissue, therefore that's why my body couldn't pass it by itself. He indicated that he did "some work in there" to try and reshape the uterus a bit. I'm not exactly sure what he meant by that but we were hoping that might explain our otherwise unexplained fertility issues and help with future attempts! On Friday, June 19, 2009 I got my last blood test and the results FINALLY came back as negative (almost 3 months after we got that initial positive home pregnancy test)!

The next two IUIs we tried both resulted in pregnancies as well (August 2009 and October 2009) but sadly, they too failed (luckily though no more D&Cs were necessary). We did one more IUI in November 2009 without success. At this point I was beyond frustrated and decided to consult another RE to get a second opinion and see if there was something we may have missed, meanwhile I also started seeing an acupuncturist on a regular basis.

2007 - 2008 Re-Cap

We started trying to conceive (TTC) by  "not avoiding" in early 2007 (I was 33 at the time and Brian was 37). After several months of no success it was time to get our butts into gear and actively started  TTC in Sept 2007. I quickly realized something wasn't right when:

a.) we weren't having any success and

b.) I was consistently experiencing spotting in the middle of my cycles, which seemed odd.

Off to the ob/gyn I went and she ordered the usual battery of fertility testing (both his and hers). The results indicated everything seemed pretty normal for both of us except the results of an HSG ; it appeared I might have a slightly atypical shaped uterus and the radiologist that interpreted the test results thought that one of my tubes may have been partially blocked. This landed us at an initial consultation with a reproductive endocrinologist (RE) in Feb 2008.  The RE didn't seem to think there was anything terribly wrong with my uterus and that my tubes appeared to be fine. The options he layed out were:
1.) go straight to fertility treatments and try intrauterine insemination (IUI),
2.) surgery consisting of a laparoscopy and hysteroscopy,
3.) do nothing and continue trying on our own.
At this point we were still very much in denial that we couldn't do what everyone else around us was doing so easily and get pregnant on our own, so we chose to wait a while longer and see what happened. Well, nothing happened, so in June 2008 we decided to move forward with the surgery.

As a side note, the vast majority of health insurance in this country does not cover fertility treatments, however, most insurance policies do cover "the diagnosis and treatment of an underlying cause of infertility". Our insurance, being consistent with the norm, would cover the diagnostic procedures and surgery but wouldn't cover any kind of "treatment" (i.e. IUI), so we opted to try the surgery and see if we could figure out the problem and fix it. The results of the surgery revealed some mild endometrioses, several uterine polyps and one fibroid, all of which the doctor removed/corrected during the procedure. He also tested my fallopian tubes and confirmed that they were clear. We were hopeful that this was the cause of our baby making challenges and continued TTC as soon as we got the "all clear" after the surgery. Disappointingly, the surgical "clean up" didn't do the trick and by the end of 2008 we were still babyless.

Let's Catch - Up

The past four years have gone by in a flash as we have been busy trying to start a family ... along with Brian finishing grad school, starting a new job, both of us working full time, remodeling our house, travelling, and me returning to school for my MBA. I will attempt to briefly re-cap the trials and tribulations that have characterized our journey and will organize it as separate posts listed by year (it's pretty sad when you can quantify the attempt to start a family in terms of years).