A Good Sign

Today was an odd one.  Changes at work which have lots of my friends and coworkers concerned.  I completely understand where they are coming from, but I can't let myself get caught up in worrying.

I saw a doctor in my primary care physician's office on Monday in order to get the referral for the hematologist.  She questioned why my RE would have ordered all those blood tests after only one failed IVF attempt.  She actually said, "The thing is, if you do enough tests, eventually something will come back abnormal" and then promptly listened to my heart and lungs and felt my throat while having me swallow repeatedly.  When she asked if I was feeling otherwise okay, I said "I'm perfectly healthy with the exception of not being pregnant."

She then advised that she felt a nodule on my thyroid and was ordering an ultrasound and blood tests.  She'll call me if anything comes back abnormal, but said I probably wasn't pregnant due to a thyroid issue.  After all, she is an endocrinologist, even if not a reproductive endocrinologist.  She suspects that the PAI-1 gene anomaly is actually a "red herring."

So now I'm waiting for my referral to the hematologist and for an ultrasound of my thyroid.  On a side note, this doctor did say that it is up to my RE whether he wants to put me on an aspirin or Lovenox protocol and hematologist really doesn't need to be involved in that decision.

I have yet to speak with my RE about all this, although I did speak to his nurse about it and, while she did say he would call me today, he did not.  Still...I'm not going to get caught up in worrying.

As the work day was coming to a close, an allergy attacked seized control of my body.  I've been sneezing fairly uncontrollably for the past hour.  I took Benedryl 30 minutes ago to no effect.  The last time this happened was while I was taking Clomid.  Before that, this type of allergy attack occurred while I was taking birth control pills.

I don't know if this means that the Lupron I started yesterday is effecting me on some level or if some allergen just get into my system.

Still...I'm not going to get caught up in worrying.

As I pulled off the freeway near my home, rain started to fall.  Big drops splashed on my windshield, hood, roof.  Thunder rolled and a flash of lightning brightened the skies.  Moments later I pulled into my driveway to be welcomed home by a double rainbow over the neighborhood.  And while the dogs aren't terribly happy with the weather, I think of it as a good sign.  Of what, I'm not so sure, but a good sign all the same.

And So It Goes

I have had a lot of conversations with the RE over the past week.  In fact, I think today is the first day I haven't spoken to him since last Thursday (the weekend not included).  It feels odd.  I'm kind of hoping to hear from him regarding the various blood tests that were being run.

As for those tests, one result has come in.  Apparently I have an anomaly in my PIA-1 level.  Most people have an 4G/4G or 4G/5G allele.  I have a 5G/5G level.  My doctor spoke to a hematologist who said that, pending my seeing him or another hematologist, that most likely it would be recommended that I begin a course of injectable blood thinners post egg retrieval.  From the little bit I understand, this anomaly can cause a person to develop blood clots which, in the case of pregnancy, can prevent implantation and could also cause complications further along in pregnancy.

None of the other panels have come back yet.  Hopefully there won't be anything else unusual in those results, so only this one will need to be investigated further.

Of course, my RE wants me to see his friend who is at one of the most prominent practices in the city.  And, of course, they do not accept my insurance.  Even if they did, I would need to get a referral from my primary care physician.

So, in the hopes of seeing someone in-network (of which there are surprisingly few based on a preliminary search on-line), I have an appointment on Monday to secure a referral.  It's not with my primary care (he's booked through the end of October), but another doctor at the practice.  Hopefully his doctor will understand the urgency and will expedite the referral (my the potential egg retrieval date is in three weeks).

Failing a quick referral, I have spoken to the office manager at this specialist's office.  She was lovely.  While an initial consultation is only $325, if the doctor wants to order any tests, those can start anywhere from $200 - $300.  She gave me her direct number and said that, if I can't get an in-network referral quickly enough, I would be able to get an appointment with this doctor within a day or two of calling.

My RE also said that if I'm comfortable with adding the injectable blood thinner to my protocol this cycle, he will prescribe it without my first consulting with a hematologist.  And from what I've read on various fertility sites/forums, most women who have this same anomaly have been put on this med, so it appears to be the most likely course of action.

Tuesday I'm set to begin Lupron again.  While the initial protocol in my calendar dictated no changes from our first (failed) attempt with this med, after speaking with my RE, he opted to increase the dosage to prevent my body from "break through."  I'll know on October 4th if the suppression was successful.  My fingers are crossed.

4:26am

I can't sleep.  My problem is that I'm a thinker.  I always have been.  Hell, referring to obsessions in the title of this blog probably clued you in.

A thought will get in my head and then it's stuck there until something jars it loose or changes proving said train of thought was wrong, misguided or just not worth the time.

I'm having a really hard time letting go of this thought: Maybe we're just not meant to be parents.

I'm not fishing for folks to say "You are!  You are both loving and nurturing."  I'm simply stating what's in my head because, let's face it, when you try and try and try, it starts to feel that way.

Thursday eight or nine vials of blood were drawn to test me for antibodies that might be causing my body to reject the embryos and also to test to see if I might be making blood clots in the uterus which would prevent implantation.  The lab tech was kind enough to tell me my insurance isn't very good and I might have to pay for these panels myself and they're expensive.  Um...thanks D.  My doctor ordered the tests, so there is a reason for them.  It's not like I'm not going to do them, regardless of what my insurance covers.

Tomorrow it's more lab work and another ultrasound.  The doctor wants me to go back on birth control and then likely try a Lupron protocol again.  A protocol which caused an estrogen spike which cancelled the first IVF cycle we attempted.  I honestly cannot understand why we would go back to that and I asked the doctor.  He said we might do Ganirelix, but he wants to make sure that my ovaries are resting so either way, he'll want me on the birth control again.

Eric spoke to him later on.  Apparently the doctor thinks my reaction to the Lupron the first time was a "fluke."  There are a number of other factors that could have caused the spike and he doesn't think it was that medication, although he didn't elaborate on what any of those other factors may have been.  So much for avoiding them.  Supposedly he understands and appreciates my concern and anxiety about trying that protocol again, but he expressed to Eric that he wants to try this protocol again because he believes we might get a better result.

A better result than what?  Not having the cycle cancelled?  A better result than 15 mature and good looking eggs retrieved with the other protocol?  Or does he think the protocol used to get those 15 eggs caused there to be a problem with them, hence the stalling at day four of development?

I'm no expert on this science.  All I have to go with is what I'm told.  When the first cycle was cancelled, I spoke to the doctor and asked him if there was a better success rate with a particular protocol.  He said there wasn't.  Basically it's six of one, a half dozen of the other.  So I'm not sure what "better result" he was talking about with Eric.

I feel like I'm getting so many conflicting messages right now.  And maybe it's that I'm too close to the situation to be objective, but I think I might completely lose my mind if three weeks from now I go in for blood work after starting a Lupron protocol and the cycle is cancelled again.  The doctor said, "You'll probably hate me if that happens."  And while I don't think I would hate him, that's a bit extreme, I'm not sure that I'll trust him.

And on top of the expensive blood panels that my insurance which "isn't very good" likely won't cover and a protocol that I feel will only end in another cancelled cycle, the doctor feels that we should do genetic testing this time around since none of the embryos developed to the blastocyst stage.  My bad for thinking the two grade B embryos they transferred were at that stage.  And what if the testing show abnormalities in all our embryos?  What then?

Am I getting too far ahead of myself?  Yes.  Am I feeling pretty hopeless at this point?  Sure am.  It so different from how I felt when we decided to go down this path.  I was so sure that this would work and I knew it might not happen the first time, but even if that didn't happen, there would be frozen embryos and it would just be a matter of transferring a couple more.  Even that didn't happen.  And ultimately it all comes down to something my body isn't doing or my eggs being the problem.  So much for no one being to "blame."

And I know that Eric isn't putting the success or failure of this process on me, let's face it.  When it comes to fertility, it's always on the woman.  We try everything.  We read everything.  We're pointed to more resources.  We're put through the hormonal ringer.

Like I said.  I'm a thinker.  It's what I do.  And, lucky for me, it's kept me up for the past three hours.  And even luckier for me, I have a whole two hours before I have to leave to be at the clinic again.

Running the Numbers

Cycle 1:

11 injections
1 cancellation due to elevated estrogen

Cycle 2:
16 injections
9 blood tests
6 ultrasounds
1 surgery
4 embryos transferred
0 pregnancies

I'm not even going to get into the financial costs since most of those are still pending with insurance and I'm not at all sure how much we're going to have to pay out of pocket.

Eric is calling later today to make an appointment for us to meet with Dr. Ghadir (hopefully Friday) to go over the cycle and the detailed lab sheets to see if there is anything which indicates why none of the embryos implanted.  Depending on what that shows, we'll try again.

It has not been easy.  Since we started trying to conceive there has been so much hope and so much disappointment.  Every month when I would get my period it would be a disappointment, but at least it wasn't debilitating.  I mean, at least there was fun in trying, right?

The negative home pregnancy test after trying IUI was harder.  I had just hoped even more so that with that little bit of help we'd be there.

Now we've gone through a full IVF cycle and still have a bit fat negative staring us in the face.  When I got the news at 4pm yesterday, I cried...again.  It the hardest I've cried since we started this journey back in February 2009.  I cried so hard that my eye lids are still puffy.

So today I'm wearing what I am calling my power outfit.  It's what I wore on Eric's and my first date.  I wore it again on the night we went out to celebrate our engagement.  So, for what it's worth, I at least look hot, even if I'm not really feeling hot.

Not Much To Say

We're in the middle of the waiting game.  Only four more days to go.  I've driven myself a bit insane over thinking things when the reality is either an embryo has implanted or it hasn't.  There's really nothing I can do at this point to change the outcome of next week's blood test.

Instead I took a few minutes this morning to scan the pictures from the embryo transfer.

These were our embryos.  I have no idea which four were transferred, but I believe the two at the top were the two best out of the bunch.

And this is where they put them.

Don't Count Your Embryos Before They're Hatched

Yesterday was "The Big Day."  It seems I've had a few "The Big Day" days in my time with Eric, our first being our wedding day, the second being the egg retrieval and the third being the embryo transfer yesterday.

I felt a little anxious in the morning.  It wasn't that I was at all concerned about the procedure, but rather that this day had been four months in the making.

Upon getting to the clinic, Eric dropped me off so he could go find parking (the garage for the building is closed on weekends).  I went up to the fifth floor and waited.  One of the embryologists came out, called my name and then took be back to the room for the transfer.

It was a little room equipped with one of the most powerful air conditioning units which was actually labeled "IVF AVF" (I can only assume that it has some sort of a filter to sterilize the air while also cooling it significantly.

I then donned an ID bracelet and gown, popped a Valium and laid back on the table.

A few minutes later the ultrasound tech came in to check my bladder which needed to be full in order to best visualize my uterus.  Check.  My uterine lining looked great as well.

Doctor Ghadir arrived a few minutes.  He was in a jeans and a polo shirt.  Clearly he's only in the office on weekends for procedures since I had always seen him in shirt, tie and slacks on weekdays.  He then showed us pictures of our embryos and gave us the low down.

Two are grade B.  One is still in the morula phase and one is still at the 8-cell blastocyst phase.  The rest aren't developing well.

We started with 15 eggs of which seven fertilized which then increased to nine.  Then we were down to four or five grade A blastocysts and now we only had two good embryos and, let's face it, as Ghadir was running down the numbers my hopes were slowly being dashed.

There aren't any to freeze.  This is it.  If one doesn't take, we would have to go through everything again.  There are no second chances here.

His recommendation was to transfer the four I mention above.  The two that are a bit behind in development wouldn't be worth freezing and it is highly unlikely that all four would implant.

So that's what we did.

After it was done they slid me back on the table, recovered me with blankets, reclined the table and told me to rest for 30 minutes.

And when the clinic's staff left the room, I started to cry.  How is it possible that we went from so many possibilities to so few?  Eric tried to reassure me that there were two good embryos, but I couldn't hear him.  All I could think was that if this didn't work we'd have to start all over again.

The ultrasound tech came back in and said I could get dressed (I guess a half hour has passed) and I was still sobbing.  Eric asked if Dr. Ghadir was still there and she went to get him.

He did his best to assure me that I did everything I could.  I did everything right.  There were two good embryos and the other two may have just been a few hours behind in development.  He told me that some couples never even get to this phase.  Try not to worry, he said.  Try and stay positive.  It only takes one.

And so today, as I type this while laying on my side since I'm not to have the lap top actually on my lap (no one ever should because it's terrible for one's genitals, per Dr. Ghadir), I'm trying to stay positive.  I'm trying to remain hopeful.  I'm trying not to dwell on the ones that didn't develop.

If we end up having to (deciding to) do this all again, he said he'd likely increase the stimulant to try and get even more follicles to develop and he would also recommend genetic testing to determine if there is something else going on.

So the moral of the story is, don't count your embryos before they're hatched.  Otherwise, you might end up putting them all in one basket.

Grade A

According to Dr. Ghadir, when they checked on the embryo development Thursday morning, they had a bunch of "grade A eight celled" embryos going.  He said there was also one at seven cells.  The two eggs which were fertilized with the delayed ICSI procedure aren't doing that well.

I wish I could remember exactly how many grade A eight celled embryos we had developing.  I just don't remember.  I'm generally a smart woman who picks up on what people are saying in conversation pretty easily, but I'm starting to suspect that I need to have a basic knowledge of what is being discussed in order to have that quick understanding.

What's that?  Why no.  I don't have an innate understanding of reproductive endocrinology or embryo fertilization and development.  I've been learning a lot, but, let's face it.  It really is foreign to me.  Grade A embryos.  Excellent!  Although I don't think they can be called free-range or cage-free.  (Ugh...sorry.  A terrible joke that a coworker made, so I had to pass it on.)

Tomorrow is our embryo transfer day.  I'm expecting a call from a nurse at the center to give me the details of when to be there and what I need to do, if anything, to prepare.  Thereafter it's 48 hours of bed rest.  I already know that I'll be going a bit crazy just laying around for two days, but so be it.

In the end, all of this will be worth it.

Take Me Out To The Ball Game!

My phone rang around 11am Wednesday morning.  The caller ID read "Dr. Shahin Ghadir Work" and my heart skipped a beat.  When he called with the fertilization report on Tuesday he indicated that we would speak again on Thursday, so I was caught off guard upon seeing his name on my phone.

Now you have to understand.  There has been much talk of late in my office about a curse.  A number of coworkers have had family members pass away.  Others have been in car accidents or horse riding accidents or were simply afflicted with random, albeit not life threatening, ailments.  And while I'm not one to believe in such things, it has been such a prevalent topic of conversation as of late that for a split second I thought "Oh no.  Please don't tell me something happened to our potential embryos."

Thankfully my moment of worry was quickly replaced with joy.

"Good news," the doctor said.  "All the eggs that didn't fertilize with the natural process were directly inseminated and two more have fertilized.  It's called delayed ICSI."

"Wow.  Great.  I'm always happy to have our odds increase."

I thanked him for the call and quickly called Eric with the news.  He was just as happy as I.

Then I called my mom and confirmed that there are, indeed nine players fielded on a baseball team.  She and I chatted about how I'm handling all the meds I'm currently taking and a little bit about her starting to look at plans for coming out for a visit to help me when the time comes.

Then it was into a staff meeting where the curse was again mentioned.  I leaned next to a coworker I'm close to and said, "The curse doesn't exist.  We now have nine eggs fertilized.  If we were cursed the number would have decreased, not increased."

In the afternoon I spoke to Eric's folks.  He had spoken to them very briefly, so I explained more about it.

Later today I'm expecting a call from the doctor to get an update on the zygotes development.  I'm hoping that he can email me a picture of them.  Not that I expect I'll be able to tell which look like they are developing normally, but just to get a look at them.