Finally Arrived

It's a Regular High School Clique in There

Here I am on CD 22 of my busted IVF cycle, a week past my disastrous one-egg retrieval.

I should be feeling peachy, physically, anyway.  But instead, I feel like my ovaries are swollen and tender, reminiscent of the times I had ovarian cysts in my mid-20s (ah, those were the days.  I might have actually been fertile back then).  Any movement -- jogging, running up stairs, fifth anniversary sex -- that jostles my personage is quite uncomfortable.

My wild-assed theory is that those damn follicles that were stalled at 3-5 mm have finally decided to join the party, but a week too late.  Idiots.

This isn't the first time this has happened.  During my first IVF cycle, on CD2 I had two follicles on the left and one on the right that looked promising. But by day 12, only the right one had gotten off the couch.  So, we canceled the retrieval, switched to IUI, and I immediately started up IVF #2 once my period arrived.  And on CD #2, they did an ultrasound and -- lo, and behold -- those same two lazy-ass follicles on the left had grown and were already 10mm. 

It was like my left ovary did not get the memo that the follicles are supposed to grow during the FIRST half of the IVF cycle, not the second.  Like it was out of sync with the rest of my body.

Eventually we proceeded to retrieval after just 9 days of stims, retrieved 8 eggs, fertilized 3, transferred one which resulted in an ectopic pregnancy, and froze a blast.

(Are you following all this?  I'm impressed if you can. I feel like I should draw a diagram.)

Fast forward to IVF #3.  Again, on CD2, the left ovary had lots of antral follicles. The right had just one.  By CD 6, only the right follicle had grown.  All those ones on the left were doing nothing.  Eventually, after 13 days of stims, I went to retrieval of just one egg which fails to fertilize.

And now, a week later, here I sit on the couch with cystic ovaries.  I can feel them.  Cannot tolerate the dog lying on my tummy.  Discomfort here at the HoldingPattern house.  Ouchie.

So, I have invented a new infertility disorder that describes what's going on with my body.  My uterus, left ovary, and right ovary are like three rebellious teen-aged siblings that all refuse to speak to each other. In fact, before my tubes were removed, they were in on the game too, deciding to keep fertilized embryos instead of handing them off to their sister, Uterus. Each of my female organs keeps its own schedule and likes to do things its own way. Their common attitude: Who cares if its the appropriate time to get a uterine lining going or a follicle developing? I'm doing it MY way. I know best.  And screw that damn pituitary gland (aka "Mom") trying to control their behavior!   Bitch. 

I call this new disorder "Oo-hystero-salpingo Self-Righteous Bitchitis."

I might use dumb analogies or names for this, but I honestly, truly believe this is what is going on with my body.  But I have never heard of this in anyone else, and am sure Dr. Blonde would laugh if I mentioned this cockamamie theory to her. 

Has anyone else heard of this or experienced it?

IVF #3/ FET #1: Boxing Match Results

"Bob," Announcer #1:  Well, here we are in San Francisco, witnessing a battle royale of epic proportions between Susan Holding Pattern, in the blue corner, and Infertility, in the red corner. 

This battle to the end has waged for 40 cycles, er... rounds, thus far.  Will it ever end?  Will either warrior ever cede to the other?

"Tom," Announcer #2: That's right, Bob.  Throughout the fight we've seen ups and downs. Susan nearly knocked out Infertility in rounds 10 and 29 by getting pregnant, but both times Infertility got up off the mat and exerted severe retribution on Susan,  slugging her with ruptured ectopics.  It basically sent Susan to the hospital, er... corner, for a bit.

Bob: At this point in the match, though, it does seems Susan is over-matched.  She did well in earlier rounds, but, well, 40 rounds is a really long match.  Her endurance is waning. She is stumbling around the ring in a daze, where Infertility still seems confident and strong.

Tom: Gotta hand it to Infertility, it has tons of endurance. 

<RING, RING>

Bob: And round 41 begins.  Susan starts out strong, making a full charge at Infertility.  A right hook with Gonal-F, left upper-cut with Letrozole, and another right hook of Menopur.  Wow! What a combo!...But, UNBELIEVABLY, Infertility seems unfazed.  Not even budging an inch!

Tom: Amazing, Bob. Infertility should be whimpering on the floor after that killer combo that used max doses of every medication available.

Bob: Infertility winds up... and sends a MASSIVE straight punch to Susan's face.  OW!  That's gotta hurt, just one egg retrieved! ...Susan is staggering around...Now Infertility pounds her with a cataclysmal left hook--no fertilization!  A devastating hit.  Susan falls to the mat. This might be it... WAIT! She is getting back up! Stumbling to her feet...

Tom: At this point, Bob, Susan is calling on all her reserves just to get through this round. But she doesn't have much left, I tell you, just one frozen embryo.

Bob: Susan pulls her self together... She makes another run at Infertility, pounding it with everything she has...But again, Infertility unaffected! This thing is a machine!...Infertility hits her with a no-mercy jab-cross-hook combo.  Her one frozen embryo doesn't survive the thaw!  A killer blow!...Susan is down on the mat, struggling to get up. Can she get up?  Or should she just call it quits for good?  The referee starts the eight-count.... 

Tom: No doubt Susan is thinking Infertility seems absolutely unbeatable!  How much more punishment does she want to take?

--------------------------------

Stay tuned to see if Susan is, in fact, down for the count,and whether the match is over.  Regardless, though, this round is over and goes to Infertility.

IVF #3 / FET #1

Hello,

I wanted to thank all of you for your support and kind comments. I don't know how I would get through any of this if it weren't for all of you. 

My husband just says sentences that begin with "Well at least we still have...." True enough phrases, but they don't make me feel any better.

I am still in a Pit of Despair, barely able to function. So, I hope you will forgive me for not answering emails for a bit, and for not commenting on your blogs for a few days.  But even though I am not commenting, know that I am reading!  Every blessed blog listed on my sidebar, multiple times a day.  It seems blog reading is the only thing I have energy to do.

Unrelated Question:  Are any of you in the Kansas City area? Looks like I will be there all next week for business, and possibly the following week as well.

IVF #3: Fertilization Report

I received the call.

The lone egg retrieved failed to fertilize.  Yes, we did ICSI.

So now the plan is to try an frozen embryo transfer this Saturday.  We only have one frozen embryo - a day 5 blastocyst. To say I hope it survives the thaw is an understatement. I feel like my life depends on it.

I must go. I suddenly feel that I must throw up this instant.  I must somehow wake myself from this bad, bad dream. And if it isn't a dream, I must somehow find a way to numb myself enough to function.

Day 2 vs. Day 3 transfer

This cycle is pretty much a bust - only one egg retrieved.  So, I asked for a transfer on day 2 instead of the originally planned day 3.

Why? Because:

1. Embryo are proven to grow better in the uterus than in a petri dish.
2. The reason most transfers are on day 3 instead of earlier is to improve embryo selection; it is easier to identify the embryos with the highest implantation potential on day 3 in later.  For most IVF patients who produce >4 eggs, the benefits of better embryo selection outweigh the risk of embryo arrest.
3. But if you are a piss-poor responder and only have one embryo, selection is irrelevant.  You might as well transfer it sooner to give it a better chance of developing.

For a more detailed explanation of all this, see here.

In fact, now I am thinking that I should have asked for a day 1 transfer...

IVF #3: Just One...

We only retrieved one egg today. 

While I am not surprised, I am profoundly disappointed.  After taking this entire mountain of drugs and then some (I had to buy two more boxes of Gonal-F to get me through 14 days of stims), all I have is one lousy egg.  The same egg I would have produced on my own (I do ovulate) without any drugs at all.

All this medicine, gone to waste.  All those needle sticks, for naught.  All that wasteful packaging, now polluting our landfills.

The thing I don't get is why is this happening to us? I'm supposedly too young, having just turned 35, to have this poor a response.  We started trying at age 31, which should not have been too late.  I did not put child-bearing on hold for the sake of my career.  In fact, I've essentially put my career on hold to have a family which never seems to materialize (I've had interesting job offers that I've declined to keep schedule flexibility and health coverage for infertility ). Not that I'm bitter or anything (yeah, right).

It's bad enough that I have tubal problems (as in NOT having any), but why poor response as well? Aren't I infertile enough already?

Why does God not want us to have children?

My whole life I've always done everything "right" -- the way you're supposed to, the way my parents wanted.  I was a good girl.  I earned straight A's, studied hard, always had safe sex, voted in every election, took care of myself, established a perfect credit rating, did and paid my own taxes, never had a one-night stand, never stole or cheated, gave blood, never tried illegal drugs or gambled, volunteered, never cheated on my boyfriend or fooled around with someone else's man, gave to charities, and tipped reasonably well in restaurants.  In general, since age 11, I've been the epitome of responsiblity and reliability. 

I just wish that any of it mattered.

PS - Okay, I'll confess to some vigorous social drinking in college and B-school.

IVF #3: Images of My Lazy Ass Follicles

My lead follicle, now measuring 17mm, is doing well.  It is reliable enough to hold a regular job, and shows up at the office on time every day.  It's working hard to do the right thing.  It looks like this:

The other follicles are total slackers, stalling out at 3 to 5 mm.  Those follicles are so enjoying that gonadotropin high and blissful relaxation that they can't be bothered to move off the couch and actually DO something constructive. They look like this:

IVF #3: Sticking With Original Plan

So, after spending the entire morning on the phone with the insurance company, I learned that even if I downgrade this cycle to just an FET and skip retrieval, I'll still use up one of my 3 lifetime IVF attempts covered by insurance.** I was told the wrong info by my RE's insurance coordinator.

So, with that in mind we're going to stick with the original plan: proceed with retrieval on Monday 9/12.  If I'm going to use up an attempt, I at least want those euphoric retrieval drugs.

If an egg is actually retrieved, fertilizes, and grows, then we'll do a 3-day transfer on Thursday 9/15.

If  not, then we'll do an FET on Saturday 9/17.

** The attempt is "used up" when either or both of the following CPT codes occur within a week of each other: 58970 - follicle puncture for oocyte retrieval; 58974: embryo transfer, intrauterine

IVF #3: CD11 & The Plan

Had another ultrasound today.  Lead follicle is 17mm, the 2nd is way behind at only 9mm.   No other follicles are growing.  Dr. Blond likes my uterine lining, though, which is 7 mm - very good for me.

Dr. Blond recommended I cancel the cycle and try again another month.  She's hoping that this month is an aberration, since I did get 8 eggs on the same protocol 9 months ago. That way I won't use up one of my 2 remaining "life-time IVF attempts" on a cycle with a bad prognosis.

Good point.  So now I'm confused.

The original plan was:

• Retrieval of one egg, or maybe two if I'm really lucky, on Monday 9/12 (CD16).
• If successful fertilization and continued growth, do a single-embryo transfer on Day 3, Thursday 9/15.  (Because of the shape of my uterus, I cannot risk multiples, so transferring more than one embryo is out of the question no matter how many eggs I produce.)
• If there's nothing to transfer, thaw out my one frozen day-5 blastocyst and attempt a transfer on Saturday 9/17.
• If nothing works, try again next month with a different clinic or move on to adoption.

Note that downgrading to an IUI is not an option because I have no tubes, and therefore my eggs are stranded in my ovary unless extracted via retrieval.

Now I don't know what to do.  My head is swimming.  It all hinges around whether I should use one of my two remaining lifetime attempts covered by insurance?  The insurance company "uses up" an attempt when I go through retrieval.

• Should I proceed as originally planned?
• Should I cancel this retrieval, downgrade to FET this month, and try again next month with the same protocol and same clinic (it yielded 8 eggs last time after all)?
• Should I cancel this retrieval, downgrade to FET this month.  Then, immediately transfer to another clinic that caters to poor responders  (local: Zouves, travel: SIRM, Cooper)?

My head is swimming. All the things I though I had already decided I am now reconsidering.   Am quite confused.

What would you do if you were me?  With no tubes, a history of poor response, high FSH (14.9), quasi-T-shaped uterus that prevents multiple embryo transfers, autoimmune hypothyroidism (Hashimoto's), history of poor uterine lining, mild endometriosis, and increased incidence of miscarriage due to DES exposure and anti-thyroid antibodies, ...

The Good vs. The Bad

The Good:

• I lost 4 pounds this week, for a total of 6 since joining WeightWatchers.  14 pounds to go!
• Things are looking much better at work for me career-wise. Good things will happen come Jan. 1 (I dare not give details in case someone from work finds this blog.).
• I received my brochure for the No. Cal. RESOLVE conference, Options 2005,  on Oct. 29.  It looks great, with tons of sessions on IVF, donor egg, adoption, surrogacy, etc...  If IVF #3 fails, you'll find me taking notes in the adoption sessions.
• I feel a lot healthier since I stopped drinking the soda and eating all the sugar. 
• I ran 4 miles on Monday; slowly getting back in shape.
• I've updated my blogroll so that it displays all the blogs that I am currently reading with Bloglines.

The Bad:

• Katrina: my grief at all the lost lives, and my anger at FEMA for fucking this up royally.
• IVF #3 is going terribly.  Looks like we'll only get one, possibly two, eggs.
• I applied to volunteer at the Women's Community Clinic in San Francisco, but, sadly, they rejected me.  :-(  And they won't tell me why.  I didn't even make the cut to be interviewed. I'm very sad because I think I could have really helped them, and I very much want to do some work with clinical exposure in women's health, especially since my backup plan is still in force.  Unfortunately, these opportunities are hard to find given the new privacy laws.
• I miss InSpring.  Where has she gone?  Not knowing what happened to her makes me feel lost, like a good friend has just disappeared.