Finally Recovered from The Valium

I only expected the valium to take the edge off. Wednesday, the day of my transfer, I was prescribed 10 mg valium to prepare for the transfer. They want the uterus to be relaxed.

I had a qi gong session with Chris Fernie right before my procedure, so I was already feeling relaxed. He worked a lot on moving my lymphatic system and channeling my binqi out. It was so cold, but that's for another post. I guess I was so relaxed from the qi gong session, I didn't realize the valium had hit me until I was wandering around the tiny hospital bathroom like a goldfish.

Once we were in the transfer room, Dr. Huddleston gave us the fertilization report. I think it was:

#1: grade 2, 10 cells
#2: grade 3, 8 cells
#3: grade 2, 6 cells
#4: grade 3, 6 cells
#5: grade 2 (?), 4 cells

Grade goes from 1-5 scale, with 1 being the best. 2 is most common at 60% of embryos.

The first three were selected for transfer. Here are the three in this picture! The last two could not be frozen because of the quality. They think #5 didn't make it, since the embryo should have greater than 4 cells by day 3.

The experience was so clinical. One person confirmed my name on the syringe. After Dr. Huddleston shot the embryos in, they rechecked the syringe under a microscope to make sure that all of them transferred. Then we were up, out of there and back home. No waiting for 20 minutes with a pillow under me, as I had to do with the IUI.

Having finally convinced my mom that I didn't have to take bed rest, sleeping ended up being all I could do. There is a lot of debate on bed rest after transfer. UCSF and other sources say that bed rest is not required, and in fact there are a number of studies showing that bed rest does not improve implantation. My mom's stance had been "why take a chance?", but she's a scientist so she had to accept the study results. In the end, I frankly wasn't in much of a state to do anything else but sleep. I vaguely remember Anna coming over to needle me (thank you!) and leave me with OK! magazine and a couple DVDs.

And then it was Thursday...

5 for 5

Unbelievable! Five eggs retrieved, and all five fertilized. Now my transfer is Wednesday, pushed back a day so the embryos can grow a little more and the best ones can be picked. Trying to remain cautiously optimistic.

Ready

Thursday ultrasound. More survival-of-the-fittest nature channel on in the waiting room. Follicles at 18, 16, 14, 14 and 12 mm. and two 6 mm + a 7 mm. Estradiol 1191. I was surprised that Dr. Huddleston said she likely wanted to trigger me on Thursday. Wednesday she had said my protocol - E2 antagonist - called for two follicles 17 mm or larger. But, I think she was concerned that my leading follicle would get too large. In the end, she and Dr. Rosen decided to have me go one more day.

Friday. Successfully avoided the TV this morning. Follicles at 19, 18, 17, 16, 14, two 9 mm + three 7 mm. Estradiol 1627. Trigger will be tonight! Retrieval on Sunday. Wow.

Ultrasound #3

Third ultrasound today. I still have five follicles growing together in a cluster. One is moving out in the lead, but just slightly. Now they are: 16, 14, 13, 13 and 12 mm. Two trailers at ~6 mm. Estradiol 821. Dr. Huddleston says my retrieval will be Sat/Sun/Mon. Is this good? I'm just glad my cycle hasn't been canceled yet. I spent some time last night reading other people's blogs, learning about cycle cancellations. Got me very anxious this morning while I was waiting for my appointment. The big-screen TV playing the survival-of-the-fittest nature show didn't help. Alligator pulling buffalo back into river, buffalo going under. Hmm.

N = 5

Second ultrasound today. Day 6 of meds. Estradiol 489. Started Ganirelix.

I have five follicles all around the same size - 10, 11, 11, 12, and 13 mm. And, one trailer at 6 mm. The doctor seemed happy, and said I'm early in the process. Hopefully there are enough follicles. Ideally, I would have 8-15 good size ones - 18-22 mm - when I am ready for retrieval, but I'm a non-responder so I'm expecting fewer. Also, not all follicles result in an egg, and not all eggs fertilize... So I really can't count my chickens before they hatch.

Next ultrasound Wednesday...

4.7

I have been seeing Anna again for acupuncture and herbs, this time for six months. In February, I had my day 2 FSH taken; UCSF needed new blood work before I could start IVF. My FSH was 4.7! 4.7. The number that started all of my worries was 13, in December 2008. 13 is "slightly elevated for my age" - I think my nurse used the word "slightly" to soothe me. 4.7, on the other hand, is downright sprightly. I know FSH bounces around cycle to cycle, and generally the highest value correlates with an individual's ability to get pregnant. But, I'm focusing on the 4.7. And I do think it's due to Anna's work.

Allons-y

We start. I had my first ultrasound today. Six follicles on the left, four on the right! No cysts. Very good. Dr. Lamb was surprised because Dr. Rosen had only seen four total in previous ultrasounds. I hope I'm on the right protocol. I'm on an E2 agonist protocol, which is for non-responders. I assume because I didn't get pregnant via IUI.

My protocol started with 2 mg estradiol daily, a week after ovulation. So, similar to my IUI flare protocol, no down regulation. I had to use ovulation strips to determine my ovulation day. Audra, my nurse, did not want me to use the fertility monitor, just the "cheap strips". So, I ended up using two different kinds and testing twice a day just to be sure I didn't miss it - since I had never used strips before. I liked the ones that come in a little tube, like a pool test kit. They were also super cheap.

First day of my next cycle, I stopped the estradiol. Baseline ultrasound day 2, today. First shot tonight. I take 2 vials Menopur and 4 vials (300 IU) Gonal-f. Six vials: a lot of mixing and transferring. But the shot didn't sting. Two good things today.

I'm optimistic now, but not excited about the timing. Next week is my 10 year reunion for business school. My transfer may happen over the weekend, so I would end up missing a lot of the festivities. But, timing is never good. At least we are finally almost done with our house remodel. Wasn't I saying that in November?

Big Box O' Drugs

I wasn't prepared for the size of the box. I reviewed the long prescription list with the pharmacist, but didn't expect a 2' x 8" x 8" box. And, when it arrived, I didn't think it would be full. I have Gonal-f, Ganirelix, progesterone, HCG, estradiol, and lots and lots of needles. Lots of needles. And no bubble wrap. The only good thing in the box is the valium for my transfer; it has the added benefit of not being administered by a needle. I had Menopur left from my IUI regimens, so at least I didn't have to order that.

The needles. The needle gauge is inversely proportional to the actual needle size, so large gauge = small needle and vice versa. The mixing needles are 18-1/2 gauge and gargantuan. We will still use the tiny 27-1/2 insulin needle for most of my shots, which is comforting. I'm used to this now. The needle that terrifies me is the 22-1/2 gauge that will be used for progesterone. UCSF's protocol calls for intramuscular progesterone in oil. The needle must be wide so the oil can pass. We don't use the progesterone until right before or after my retrieval, but at that point I get a daily shot until my pregnancy test. If it's positive, I take a daily shot for NINE more weeks. Lovely. I just hope my husband or I don't need to travel during this time. I don't know if I can inject my back hip with the monster-needle.

New Year, New Approach

I can't believe it's already April. The new year's not so new any more. And, I'm finally ready for my next fertility treatment adventure. Four IUI rounds with decent - even good - follicle counts, but no pregnancy. So, on to IVF. My company's Kaiser plan didn't cover IVF. We're lucky that the UHC PPO covers 70% of up to $18K. We changed insurance from Kaiser to United Healthcare PPO in January. I didn't want to leave Kaiser, and I still haven't learned to navigate the how's of finding a primary care physician, etc. But, I did manage to get a mammogram, which wasn't as bad as some of my girlfriends' stories, despite my minimal endowment.

Following the rules to get PPO coverage for IVF meant waiting until we were officially covered in the new year, calling UHC's family planning referral center to get assigned a case nurse, playing phone tag with a nurse who always left me a message at 4:29 pm saying she finished work at 4:30, finally securing approval from the nurse for IVF at an approved center, then making our first appointment at UCSF. We had our first appointment at the end of January.

Ivan, my doctor at Kaiser, recommended a few folks he has worked with at UCSF, but I chose first available because I'm i-m-p-a-t-i-e-n-t. So we got Dr. Rosen. He is a researcher, which I like. And he's a bit geeky, which I also like. He always has a student/resident working with him, which I really like.

Dr. Rosen posits that I did not get pregnant with IUI because I have a blockage in my tubes, possibly due to my miscarriage last year, and/or my appendix removal. He says that the procedure I had last year to open a blocked tube, a tubal recanalization, does not always open the tube. So, he thinks I may have better success with IVF. He gave me 20% probability of getting pregnant, and said I might have to go through several rounds of IVF.

20%. Ivan said 10-15% for IUI. The IVF odds don't seem a whole lot better. But, maybe it's a blocked tube so the mechanics of IVF will make a difference...