missed call

I'll try to get my numbers when I go back tomorrow for another u/s and more b/w. I was away from my desk when the nurse called, and the message was limited to new doses and tomorrow's re-visit to the office. No trigger tonight. Instead, I drop my Gonal-F dose a smidge...

CD9-
5u Lupron + 75u Gonal-F- AM
report to the RE at 7:50 for b/w & u/s
37.5u Gonal-F- PM

CD10-
5u Lupron + 75u Gonal-F- AM
report at 8:40 for b/w & u/s

Today's u/s tech suggested I show up mega-early when I have a "later" appointment. I'm not a fan of rush-hour traffic, so I'll heed the tech's advice. We'll see if that works tomorrow, or if I end up sitting in the waiting room for an hour.

Sitting at a desk is becoming increasingly uncomfortable as the day progresses. I may have to wear sweats tomorrow.

if only my arms were longer

I am at work, leaning back in my desk chair as far as I can and still reach the keyboard. Even with my pants barely zipped, and not at all buttoned (held up by the wonderful BeBand), I wish I could lean further. Horizontal would be really nice. I'm so thick in the middle that I just don't fold in half like I did a few days ago. Luckily, it's still un-summery here in New England, so I was able to wear a long-ish fleece shirt to work. It's loose enough and long enough to camouflage my engorged mid-section.

I'm waiting again. Blood was drawn and an u/s done this morning, so I expect to receive new instructions in a couple of hours. One of the nurses (one who was very uninvolved & distant last cycle) took a quick peek at my ultrasound images and expects me to be back for the same tomorrow. This was in response to my guess that I'd be triggering tonight or tomorrow. She agreed that I'm close, though. This was as engaged as I've seen this particular nurse. Maybe they're all warming up to me because I've been there for 6 months?

C's sister-in-law has agreed again to administer my trigger shot (Thank you!). She's a nurse, and took care of my trigger last time- painlessly, I must add. I know I'm lucky to have her nearby, and willing to be woken in the middle of the night to stick a needle in my butt. I'm sure C could do it if we had no other options, but he'd be nervous and I'm sure it would hurt... both of us.

This is the fast-paced, edge-of-my-seat, manic part of IVF. Monitoring every morning means getting out the door by 6:30am. I haven't slept well since Thursday. Days and nights are blurring together, and the anticipation builds with every "this looks good" that I hear from the nurses (I even got one this morning!). I'm completely unfocused at work, although I did manage to pull off a big A on an accounting exam over the weekend (online). I admit, I'm utterly useless at the moment. I gave the nurses my work number to call today so I'm staying in my office at least until the call comes. Then, I think I will need to go home and try to take a nap.

ch-ch-ch-changes

CD7-
5u Lupron + 225u Gonal-F- AM
[E2=814]
187.5u Gonal-F- PM

CD8-
5u Lupron + 150u Gonal-F- AM
report to the RE at 7:30 am for b/w & u/s.
[E2=1757; 12 measurable follies: Left=8 measurable + "many" smaller follies; two biggest are 18x10 & 14x14; Right=4 measurable + "lots" of smaller follies; two biggest are 16x13 & 16x11]
150u Gonal-F- PM

CD9-
5u Lupron + 75u Gonal-F- AM
report to the RE at 7:50 for b/w & u/s

It's happening well and fast. The nurses staffing the office this weekend are on rotation from the affiliated hospital, instead of the usual taciturn nursing staff. The nurse who called this afternoon with my results and new instructions began the conversation with, "Holy canoli!" then gave me my numbers and counts. She was incredibly encouraging and sounded like she genuinely cares how this all plays out. Such a contrast to the feeling I get from the RE's regular staff, who appear to go out of their way to remain detached and uninvolved.

So, another trip to the RE tomorrow. I can't wait to see what has changed in one day, and I'm very eager to find out when to trigger. It won't be too long now. Go follies, go!

order up!

Unsolicited call from one of the RE's nurses today. That essentially never happens, so I was afraid something had gone wrong- but how could it when they haven't seen me, my blood, or my ovaries since giving me the all-clear on Monday? It turned out they wanted to share information. Critical information. Information that might have led to a completely useless cycle had they not decided to share it with me.

I was instructed to order the donor sperm TODAY. For delivery Monday. To the HOSPITAL. Now, they've emphasized again and again that DS needs to be shipped to me because they're not equipped to store it. Presumably, the hospital is equipped, while the satellite clinic is not. Good to know. Also, another nurse told me on Monday that I could have the DS shipped to the hospital, but only if it arrived within 24 hours of the ER. At this point (CD6 or Lupron day 15 for those keeping track), no one is willing even to guess when ER will happen. DS is good in the shipping tank for 5 days. So even though no one has seen me since I started stimming, and no one has any more information than they did on Monday, they suddenly know that ER will happen between Monday and Wednesday? And they still won't "predict" that ER will occur between Monday and Wednesday?

Then again, maybe the hospital has cryo-facilities so shelf-life in a portable tank isn't an issue.

Hopefully, someone will tell me tomorrow to expect ER to be some time between Monday and Wednesday. Otherwise, I will worry.

My other worry- no one gave me the hospital's address, and I forgot to ask for it until I was on the phone with the bank. I pulled it off the hospital's web site, but then called the RE's office to confirm I had the right address- left a voicemail, but no one called me back and they all leave at 3:30. Aaargghh! I was feeling so good, and so calm. Now I have new things to worry about.

waiting for the call, CD2- **UPDATED**

AF made her appearance yesterday afternoon, which turned out to be CD1, not CD30. If anyone out there wonders as I did whether Lupron has an affect on cycle length, the answer would be no. At least in my case, taking Lupron beginning on CD22, at a dosage of 10u every morning, had no impact on cycle length. Good to know.

I headed to the RE's for u/s and b/w this morning. Assuming my hormone levels are in line and there are no unusually large cycts in my ovaries or fibroids on my uetrus, I expect to start taking the Gonal-F tonight or tomorrow. Then we head down the slippery slope of IVF... things start off rather slowly, then get a little out of control with daily monitoring and dosage changes and bloating and lack of sleep and finally the trigger, ER, and ET. Then comes the v e r y s l o w TWW. Time will literally fly between now and ET, which is part of why the TWW feels so darn long. Interminable as it may be, I'm eager to get there. I'm excited to become PUPO again, and hopeful (as always) that this is the time that will work for us.

**
Got the call from the nurse- no cysts, no fibroids, no follies. Lupron did its job and E2 was 19, progesterone was 0.5. I have to take her word for it, since I don't know what all those numbers mean, but she said I have the green light to start Gonal-F tonight, 225 units twice per day, and cut my Lupron dose to 5 units each morning.

Back to the RE's on Saturday for b/w. No guesses yet as to when ER will be, but almost certainly between June 30th and July 4th.

what's next

I met with the RE this morning to review my failed IVF and to find out what the plan is for the next attempt. The good news is that she's submitted a recommendation for an IVF cycle to my insurer and fully expects the procedure to be approved. The bad news is that I turned 41 and have entered a whole new statistical bracket, full of very depressing numbers.

First, the recap...
I responded well to the gonal-F, but only 5 of the 11 retrieved eggs were mature. The RE normally likes to see 70%+ maturity. Three of the five mature eggs fertilized, which is acceptably "normal," and actually pretty good considering my age. A moderate amount of fragmentation was noticeable on all three fertilized embryos. Fragmentation is associated with embryos not implanting in the uterus. The transferred embryos were 10-, 7-, and 5-celled. Ideally, embryos should be 6 or more cells for a 3day transfer.

The plan...
Eleven eggs is roughly the goal of stimulation for an IVF cycle. In order to increase the number of mature eggs, I'll start lupron three weeks after my next CD1. The goal is to grow the eggs a bit more slowly and consistently so we end up with most of the eggs maturing at the same time. I'll be injecting gonal-F starting around CD5, 225units twice each day. The dose and frequency both increase over the last cycle to compensate for lupron's suppressive effect. So, even though I'll be injecting more than double the gonal-F of the last cycle, I should develop about the same number of eggs more slowly than last time.

There's nothing we can do to influence the amount of fragmentation, but my uneducated guess is that a more mature egg will develop less fragmentation.

I was a little disappointed to learn that the "start" of an IVF cycle is three weeks into a cycle. So, instead of taking one complete cycle "off," it'll be more like 1.75 cycles. That's seven weeks of doing nothing. We're looking at lupron starting around June 11th, with ER and ET in the week of the Fourth of July.

I hate that my mind does this... I immediately started thinking that the ultimate birthday gift for C would be a pregnancy annoucement. His birthday is July 18th, and our beta would be right around then if I counted this out correctly. Our due date (because I just can't shut off these thoughts) would be right before my 42nd birthday.

ten, seven, and five

We transferred all three embryos (10-, 7-, and 5-cells) today. I'm taking it easy ... watched a little TV, and will take a nap now (to make up for staying up almost all night worrying we'd have nothing to transfer). I'm planning to go to work tomorrow, but will avoid the stairs as much as I can and will basically just sit at my desk all day. No different than if I stayed home, really. I still feel pretty bloated from the ER, and I suspect that some of the medications are responsible for last night's insomnia. Generally, I feel good. We'll have our beta on 4/21, so now I just need to keep on hoping.

more than two; fewer than four

Three eggs fertilized.

When I heard they'd retrieved eleven, I was concerned that they might do the assisted hatching on too many embryos and I'd either be coerced into transferring more than I'd be comfortable with, or some would be wasted because I think you can't freeze an embie that's had a hole cut in it. I coached C on exactly what I wanted to ask the embryologist, or what I wanted him to ask if I weren't home to take the phone call. I needn't have worried. We have three fertilized eggs as a result of this cycle. I'm thankful for those three. There will be nothing to freeze, and that's OK. I just want something to transfer on Monday.

11 on CD11

Retrieval today went without a hitch and 11 eggs are now exposed to sperm. Tomorrow afternoon, they'll let us know how many fertilized. On Sunday, they'll tell us what time we should report for Monday's transfer.

C is incredibly optimistic this cycle, repeatedly saying, "Everything is moving along like clockwork," and things like that. I am optimistic, too. But I have to bite my tongue every time he quips something like that. My instinct is to tell him that everything was like clockwork for each of our failed IUI cycles, too. I have no more and no less hope for this cycle than any other. Except maybe the first one, when I thought our only hurdle was getting our hands on some sperm. I thought sperm was our magic bullet. I think C believes IVF is.

Anyhow, things look good so far. Eleven eggs on a converted OI/IUI cycle is more than I hoped for. The embryologist said the norm is about 70% fertilization, but he's seen everything from 0 to 100. I'm just hoping that we have something to transfer. A couple to freeze would be gravy. But for the moment, my focus on on the transfer.

Recovery-wise, I feel pretty good. A bit sluggish bloated and crampy, but otherwise normal.

Oh, and the hcg shot? Well, I am incredibly grateful that my husband has a sister-in-law who happens to be a nurse and who didn't mind me showing up in her kitchen at 1:15 am.

jump to the head of the line

Holy crap- we're doing IVF. Hcg shot tonight- intramuscular, because now it's an IVF cycle, not an IUI. Eleven follies- 3 on the right and 8 on my left (no wonder my left ovary hurts!). Estrogen is 1181... I don't know what that means. Retrieval will be some time on Friday, 34 hours after the trigger.

I'm not prepared! I've read blogs written by women undergoing IVF, but since I was stuck on IUIs for at least another cycle, I didn't memorize anything. I know the basics as far as what will be done procedurally, but I feel pretty clueless right now. Hopefully, tomorrow's meeting with the RE will answer all my unasked questions (I'm not even sure what to ask).

I'm so nervous/anxious/excited that I am shaking. It's a very good thing C isn't already back to work.