It's Go Time

Well, my Estradiol levels came back over 3000...3100 something, meaning it more than doubled again. I was allowed to stim last night, but I'm officially cut off now due to my E2 levels. Which means we're moving ahead with a lupron trigger. My personal opinion is that this is unnecessary, but they don't really ask my opinion. I think it has to do with the lack of capital letters after my name. Lame. 

They are assuming my E2 is somewhere between 3600 and 4000 today which sealed the deal... no hCG trigger for me. The good news is that my doctor is in fact NOT a moron. I think I'm supposed to assume that based on the fact that he does have a bunch of capital letters after his name, but let's be honest, that doesn't always mean a whole lot. In my research yesterday (just to clarify, when I say research I do not mean message boards, blog posts, or other unofficial sources. I'm using google scholar and wading my way through peer reviewed articles.) I discovered a lot of what I expected... implantation rates are lower and miscarriage rates are much higher after a lupron trigger. From what I can tell, it has to do with the estrogen and progesterone levels. While hCG helps the body to continue producing both, lupron shuts the body down... bad news for a little embryo. The solutions are: 1-freeze all, 2-dual trigger, 3-luteal phase rescue, 4-aggressive hormone replacement. 

We're going with number three. Essentially, I'll trigger (twice) with Lupron. Then, at the retrieval, they'll give me 1500iu of hCG. It's typically not enough hCG to allow for hyperstimulation, but it is enough to salvage the body's ability to produce its own estrogen and progesterone. We're also upping the dose of Crinone. It's not really "aggressive" hormone replacement, but it's more than I would have had with an hCG trigger. As I didn't ask for any of this (this was his plan all asking) and my research suggested this was all correct, I've decided that my doctor is not a moron, but rather an intelligent man who knows his stuff. I expect nothing less, but it's nice to have that confidence back. 

I definitely still wish that I could do a standard hCG trigger, but whatever. We're moving on. Second guessing every decision I and the doctors have made won't get us anywhere. I trigger tonight (10pm) with the first dose of Lupron and then follow it with the second dose tomorrow morning (10am). I'm also starting Dostinex, which supposedly helps prevent fluid from leaking out of the ovaries, further eliminating the risk for OHSS (like I said, a little zealous in the OHSS dept). Retrieval is set for 9am Thursday morning. 

In other news, the Prohibition of All Things Yummy is still going, and I officially hate protein. Blah! If I don't see another chicken breast for a month, I'll be happy. I'm not sure if it's the diet change or the meds, but I've never been less hungry in my life. My stomach is not really upset, more just uninterested. I've been having a hard time for the last few days coming up with a food that sounds good. Once I finally decide on something, I start eating and four bites in, I'm so over it. I keep eating, but I don't think I've finished a meal in three days. Food just makes me gag. The only thing in the world that sounds good is a bowl of plain Rice Krispies, which is super weird... most definitely not my standard cereal. And as I'm fairly sure Rice Krispies are 100% carbs, they aren't on the menu for a few more days. You would think that between no carb eating and just eating less, I'd still be losing weight, but it all stopped about five days ago. Now I'm slowly gaining. Thanks a lot IVF meds!

And lastly, Floridians look about as miserable as I've ever seen them this morning. I'm not sure if it has to do with an FSU victory (I'm terribly close to Gator country) or the cold... my guess is the cold. It was 26 degrees when I woke up this morning... not your standard Florida weather. Thankfully, it's going to warm up just in time for Sam to arrive... Thursday, Friday, and Saturday are in the 70s (don't hate me). 

That's about it... Hubby should arrive later tonight. Hopefully we can squeeze a few fun things in while he's here. I would obviously appreciate your prayers going into Thursday. We're hoping for lots of mature, healthy eggs that can grow into beautiful embryos!

Risking Hyperstimulation

Man, I sure do wish I could bottle estradiol. It would be lovely to syphon some of that junk out of my body right about now. I finally got my E2 levels from the past three visits.

Friday, December 27- 29
Monday, December 30- 120
Friday, January 3- 1143
Monday, January 6- TBD

Now I didn't think 1143 was that bad, I mean it's higher than some people, but it's not like it's 4000 or heaven forbid, 6000. But I think the panic set it at the rate of it rising. Research seems to show that if the Estradiol levels more than double in 2-3 days, the risk for Ovarian Hyperstimulation Syndrome is elevated... Well mine significantly more than doubled (more like 10x) in 4 days. So yeah, needless to say Dr. Duffy wasn't super pleased.

At this point he is predicting a lupron trigger (rather than an hCG trigger) on Wednesday with a retrieval on Friday. He's hoping that I can stim at lose doses tonight and tomorrow night. Other options are to trigger earlier (tonight or tomorrow night) or coast a day or two without meds. I am fine with all of the above except the lupron trigger. Dr. Slayden had previously predicted the need for a lupron trigger (he was thinking 20-30 eggs), but he said that he would do a freeze all with a lupron trigger because pregnancy rates are lower after lupron triggers. Another doctor I saw during the hunt for the right clinic agreed with that... freeze all if we need lupron. Dr. Duffy doesn't seem to agree. He wants to do a lupron trigger and then give me just a bit of hCG on the day of transfer for luteal/pregnancy support.

Obviously, I have A LOT to research today... I absolutely do not want to transfer after a lupron trigger is it will jeopardize the success of the transfer. But I also hate the idea of doing a freeze all. Blughhh... If anyone has a method of extracting Estradiol from my blood, I'm all ears.

Now my Estradiol may be skyrocketing, but my follicles are not. There still hanging out at about a 1-2mm growth rate per day... sad trombones.

For comparison, here is Friday's ultrasound results:

Right ovary- 7, 9, 9, 9, 10, 10, 10

Left ovary- 6, 7, 9, 10, 10, 10, 10, 10, 10, 11

Lining- 10mm

And today's results:

Right ovary- 14, 16, 14, 15, 13, 12, 11

Left ovary- 17, 15, 16, 15, 14, 15, 8, 9, 16, 13, 17

Lining- 10mm

Now Dr. Duffy said that he'd like to reach 18-19mm for most of them before triggering, which would require another 1-2 days before triggering. Prayers for a lowish E2 level today would be much appreciated! I would really like to get the four 15mm follicles to 18mm before triggering.

So that's about it for me. I have less than 36 hours until Sam gets here... I cannot wait! This is the longest we've EVER been apart (slightly pathetic, but whatever) and I'm ready for him to be back in on the action! I'll update with the E2 results and the plan later! Oh, and hyperstimulaters: what were your E2 levels right before triggering?

Slow and Steady

I'm going to preface this entire post with this: I totally realize I sound like an ungrateful jerk. And maybe I am. I can think of quite a number of ladies who would trade places with me in a heartbeat. All I can say is that if infertility has taught me anything, it is that expectations can be hard to overcome. I expected to get pregnant easily at 25... when that didn't happen I felt robbed, betrayed, and pissed. Then I thought I'd get pregnant not so easily at 26, with a lot of hard work and a little patience... when that didn't happen I felt confused and frustrated. Then I thought 27 would be the year and it would take several thousand dollars and a lot of tears... when that didn't happen, well you know, that brings us to here and now. However, if I had known going into my marriage that this is what I should expect, I would have been much more prepared to face it... It's all about your expectations.

My expectations for IVF and my body may have been a bit too grand. I'd like to blame my doctors. Dr. Slayden talked like my biggest struggle would be hyperstimulation... he expected 20-30 eggs to just spring forth on low doses of meds. Dr. Duffy has compared me to a donor from day one. He said he would use his standard "donor protocol" and that we could probably get 20+ eggs without trying. So those were my expectations. I've spent the last three months researching, thinking, and praying about what to do with all of these eggs. Sam and I finally hammered down a protocol for what to do if we have 20 or more eggs. And here I sit, with 17 follicles knowing that some of those will not be mature.

Right ovary (the slacker)- 7, 9, 9, 9, 10, 10, 10

Left ovary (the overachiever)- 6, 7, 9, 10, 10, 10, 10, 10, 10, 11

Lining- 10mm

I know that I should be thrilled. I know that I should be so incredibly thankful. But if I'm being honest, I'm kind of disappointed in myself. Which is totally dumb; it's not like I can control this. I'm not choosing how many follicles should grow and at which speed (because that would be nice). I guess I've recognized that my eggs and my lining were a point of pride for me. "I may not know whether the eggs suck or not, but I can count on them to be bountiful and for my lining to rock"- that's kind of been my thought process for a long time. I honestly don't even know at which point I would be satisfied. I told myself last night that as long as I had 16 follicles, I'd be happy. Well, I have 17 and I'm not. Ughhh. So frustrating. I confessed my pride to the Lord and reminded myself that He is already fully aware how many follicles I will have and if any of them will turn into our children... He is in complete control. It's just hard to remember somedays.

I think I've kind of surprised my doctor too. He keeps talking as if I'm a bomb about to explode... follicles everywhere. Today he started off the consult (pre wanding) with his thoughts. He compares me to an airplane... got to get going fast enough or I'll never get off the ground, but once I'm up in the air, we can drop it waaayyyyy back. And then the ultrasound started and his response- "huh"... I'm guessing he was expecting more too. The lead follicle went from 8mm to 11mm- only 3mm in 4 days. Slightly underwhelming to say the least. After the ultrasound he decided to leave the meds at the higher dose for three more days pending the results of the blood work. Well the blood work came back, and I keep forgetting to ask what my E2 actually is, but it must have been higher than expected... I'm now going with 150iu of Menopur for three more days and 225iu of Gonal-F for two days, and only 150iu on the third. My next monitoring appointment is Monday. I guess we will know more then.

I've been reminded throughout the day from some special ladies that good eggs take time and that less is often more. I'm trying to keep reminding myself that the extra $900+ in medications that I just shelled out today will be worth it for good, healthy eggs. Slow and steady wins the race, right?

So Another Year, Huh?

The years just seem to melt away now. I mean, I can literally remember sitting with Sam on the couch in Augusta on New Year's Eve in 2010... it doesn't seem that long ago. And yet, in some ways, it was a lifetime ago. In a lot of ways, I feel like I've aged a decade since then.

2013 was actually a pretty good year for Sam and I... much better than 2011 (miscarriage) and 2012 (jobless and failed IUIs). In 2013, Sam graduated from MCG with his Doctorate in Physical Therapy. I can't even really comprehend how huge this was for our family. Graduation was the fulfillment of a fifteen year dream for Sam and a lot of hard work and dedication for both of us. We certainly wouldn't be where we are today if not for Sam.

We both got jobs in 2013 which allowed us to really get our finances under control. We paid off all of our debt (minus student loans). And once we were free from credit card debt, we tackled saving for IVF. Those were two huge accomplishments for us and I honestly can't even put into words how thankful I am for the Lord's provision this year. We have been insanely blessed and our sacrifices have led to abundant multiplication time and time again.

2013 brought greater friendships both through the blog and in real life. Sam and I have both felt so supported in our journey by our friends in our small group, through our church, our work... friendships have simply blossomed this past year.

For me personally, this past year brought a quiet peace in the midst of my infertility. The days of feeling an absolute desperation; a frantic need to do more, try more; a desire to hurry everything along just seemed to melt away. The Lord slowly and quietly worked in my heart until I've finally come to a place where I recognize that the Lord is in complete control. It's been a year of subtle changes on an emotional and spiritual level, and I am in a much better place because of them.

And of course, 2013 brought us here: to IVF in Jacksonville. It's still pretty surreal. Last night I was filling in my medication chart when I realized that I've already done 5 days of shots... if I stim for 10 days, I'm already half way there. It just doesn't seem like this could be it, that we could be here.

So 2013 has come to a close. Obviously for Sam and I, 2014 holds a lot of potential. We could be three to four weeks away from a positive pregnancy test. And if the Lord does bless us with a bring home baby from this IVF, we would actually deliver in 2014 too... that kind of blows my mind. So yeah, 2014 has a lot of potential. And not just in terms of building our family but for other things too like paying off more debt and saving for our first home. We are incredibly hopeful for the year ahead and praying that the Lord will continue to bless our little family.

Wishing all of you the best in 2014! May 2014 bring good news and greater blessings to us all!

Chuggin' Along

Well, I guess I should start off by saying that I survived the first round of shots... and the second, and the third, and now the fourth. I know; I wasn't sure I was going to make it either. We've decided that applying ice beforehand helps. Other than that, I'm at the mercy of my injector, but thus far it's been fairly smooth. I did have one small snafu on Saturday night in which I didn't properly screw the small gauge needle on, so during the injection, the Menopur came out of the joint between the syringe and the needle rather than going into me. That was a rough night... lots of cursing as I had to be injected an additional time. Otherwise, we've been doing okay.

This morning I had my first monitoring appointment with Dr. Duffy. As I've never been monitored on CD 4 before, I had no idea what to expect. I didn't have my phone handy to write down all the numbers, but I'm guessing he called out 12-15 follicles between left and right... largest measured 8mm and smallest measured 4mm. I figured he was going to keep me at the same dose or even bump me down... 8mm seems larger for three doses of meds. He seemed to disagree. He's bumped the meds up to 225iu of Gonal-F and 150iu of Menopur, which means I definitely have to order more Menopur and most likely Gonal-F as well. Boo. I'm trying not to be too suspicious of this increase... I could second guess every decision along the way. I'm of course a little concerned Mr. 8mm is going to surge ahead and leave everyone else behind. I'm also concerned that I'll ovulate before I go back in, but he's got me starting Cetrotide Thursday morning, so hopefully that will be soon enough to waive off any ovulation signals my body may start sending.

As if venipuunctures and shots weren't enough, I also decided to do acupuncture during IVF. Obviously, as I haven't tried acupuncture until now, I'm sort of suspicious of it. Essentially, anything that claims to be able to fix EVERYTHING with the same procedure/protocol/pill, well, I'm a little suspicious of that. And thus far, I feel like my preconceived notions of it were fairly accurate. They all seem 150% confident that acupuncture will help A-get me pregnant, B-heal my body, C-keep me pregnant, and D-remove all the stress in my life. All right then, let me see it! Today was session one. Unfortunately the practitioner that I chose was unavailable this week, so she sent me to another lady so I wouldn't have to miss any appointments during my stim cycle. She was okay... she seemed to hint regularly that "western medicine" may call me unexplained, but she has already found many things that are wrong and she's confident that acupuncture can help/fix them all. The session was okay... not really what I'd call relaxing. I was freezing cold and obviously, couldn't cover up as I had a bunch of needles sticking out of me. Essentially, it was just odd. And I had a pretty fierce headache after that lasted about half an hour. However, this trip is all about no regrets. I figure acupuncture can't hurt, so I'll see it through till the end.

In other less tedious news, I got new makeup! Eekkk! As a high schooler I was all about Mary Kay makeup... as a newlywed I discovered that I couldn't rationalize twenty dollar foundation and ten dollar eye shadow. I've been using the same makeup for years (and years). The essential things that I run out of like foundation have been replaced with cheap drug store products like ELF. Well today was the day! Sam got me a gift card to Ulta for Christmas and my mom graciously filled in the gap. I am the proud new owner of some lovely Bare Minerals products! Soooo fun! I might actually enjoy wearing makeup again. Here's a pic to show off the new look:

Let's agree to pretend that I did my hair today and that
I'm not in pajamas at 5:30 when this was taken, okay?

So that's about it. Overall, I'd say I'm doing pretty well. I lost a few tears the night of the Menopur incident and a few more the morning Sam left, but otherwise, the emotions seem to be fairly stable. We will see how long I can hold it together on the larger dose. Next monitoring appointment isn't until Friday!

A Little Reality Check

The title of this post was supposed to be "Green Light" meaning we got the go ahead to proceed with IVF: no cysts, no wonky blood levels, no issues. Start your engines kind of talk. That was the title until our consultation this afternoon. Let me go ahead and end the suspense by saying we did eventually get the green light, but there was a total of about ten minutes there where I wasn't sure we would ever do IVF. Okay, so now that I've peaked your interest, lets rewind, shall we?

This morning I had my appointment for ultrasound and blood work... I was expecting it to be thirty minutes max. It was over three hours. Blood work was quick... only one vial. I'm not sure why, but I assumed IVF required like 80 vials a day or something terrible. Then we proceeded to the ultrasound room. Why nurses feel the need to tell you to strip half naked when the doctor is running behind I will never know. Hanging out on a table with a sheet covering you for half an hour is just not fun. However, the doctor came in and the party officially started. He was all excited, which helped me to get excited. "Woo hoo, here we go," kind of stuff. The ultrasound was fine. I'm not exactly sure what my antral follicle count is. He said 5 at one point while looking at the right, which just about made me come off the table. But then he said, "I don't count higher than 5" when I asked, and he then proceeded to show me that the left had more than 10.... not sure if the right had more than 5 too. I'm trying to be happy and satisfied with the fact that I have follicles... some women would kill for those.

There were no cysts, so that was all good. I assumed that was the end, but he then sent us to talk with a nurse. She went over all the paperwork (more signatures required than buying a house) and injections again. They decided they needed a HIV test and a semen analysis on Sam as his last tests were from December of 2012. We had to wait forever for the next person who went over the costs of everything. I don't care how low the cost starts, it's always more than you were planning... there are always little extras that "aren't included" like anesthesia. It was about $1100 more than we had previously been quoted after all was said and done, but whatever. We're moving on.

We finished up the morning (now afternoon) with a semen analysis and then finally got released. We managed to get Sam's prescription for antibiotics filled (FREE) and then grab a little lunch before heading back to the clinic for our consultation with Dr. Duffy regarding eggs, embryos, what to freeze and when. And that is where all hell broke loose.

When we got there, they took us straight back to his office and the nurse said she'd check to see if the analysis was ready from earlier. She came by and clipped something to our file a few minutes earlier. After about ten minutes Dr. Duffy showed up to review the analysis and begin our consultation. We could tell he was really unsettled. He asked Sam if he'd ever done an analysis before... ughhh, yeah, like five or six.... we've been to a urologist for goodness sake. He flipped through our records a few times before finally saying that he was just stumped. He asked Sam if anything traumatic had happened, did he have surgery, was he on testosterone, had he done anything to cause this: (at which point he showed the results) 14 sperm. Not 14 hundred million, not even 14 million, just 14 and they were ALL non-motile. Cue absolute freak out.

I some how internalized in 2.4 seconds that it would not be good if I lost it in front of Sam. I didn't want him to think I was blaming him, mad at him, any of that, so instead of sobbing or screaming I just started flipping through my notebook. I'm pretty sure I said "this is impossible" like ten times as I kept handing the doctor more and more old tests. He started talking about options: things like, test again in a week, go back on birth control, cancel the cycle... I'm pretty sure I was starting to unravel. I could tell Sam was really upset. He was perfectly still, but I touched his leg and it was about 100 degrees... he was about ten seconds away from bursting into flames. At which point Sam leaned forward and said "that's not my social". People, I. nearly. died.

For a full ten minutes I was in somebody else's shoes; I've never been so thankful to enter back into my own. It was an incredible reality check for both of us... as awful as it is to be here, to need IVF, at least IVF can help us. IVF can't do anything for 14 dead sperm. The doctor just about lost it himself but not from relief, from rage. I wouldn't be too surprised if someone lost their job over that little error. Needless to say he apologized a ton, reassured us that mistakes like this are incredibly unusual and that he and everyone who works at the clinic are held to a high level of responsibility. I was so relieved, I didn't even care. He went and picked up the correct analysis and returned with a much better report. We were able to salvage the rest of the consult, though it's probably needless to say that I was extremely frazzled and he was still really mad. I think we scrounged up enough info to move forward, but that's a post for another day.

For tonight, I'm simply insanely thankful to be where we are. Our hopes and dreams almost came to a screeching halt today. There's nothing like a little reality check to remind you that there are always worse scenarios than the one you're in. Instead of a cancelled cycle, we have a green light to move forward. We start meds tonight... 150iu of gonal-F and 75iu of Menopur. I can honestly say that I've never been more excited and I've never felt more blessed to be able to do these injections. We are so incredibly blessed to be here, financially able to afford this, with the chances we have due to the eggs and sperm we have... so, so blessed.

Merry Christmas to Me

This is going to be brief you guys... I'm exhausted. We literally just got into our hotel room. After three attempts to enter three different rooms, it has been determined that the key card system at the hotel has malfunctioned... only the master key card works. Thank God, that it does or I'd be asleep in the hallway of the StayBridge Suites in Jacksonville... I'm that tired.

Christmas came and went in a flurry as usual. My mom has a big family. Her mother is still living along with four siblings all of whom have children and three of the five siblings have grandchildren now. There were about 30 people in her house last night. My introverted self was exhausted just from that, but add in all the cooking, cleaning, and decorating, well, I'm just not sure how my mom does it. But it was beautiful! And yummy, except, I wouldn't know about that!

We started off Christmas morning at my mom's with just my mom, stepdad, Sam, and I. Sam and I received some lovely gifts from everyone! Most notable were:

Despicable Me 2: first up on the list of movies to watch in Jville

A new nutcracker to add to my collection

You can see that Everest was chilling out Christmas morning as well. What you can't see is that she went CRAZY over a little furry hedgehog thing with catnip inside. Love that little girl. You can also see that I added some awesome infinity scarves to my pajama attire... lovely.

Happy Christmas family-sans Boo Boo

Unfortunately we didn't get the full family. It's hard enough to get a good photo with Sterling, add in Everest and her tendency for red eyes, and well, our family photos usually fail. Just imagine a sweet little fluff ball, okay? And just to prove that we clean up, here's one of us in front of mom's (ah-mazing) tree!

Nine Christmases with this handsome man!

And last but not least, let us not forget the best gift of all:

IVF meds

That's right people, it's almost time. I'm fairly certain this is the most expensive gift to ever grace my home the week of Christmas... so Merry Christmas to me. I'll be back tomorrow with an update after our appointments and when my brain is slightly less frazzled from a 7.5 hour drive.