May 27, 2011
Hooray!
I ovulated :) That is really all there is to say. Now I know that barring any disasters, at least within 2 weeks our IVF cycle will start. Good job, body! In other news, if someone found my iPhone and saw how many of my text messages to Y are about my ovaries, they would be seriously disturbed.
May 25, 2011
Limbo
Well I am right back to where I have been since the end of March - limbo. Still, there is more reassurance and more of a plan than there was before now, but I am afraid the time frame and start date of this cycle is just as uncertain as it was then. As I wrote in my last post, I was originally supposed to start Lupron this cycle around CD21, with the idea that CD21 would be approximately 1 week before my next period, and then start stims with the arrival of AF. Knowing that my cycles are erratic at best, I was a naysayer to this plan all along and requested to start BCPs so that whether or not I had ovulated by CD21 and whether I ovulated at all would be a moot point this cycle. However, I was basically told to chill out and forget about the BCPs.
Fast forward to today - CD21 and still no positive OPK or fertile CM or hint of impending O or really, hint of anything. We had an orientation/logistics meeting today with our nurse (who is so wonderful, btw), and she was really surprised when I said that I hadn't had a positive OPK yet and wondered if my cycles are irregular, why I hadn't been on BCPs (AHHH!). Unfortunately, 'I told you so' never feels good. Tomorrow morning I am going in for u/s and b/w to try to get an idea of where I am in this cycle. If ovulation isn't imminent, they will start me on BCPs and I will wait another 3 weeks or so to take a stab at this cycle:( I would appreciate any good vibes you've got that I won't be postponed another month.
The other curve ball is that my protocol has been changed from the agonist protocol (aka long Lupron) to an antagonist protocol. The nurse explained to me that while the agonist protocol is still the first-line first timers protocol for young(er) people who are good responders and while it was what had originally been decided for me, the doctors were discussing my case at their staff meeting and serious concern was raised by my history as an over-responder (after a rather interesting scenario with 9 follicles on 50mg Clomid, I could always be controlled well with 2 nice follies during Clomid and injectable FSH IUI cycles by simply halving the lowest recommended dose).
They think that no matter what they do, I am at serious risk for OHSS, but that they can maintain tighter control of me with the antagonist protocol. They also want to trigger me with Lupron instead of a hcg trigger which should hopefully help to further limit the risk of OHSS. They prescribed me a hcg trigger as well just in case I defy their expectation and produce a normal amount of follicles and not 9 bazillion. So there you have it - I will be doing a Gonal-F/Cetrotide protocol in the end.
The nurse also said they will ICSI at least half of the eggs and let the other half fertilize (or attempt to fertilize) naturally. This way if we have a fertilization problem we won't be scrambling to do rescue ICSI or blow the whole cycle. I was very satisfied with that. She also said that we should expect a 3 day transfer and that they will freeze all embryos we don't transfer that haven't arrested by day 3, even if they're crappy quality. She said this is contrary to what is usually done in the U.S., where they will only attempt to freeze high quality embryos. We also discussed the pros and cons of a single embryo transfer vs. 2 embryos. Of course this is all very hypothetical because if we don't have one good embryo, we will default to two. We still have to think a lot more about this, though, and at least have some kind of party line.
The nurse was so wonderful in answering all of our questions and she was just clearly very competent and intelligent. I feel more clear about things, but I am still so bummed that I am still in limbo with no idea of when I will be able to start, especially since I have given up so many really important things to be able to cycle now. It is true that we are going somewhere, but it seems that we are taking our sweet time getting there.
Fast forward to today - CD21 and still no positive OPK or fertile CM or hint of impending O or really, hint of anything. We had an orientation/logistics meeting today with our nurse (who is so wonderful, btw), and she was really surprised when I said that I hadn't had a positive OPK yet and wondered if my cycles are irregular, why I hadn't been on BCPs (AHHH!). Unfortunately, 'I told you so' never feels good. Tomorrow morning I am going in for u/s and b/w to try to get an idea of where I am in this cycle. If ovulation isn't imminent, they will start me on BCPs and I will wait another 3 weeks or so to take a stab at this cycle:( I would appreciate any good vibes you've got that I won't be postponed another month.
The other curve ball is that my protocol has been changed from the agonist protocol (aka long Lupron) to an antagonist protocol. The nurse explained to me that while the agonist protocol is still the first-line first timers protocol for young(er) people who are good responders and while it was what had originally been decided for me, the doctors were discussing my case at their staff meeting and serious concern was raised by my history as an over-responder (after a rather interesting scenario with 9 follicles on 50mg Clomid, I could always be controlled well with 2 nice follies during Clomid and injectable FSH IUI cycles by simply halving the lowest recommended dose).
They think that no matter what they do, I am at serious risk for OHSS, but that they can maintain tighter control of me with the antagonist protocol. They also want to trigger me with Lupron instead of a hcg trigger which should hopefully help to further limit the risk of OHSS. They prescribed me a hcg trigger as well just in case I defy their expectation and produce a normal amount of follicles and not 9 bazillion. So there you have it - I will be doing a Gonal-F/Cetrotide protocol in the end.
The nurse also said they will ICSI at least half of the eggs and let the other half fertilize (or attempt to fertilize) naturally. This way if we have a fertilization problem we won't be scrambling to do rescue ICSI or blow the whole cycle. I was very satisfied with that. She also said that we should expect a 3 day transfer and that they will freeze all embryos we don't transfer that haven't arrested by day 3, even if they're crappy quality. She said this is contrary to what is usually done in the U.S., where they will only attempt to freeze high quality embryos. We also discussed the pros and cons of a single embryo transfer vs. 2 embryos. Of course this is all very hypothetical because if we don't have one good embryo, we will default to two. We still have to think a lot more about this, though, and at least have some kind of party line.
The nurse was so wonderful in answering all of our questions and she was just clearly very competent and intelligent. I feel more clear about things, but I am still so bummed that I am still in limbo with no idea of when I will be able to start, especially since I have given up so many really important things to be able to cycle now. It is true that we are going somewhere, but it seems that we are taking our sweet time getting there.
May 24, 2011
nothing
Since I am in a natural cycle right now, I can't start Lupron until after I ovulate. The plan was for me to start Lupron around one week after ovulation, meaning approximately one week before my period is due. However, here I am on CD 20 and still nothing - no positive OPK or fertile CM...I am not even close to ovulating. Who knows if I will actually ovulate at all. We are supposed to meet with the nurses tomorrow morning to receive detailed instructions and get started with Lupron.
Needless to say, it is becoming quite obvious that our IVF start date is going to get pushed off, at least until I ovulate and it is safe for me to start Lupron. Has anyone had a similar situation with starting Lupron during a natural cycle and waiting to O or better yet, not Oing at all? You know what would make all of the frustration waiting to start this cycle worth it? If it results in a viable pregnancy and the birth of a healthy child. Then I will be able to let go of all of my frustration, agitation, and angst for this bloody cycle that I have been waiting to start since the end of March.
Needless to say, it is becoming quite obvious that our IVF start date is going to get pushed off, at least until I ovulate and it is safe for me to start Lupron. Has anyone had a similar situation with starting Lupron during a natural cycle and waiting to O or better yet, not Oing at all? You know what would make all of the frustration waiting to start this cycle worth it? If it results in a viable pregnancy and the birth of a healthy child. Then I will be able to let go of all of my frustration, agitation, and angst for this bloody cycle that I have been waiting to start since the end of March.
May 21, 2011
Happy ICLW!
It's been a few months since I've participated in ICLW, and I really look forward to jumping back in!
For anyone who is here for the first time, as a quick recap, we did our first IUI (unmedicated) in August 2010. After a nice vacation to visit our families in North America in September, we did our second IUI (with Clomid) in October 2010. I over-responded with 9 follicles, but thankfully 2 were well ahead of the rest, so we were able to salvage that cycle by triggering a little early. I got pregnant that cycle but at our 2nd ultrasound, the baby had no heartbeat and I was diagnosed with a missed miscarriage.
At the end of December, we did our 3rd IUI, also with Clomid, which failed. During January, February, and March, we did IUIs #4-6 with FSH injectables. All of those cycles failed as well. After a 2 month break I am now waiting to start Lupron late next week to begin our first IVF cycle and I have lots of hope that we are getting closer to our elusive take-home baby! You can find a more detailed version of our story here.
Also worth mentioning is that we live in Israel - as North American transplants, navigating the Israeli system is always a grand adventure (and occasional source of unprecedented levels of frustration), though we are very blessed and grateful to have full infertility coverage as part of the socialized healthcare system here.
May 17, 2011
Shaping up
Today I dug through the subterranean trenches of our bathroom cabinets to bring out into the light the Rainbow Light PNVs, high-dose folic acid, and vitamin D - also known as The things I might take if I was actually expecting to be pregnant soon stash. I am embarrassed to admit it, but I gave up on taking PNVs and extra vitamin D ages ago and I haven't taken any folic acid since my last injectables cycle. Among other embarrassing confessions, those PNVs used to make me a little bit giddy back in the day because they had the word 'prenatal' on them, and taking anything that pregnant women take made me feel so close to that stage I could almost taste it.
I am so used to thinking that I am not going to be pregnant in the most endless and infinite sort of way, it is quite a change in thinking to realize suddenly that I need to pony up and start taking better care of myself and act like someone who could soon be pregnant, much like my former naive new-to-TTC self. That girl was so hopeful for the future and so confident, healthy, and might I add sooo THIN, it is hard to get back in touch with her after all the sh!t that's gone down since then.
Ahhh, I hate this hope and all these high expectations for this upcoming cycle but at this point, it's all I have and so I love it too because it is what propels me forward and inspires me to carry on. Will I look back on the present a few months from now and think how naive and foolish I was to think I might get lucky on IVF #1 or is there a chance I could actually be That Girl for once?
I am so used to thinking that I am not going to be pregnant in the most endless and infinite sort of way, it is quite a change in thinking to realize suddenly that I need to pony up and start taking better care of myself and act like someone who could soon be pregnant, much like my former naive new-to-TTC self. That girl was so hopeful for the future and so confident, healthy, and might I add sooo THIN, it is hard to get back in touch with her after all the sh!t that's gone down since then.
Ahhh, I hate this hope and all these high expectations for this upcoming cycle but at this point, it's all I have and so I love it too because it is what propels me forward and inspires me to carry on. Will I look back on the present a few months from now and think how naive and foolish I was to think I might get lucky on IVF #1 or is there a chance I could actually be That Girl for once?
May 16, 2011
closer
I got the approval today from my health fund for our IVF! I never take anything for granted with Israeli bureaucracy, so I breathed a sigh of relief that it finally seems like this will actually be happening.
I am trying to work on being more positive about things - I feel myself becoming increasingly negative about this cycle as a defense mechanism but after talking to Child Psychologist Dad last night (yes, my wonderful dad is a shrink!), I see that it is important to allow myself those feelings of optimism and hopefulness because I realize that if this cycle doesn't work out, it is going to be a soul-crushing blow no matter how you slice it, and having a little faith in my body and in my doctors for once can probably only help at this point.
I recently purchased the Anji IVF imagery and meditations CD and the Circle & Bloom IVF/IUI series, and I look forward to testing them out as I G-d willing begin Lupron next week. I will definitely write about what I think of them once I start using them. I also recently learned about mind/body strategies in Conquering Infertility by Dr. Ali Domar, which Y makes fun of and I highly recommend. Maybe I will write more about that too soon.
Lately, I have been thinking a lot about how miraculous it is to get pregnant and give birth to a healthy child. You know how when you watch Olympic figure skating or gymnastics it looks so natural that it could be almost effortless? I feel that's how most women go through getting pregnant and pregnancy - what is going on in their bodies is nothing short of an Olympic figure skating performance but they make it look so natural, so effortless, like it just, you know, happens. I feel like the one who can't even stand up on her skates while holding onto the wall - the girl who flails helplessly in every direction just trying to get herself in a half-standing position while holding on for dear life.
I am sure if it was another part of my body that failed me, I would be filled with similar wonder for the miracle and complexity of its function - all the simultaneous physiological and molecular events that must occur, for instance, in order to breathe. It's amazing to think about everything we take for granted when our body does exactly everything that it is supposed to do so gracefully and effortlessly! I will stop waxing philosophical, and just say that I am so happy we have a new opportunity to make a baby:)
I am trying to work on being more positive about things - I feel myself becoming increasingly negative about this cycle as a defense mechanism but after talking to Child Psychologist Dad last night (yes, my wonderful dad is a shrink!), I see that it is important to allow myself those feelings of optimism and hopefulness because I realize that if this cycle doesn't work out, it is going to be a soul-crushing blow no matter how you slice it, and having a little faith in my body and in my doctors for once can probably only help at this point.
I recently purchased the Anji IVF imagery and meditations CD and the Circle & Bloom IVF/IUI series, and I look forward to testing them out as I G-d willing begin Lupron next week. I will definitely write about what I think of them once I start using them. I also recently learned about mind/body strategies in Conquering Infertility by Dr. Ali Domar, which Y makes fun of and I highly recommend. Maybe I will write more about that too soon.
Lately, I have been thinking a lot about how miraculous it is to get pregnant and give birth to a healthy child. You know how when you watch Olympic figure skating or gymnastics it looks so natural that it could be almost effortless? I feel that's how most women go through getting pregnant and pregnancy - what is going on in their bodies is nothing short of an Olympic figure skating performance but they make it look so natural, so effortless, like it just, you know, happens. I feel like the one who can't even stand up on her skates while holding onto the wall - the girl who flails helplessly in every direction just trying to get herself in a half-standing position while holding on for dear life.
I am sure if it was another part of my body that failed me, I would be filled with similar wonder for the miracle and complexity of its function - all the simultaneous physiological and molecular events that must occur, for instance, in order to breathe. It's amazing to think about everything we take for granted when our body does exactly everything that it is supposed to do so gracefully and effortlessly! I will stop waxing philosophical, and just say that I am so happy we have a new opportunity to make a baby:)
May 9, 2011
the unabridged version
For a while now, I have wanted to write out a more complete narrative of our experiences than the timeline posted on my sidebar, especially since we began fertility treatment before I began writing this blog. Finally, today I had some time and also the motivation to write everything out. It can be found under the tab "Our Journey...So Far". It was actually quite therapeutic to write and I hope that at some point it will be helpful to someone else. I would say "enjoy!", but it's not such a happy story so far - I just pray that some day it will have a sweet ending!
May 4, 2011
Crap
Still no AF:( Come on body, please cooperate!! For various reasons, it's technically impossible that we conceived this month (I must admit, it was kind of nice to have a break from all of the mind games and false hope). If it weren't impossible, now is right about the time when I would swear I must be pregnant. Since it was a natural cycle and I decided not to chart, I really have no idea when or if I ovulated, though all indications, including a highly positive OPK, suggested it happened on CD 17 or CD 18 and yet still, no spotting, no tiny bit of blood, nada - just bad menstrual cramps for the past five days. Now that the Israeli healthcare system seems to be taking a break from mocking my control freak ways, my body is taking up the slack - awesome!
If still no AF come CD40 next week, I am going to see if I can at least take BCP whenever CD 1 does arrive so I am not relying on my wonky natural cycle anymore. Actually, I have a question about that - will my Lupron period be a real period or will the Lupron actually induce it? In other words, if I continue to just go with my natural cycle and then I start Lupron around CD 21 of this coming cycle, will my next period still be a real period at the whims of my unpredictable body and when I ovulate or will it be induced by Lupron and therefore have nothing to do with when I ovulated during that cycle? I hope that question made sense/is not unspeakably dumb:)
If still no AF come CD40 next week, I am going to see if I can at least take BCP whenever CD 1 does arrive so I am not relying on my wonky natural cycle anymore. Actually, I have a question about that - will my Lupron period be a real period or will the Lupron actually induce it? In other words, if I continue to just go with my natural cycle and then I start Lupron around CD 21 of this coming cycle, will my next period still be a real period at the whims of my unpredictable body and when I ovulate or will it be induced by Lupron and therefore have nothing to do with when I ovulated during that cycle? I hope that question made sense/is not unspeakably dumb:)
May 3, 2011
A really good appointment!
After last month's debacle with the 90-second appointment, I had a terrific appointment yesterday morning. It was off to an usually good start when I didn't have to wait longer than a few minutes before being called. I saw a younger colleague this time and he spent a full hour with me answering all of my questions and thoroughly reviewing my records and all of my past treatment cycles. We also went through all of the IVF consent forms, I had a quickie check-up (no stirrups involved for once:), and I signed my life away. Since Y wasn't there, he'll have to go back to sign the consent forms. I was also very pleasantly surprised to learn that cryopreservation of any embryos that make it to freeze is free for up to 5 years.
He said I will be doing the long lupron protocol. They will submit the paper work to my health fund and assuming everything is approved in time, I will start lupron this coming cycle (AF is due today or tomorrow) and then begin stimming around June 1 with an estimated ER/ET mid-June. He said once the paperwork goes through, a nurse coordinator will contact me with a time to go over the medication specifics.
I was surprised to learn that they favor 2-day transfer over 3-day or 5-day transfer (apparently they sometimes do 3-day transfer, but 2-day is most common for them). I worry that at 2 days, assuming that we have more than 1-2 fertilized embryos, it will be hard to determine which ones are the best. I know that I just need to trust them that they will make the best choices.
I felt a huge weight lifted off of my shoulders once the appointment was over, though I must admit that I am pretty anxious about everything! In addition to being anxious, I am also more excited for this than I have been for anything in a very long time. It is difficult for me to write that, since I always feel the need to be guarded in my expectations. Now I am just waiting for AF to come and hoping we get the health fund approval in a timely fashion.
He said I will be doing the long lupron protocol. They will submit the paper work to my health fund and assuming everything is approved in time, I will start lupron this coming cycle (AF is due today or tomorrow) and then begin stimming around June 1 with an estimated ER/ET mid-June. He said once the paperwork goes through, a nurse coordinator will contact me with a time to go over the medication specifics.
I was surprised to learn that they favor 2-day transfer over 3-day or 5-day transfer (apparently they sometimes do 3-day transfer, but 2-day is most common for them). I worry that at 2 days, assuming that we have more than 1-2 fertilized embryos, it will be hard to determine which ones are the best. I know that I just need to trust them that they will make the best choices.
I felt a huge weight lifted off of my shoulders once the appointment was over, though I must admit that I am pretty anxious about everything! In addition to being anxious, I am also more excited for this than I have been for anything in a very long time. It is difficult for me to write that, since I always feel the need to be guarded in my expectations. Now I am just waiting for AF to come and hoping we get the health fund approval in a timely fashion.
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