IVF #1 = BFN

This morning (12dp3dt) I went in for my beta, which was zero. There were no surprises here- after testing on 9dp3dt I tested again on 11dp3dt with another FRER, so it was pretty obvious to me that neither of those beautiful embryos took. Tonight I indulged in my monthly fertility treatment failure sushi extravaganza, of course complete with a glass of red wine. Is it sad or funny or both that I can measure my failures in sushi dinners?

We started this tradition of going out for sushi whenever a treatment failed and/or AF arrived early on in our (in)fertility journey. I remember many a tearful sushi dinner - dinners when I would just burst into tears at the table and the waiter or waitress and people seated around us would do their best to pretend not to notice or sushi dinners when Y would order for me while I sobbed in the restaurant bathroom.

These days with the arrival of bad news every month, I just look forward to the sushi with gleeful anticipation for raw fish. I am much happier, calmer, and more content at our monthly sushi extravaganza. The evolution of the sushi dinners is an interesting frame of reference in how I have changed over time with respect to how I view my infertility.

I am not going to say that it has gotten easier, but my infertility certainly has taken on a chronic disease-like role in how I view it and how it affects my life. It is now a permanent part of my identity and I continue life with it or in spite of it or around it, whereas once it was a constant state of crisis. That sounds awful, but in some sense it was also hopeful - a state of crisis is temporary, it is not sustainable in the long-term. In a strange way, the sense of crisis was an indulgence. It meant that I saw a way out of the crisis and that I in fact expected a way out any day.

Now I ease my way into that huge plate of sushi with a singular focus toward that deliciously raw salmon and tuna - no tears, none of that rawness or surprise or lack of control that I once felt with each new failure. This is my new normal - how could I expect anything different than for things to continue just as they have been and just as they are? How could I reasonably expect not to fail?

9dp3dt = BFN

I tested this morning with a FRER (from my coveted American stash- I only break out the good guys for special occassions!) and of course it was stark white. I was expecting it since I feel normal and my OHSS symptoms never returned. I am glad I did it - I need a couple of days to emotionally process the failure before I get the infamous beta phone call. You could say I should still hold out some hope but hoping for a miracle at this point (a miracle being not just a positive beta, but a viable pregnancy) just feels cruel and dishonest to myself. I had a late implanter once. For me, I know what that means. That baby's due date was yesterday but I am no closer to holding a live baby in my arms. So it goes. Also, thankfully my beta was moved up 2 days to 12dp3dt (Monday).

sweet dreams are made of these

6dp3dt - I am really going off my rocker. I had a pretty annoying headache this evening, and since my trusty excedrin/coke combo is verboten, I decided to take a nap to see if I could sleep it off. And what a lovely nap it was - I had a very vivid dream that I was cleaning the living room, which somehow involved the loveseat being tilted at an angle and then subsequently falling on my back. All I could think was "Fvck! If anything had somehow miraculously implanted, I am sure it un-implanted now!" Needless to say, I woke up from my peaceful nap feeling as "un-implanted" as ever. Also, IRL, the living room does really need to be cleaned.

postcard from the middle of nowhere (5dp3dt)

Well, it looks like I am deep in the middle of the no-data zone - the black box of the 2ww where the side effects of the vast quantities of supplemental progesterone and estrogen are in full-swing, the giddiness of seeing those 2 beautiful embryos is becoming a memory, and the knowledge of the final outcome of this cycle seems impossibly distant.

The IVF cycle is such a rollercoaster of inactivity and activity - you twiddle your thumbs anxiously waiting weeks or months for your cycle to begin - you start cycling and all of the sudden you're in this day-to-day whirlwind of action where things keep changing constantly and you're always on your toes and just thinking from one day to the next and then suddenly after ET, there is this peaceful calm - back to twiddling your thumbs again and back to waiting. At first, I found the peaceful calm after ET a relief, but now I must admit I am getting pretty anxious and nervous.

In fact, I am so freaking nervous I have had little desire to write in my blog because frankly, writing about how I am nervous just makes me feel more nervous. Actually, pretty much everything makes me nervous right now. Our clinic doesn't do an initial beta until 14dp3dt, which I think is REALLY late. I am sure I will end up testing before then, but I want to wait until there is at least a really good chance of getting a 2nd line on a FRER if something worth writing home about is going on. I know I definitely won't be testing on Thursday, which is not only questionably early, but also the due date of my first (lost) pregnancy. After that, who knows...eek.

Welcome home!

Today was our embryo transfer. We were told to arrive at 10:30am and the transfer didn't happen until 2pm, so that was pretty annoying! The day would definitely have been more pleasant if we arrived later, had lunch first, brought some entertainment with us, and if I didn't start chugging water until right before the transfer! In the end, the transfer went super smoothly, though, and that's what is most important!

Of our 8 embryos, 1 was blatantly abnormal (the outer shell was missing entirely) so it will be discarded, and the other 7 were continuing to grow and do their thing. We transferred 2 embryos, an 8-cell grade AB and a 10-cell grade B. The remaining 5 which will be frozen were grade B with respect to degree of fragmentation (it is possible that 1 of them was actually grade C or BC). We weren't sure if we were going to transfer 1 or 2, but my gut was to go with 2 and Y felt it was ultimately up to me, so that's what we ended up doing.

It was really one of the most amazing experiences of my life to see those 2 embryos on the screen and watch them get sucked up by the glass straw and then to watch by ultrasound the little flicker as they went inside my uterus...pretty incredible. I really hope and pray to be blessed enough to meet one or both of those little guys again this coming winter. Y made a video on my iPhone of the embryos on the screen, but I don't think that the quality is so good.

The real kicker is this: my former boss performed the transfer! Before grad school, I worked in a stem cell research lab for a couple of years as a research technician. The head of the lab was a MD/PhD whose training was as a RE. Anyhow, he does 1 day a week in IVF and today was his day! He was really friendly and professional about it and he offered to get someone else if I was uncomfortable. We were already in the OR, though, and by acknowledging the situation, it actually made me feel okay with him doing it. In truth, I really only run into him once a year or so, and I trust him very much, so I figured I'd just go with it. Obviously, if he was someone I was still working with currently, it would be totally different. Still, crazy, right?

They brought me on a gurney to the ob/gyn ward afterwards to lie totally still for an hour, which seemed like total overkill to me. Once that hour was over, I was just so ridiculously happy to get up and PEE. Finally, we got out of there a little before 3:30. I am still feeling pretty crummy but I am beginning to walk like a normal person now, thank goodness, so I think I am on the mend. Now I am just thinking happy thoughts for my 2 embryos and hoping and praying for the best.

I am excited to have gotten this far - when my E2 wasn't rising and with the stress of not responding as well as they had hoped transfer seemed so far-off and built upon so many what-ifs. Now I just feel relieved and filled with gratitude to have just made it to this point. Seeing those 2 beautiful embryos inspired me and now I am doing my best to put my faith in them and in my body (though true to my usual form, I am still planning ahead for The Worst Case Scenario).

post-retrieval blahs

A few things - first, I am sorry the quality of my writing seems to have taken a nosedive lately (not that my quality of writing was ever anything more than slightly below mediocre, but I am afraid that my writing has become even less interesting than usual as of late). Second, I am sorry I had the compulsion to change my blog background for the nine zillionth time. Anyone who has been reading my blog for any length of time knows I have a tendency to change my background approximately every 5 minutes. Thirdly, happy ICLW! I cannot believe it is that time of the month again!

After my retrieval I was feeling pretty good - crampy, sore, and dazed for sure, but I could still walk around okay and I was definitely managing. Yesterday morning when I got up I felt worse than I had the evening before, so I decided I would allow myself an hour or so to get my act together before going to work. Instead, I started feeling progressively worse - really bad cramps and soreness and trying to walk or move in general was pretty painful. I also had the runs (lovely) and was feeling overall really crappy.

Needless to say, I never made it in to work yesterday. Y suggested that maybe I have mild OHSS, which just boggles my mind, since my E2 never got that high. Sure enough, I gained 2.5 kilos (5.5 pounds) in the past 24 hours. Y got me some insanely overpriced Gatorade (which is available at very few places in Israel at high mark-up) and downing large quantities of that has seemed to help.

The good news is I do feel slightly better today (much less nauseous!) and I even went in to lab for a few hours (turned out to be not such a good idea since I still can't walk like a normal person so I look really funny and moving is very painful). I am sure if I do have a little OHSS it is very mild and will be self-limiting. I thought about calling the nurses today but I am pretty sure when I go in tomorrow for the transfer they will be able to tell if there is mild OHSS anyway. Usually I am pretty energetic so having to slow down and take it easy is psychologically difficult for me. I am just trying to think positive thoughts about our transfer tomorrow and hoping that our embryos are going strong and that all will go according to plan tomorrow!

fert report - 67%

I got my fertilization report about 30 minutes ago. I was getting so nervous and antsy waiting for the news, especially since I had no idea what to expect at all. I mean, with the retrieval I was already going in with a fair amount of information from my last ultrasound about what to expect. I knew to expect 11 eggs and that anything more would be a bonus and anything less would be a little disappointing. In comparison, the question of how many eggs would be fertilized just felt like a black box! Anyhow, 8/12 of our eggs fertilized, which is better than I was expecting - that is a 67% fertilization rate.

We did a split batch - half ICSI and half left to fertilize naturally. Interestingly, the results were the same between both batchs - 4/6 that were ICSI'd became embryos and 4/6 that were left to fertilize naturally became embryos. We go back in on Wednesday at 10:30am for our transfer. Right now I am just trying to go with the flow and hoping for the best.

12 eggs!

My egg retrieval was this morning. In the end, we got 12 eggs. No great surprises, but that's just about as good as we could reasonably expect so I am happy. I also had an irrational fear that I would have already ovulated, so I was so relieved to hear there were actual eggs in there:) The whole experience was very surreal, probably thanks to the anesthesia.

We checked in to the day surgery department at 8am. The nurses took my vitals and I got my uber fashionable gown and hospital pj pants. Y went to to hand in The Sample and I listened to my Anji pre-retrieval meditation track on my iPhone one last time:) After 30 minutes or so, they brought me down to the OR. They brought us into a smaller inner waiting area off of the ORs. There was another couple there when we arrived. After about 20 minutes, they were called in and a few minutes later, another couple arrived. This couple, who we would spend most of the rest of the day next to, was on their 5th IVF. I so very much hope that they are successful this round! Once they arrived, we waited a full hour before the nurse called me back! This was definitely the most nerve-wracking part of our morning, and the other couple was getting pretty anxious and antsy, too.

Finally, I was off to the OR. The anesthesiologist arrived and asked me questions about my health and anesthesia history. Since the REs in the clinic do the ERs on a rotating basis, I had no idea who I would be getting. I was really relieved and happy to get my favorite RE. He did my hysteroscopy as well and I know that he is very gentle.

He asked me how many eggs I was expecting and when I told him just around 10, he surprised me by asking whether I wanted local anesthesia instead of general and whether I have good pain tolerance. I know Y also prefers operating under local anesthesia whenever it's possible since it means fewer risks and a quicker recovery for the patient, but I wasn't too thrilled with this idea. The thing that's funny is that a few years ago, I probably would have said yes, seeing it as some opportunity to prove myself. However, I really didn't feel like I needed to prove anything so I told him the truth, which was that I wasn't so afraid of pain but that I didn't want to remember a thing!

Anyhow, the anesthesiologist put in my IV. I asked him if he had started pushing the drugs yet and he said no. Then he said he would start slowly and that the anesthesia would be progressive. The next thing I know the RE was telling me he got 12 eggs. The funny thing is that I don't remember seeing him or having my eyes open. What seemed like only a minute later, I was in the recovery room and Y was there. Y said a full hour had passed since the time that we parted ways - amazing, because to me it could have been just 10 minutes. After about 30 minutes, the pulse oximeter and EKG leads came off and an orderly arrived and I was on my way!

They brought me back up to the day surgery unit, hooked my IV back up, and then I was able to drink some tea. The whole thing was kind of a production - I thought I would be out of there by noon but the day wore on. First, they wanted me to eat something after my tea. Then, they wanted me to pee. I spent most of the afternoon napping. Finally, around 2:30 a RE (a different one) came around and went over instructions with us and discharged me. I was so ready to get out of there and go home!

Unfortunately, because of where Y parked the car, we had to walk through the medical school (where my lab is located) in order to get out of there. I was sooooo cranky and I didn't want to be seen by anyone because I knew I looked like crap and I prefer to keep my treatments as private as possible. I kept seeing people I know, averting my eyes, and whining to Y. It was pretty embarrassing.

I asked Y to get me a giant fruit smoothie on our way home, which I consumed in about 3 minutes. I was so happy to be home, take more Optalgin (awesome OTC pain medication in Israel that is illegal in the states), and sleep! I was quite uncomfortable and groggy for a while, but now it is 10:30pm and I am awake and feeling better and more with it - just sore and crampy. Hopefully, I will be able to go to work tomorrow - we'll see.

Tomorrow is another big day for us - we should get the fert report around 10am. I am hoping and praying that across town tonight, my eggs and Y's sperm are playing nice, giving rise to some beautiful, healthy embryos!

E2 never went up

According to the nurses, my E2 hasn't gone up at all since Tuesday and the rise between Sunday and Tuesday was very modest. Interestingly, my follicles continue to grow - today I had 21, 20, 19, 17, 16, and 16 on the left and 22, 16, 15, 15, 13 on the right with a lining of 13mm. Yet my E2 is still shy of 1000 pg/ml which just doesn't correlate with the follie growth. They decided we should still go through with ER, which will be on Sunday, so I will trigger at 11:30pm on Friday night. I will continue stimming right up until the trigger, taking my last dose of Gonal-F the same day as the trigger.

I already view this cycle like a failed science experiment but hopefully we will learn some valuable things for next time. It's safe to say that I would be absolutely shocked if this cycle results in a viable pregnancy - even if we do get a few half-decent embryos there is the whole issue of decreased endometrial receptivity that comes with stimming past the point when the lead follicles are in their prime. My lowered expectations are actually sort of comforting - I feel like a lot of stress and anxiety has been lifted from my shoulders now that I feel fairly confident in the outcome.

I do worry what my bizarre-o response says about my egg quality in general and what the future holds for us in trying to use my eggs, but then again, I am Jump to the Worst Conclusion Girl. At the end of the day, I will be really interested to hear what my doctors think of the E2 that doesn't budge despite growing follicles, but from what I've read it seems likely that my E2 isn't increasing because a lot of those eggs are of very questionable quality and/or that some of those follicles are empty. I am looking forward to the egg retrieval with a very detached intellectual curiosity at what will actually be retrieved. I think I am trying my hardest to emotionally distance myself from the cycle as a defense mechanism to prepare myself for failure. I just don't get it- this pretty much sucks.

day 9 of stims=disappointment

When I went in on Sunday, we were told we were on-target for a Thursday egg retrieval. Unfortunately, due to disappointing progress since then, we've been postponed until next Sunday since they don't do ERs on Friday or Saturday. Of course I am incredibly anxious about postponing ER until Sunday because it essentially means sacrificing the current leaders with the hope that the larger cohort of smaller guys will play catch-up. The problem is that I just don't have such a large number of follicles to begin with and the ones I do have are still a wide range of sizes. On my right I have 19mm, 18.5mm, 16mm, 14mm, 13mm, and 12mm (2x) and on my left I have 21mm, 13mm, 12mm, and 11mm (2x).

Frankly, I would have felt comfortable with Plan A, which was to get in another shot of Gonal-F this afternoon and then trigger tonight for a Thursday ER, knowing that I probably won't get a very high yield of mature eggs but also that the current leaders will be in prime shape. My E2 was in the high 3000s today (equivalent to around 1000 pg/ml), so really not that much has happened for me since 48 hours ago.

I guess the logic now is to just keep pushing me out longer with the hope that everything currently in the 11-14mm range will be ready come next Sunday. I have some misgivings since the little guys have actually moved hardly at all since Sunday. It's a leap of faith for me that they won't just fizzle out the same way all those 10s and 11s did during injectable IUI cycles and I am sad for the current leaders who have been growing so nice and strong that we are essentially sacrificing them! I've also read that in general, pregnancy rates are lowered when you postpone trigger more than 24 hours past when the lead follicle reaches 20mm. I know as this process unfolds, I will always find something new to worry about! The irony is not lost on me that the doctors were initially preparing me for a hyperstim situation. Is it sad that I've already started thinking how we can improve our next fresh IVF cycle when I haven't even reached ER yet with this one?

ETA: I believe that this is the most often cited paper on the topic:

Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril. 2004 Jul;82(1):102-7.

The gist is this: they took two groups of patients with similar diagnoses, all on the antagonist protocol. Half of the patients were triggered when at least 3 follicles were at least 17mm and half of the patients were triggered 48 hours after this criteria was met (in my case, I will trigger over 72 hours after this criteria was met). On the whole, the patients in the late trigger group had higher E2 levels at the time of trigger and more mature eggs retrieved than the early trigger group. However, despite the larger numbers of mature eggs, the ongoing pregnancy rate in the late trigger group was 25% compared to 35.6% in the early trigger group. The theory is that prolonged stimming leads to decreased endometrial receptivity and lower implantation rates, perhaps as a result of the increased progesterone level at the time of trigger that comes with pushing the mature follicles past their prime. I can't help but feel doomed already knowing that my trigger will be over 72 hours past the time 3 follicles reached 17mm.

monitoring update - CD 9 (day 7 of stims)

This morning I went in for my first monitoring appointment since starting stims. There's not quite as much going on as I had hoped given that I am feeling pretty uncomfortable already and the doctors were being a little alarmist about my OHSS risk before I even started. I am actually feeling a little let down by my response so far, but I know things could change quickly. I have 5 follies at 10mm, 2 follies between 12-14mm, and 2 follies at 15mm. As I predicted, today was a little on the late side to start the antagonist, so the nurses were very happy that I brought cetrotide with me and I was able to do the injection right then and there after my ultrasound. My E2 is ~2700 pmol/L, which is equivalent to around 700 pg/ml - the units used in most American labs (there's an approximation sign there because I didn't quite catch the whole number over the phone).

The plan now is to continue along with the same dose of Gonal-F tonight and tomorrow night along with Cetrotide and then I will go in on Tuesday morning for my pre-op and another monitoring appointment. It seems like I am stimming pretty quickly but not necessarily with so many follies (weirdly, so far my response is almost identical to my response to just 50mg Clomid during the cycle when I over-responded...I think my body is pretty unpredictable/variable). I am really hoping to somehow hit that elusive sweet spot where they get a satisfying number of eggs but not quite enough to push me into high-risk for OHSS territory.

I am honestly just a little underwhelmed that I already feel as uncomfortable as I do with only 10 follicles (5 of which I would say are a little iffy...many times during IUI cycles the little guys at 10 or 11mm would just fizzle out).

All in all, things are moving along okay I think, but I hope I will have a more enthusiastic update come Tuesday!

P.S. I would love to hear from other ladies whose response was somewhat similar to mine in terms of how things ended up for you by the time of ER!

Here goes nothing! - IVF begins

Tonight Y gave me my first Gonal-F injection. I am pretty scared (mostly that it won't work and that I will be heartbroken), but I guess I am also excited, too. I guess no matter how this turns out, we will at least be one step closer. One step closer to what precisely, I am not sure, but I do believe one step closer to children in some form or incarnation.

baseline and green light for stims

I went in for my baseline bloodwork and ultrasound today (CD2) and all is good so I can start Gonal-F tomorrow evening. My only concern is this - my clinic doesn't do monitoring on Friday/Saturday (I know most North Americans will find it horrifying that we have no monitoring access at all during those two days, but here in Israel it is the norm due to Shabbat...I must admit it would be great if we at least had monitoring on Friday mornings). As a result, I was told not to return for monitoring again until next Sunday (CD 9).

My concern is this: on 2 out of 3 of my injectable IUI cycles, I stimmed for just 7 nights before triggering. Given that information, waiting until next Sunday (7th day of stims) before doing any monitoring and therefore deciding when to add in the antagonist (Cetrotide) seems like a horrible idea to me. I do get that on Thursday (CD 6), I will have only done 3 nights of stims so probably not a whole lot will be going on, but the alternative of waiting until Sunday before doing any monitoring at all given my previous quick response makes me very nervous.

So: 1) Am I just being my neurotic paranoid self or am I right about this?
2) If you agree that I should go in for monitoring on Thursday, should I just show up and do bloodwork and ultrasound (the way it is set up, no one is going to stop me from doing this and I have the bloodwork/ultrasound stickers to use at will...on the other hand it is basically not following the clinic's instructions) or should I call the clinic tomorrow and actually try to reason with them why I think I should come in on Thursday? (The drawback is they may just tell me to stop worrying...everything will be ok...oftentimes easier to explain your crimes than ask permission). I would especially like some guidance from my Israeli readers concerning question #2:)

CD1...

...is here. Well, that's pretty cool. Aboutfreakingtime to get started with this cycle! I will go in tomorrow morning to get bloodwork and ultrasound. Hopefully all will come back clear and I can start stims come Monday. Y woke up really sick this morning, which is disquieting since he rarely gets sick and even more rarely becomes incapacitated by illness. He says the last time he felt this bad was when he had Hep A. Not good. I really hope he is on the mend come morning and also that I do not catch the death plague he is incubating. After treading for so long it's time get my sh!t together and get back in the game. I'm ready.

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.

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.

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.

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?

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:)

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.