and the painted ponies go up and down.
We returned today from our 2.5 week trip to North America to another bright, sweltering hot day here in Israel, while on the other side of the pond, slightly cooler temperatures and the first signs of fall seemed to already be upon us. It's hard to believe that it's almost Rosh Hashana, the Jewish New Year, again. Last Rosh Hashana was the cycle that I got pregnant via our 2nd IUI.
Since we received the negative beta for our 2nd FET, I've been back on birth control. The current plan is for me to discontinue BCPs on October 14 and start the stimulation for a new IVF on October 17. I will be doing the antagonist protocol again with the same dose of Gonal-F and some Luveris (LH) added in as well to help with the final maturation of the follicles. We would really like to make it to a day 5 (blastocyst) transfer this time around, so here's hoping for healthy embryos and some good looking blasts!
Y has army reserve duty during October and November (he is the physician for a combat unit- basically, he oversees a group of combat medics) and that is definitely adding some extra anxiety to our next IVF, especially as the political climate continues to heat up here in the Middle East. He should be able to take a day off for the egg retrieval without a problem, but still, his emotional support and just having him around while I cycle means a lot to me and of course I worry about him while he is away.
I don't know what it will take to get us pregnant with a healthy, sustainable pregnancy, and as usual, I which I knew how much of this marathon we've already run to get there, but I am always hoping hoping hoping we are further to the end of this journey and closer to the beginning of the next era than we think. I am very happy with our choice to switch REs and clinics, and I am hoping the new place and new year will bring us a change in luck.
Showing posts with label antagonist. Show all posts
Showing posts with label antagonist. Show all posts
Sep 19, 2011
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.
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