Meet my embies!

My transfer went really well today (except that I had to hold pee for a very long time for the procedure - a full bladder helps it. It was uncomfortable!). I had three surviving embryos when I arrived at the doctor's office. The other three stopped growing (sorry embies), and they weren't the candidates for transfer. The surviving three were "fully expanded early blastocysts" which were "quite good" according to Dr. T. We transferred two of them and we hope to freeze the remaining one. The remaining embryo has to grow to a "full blastocyst" before we can freeze it. I hope he/she will mature into a full blastocyst without a problem. We didn't consider transferring all three because Dr. T thought the risk of having triplets were too high with these three good embryos. Now I have to wait for the pregnancy test on the 4th. Dr. T gave a 65% chance of success though! That's very good in the IVF world (really!).

My favorite nurse, Franny, was there to assist the procedure. She told me to be a "couch potato" today so I'm spending a quality time with my cat on a couch. I can go back to my sort of normal activities tomorrow. I said "sort of" because I still can't lift anything heavier than 10lb until the pregnancy test, and it will be a challenge to do my job without any lifting. I guess my patients have to lift themselves for the next few weeks.

I don't have bad eggs

I realized I was wrong about my egg quality. I was just reading an online article written by my doctor about diminished ovarian reserve (DOR). DOR only means that I don't have many eggs left in my ovaries. That's it. The quality is related to the ages of women. A relatively young 32-year old woman (like me) with DOR can still produce high quality eggs, jut not many of them. Also, the pregnancy rate is related to the egg quality more than the number of embryos produced during IVF cycle. It was very interesting, so I am putting the direct quote here.

"Recent studies have shown that young women with high FSH levels demonstrate lower numbers of growing follicles but can still achieve good pregnancy rates if oocytes and embryos are obtained. This highlights the premise that age reflects egg quality better than FSH levels do. (by Dr. Tortoriello, cited from http://www.ivfauthority.com/2009/09/ovarian-reserve-overview-guest-post-by.html)"

I feel lucky to find my doctor who knows tons about how to manage cases like mine. I didn't know about my issue when I selected a doctor. The fact I did not go to Cornell, for example, was crazy since I work across the street from the medical center. I just felt right about choosing Dr. T when I needed a doctor. It is like someone was sending me to his doorstep. Dr. T is an amazing doctor, and I know it is my destiny to have a baby (or babies).

Baba-sama

This is a picture of the most fertile woman I know - my grandmother (with me with horrifying haircut). Baba-sama is how we call Grandma in my family. She had seven kids. I got her fertile genes!

A little scare (actually it wasn't "a little...")

So I spent a day in a research class in the basement of my hospital. Here was the big problem: I was waiting to hear from my nurse Jocelyn to get the progress report on my embies, and I had no cell phone reception in the basement (!). Jocelyn and I did a few phone tags before I finally got to talk to her. Meanwhile, my insurance company called my cell phone and left a shocking message. "I spoke with your doctor's office and cancelled the predetermination review for your cancelled procedure." WHAT? WHAT ARE YOU TALKING ABOUT? A CANCELLED PROCEDURE? I was in panic for a while. I thought something happened to my embies and my transfer got cancelled. I couldn't breath right. I was half crying. Well, fortunately my assumption was wrong. Jocelyn said I have 6 embies surviving. They should contain 6 or more cells on Day 3 (today was day 3). Three of them have more than 6 cells and three have only 4 cells. Jocelyn thinks these three slow ones can catch up by Sat. And they got my genes. I am not the fastest person in the world so maybe these embies are just taking some time too. Hopefully they can become strong candidates for the transfer by Sat. We are not sure how many embryos we are going to transfer back to my uterus. I'll see what my doctor says. I trust him 100%.

So I'm all set for my Sat transfer at 11am. I've made acupuncture appointments as well. It is happening!

I did ask Jocelyn about my insurance company, but as far as she knew, no one from my doctor's office called to cancel the procedure. So, I guess my insurance company has an employee hearing imaginary voices. I have to call her back tomorrow morning and send her to this address: 462 First Ave. It's Bellevue Hospital's Psych ER. I can't believe she made me panic. I don't need this kind of stress now. I am still bitter.

"I Believe"

Seven

I got a call from my nurse Jocelyn this morning. A good news. Seven eggs were fertilized! So, seven embies are growing at my doctor's office right at this moment. I can't wait to meet them. My transfer is scheduled for this Sat. It is the day 5 transfer as I wanted. I'm very happy. Meanwhile, I'll continue with the Progestrone shot. I am not a big fan of intramuscular shot but I'll be more than happy to do anything to get me pregnant.

Since I am crazy, I had to give names to those embies. Here you go (with meanings): Amare (immortal), Bern (brave), Caden (fighter), Day (hope), Emlyn (to strive), Falan (fruitful), and Gene (well born). Again, they are not our top choices for baby names. We chose the names based on the meanings.

Can't wait to get more progress reports about them. I have to wait until Thursday...

Fourteen

My retrieval went well. My doctor retrieved 14 eggs - 7 mature ones and 7 sort of mature ones. That's more than what I expected and I am very happy. Now the waiting game starts. My nurse will call me tomorrow to let me know how many eggs are actually fertilized. I'm hoping for more than 5 embryos so that I can do the day 5 transfer. I said to my doctor that I hoped for the day 5 transfer, and he agreed that it looks like the plan for now. We'll know more tomorrow. TOMORROW. I can't wait...

My body has completely recovered from the procedure. No more pain in the ovaries. The progestrone injection starts tonight. It is an intramuscular shot and it has to go to an area in the buttock. I can't do it myself, so my husband has to be in charge. Good luck to him.

I just found out that one of my friends went through fertility treatments in the past. She now has beautiful babies. I am happy to learn about those success stories. I was feeling loneliness in this fertility journey, but I've started to realize I am not alone. There are many people who had the same struggle as I had. I hope I will be one of the successful IVF stories people talk about in the future.

Hello, follicles. How are you all doing?

Today was the first day without any injections. I administered the "trigger" hCG shot with my husband's help last night at 11pm. That was the last shot needed before the retrieval tomorrow. I don't miss shots, but I feel funny without them. It feels not normal. Also, I did not have to go back to see my doctor today. No ultrasound. No blood draws. I should feel good about not going to a doctor's office, but I wanted to see those follicles. I learned about their progress every day during the past few days, and I feel anxious not knowing how they are doing today. I guess I'll know tomorrow. Tomorrow is the retrieval. The big day!

I wanted to do something productive today. But I couldn't force myself. I am so distracted. I guess I'm pretty nervous about tomorrow. I'm not nervous about the procedure but the result. How many eggs will I get? I hope for a good number.

Ovary boot camp

So, those 15 mm follicles stayed 15mm in today's ultrasound. GRRR. They needed to grow because they are right now too immature. Meanwhile, other ones got bigger and doctor does not think I can wait to trigger anymore. These big ones will be gone otherwise. I just gave myself Follistim and Luveris hoping that these medications will make those 15mm follicles bigger during the next 12 hrs or so before I get the trigger shot. My doctor thinks they can mature in the 12 hrs. So, these 15 mm follicles are officially in the ovary boot camp. The plan for next 12 hrs is: rest, relax, eat well, some meditation, fertility yoga, and massage. No stress because I need my blood vessels to relax and carry the medications to the small follicles in my ovaries. I wished for a nicer day because I think I should to be outside in the nature as well. I now see a blue sky coming out. Great.

So, my retrieval is scheduled for sometime on Monday. I'm waiting to hear from my nurse for the exact time. So far my lineup is the following follicles (each of which contains an egg): I gave random names to identify these follicles. Just so you know - they are not our top choices for actual baby/babies but they have nice meanings. 18mm follicle "Arav," 18mm "Balint,"17 mm "Cai," 17 mm "Damali," 16 mm "Edison," 16 mm "Fareeda," 15 mm "Gale," 15 mm "Hafwen," 15 mm "Ida."

I sound like a crazy person...

It's not a good day...

I can't sleep. I've been suffering from insomnia for the past few years since I started working night as a nurse. It has been worse during the past few days. I am anxious. Anxiety makes the insomnia worse. And feeling tired from insomnia makes my anxiety worse. So it's basically a vicious cycle. When I was planning for IVF, there were certain rules I made for myself. One of them is that if I don't get at least 3 hr sleep, I can't work. I slept only for 1.5 hr in the past 24 hours. So, I'm not going to work tonight. I feel bad for my colleagues who have to work extra hard to cover my absence, but I don't think I can function like this. I honestly think it is better to stay away than going to work in this condition and possibly making a huge mistake.

I'm not yet ready for the trigger shot. There are about 10 follicles between 15mm and 18mm. My doctor hopes to get all of them. They need to be between 18mm and 20mm. I hope the smaller ones grow fast and the bigger ones slow down a little. I hope they will cooperate. I'm back to doctor's office for more monitoring tomorrow morning.

Go follicles go!

I went for another blood draw and ultrasound today. My follicles are not growing as rapidly as they expected. I only had two follicles that were in the okay size. So a little more waiting time. I'm going back to doctor's office tomorrow to see the progress. Once my doctor decides that my follicles are in the right size, I will need a "trigger" shot, which get all the eggs ready to ovulate. But instead of letting them actually ovulate, my doctor will surgically remove them (with a needle) from the ovaries. That's the process of retrieval. Right now, my retrieval is scheduled either on Sunday or Monday depending on what we see tomorrow at the ultrasound.

Mike and I went to an information session by an OB practice this evening. I am not pregnant quite yet, but I will need a doctor if this IVF works. I did have a midwife who was doing well-woman care but I decided to find another provider. The midwife didn't take me seriously when I suspected that I might have a fertility issue. To be fair, it was still early in my "try to get pregnant" phase, so she did not have a strong reason to believe that I had a problem, well, except the fact that I had a reason to believe so. I usually know what I'm talking about especially in medical stuff. I'm not sure if she is the most caring provider, and I don't want to go back to her. I was deciding a midwife vs OB doctor. I love the idea of midwife and I WAS 100% certain that I wanted to go with a midwife practice until I had this fertility issue. I still want unmedicated birth if possible, but I do want to get monitored closely. Midwife practice does not use much technology to monitor pregnancy, which I think is okay and great for people with uncomplicated pregnancy. I want tons of monitoring, however. I'm spending so much energy getting pregnant that, if there is any problem during pregnancy, I want to know RIGHT AWAY. The OB practice I found sounded perfect for my needs. They call themselves "minimally invasive."They like when patients delay epidural even though they are not against it either. They like to do whatever to avoid c-section (mostly by being patient with a slow labor progress), and their c-section rate is as low as a birthing center (even though they take high-risk cases). It's basically two doctors who just love delivering babies. Here is their website: http://www.villageobstetrics.com/index.html

I was telling my ovaries that I found the good OB doctors so I can really get pregnant now. Get these follicles working! Okay, I've started sounded like a crazy person, so I'll stop here :-)

Anxiety creeping up

I woke up this morning feeling a little anxious for no reason. I just don't feel as optimistic as yesterday. I don't know why. Maybe I need another acupuncture session? (back to acupuncture tomorrow) It is a beautiful day out, so I'm going out instead of feeling this at home. Maybe some retail therapy will help.

I did get ganirelix via Fedex this morning. Everything is going on schedule.

Insurance company = my enemy?

I had a little bit of stressful time dealing with my insurance company. I am grateful that my insurance company will cover most of the cost for the IVF and medications. I really am. But I guess they won't let me go through the experience without any hassle. Yesterday, my doctor told me to increase the dose of ganirelix. I didn't have enough left at home. I figured that I would get refill at the local pharmacy from where I got the same medication previously. Not a big deal - I thought. But I was wrong... My insurance company decided without telling me that I had to order refill from a mail-order pharmacy in MA. The problem was that I had already ran out of the medication and I can't just go to a pharmacy in MA to pick up refill. I paid out of pocket for one dose of ganirelix at the local pharmacy for today. I called my fabulous nurse, Frances, at my doctors office this morning. She immediately contacted the mail-order pharmacy. The medication is being Fedex'ed to my apartment at this moment so that I will have it tomorrow morning. I also spoke with a customer rep at the mail-order pharmacy (Freedom Pharmacy), and she was really helpful. It was a little bit of stress to deal with this, but I am happy to know that both my nurse and my new pharmacy are really good at trouble shooting. It is nice to have them on my side.

My body listens!

I had a ultrasound & blood draw yesterday to check how my ovaries are responding to the medications. With my issues (diminished ovarian reserve or DOR), my biggest fear was that I could not respond to the medications I was taking (although I am taking daily max dose). Last week I said a few times that I would be very happy if I get 10 eggs retrieved. Well, my body listened. I had 10 follicles measuring 10mm-14mm. My doctor thinks that their sizes were close enough. He should be able to retrieve all of the 10 eggs as long as they keep growing together. So, I'm telling my follicles to take care of each other and GET IN TEAMWORK. I need all of them together.

Here is the reason why I want 10 eggs retrieved- I want more than 5 embryos. Not every egg will be fertilized or survive during the initial few days after fertilization. I'm thinking if I get 10 eggs and if more than 50% of them survive the process, I will have at least 5 embryos. Why 5? Because I want the embryo transfer on day 5 and NOT day 3 after the retrieval. Traditionally, embryos are transferred back to women's uterus 3 days after the retrieval of eggs. Then, doctors figured that if we wait until day 5, embryos will grow more and we'll know more about the quality of each embryo. They can then select the best ones to transfer back to the uterus (and freeze the rest). Better embryos of course have better a chance of pregnancy. My doctor will do day 5 transfer if I have more than 5 embryos. He will select the best ones to transfer back. If I have less than 5 embryos, they will do day 3 transfer because they don't want to risk losing any embryos by waiting two extra days. They won't know much about the quality of the embryo on day 3, but they will do their best to guess which ones. So, 5 or more embryos please!

Good or bad?

I started Luveris last night. Luveris is another hormone that stimulates my ovaries. Right now, I am on Ganirelix, Follistim, Luveris (3 injections daily!), Decadron, Folligard (=Folic Acid), and Prenatal Vitamins. I definitely have side effects either from Follistim or Luveris. I get tired and dizzy. Also, with pretty bad headaches and tenderness in the lower abdomen (ovaries?). It was really hard to work last night with these side effects. I'm gaining weight every day- 3 lb in two days. I must be retaining fluid. I don't think I can gain real weight that quickly. Now, I am sort of happy because these symptoms should mean that I am responding to the medications. According to a book I read, women who produce lots of eggs tend to have severe side effects. I'm not saying that I have severe side effects, but having these symptoms should indicate that I am producing a reasonable number of eggs. I'll know more during my US on Monday. Meanwhile I'll be happy that I'm responding to the meds and feeling bad at the same time because I have to freakin' work despite these symptoms this weekend....

Want to scream...

So there was another FB posting about a newly pregnant friend. I'm very happy for her. I just want to scream "why not me?" I want to post a pic with a baby bump too... People say that I should not compare my situation to others - one brave person even told me once that "it's not a competition" (and hurt my feelings). It's really not about who becomes pregnant first. It's about me feeling unfair. I don't even know if I will ever become pregnant. I'm living in this uncertainty. How can I not feel jealous to see people getting pregnant without major problems? So again "WHY NOT ME?"

Follistim!

So, I started Follistim last night. The evening schedule is a little tricky for me because I usually work in the evening. My fear is that I get so busy with my work (we occasionally have emergencies at night) and forget about my medication. So, I decided to give the med at 8pm. It will be right before I start seeing patients if I'm at work. I take care of myself first and then go to my patients. Good plan, right? I didn't work last night so I spend lots of time at home studying the Follistim pen, which is a device to deliver the medication. It exactly looks like a insulin pen. I was actually excited to see the pen because an insulin pen usually comes with a very small needle. I thought my Follistim pen would have the same type of needle, but no. It had the normal sized subcutaneous needle just like what you see with an insulin syringe. I'm used to using the the regular sized needle so it wasn't bad, though. So far, the only side effect I've noticed is that I am dizzy! I was planning to go to Yoga this morning but decided not to. I might do some gentle yoga at home instead. But the side effect is good! That must mean that my body is responding to the medication - at least it is in my optimistic head.

Back to NYC

Mike and I had a great weekend in Kerhonkson, NY, which is a small town in the Hudson River Valley. It was not a major tourist place, but it was beautiful there. We rented a small cottage, grilled our food, and hiked in the Minnewaska State Park. We talked about how we want to bring a child to a place like that for a hiking trip. It was a nice weekend. I'm now back to the city and to the reality :(

This is a big week coming up because I am starting Follistim on Wed. It's the big gun. So far, my meds are about suppressing my hormone production in order to prevent the maturation of the follicles and ovulation. My doctor wants to stop the natural process so that he has an 100% control on my follicle/egg production. Starting this week, however, it is about stimulating. Follistim is basically the hormone that stimulates my ovaries so that I can produce follicles and eggs in preparation to retrieval.  It has known side effects, but that's not what I'm afraid of. I'm afraid to think that what if I don't respond to the medication. What if I don't produce any eggs. I can deal - and will deal with side effects (Bring it on!) as long as I can get the results I want. So I'm hoping - really hoping that my body will respond to the medication appropriately.

Taking some time off from the city life (but meds continue)

Mike and I are going away for the labor day weekend. I have been working a lot this summer. I worked both on the Memorial and July 4th weekend (it sometimes sucks to be a nurse). I finally got a long weekend off with my husband. Since I am in the middle of this cycle, we are not going too far away. We are going upstate NY 2.5 hrs away from the city. I'm missing trees and nature, so I'm excited to be there. I'm bringing my medications along with a mini fridge to store them. It was cool to find such invention. I don't have to worry about my medication go bad because of the outside temperature during travel. I hope we'll have a good weekend.

Started ganirelix

My blood test was good yesterday. I started a new medication ganirelix today. I actually slept reasonably well today for 6 hrs straight. Maybe I'll feel better on ganirelix than on lupron. I'm back to work tonight. I have to get going.

Baseline US and E2 level

I had a quick appointment at my doctor's office today. My doctor checked my uterus and ovaries. My uterus lining is 5 mm- NORMAL at this time, and my ovaries contain NO CYST. That's a good news! The nurse drew some blood to check my Estradiol (aka E2) level. I'm waiting to hear about the result. I am anxious - I'm not going to lie. Meanwhile, I have to have some sleep this afternoon because I am back to work tonight. I hope I can sleep, and I hope I get a good news when I get up. If E2 level is okay, I'm going to start ganirelix tomorrow.