.i'm surprised.

uterus: please make room for 2 little eggs. thank you.
i'm surprised how content i am, that is. usually about this time i try and google every little thing about the 2ww. i usually hate everything about waiting. i usually start to lose all hope by now. but, surprisingly, i'm content. happy, even. i don't know if that's heavenly father wrapping his arms around me, or if i really just "don't care" since we have paid to try 2 more times with dr. f. what do you think? i really just like being where i am right now...technically pregnant with twins. i'm not emotionally tied to these two..yet.. but i have been found to talk to them. didn't do that the last two cycles. i don't name them.. i don't think much about them. other than hope that they find a quaint little smushy spot in my endometrial lining. i've been thinking a lot about cameron lately. i feel bad for the poor guy. first off, no hanky panky since before vegas...ok that was like, feb. 6! and other than his date with the super well-equip pleasure room a couple weeks ago, dr said i'm off limits (well my jj) til my 2nd negative beta OR my SECOND ob appt! do you know when that would be!?!? like 5-6 more weeks! poor, poor dude. i've got to do something about that. anyway, cameron, if you read this, so sorry. i really do feel bad. i can't be a very good wife right now.

anyhow.

i'm thankful to all y'all who've kept in touch. i really am grateful. first beta will be on tuesday (in 2 days!) and the 2nd will be thursday. my clinic does their first WAY early and usually doesn't call with results til after the 2nd. but luckily..i work at IHC and can look up my labs..so i'll know. it will be low and won't really say much, other than for sure negative. happy dreams everyone...i'm off to bed.

.not so great news.

about 15 minutes after posting yesterday, i got a call from dr. fisch. he sounded all chipper and i was hoping for good news. well, i was wrong... he said that of the 10 only 4 were mature. great. and of those 4, 3 had fertilized with ICSI. i guess that pretty good rates if you don't count the immature eggs, but really?? only 3. anyway our hope for a day 5 transfer has gone out the window and we'll be having our ET tomorrow. hopefully of those 3, 2 will be of good quality, although my optimism has been shattered on more than one occasion with this shitty process. yes, i said shitty. thanks for listening.

.so far.

well, i'm down here in las vegas with cameron and my mom. it's been really relaxing and quite fun. dr. fisch is pretty good..he's a little strange..but i know he is a phenomenal dr, so i'm putting our fate in his hands. i had my first monitoring appt with him feb. 8, on day 6 of stims. my e2 was 667 and i had about 7 follicles that looked like they would be ready. i kinda thought i'd have more, but i asked him about it and he says he only likes to get between 8 and 12 because then they all have more of a chance to be mature and good quality. the next 2 days, feb 9 and 10, had 2 more appts and the results were pretty much the same. about 8 or 9 follicles. got the go ahead to trigger on the night of the 10th...2 days faster than being on the long lupron cycles..so that was good. i only had to stim for 8 days. that was fabulous. yesterday, feb 12, was our egg retrieval. it went just as well as it could. i can't tell you how much i LOVE anesthesia. the iv sedation was great and i woke up in the recovery area with my honey by my side. last time cameron wasn't allowed in recovery and that sucked. i woke up really fast, no cramps really, and went back to the condo for a small nap. they retrieved 10 eggs. and now i'm just waiting to hear from dr. fisch to see how many fertilize. i'm not too optimistic, because last time we had 9 and only 6 fertilized with icsi. but if we get 6 or 7..i'll be thrilled. anyway, i just wanted to write real quick so i don't forget how things went. can't wait to hear from the office. ahhhh.!

EMET testing?? should we?

so i need your opinion. we are obviously headed to vegas to ivf again and this time we feel like we're going to try everything to optimize success because we know we're not an easy case. so we just sat down to fill out our consent forms (which are about 40 pages long and have to be notarized...so all you guys out there that just get pregnant on a whim...be grateful...this sucks). well, on the last page there is a consent to sign up for a certain test that pretty much only our clinic does (they founded it) and it helps to pick out the embryos that are most likely to produce viable pregnancies. here is a quick synopsis of the test from SIRM itself:

The Embryo Marker Expression Test (EMET)
By measuring the concentration of a genetic marker known as sHLA-G (soluble human leukocyte antigen-G), which is released into the media in which early embryos are growing after fertilization, it is now possible to identify those embryos most likely to produce a pregnancy. This Embryo Marker Expression Test (EMET) is performed 46 hours after the egg retrieval to identify EMET-positive, or “competent” embryos. It has been determined, based upon the performance of EMET in more than 500 women undergoing IVF at SIRM, that the transfer of even a single EMET-positive embryo in women under 39 (provided that they had normal uterine linings and, when needed, were treated for immunologic implantation problems) results in better than a 60% chance of a viable pregnancy. Comparable results in women 39-43 years was above 40% . The transfer of more than one EMET-positive embryo at a time resulted in a great increase in the multiple pregnancy rate without significantly improving the overall pregnancy rate.
We conclude that measurement of sHLA-G in the media surrounding 2-day-old embryos in order to select competent embryos allows for a reduction in the number of embryos transferred on day 3, thereby minimizing the risk of high-order multiple pregnancies (triplets or greater) while optimizing IVF success.
This discovery is changing the way IVF is performed by bringing IVF practitioners much closer to the long-awaited objective of “one embryo, one healthy baby.”
Perhaps equally important is that now, by measuring sHLA-G (and perhaps similar molecular markers, as yet unidentified) produced by early embryos, we can establish a rational basis by which we can customize protocols used for ovarian stimulation to better meet the needs of separate categories of patients and so measurably improve egg/embryo quality and IVF success rates. Just as one size of any garment will not fit everyone, so no single regimen of ovarian stimulation is adequate for all patients. The use of biochemical and genetic markers of “embryo competency” such as sHLA-G could also provide researchers as well as the pharmaceutical industry with a method that would help in the development of new and more efficacious fertility drugs that produce fewer side effects with reduced risk to patients.
It is hoped that the proof that such advances can improve IVF outcome—and reduce risk as well as virtually eliminate high-order multiple pregnancies—will prompt health insurance companies to revisit the issue of universal infertility coverage. Until then, the size of the pocket book still determines the ability to go from infertility to family.
The above sections on GES, blastocyst transfer, and EMET provide an overview of the means by which the embryos most likely to implant are selected and nurtured at SIRM. How these elements are mixed and matched varies according to individual circumstances. Although it is not possible to generalize how they would be used, the following situations are examples of what might occur before embryo transfer. In the case of embryos scoring 70 or higher, we might advise culturing them to blastocyst stage; but at other times we would add one or two poorer-scoring embryos to a 70+ one and transfer on day 3 post-egg retrieval. If there are only a few embryos and all score below 70, we might transfer several at once in the hope that one might implant; but if there are many embryos scoring below 70, we might culture them 2 to 3 days longer to test if they will go to blastocyst stage. Presently EMET is available to all women doing IVF at SIRM. EMET, once requested by a woman/couple, is performed on all divided embryos on day 2 (i.e., one day prior to establishing the final GES score and transferring embryos). Thus, the EMET result influences which embryos are chosen, usually overriding the GES parameters. Each case must be evaluated individually. This is an example how a merger of the “art” and the “science” of IVF can profoundly benefit the woman and her partner.

so if you had time to read all that. would you do it.?? it's not a test that is used by most RE's but it sounds so good, and the best part...it's only $420 to do and has no real detrimental effect on the embies. but sometimes if it sounds too good to be true, then i usually is. what do you think???

.3rd times a charm?.

so, call us crazy, but cameron and i are gearing up to try ivf #3. this time we were a little smarter about it. first, we have changed drs, we'll be seeing dr. fisch in las vegas..who deals specifically with egg quality problems. he thinks the protocol i've been on is "ruining" my eggs from the beginning so they don't stand a chance to make it past day 3. with our first cycle, i had 9 eggs retrieved, 6 mature, 0 fertilized. with ivf #2 i had 14 eggs retrieved, only 9 mature, 5 fertilized with icsi, only 2 made it to day 3. we did a day 3 transfer of 2 8-cell embies, grade 1. but still bfn. second change is that dr fisch is going to put me on their a/acp protocol, an antangonist protocol, which he thinks will give me better eggs, with better fertilization rates. third change that we've made to maximize our results is that we've purchased a buy 3 cycles and if you don't take home a live baby, you get a portion of your money back. good deal if you ask me, because that includes everything except meds. it even includes all associated fet cycles if we have frozens to use.

as for this cycle, we're looking forward to having much better results on the antagonist protocol

so here's my schedule...
12/30 bcp (yaz) starts
1/20 add dexamethasone and lupron
1/24 stop bcp
1/27 stop lupron, add 0.25 ganirelix, continue this thru to hcg trigger
2/2 start follistim 375 for 2 days then drop to 225
2/4 first luveris dose 1 vial
2/6 second luveris dose 1 vial
2/10-2/11 possible hcg trigger
2/12-2/13 possible egg retrieval
2/15-2/17 possible embryo transfer

once again, this is mostly for journaling purposes, since i don't write this all down. if you're interested, then that's just a bonus.

ash

.i think explains it.

From an article by Dr Aniruddha Malpani, MD:
"The third group is perhaps the most difficult. These are women who grow a sufficient quantity of follicles in response to superovulation ; and have high estradiol levels as well. Egg collection is usually uneventful ; and the doctor often retrieves 8 to 16 eggs for them. If IVF is done, when the fertilization check is performed the following day, much to the embryologist’s surprise and the patient’s dismay , it is found that the fertilization is very poor even though the sperm are fine and actively motile. If ICSI is being done, the embryologist often finds that the eggs are morphologically normal ; or are very fragile. For example, these eggs have granular cytoplasm ; or vacuoles in their cytoplasm ; or dark areas within the cytoplasm. Since normal eggs are simple spherical formless blobs, these subtle cytoplasmic abnormalities are often missed or overlooked. The embryologist may also noticed that the eggs are fragile, and the cell membrane offers little resistance to the injection pipette. Many of these eggs may die during the ICSI process.
Unfortunately , because egg morphology has not been adequately studied , we still do not have good descriptive terms , when talking about these abnormalities. Since the eye only sees what the mind knows, often these abnormalities are not picked up. The patient is often subjected to repeated IVF or ICSI cycles , with the same poor results each time."


we're just a "hard egg case."

.ivf report.

unfortunately i didn't have the computer in cali so i've had to wait til now to update my blogs. first off i wanted to write down everything that happened in california regarding our ivf cycle.

thursday nov 12 i had my first ultrasound at dr. marrs office in LA. i had about 10-12 follicles, but some were pretty small. they were predicting that i'd be ready sat for trigger, and that we should have about 10 eggs to retrieve. i was happy about that. they did lower my fsh and upped my lh to help the smaller eggs "catch up." my e2 this day was 1158

saturday nov 14 i had my second ultrasound and it looked about the same. about 12 mature follicles, and my e2 was 2710, getting a little too high. i was given the go ahead to trigger that night at 1030 pm.

monday nov 16 we arrived for our egg retrieval. this time was WAY different. it was an actual OR, not some scary 1930's exam room. i got my WONDERFUL anesthesia and woke up to the news that they had retrieved 14 eggs. i was thrilled. cam gave his "sample" and we went back to the hotel to relax..our work was over.

tueday nov 17 got a call from dr. bronte stone, the embryonologist, and gave us the report that only 9 of my eggs were mature and of those only 6 fertilized with icsi. we were kinda crushed..but happy that we at least had that many.

wednesday nov 18 took a break from worrying about it and went to disneyland!

thursday nov 19 went back in to get knocked up. they gave us an update of the little embies. we had 2 that had stopped growing, but the 4 remaining were going strong. finally, they brought the little embryos in, in their little incubator and we got to look at them in the microscope. we got to see our little babies first photo shoot, as seen below. anyway, i have two perfect, 8 cell embryos inside my little uterus. the remaining 2 will be frozen tomorrow if they make it to blastocyst stage. we're praying for them too, in case this doesn't work, we could have a frozen embryo transfer in a few months.

.our babies.

i'm feeling so much more hopeful this time around and i feel like it's our turn. we've been patient. it would be an added reason to celebrate this holiday season.