Thursday, July 2, 2020

IVF, Round #1.5

Another day, another IVF attempt.

To recap our last episode, after starting with an AFC of 8, by stim day 13 the ultrasound tech excitedly proclaimed I had one follicle. We decided to cancel the cycle. I was instructed to do several more days of Clomid, then trigger, then start testosterone and progesterone for 10 days.

CD1 arrived and I went in for my suppression check. The same excited tech wouldn't tell me my AFC and just kept repeating that someone would call me when my labs came back. I knew that wasn't a good sign.

The call informed me that I have an AFC of 12(!!), but I also have two simple cysts at 15 and 18mm. If I had to guess, I would guess the tech missed a few smaller follicles on my last u/s before cancellation, and the increased FSH caused by the Clomid matured them. Who knows. Anyhow, the plan is to trigger again on CD3, then return for monitoring on Saturday.

I can find no research on triggering to remove leads, or what that does to AFC. Nada. I know luteal phase stim cycles are becoming a thing, and that research suggests you can get as many embryos from luteal phase stim as from regular stim. I'm trying to remain hopeful. If anyone knows of any research on triggering to remove leads, and what happens after, I'd love to hear!

Also, shoutout to Progyny and VFP pharmacy. I got the call at 2 pm that I'd need to trigger the next day. I didn't have any Pregnyl on hand. If I was still with CVS Specialty, I'd be shit out of luck, because 2pm my time is after their shipping cutoff. VFP got my Pregnyl out priority overnight, so it arrived the next day (today) at 7:30 am. The prices, with insurance, are a bit insane for the Menopur, but so far the customer service has been pretty good. They also had some issues with neglecting to send me Menopur injection needles in one shipment, then sending me an extra 60 in the next. Overall, it's a MUCH better experience than CVS Specialty, and I'm grateful.

Monday, June 15, 2020


For many years, DH and I have been members at the local arboretum. We've loved wandering the grounds and watching the seasons change. From our very first pregnancy, we've looked forward to sharing it with our children.

We went there when pregnant with Alexis and Zoe, and talked about how much fun it would be to bring them back for long walks. After we lost them, on our first visit back, there in the lilac garden we ran into another couple with a double infant stroller - clearly newborn twins. It hurt, but we held out hope some day we'd be back with our own kids. During my TAC recovery, the arboretum was the first place I went, to wander among the Christmas displays. It holds a special place in our hearts.

Last summer I was still in too much pain, and pumping too damn much, to get out to the arb with the babies. Now with COVID, it's on a 'tickets only' basis. We managed to snag tickets for last week. It was awesome. The babies had fun. We had fun. The day at the arb that I'd dreamed of finally came.

I'm overwhelmed with gratefulness for where my life is. There are so many utterly terrible things happening around the world, even right here at home in Minneapolis. I know I'm tucked in a privileged bubble, and although I feel guilt, I'm also grateful for the joy that affords me.

Thursday, June 11, 2020

IVF #1: Cancelled

Today was stim day 13, or thereabouts. I lost count. All I can tell you is that I've hit my OOP Max on my med orders. Ouch.

For monitoring, I got the super peppy ultrasound tech, who always seems to have trouble finding my ovaries, and sometimes seems to have trouble finding my uterus. At the end of the scan, she excitedly told me that my largest follicle had grown to 13! (The screen behind her said 16.) I asked if there were any others, since I'm doing IVF and one isn't very helpful. She told me that my 4 had gone to 6. She was chipper about it, then fled the room.

Note to others: When telling an IVF patient that she only has one mature follicle and won't get more, don't be fucking chipper about it.

The nurse who called later told me we were good to start cetrotide, if we were ok with retrieving only one. I asked if the doctor thought we could do better, given my AFC of 8 and past unprimed cycles with 3-4 mature. Several hours later I got a call back saying we could cancel. I was told to continue Clomid for 3 more days, trigger with Pregnyl, then start testosterone priming for my next cycle two days later.

Problem 1: when they put me on clomid, it was for 5 days. Those five days ended 3 days ago, so I"m not on clomid now. It's not possible to continue taking it when you've already stopped taking it. Apparently they're putting me back on clomid and keeping me on clomid once CD1 comes and the cycle starts. I suspect I was supposed to still be on it, and this was a medication error. That doesn't make me feel chipper. That really doesn't make me feel chipper when I know that clomid raises FSH, and my high FSH level is the number one thing we're trying to combat.

Then I get my calendar for this new cycle. Stims start July 2, which I think is roughly 4 years to the week that we started stims for Alexis and Zoe's cycle. We always have good July cycles, so I'll take that.

Based on the calendar, I'll do luteal testosterone priming, then clomid, menopur, gonal f, dexamethasone, and saizen. I stay on the clomid the entire time. All of this looks good, except for a little note that reads "Continue taking Estrace until STIM begin." Ignoring the grammar, there's a big Problem 2: Nowhere on the calendar does it say to START taking estrace. It is, practically speaking, difficult to continue taking something that you've never started taking.

So there you have it. Cycle 1 was a crash and burn and cycle 2 is, thus far, going to be confusing.

I am remaining obstinately hopeful that our July 2020 cycle will produce babies as beautiful as our July 2018 and July 2016 cycles.

Wednesday, June 3, 2020

I Got Nothin'

Monitoring this morning, after 4 nights of stims. I was hopeful. I should have known better, but I was hopeful. I mean, an AFC of 8 is worth being hopeful for, right?

Nothing. I've got nothing. The largest follicle is at 3.5 mm. I guess the good news is that I don't have a lead, so things could still grow in a cohort. (Note to self: Yeah, right, Pollyanna!)

We're adding in Clomid for five days and scanning again on Monday. Here's some research on that.

I knew this was a long shot. I know it still isn't over yet. I wish I knew if I'm letting my past successes after really long odds inappropriately influence my current decision making. What heartbreak I could avoid with a handy crystal ball to prepare me for the future!

Crystal ball-less, and measurable follicle-less, onward I go!

Monday, June 1, 2020

Vices & Grace

I've said before that I'm a long-game type of person. I make decisions now for my longer term benefit. Grad school, some early jobs, my approach to save vs. spend, all of those weighed longer term happiness over shorter term happiness. Because of that, I know I have the skill set to stay motivated today even though the results may not be seen till a far off tomorrow. Despite knowing that, it's still hard for me right now to keep focused on all the behavioral and lifestyle choices I made when trying to get and stay pregnant during 2016-2018. I'm pretty sure that the main reason for that is because the outcome of any of these choices feels so far removed right now.

I'm on stim day 3 today. Normally that timing would leave me at peak motivation for a clean diet, sound meditation strategy, and carefully crafted exercise plan. Yes, I understand that those things provide an illusion of control rather than actually improving my outcomes. Still, that illusion of control has been so important in the past. Moreover, the ability to feel that I did everything that was within my control is crucial to my long term mental health. In asking myself the 'why am I having trouble staying motivated now', two answers come up. One is that I haven't lost a pregnancy recently. Over the four cycles that led to T and A, I got more and more motivated to maintain strict lifestyle changes after each of those three miscarriages. I don't have that fresh pain changing my behavior right now. The other answer is that the tangible happy outcome is so far off that I can't quite use it to leverage my behavior today.

My crystal ball tells me that my timeline will go something like this, barring any catastrophic failures that end things earlier: 3 IVF cycles @ 2 months/cycle will wrap up in December. Two operative hysteroscopies to clear scar tissue, complete with balloon stent & estrogen, completed by March. New laproscopic cerclage and recovery complete by May. FET attempt 1, July transfer. That means I'm over a year out from the faintest possibility of a pregnancy. I know my July 2021 self will be really damn pissed at my June 2020 self, if I miscarry a euploid embryo from a cycle where I could have been more careful about diet or exercise. I still can't quite bring myself to drop my chocolate chip habit. Yes, chocolate chips in greek yogurt is my one remaining vice. Yes, I feel guilty for not giving it up.

Maybe the outcome of this first round will be enough to motivate me for the next two. Maybe the outcome will be so bad we'll stop here. Or so good that we won't have to do two more rounds. Either way, it's time for me to summon either the motivation to drop my vices, or the grace to forgive my current and future selves for them. I'll get on that, right after I have my yogurt!

Friday, May 29, 2020

IVF Round 1, Baseline

Somewhere after the consult with our RE and before my last CD1, DH told me he was solidly ready for a third child. There would be many logistics to work out to make sure things that matter to him are still possible, but having a third was worth the challenge to him. So with CD1, I called my RE's office. I got scheduled for their IVF class just over two weeks out. Took the class, then had the nurse consult where she asked if I was tracking my surge. Sure was, I said. It was yesterday, I said. Great, she said! I'll send your calendar and you'll start priming this weekend.

So there we are. I'm doing ~10 days of estrogen priming, 3 days of antagonist priming, baseline, then stims. It'll be a Gonal F, Menopur, Saizen, Dexamethasone protocol with cetrotide as the antagonist.

Baseline/suppression check was today and my AFC was 8. That's seven on the right, one on the left. Overall, I'm really happy with that, and am just pleading with them all to respond. I'm now awaiting the call to confirm the start of stims this weekend. I was relieved to hear that DH will be allowed in recovery with me after ER.

I am so grateful that I'm not going into this with the same sense of desperation I felt in all my past cycles. I am hopeful, but at peace with any outcome. Given the insurance I now have, it's in my best interest to do 3 back to back cycles. My total cost will wind up around $12k for that, which is unbelieveably amazing. If I can't get a third living child from 3 rounds, I'm ready to be done. If we get ~3 PGS normals, I'll have a pre-pregnancy lap TAC done. If not, we'll see.

Wish me and my old ovaries luck and responsiveness?

Wednesday, May 27, 2020

Baby Book: 15 Months

The last month has flown by, although I feel as if we had fewer new developments between 14 and 15 than between other months. Perhaps that's me taking things for granted. The kids continue to be amazing, and I love every second. I'm getting increasingly worried that neither has any obvious spoken words, but both have solid receptive language and decent sign language. We'll ask at their ped appointment in another week and see what she says. So much love and joy in the house with these two!

  • A is now walking, running, and can actually walk up the first step of the staircase on his own. 
  • A continues to have the most fabulous grin in the world, and remains a happy little dude.
  • A also continues to have trouble falling asleep. He gets a full hour sleep per day less than his sister does because he takes so much longer to fall asleep. He's nice and calm, and just plays with his lovey in his crib the whole time.
  • We got them a craft table with stools, and A immediately and expertly sat on his stool to play on the table.
  • The craft table came with storage bins that are nearly as long as A and T. Both kids immediately started playing with the bins, running around with them, sitting in them, and generally  having fun. 
  • A is mellow. He lets his sister steal toys, mostly without complaint, and he'll give her things she wants without getting upset. He's a sweetheart, and I feel the need to protect him so his sister doesn't overrun him!

  • T also sits up on her new craft stool by herself. 
  • T has developed the ability to stand up from a squat, and also to stand up with her legs far apart and then draw them in to walk. 
  • T will find her jacket on the sofa, bring it over to you, and put one arm in so you can help her put the other arm in.
  • My mom brought T and A a wooden puzzle. One piece is a circle with a picture of an apple. T has not let go of that wooden circle in the ~10 days she's had it. It goes on every stroller ride, it goes on every nap. We pry it out of her hands for bath time, but it's the second or third thing we hand her when she wakes up, and her face lights up like you wouldn't believe! 
  • T loves to wave at things. When the chipmunk appears in the window behind her in that picture, she waves. When we see deer outside, she waves. When people arrive, she waves. 
  • T takes what she wants. Whatever A has, T wants. She doesn't respond well to redirection in those cases. She tantrums. The next few years will be fun, I think!