Monday, July 27, 2020

Microblog Mondays: With Love

I always like to tell myself that our three oldest girls know that we love them, even if they're not still on earth with us. On Friday, I think I got the message back that they know, and they want us to know that they love us, too.

Of our living kids, T is not a cuddler. She's firey and independent, and absolutely amazing, but she's not a cuddler. DH and I took Friday off to 'celebrate' Quinn's 3rd birthday. We did a long bike ride on our favorite trail and visited the Arobretum. Those were things we had deeply hoped to do with our kids. We also got curbside takeout at the restaurant we've gone to to celebrate each pregnancy.

When we got home, for the hours between our arrival and T's bedtime, she would repeatedly run over to me, climb in my lap, bury her head in my should and hug me. Sometimes she'd bring her stuffed Bunny, and all three of us would just snuggle in a long hug. She's never done that before. She's never done that since. I don't think my behavior was any different, since DH and I had had a really nice day that felt like the right tribute to Quinn. Thus I don't think she picked up on something being off. Instead, I believe that Quinn was whispering in her little sister's ear, telling her that it was a tough day for Mom and Mom needed a hug. Sometimes something beautiful comes at a very unexpected moment. This was one of those times.

Friday, July 24, 2020

Rocking My Girl

We have a rocking chair in the kids' room. It's nice and cushy, and big enough that I can sit with both of them on my lap for bedtime stories. For the first 12+ months of their lives, we rocked them to sleep in that chair. It's a good chair.

This morning when I woke up, I closed my eyes and pictured myself rocking Quinn in the chair. I spent a good 30 minutes holding and rocking her, in my mind. I felt sad, but at peace.

Happy Birthday, Quinn. I love you.

Thursday, July 23, 2020

Still There

We know, from our long history of failed pregnancies, that DH and I routinely make blasts. You can't have a chemical pregnancy if the embryo didn't survive and grow for at least 10 days. Because we had at least a chemical with almost every cycle we attempted pregnancy, we know we always had 10 day old embryos.

Despite that, with my age having increased and the setting of an IVF lab, rather than a uterus, I wasn't expecting to get any blasts from only two fertilized eggs. Color me shocked, then, that embryo one reached blast on day 6, and embryo two on day 7. The day 6 is only graded a 3BB, and the embryologist refused to give me the day 7's grade (WTF?). Given that plus my age, I know the probability of these being euploid is exceedingly low, but I'm proud of my little fighters, having held on to blast and biopsy.

We should get our PGS results a day or two before I have my baseline for my next cycle. Irrational or otherwise, I'm going to hope that at least one comes back euploid. Actually, let's be honest, I'll be hoping that both come back euploid, even if a day 7 embryo is at much higher risk of miscarriage!

Three more weeks of testosterone and estrogen priming, and we'll see if we can produce a few more blasts.

Happy 3rd Birthday, Beautiful Girl

Friday will be Quinn's third birthday. It's almost impossible to believe that so much time has gone past, yet here we are with her little brother and sister turning 17 months on her birthday. I still miss her, and her big sisters, every day. When I look at T, I wonder if Alexis, Zoe, or Quinn would have been similar in temperament or looks. I wish so badly that we could have gotten to know all three. I send a hearty "fuck you" to the people who say that we wouldn't have T and A if we had our older girls, so it's better that we lost them. There is no way the complexity of feelings around the presence of living children as a result of lost ones should be reduced to 'it's better.'

A year ago, we booked a trip to take the Grandmas, T, and A up to the Boundary Waters, to "visit" our older girls. We booked the trip for Quinn's birthday. We should have left yesterday. It kills me to do so, but given COVID, we've cancelled the trip. If we didn't have the twins, we'd still go, no thought necessary. I missed visiting the girls last summer in a way that's almost instinctual.  Still, I won't risk exposing my living kids, and with closures and cancellations, we'd have had little to occupy their time with. I deeply hope to return next summer, but I know better than to plan for it.

For now, I send all my love to Quinn on her birthday. If a spirit exists and hers is out there, I hope she knows peace and love.

Monday, July 20, 2020

Hitting the Ground

Tomorrow we'll hear if either of our embryos made it to blast and biopsy. I am not optimistic.

I know, intellectually, that the consequences of these cycles are less impactful than any previous cycle. The difference between no living children, and more living children is vast. We've already crossed to the side of that chasm we desperately hoped for, so these cycles can not possibly have the same impact that our first six did.

While my brain knows that we'll be completely fine and happy no matter what happens with these cycles, my emotions are another matter. My mind feels like a tiny animal, trapped in a cage and racing around it trying to find the exit. In this case, instead of an exit, I'm looking for the answer to what will happen.

I've heard it said before, "It's  not the fall that kills you, it's hitting the ground at the end." I think that doesn't hold true for me in this situation. The fall is what's killing me. Once I hit the ground, I can have closure and begin to move on. While I'm still falling, there's the terror of knowing that hitting the ground is likely, and the hope from the possibility of rescue.

We have two, maybe three IVF cycles left before my insurance coverage runs out. I figure that's six months, plus the month-long wait for PGS results. That means I've got 6-7 more months of falling. If we get euploids, it'll be many months more than that, but I'll cross (or jump off) that bridge if I can get there! For now, I'm pulling out all my tools for calm and acknowledging that it's ok to hope for the possibility of rescue, even when the probability is hitting the ground.

Sunday, July 19, 2020

Ready, Set Go! No, Stop!

My first egg retrieval was on Wednesday. The nurse told me to expect cycle day 1 in 4-14 days. I went home, felt fine the next day but pretty yuck by Friday. I also started bleeding on Friday. That's 2 days post ER, for those keeping track at home.

Despite the fact that it seemed way too early for CD1, I called it in. They told me that since I did a luteal phase stim cycle, it was entirely possible that this was CD1. If so, at first they said I'd do a long testosterone prime, and then after checking with the Dr, they wanted me to start stimming for my next cycle on Sunday. I got this call at 1:45 pm on Friday, and scrambled for the next four hours to get meds ordered and the cycle authorization submitted. 

By Saturday I was still feeling pretty rough. (Side note: a fringe benefit of DOR really ought to be super easy ER recovery. Why is this not the case?!) The four pounds of water weight I'd put on in a day were gone, but my right side hurt and my digestive system was all kinds of messed up. Still, I went for a suppression check. I figured they wouldn't bring me in if there was no chance of proceeding.

My right ovary is a hot mess. Six cysts. No antral follicles anywhere. So, back to the testosterone priming plan. They're also adding in estrogen priming. I have mixed feelings about that. Our first esrogen priming attempt, which also included cetrotide priming, ended in no response. We cancelled and I mentally wrote off the thousands of dollars I paid in OOP costs. The next cycle was testosterone primed, but I also had multiple estrogen producing cysts. In fact, my E2 level was higher at suppression check in attempt #2 than in my estrogen primed attempt #1! And my ovaries responded. So it seems I can do just fine on estrogen priming. I will push back and refuse any cetrotide priming this cycle, if they suggest it. And I will hope that the E/T priming will work again. As always, it's just one grand science experiment. 

Thursday, July 16, 2020

Two Has Worked Before

At least, that's what I'm trying to tell myself now, to manage the disappointment.

Yesterday we retrieved six eggs. My doctor was extremely pleased and said she felt good about our chances.

Today embryology informed me that only three were mature, and only two fertilized.

Two years ago this week, we had 3 mature, and got T and A.

Four years ago this week, we had 3 mature, and got Alexis and Zoe.

So, two has worked for us before. But before I wasn't 40. Before those embryos were growing inside a person, not a petri dish. Before those embryos weren't going to need to pass CCS.

I'm sad. We start the next round with my CD1. I'll ask about the maturity rate and if we need to change anything.

I think my worst case scenario is actually winding up with 1 CCS normal embryo. If we have none, we're done. If we have two, I'll do the TAC. If we only have one, I don't know if I'm willing to do the TAC. That's a limbo I don't love.

Send good thoughts our way? I'll take prayers, or wishes, or just happiness if you've got any to spare. I'm not doing so well on the happiness right now.

Monday, July 13, 2020

IVF Round #1.5, the end

Despite the issue with cysts, IVF round two commenced two days after trigger with an AFC at 11 and one remaining mature follicle, in addition to two corpus luteum cysts. I suspect that means another follicle was missed from the prior day's ultrasound, but there's no changing now.

Day 5 monitoring looked really promising (for me). I had a cohort of six follicles between 9.5 and 12.5, and a couple smaller ones.

Day 7 we'd dropped down to only four in a similar range. The left ovary had given up the game and the max follicle size there had dropped to 9.5 from 11.5.

Today is day 9, and I've got 5 from 12.5 to 21. It's odd, because the tech showed me the screen this morning and the screen reflected a 22 and an 23 as the leads, and an 11.5 on my left side. The u/s report they sent is smaller on all follicles.

So, I got the trigger call. Dual trigger. Tonight. Retrieval on Wednesday.

The trigger and pre-op instructions sent to me via portal were: a) for a woman with a different name (same first initial), b) for July 9, with surgery on July 11. Also, my lab results, sent via portal, were mostly for estradiol, despite being labeled as LH and P4.  I am not overwhelmed with confidence.

So, here we go. Four years ago this week, we triggered and convinced Alexis and Zoe, from 3 mature eggs. Two years (less two weeks) ago this week, we triggered and conceived A and T from 3 mature eggs. Maybe, just maybe, we'll get a eupolid or two out of this crop of ~4.

Assuming no concerns from our RE, we'll jump into our next cycle immediately. I'm going to ask about MDLF, since EPP + antagonist is clearly not my thing, and this wasn't as successful a round as it could have been. Think good thoughts in our direction?

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.