And the RE says...

...that follistim is more potent than gonal-f, so I have been provided with the correct dosage of 625 iU. Hmmm. Well, I suppose all those times I was using both, I messed the dosing up. Oh well, it didn't seem to do any harm.

I don't really care, to be honest. At least a lower dose means a slight reduction in drug expenditure. And I don't think dosage matters at this point. I have no hope whatsoever about this cycle working, and am really resenting spending the money on it. I should have stopped by now. I mean, I shouldn't, because I would always think "what if" and so for my future mental health I know I need to do it. But I should have stopped. Because it isn't going to work and I am just throwing good money after bad.

Are gonal-f and follistim interchangeable?

Internet experts out there - what have you been told about gonal-f and follistim?

The reason I ask is that my medication calendar shows me as being on 625 units of follistim. I questioned it with the nurse, who told me that the dosing for follistim and gonal-f are different, and that 625 iU of follistim is equivalent to 750 iU of gonal-f.

I don't believe her. Previous RE's have said that they're completely interchangeable. In fact, I have been interchanging them for the last three cycles due to left overs, donations and uh, grey market purchases.

I've emailed the RE, as something doesn't seem right here. But in the meantime, what is your take on this? Are they one-for-one or different?

Trash thoughts

No, really, this post IS about trash.  Not trash as in trashy novels or trailer trash, but actual trash.

So, the last two Saturdays I have gone down to a little beach in my neighborhood and picked up trash.  I just couldn't bear to look at it any longer every time I walked past.  There used to be a volunteer beach cleanup the first Saturday of every month, but I don't know if they stopped doing it or if a particularly large amount of trash washed ashore recently.  It's not a fancy swimming beach or anything, as it's not on the ocean, so it isn't cleaned up by the county.  It's also not a sunbathing or swimming type beach, so I guess people don't care as much, but people do take their dogs and kids down there for a romp on the beach, surrounded by trash it seems.

Anyway, what is it with plastic drinking straws, America?  I think I've picked up dozens of drinking straws in the past two weeks.  I mean, we get drinking containers (which we also throw away indiscriminately) and then add additional plastic on top because why?  We are too lazy to wipe the top of the container?  Don't want to reapply our lipstick?  Don't want the ice to hit us in the nose?  I've been really disgusted with straws just from the sheer number I've been picking up, and I'm going to try hard not to use them again.

And, if you're having a day out on a boat, or anywhere really, please don't throw your plastic water bottles overboard.  I picked up 50 bottles and cans yesterday.  50!  I picked up 38 last week.  And both times I was only hampered by the size of the bags I took with me.  In fact, please stop using disposable plastic water bottles, and buy a refillable bottle for goodness' sake. Oh, and if you do have a disposable bottle that you kindly take home for recycling, (and thank you for that, by the way) please don't just toss the bottle cap away.  I think the bottle caps and the straws are vying with each other for "most discarded item of trash".

Sincerely,

Grumpy McTreehugger

The low country

Feeling very low today, and I don't even really know why. I guess it's to do with thinking about my final cycle and the end of three and a half years of my life. Well, longer than that really, as being a mother and even going down to the sperm bank to do it is something that I thought about for years before actually trying to do it. Decades in fact. It was always a comforting thought even as a younger adult - oh, if I'm not married by the time I'm xx, I'll get a kid using a turkey baster!

I suppose also it's bringing up all those old feelings of letting my family down by failing to have children. I still can't imagine telling my dad that I'm stopping treatment and he won't be a grandpa. It just hurts so much to think about the hopes and dreams he had, all coming to nothing.

I recently had some contacts from facebo.ok from my high school days too (well, one was from elementary school) and I guess finding out about their lives is also poignant. Oh sure, I seem to be the exotic one that has the fun life and got away from our crap home town. I have the best job. I live in sunny Florida, after all. But they have kids and I don't. And that will (very probably) always be the divider between me and most of the rest of the world. It's funny, really, they envy me for something I don't care about any more (the fancy job), and I envy them for something they probably don't think about (the ability to get knocked up). I suppose the grass is always greener, and all that.

Prepare for ovary blast off

So, I spoke to the RE. Half an hour late - what IS it with docs and their inability to stick to a schedule?

We went over the cycle, and we were both actually happy with how the cycle had gone. Apart from the end result, obviously. Stimulation was nice and even, I got a reasonable number of eggs, the embryos looked good and did well getting to blastocyst, blah blah blah. They just sucked, chromosomally speaking. He thinks it's totally possible I could get a normal one, though, so he thinks all hope is not lost. He said one woman on the cycle got pregnant from one embryo, so he only needs one good one to work with. So when he suggested not changing much, I wasn't surprised. And unlike on previous occasions when docs have suggested not changing things, I wasn't unhappy at that.

We are, however, going to change very minor things. For one, I am switching back from gonal-f to follistim. He said he has a marginal preference for follistim. I didn't tell him that I actually did half-and-half because I had some leftover follistim, but whatevs. Then I am going to be on their highest stim dose. And when I say highest stim dose, I mean a truly, phenomally giant amount of stims. Oh yes, your average RE may say that the absolute maximum dose of stims is 600 iu, usually formed of a maxium dose of follistim or gonal-f of 450 iu plus some menopur or repronex. They may say that you can't possibly go higher than this. But I shall. I shall be on 750 iu of follistim per day. If that doesn't blast my ovaries into submission, I don't know what will. And we'll add lh in increasing amounts as we get closer to trigger. I said "so, clearly you don't subscribe to the theory that increasing stim dosage is actually bad for egg quality then?" and he said "no, I think the body just wastes what it doesn't use". Okee-dokee.

And that's it. He said we may push trigger for an extra day. We may try to do two vials of lh on the last day of stims.

We briefly discussed doing CGH again, and I said to sign me up. I think I'd rather know in advance than go through the 2ww praying and hoping and dealing with progesterone issues.

All in all, it was pretty much what I expected. And that's fine by me.

Happy Earth Day!

What are YOU doing today?

Me, I took the bus in to work. I know, nothing terribly amazing about that, but it's something. I might even walk home if I feel energetic. Although it's a pretty long ass walk.

But, I guess walking home will give me time to ponder on the RE's suggestions for next cycle, which I should be learning at 5.30. I'm not expecting much, as actually I thought the protocol worked well. But I'll see what he has to say. I am not optimistic for the next cycle at all. "At all, at all" as I'm probably imagining Mrs. Doyle would have said in Father Ted. But I will go through the cycle just because I said I would, and I'm stubborn like that. "Ahh, go on! - Go on, go on, go on, go on, go on, go on..."

Sorry, but god, I loved Father Ted. I think it somes up the ethos of the series to learn that "Dermot Morgan, who played the title role, died in 1998, aged 45, from a heart attack he suffered during a celebratory party the day after filming the final episode." Now, if there isn't a man who was enjoying life, I don't know what to say.

Ohh, wait, I've rambled off topic. So, Earth Day. Did you do anything? Change a lightbulb to CFL? Start a compost pile? Hang your laundry out to dry instead of using a dryer?

Infertility sucks ass

I'm sick of infertility. Sick of it. I want my life back. I want to stop worrying and stop weeping and living life stuck in this hell.

As a small example - yesterday I watched Dateline. They had a feature on toxic load, and tested two families - the treehugging vegetarians and a regular family. Not surprisingly, the treehuggers had fewer chemicals in their bodies, apart from Bisphenol A, where they had high loads, and way more than the average folk. Which was due to all the canned beans they eat, because even the cans of organic beans are lined with Bisphenol A-containing plastics. So of course I immediately started berating myself for being a treehugging vegetarian who eats canned beans, and wondering if that is the cause for my infertility. And it didn't matter that I didn't KNOW about this Bisphenol A in cans until a few weeks ago. I was still kicking myself. I hate that. I mean, I've chosen not to buy any more canned things, but am still going through my cupboards using them up. Then I was wondering if I should stop eating the canned beans until after the IVF or if that was just too much overkill. I mean, really, I was beating myself up when it wasn't my freakin' fault. But yet I can't stop, because there's always that little voice inside my head wondering WHY this has happened to me, and if there's anything I can do differently to fix the problem.

And then a little later I watched Masterpiece Theatre which was showing My Boy Jack. About Jack Kipling (ably played by Harry Potter, er sorry, Daniel Radcliffe) going off to war in WWI. Where he was killed at 18 years and 1 day old on his first day of warfare. And they had had a daughter who died when she was 7. I sobbed and sobbed at the thought of children dying. At war. At the thought of me never having children, of always having to live with that sorrow. And in general at just the crapness of life that you open your heart up so much and then have it ripped apart. I never used to be such a weeper but I am now and it doesn't seem to be going away any time soon.

So there you are. What should have been a mindless evening of TV watching yet again turned into a reminder of why I hate infertility.

Saturday

Thanks for the support, guys. It really does mean a lot.

I am slowly (I hope) climbing out of the pit. At least, I have no more ice cream or cheap wine in the house, and I don't intend to buy any today! Hopefully I can move forward.

I am interested in what the RE has to say on Tuesday. I am not sure there is much more we can do, protocol-wise. This WAS supposed to be the protocol that improved the quality of my eggs. And I guess the real issue is that it may have done that! I don't know just how bad my embryos were before! But anyway, it may simply be a numbers game, in that I may still have a normal one in there somewhere or I may not. Well, we'll see what he's got. I think I've been on every protocol that there is out there, apart from the mixed clomid or femara pus injectables one. At least with this RE I have some confidence that he will go through my file and think hard about what the best next step is, rather than just saying "well, we have a lot of success with the long lupron protocol, and it's a numbers game, so let's try that again." Which, for the record, is the advice from my RE at NY Clinic on what to do next. When I've done long lupron twice with no success.

I will do the CGH again, I think. As long as it's still free and they haven't kicked me out of the study for having the worst embryos they've ever seen. As shocking as these results were, it was easier than doing a transfer. I didn't spend two weeks praying over my embryos, trying valiantly to keep a positive attitude and imagine them dividing properly and implanting. I didn't have a photo. I mean, sure, I worried over them and was anxious, but was nowhere near as emotionally tied up with them as with a regular cycle. And besides, getting that answer sure tells you WHY it isn't working, instead of worrying about whether that time you lifted something heavy in the 2WW caused an issue.

As for whether this could be caused by the sperm donor - it's not. It's me. Three RE's have told me that it's due to egg quality. 80%+ of chromosomal abnormalities are caused by the eggs not the sperm, and that's presumably using regular guys' sperm, not carefully selected donors (allegedly only 5% of guys who apply to be donors are eventually selected). And, the clincher to the argument, I'm on my fourth donor. If it was the sperm's fault, I would have got knocked up on changing from the first to the second donor. Or, you know, the second to the third. The donors are all proven with other pregnancies - I made that a criteria I absolutely had to have after the first one (who is now also proven - he just wasn't at the time I bought the goods).

And donor eggs? Yeah, I already went through that. I am not going to use DE. At least, not at this time. I want my own genetically related child. And if this next cycle doesn't work, I am stopping TTC and going to live for a few years without infertility treatments looming over my head. I am going to go to acupuncture school and radically change my life. I'll probably move into a small downtown condo in the city where the acu school is located, so that'll be a change of scenery too. Cutie acu said he had a dream about me that I'd quit all the treatment, meet a nice guy and immediately become pregnant the old fashioned way. He's not the first person to tell me that, either. It's probably wishful thinking, but hey, wouldn't it be wonderful! At least I might have the opportunity to meet different men at acu school / in the condo building's gym and get to have some s-e-x! Anyway, if at the end of school, once I am actually earning some money again, I decide DE is right for me, I will pursue it at that point. That's the beauty of DE - I can do it when I'm 43/44 because time is not ticking away so urgently. Right now I am so beaten down with treatments that I think I'll probably just live child-free. But we'll see. Hey, if I manage to marry a US citizen, that opens up the option of international adoption, so there's another thought.

I guess this is all a long-winded way of saying that I know the odds of success on the next cycle are miserably low, but I'm going to do it anyway. With my eggs. I think I'll have plenty of closure if I get similarly bad CGH results, and will be able to walk away knowing that I tried everything.

Oh, and as for the badness of the results, I am less shocked by it now. Thinking about it, because most people either don't know their PGD or CGH results (maybe they are just told 3 abnormal + 2 normal and not the actual issues), or don't publicize them, and as most people don't even do PGD or CGH, we don't usually hear how abnormal the abnormal ones are. The only things we come across regularly are where women have a genetic test done on a miscarried fetus, where they will say it was trisomy 13 or whatever. So we come to expect that an abnormal embryo/fetus will only have one chromosome out of whack. But the ones that make it to 8 weeks and get miscarried are inherently stronger/better than the ones that don't implant. So it does make sense that the embryos that don't implant or which lead to chemical pregnancies have more than one chromosomal error. Not that I'm trying to put my results in a better light. They are terrible, I am well aware of that. But I am just not so shocked now that they each have multiple issues, as it does make some sort of logical sense.

Holy Fucking Crap

The RE just called with the CGH results. Yup, they did them within a week, which is amazingly fast.

ALL the embryos were hopelessly abnormal, each with multiple problems. In fact, just so you know how bad they are, here's the results:

Embryo 1: trisomy 1, 6, 8, 12, 18 (trisomy meaning 3 copies of the chromosome instead of 2).
Embryo 2: trisomy 1, 8, 16, 19, 20, + monosomy 18 (monosomy meaning 1 copy of the chromosome instead of 2).
Embryo 3: trisomy 12, 20, monosomy 2, 13.
Embryo 4: trisomy 4, 19.
Embryo 5: trisomy 1, 3, 19, monosomy 2.

Holy crap indeed. No wonder I wasn't getting pregnant. These are appallingly bad results, although I did ask them if they were spectacularly bad and he said that they are finding that where embryos are abnormal there are usually multiple issues with them. So he didn't seem that surprised.

I am seriously bummed. I mean, god, I expected maybe a trisomy 21 or something but having one embryo with 6 chrosomomal errors out of 23, and having the best one with 2 errors is quite sobering.

Needless to say, he suggested donor egg.

I said I'd signed up for the two cycle plan, and I intended to do both of them with my own eggs, then would stop. So he's going to think up what we can do differently with the drug protocol, and we will talk again on Tuesday to see what ideas he has.

Fuck.

But hey, at least CGH did its job, right? I got some answers. Boy, did I get some answers.

13dpER

One week since freeze day. Sigh. I wonder if this really was the right decision? I'd have a beta result by now if I'd just transferred all the embryos, as LV Clinic does early betas. In fact, I'd be doing my second beta today. So I'd know what the score was and wouldn't have to wait until frickin' June.

But then again, if it was a BFN I'd have no additional information over previous cycles and still would have no clue whether the problem was my eggs or my uterus. So I do know that doing the CGH was the right choice. But you can't help but wonder sometimes.

Sigh. Not doing so well with the waiting. I feel so anxious to know about the embryos, which surprises me. I thought I'd be doing better than this. I am just as stuck and obssessed as with every IVF cycle, so there seems no escape from the constant worrying. Hopefully I'll be able to relax once I get the CGH results and just focus on the next cycle but this is just more of the same old torture right now.

In other news, I am down 3lbs since ER day. Which as we know is mostly water weight from the meds. But hey, not bad! The food and exercise stuff is going well and I am determined to be in good shape for June, whatever I end up doing.

Waiting, waiting

OK, you convinced me, I'll stay on the BCP continuously. The only reason that I'm worried is that for one cycle I was on them for 6 weeks, and had a much lower response (5 eggs) than the prior cycle (14 eggs) even though the protocol was the same. As the only difference had been double the length of time on BCP, I always blamed the BCP. Hence my worries about oversuppression. Although I was taking DHEA thinking it would give me like 20 eggs, so maybe that was just slowly damaging everything after the first initial success of getting 14 eggs after a cancellation. But going on and going off BCP probably will mess my system up worse than staying on for 4 weeks. And besides, who wants to be bleeding that often? But I will just hope for the best.

Oh, if only I could just blithely assume that I will be doing a transfer and not worry about my ovaries being oversuppressed! How nice that would be. But that would require removing about 3 years of infertility hell, and we all know that that can never be erased! God, I find myself becoming more and more anxious about the embryos. I couldn't sleep last night worrying and hoping I'd have 2 normals. Yes, lets face it, I've already ratcheted up my hopes beyond 1 normal to wanting 2. I can't stop myself! I keep thinking I'd have a much better chance of this working if I had 2 normals to transfer. But then also, what if I transfer 2 normals and it STILL doesn't work? I think the depression might just tip me over the edge at that point, although I guess CGH will have done its job in identifying an implantation issue.

I keep hoping maybe the CGH lab isn't moving and my testing will proceed without any moving delays. But even though it is a "separate" lab from LV Clinic, it is owned by them, and is in the same building. So I assume that they will be moving right along with LV Clinic, and I won't find out about the embryos for a while yet.

Sigh. Not so good at waiting.

Taxing

Taxes are done. Phew! I filed this morning. I am getting a giant refund, even bigger than last year's giant refund, despite the fact that I claimed less in medical expenses. Not quite sure how I got a bigger refund, but I'm not going to say no to it. The medical expenses annoyed me, of course, partly because of the hours of painstaking work tracking everything down. But that's my own fault due to a lack of organization. Actually, the fact that they were lower ALSO annoyed me, because it reminded me that after a year with NY Clinic I only managed to do 2 IVFs. I mean, OK, one of those wasn't their fault, due to the giganto cyst and Hep C nonsense, but still. In the previous year I managed to do 4 IVFs with Local Clinic. So, it's irritating and makes me wonder if I missed the golden egg during one of those periods that NY Clinic closed its lab down. I am having some anger issues with NY Clinic! And I'm annoyed with myself that it took me so freakin' long to get the taxes filed, when I was actually owed money. AND you can only claim $50 a night for hotel expenses when you travel for medical treatment, which is not exactly much when compared to NY prices. But, whatever, it's water under the bridge.

I emailed the nurse at LV Clinic yesterday, to ask about possibly transferring in May if I have a normal embryo or two. And unfortunately, I already missed the window for getting into the May cycle. :( So it looks like the next time I will be going to Vegas will be in mid-June. And unfortunately also, in order to make the cutoff for the June cycle, I have to start BCP right away, so I won't get to have an unmedicated rest cycle. Pooey. But, I can delay until cycle day 5 at the latest, so that's when I'm going to start them. If I take them continuously I will have to be on them for about 4 weeks, so I hope that doesn't oversuppress me if I end up doing a fresh cycle. Eeek! They said that I have to start BCP by May 6th at the latest for the June cycle, and if I have a natural cycle there's no way it'll be over with by then. There's a part of me that's toying with the idea of taking them for two weeks, to May 1st, then stopping for 5 days to have a withdrawal bleed, and then starting up again on May 6th and taking them for 10 days before having another withdrawal bleed. Does that sound like a good plan, or should I just take them continuously and not have to bleed so much? Decisions, decisions...

Idiot!

So where was I? Oh yeah, the lack of progesterone doesn't affect me, rock star uterus, normal luteal phase, blah blah blah. D'oh! I am an idiot. Of course doing an IVF cycle without progesterone is going to affect things! And I should know this, because I've done one before. On my first IVF, which was cancelled at trigger and converted to IUI, I didn't take any progesterone. I guess the RE had given it up as a foregone conclusion by that point, although I always thought he should have encouraged me to use the progesterone just in case the IUI might work. Of course, it was then my 9th IUI so I suppose he knew with a fairly high degree of certainty that nothing was going to happen. But still. No progesterone. I didn't have the mechanical damage caused by egg retrieval, but had the hormonal damage caused by lupron so I did not have a normal luteal phase. I had spotting on 9DPO and my period arrived on 10DPO.

So why would I think this time would be any different?

Because I'm an idiot, that's why. This time was no different. Today is 10 days post egg retrieval and the old hag is here. Right on time.

Other reasons for remembering I'm an idiot:

LV Clinic is moving to a new location at the end of this week. Including moving my embryos. So if they have any sense, they won't be doing any CGH testing for the next 2 weeks, and I should not therefore expect my results to come out within 2 weeks.

It's April 14th and I still haven't filed my taxes. I spent frickin' hours yesterday on my medical expenses, and am still nowhere near complete. Why do I think stuffing receipts in random locations throughout the house is a good filing system?

Message from cloud 8

Thanks guys! I still can't quite believe it myself. Five blasts in the freezer! It's more than I ever thought possible. Even if I'd have gotten 10 embryos I think I still never would have imagined 5 of them making it to the freezer, so to have 5 out of 5 is amazing. I am in a happy fog of...happiness.

But don't go getting all cocky on my behalf, now, and start thinking I might have 3 or 4 good ones. It's still quite likely that none are chromosomally normal, especially with my history. That's why we're doing the CGH after all, to get answers once and for all on my embryos. However, the good news has definitely increased my hope that I'll have one good one. And enabled me to have a little spark of hope for two. Not that I think two is necessarily achievable, but you know, one likes to have wild dreams every now and then. Can you imagine? Two normals? I might actually have a chance of....shhhhh....getting pregnant!

It seems like the most recent CGH results have come out in 2 and a half weeks (thanks Staci and Charlene!) so hopefully it won't be as long of a wait as they are saying. But, whatever, I can wait it out. I wonder if I'll be able to transfer in May if that's the case? I'll have to email the nurse about that. I could go to Vegas in May for an FET, because it'd only take 2 or 3 days presumably, and I can lie to my boss and say I'm going to Orlando to see friends over from England or something, but I don't think I can make it in May for a fresh cycle, because I don't think I can take so much time off work that quickly. So I guess I could start BCP as soon as the crimson tide shows up in preparation for either cycle, hoping for a May transfer, but I'd have to stop them again if there were no normals. I wonder if that would mess things up.

Talking of the old hag, I am not on any progesterone so I thought she'd be here by now. I guess I bought in to the theory that IVF damages the corpus lutea so much that they can't produce progesterone. I got one shot of progesterone right after ER and that was that, so I guess I must be producing enough progesterone on my own to sustain my usual luteal phase. The nurses made a big fuss of wanting to give me the progesterone while I was still coming around from the anesthesia so I wouldn't feel it, and then they couldn't for some reason - I guess they got busy and I woke up pretty fast. So then they were all apologetic about having to give it to me when I was...gasp...awake! I was like, please, I've given it to myself six bazillion times, I really don't mind.

And, I gotta say, I am quite liking this whole "no transfer" thing. I feel like I've already recovered from the IVF drugs and like I'm totally normal again. In fact, I was pretty much normal by Sunday or Monday. It's so nice not to have all the continuing side effects and stress post-transfer, trying to keep up being perfect and thinking positively so the embryos will implant, and all that jazz. It's nice to just focus on me, and trying to get healthy again, but being able to allow myself a cup of coffee or glass of wine at the same time.

Anyway, have a great weekend, everyone! Guess what I'm doing this weekend? That I faithfully promised to do a month ago? Yup, my taxes. Ya boo sucks. Somehow adding up those medical expenses is not something I'm looking forward to. I wonder why?!

OMG! OMG! OMG!

They froze all FOUR other embryos!

Yippee! It's the best news I could have hoped for. I asked if that meant all four expanded, and the RE said that two weren't quite completely expanded, but they were almost there so they decided to go ahead and freeze. He said three of them look good.

So that means all 5 made it, because one was frozen yesterday, and they will run the CGH assay on all 5 embryos. He said the results will probably take about 4 weeks, although I notice some people have been getting their results quicker.

OMG!

The call!

The headline news is that 1 embryo is ready to freeze today, and 2 may be ready tomorrow.

So far, so good. Then I asked how they compared to day 3. Apparently on day 3 I had:

Two 9-celled embryos.
Two 6-celled embryos.
One 5-celled embryo.

He said that one of the 9 cells is the one that is good to go today. The other 9-cell is a non-expanded grade 2 blastocyst and is one of the ones that may be good to go tomorrow. I guess once it expands. (?) Then he said that the one that was 5 cells is the other one that may be good tomorrow, and is a compacting embryo so isn't quite to blast yet. So I said "oh, so the 5-celled one is doing better than the 6-celled ones?" But he said that the 6-celled embryos are both blastocysts but are non-expanded grade 3's.

I guess a grade 3 isn't good enough for freezing. (?) But if we're doing CGH why not freeze everything that isn't clearly dead and see what comes out with the test results? Of course, I didn't ask him that point, as I was a bit confused by then. He said they'll keep them all in culture medium for another day and watch them in case they improve. It would be nice if they did improve. I think I'll have to go off and see if I can find out their freezing criteria.

My guess is that I'm going to end up with two - both of the 9-celled guys from day 3, although I hope my little compacting embryo puts on a growth spurt and catches up. But at least the one that is good to go today sounds healthy. I only hope that it really IS healthy.

At least they're all still alive today, so that's one good thing!

ETA: It seems like they only freeze expanded blastocysts. I found this on their website, so they seem pretty rigid on this and presumably won't freeze an embryo that isn't expanded. I guess that's more important than the grade:

Unexpanded blastocyst: A fully "competent" blastocyst, given enough time (an extra day) to develop in culture, will always expand due to the formation of a fluid filled center (blastocele). Failure to expand indicates "incompetence".

Care for some botox with your floss?

Forgot to say earlier -

I went to my dentist this morning for a cleaning, and they are now offering botox. Yup, my dentist went off and did some classes and got himself certified. But seriously, if I was going to get botox done, I would not be having it done at the dentist's office. I mean, call me rigid in my views here, but I'd rather have a dermatologist or plastic surgeon in charge who actually knows the skin and wrinkles and all that. Botox parties or botox wielding dentists are not for me. I mean, OK, I begrudgingly allow my dentist to stick a needle in my gums when I need to get a filling, so he's no stranger to injections. But on the outside of my face? Where people can see? Uh, no thanks.

I told the hygienist this, and she said that they've had one patient do it. So, yeah, I guess other people think like me and it's not going to be a big revenue earner for them. The dentist's assistant also had it done, and I'll admit, her forehead did look lovely and smooth. But I'm sure he did it to practice on her.

Although, now I think about it, if I had to be in the chair for a long time, say for a complicated filling or a root canal, maybe I could tell him to just nab a few forehead creases while he was at it. You know, while waiting for the composite to harden or whatever.

Nervous

I'm nervous. Waiting for the call from the RE, which probably won't come until later this afternoon. It's day 5 today, so I'll find out today how many made it to blast or look like they might make it to blast tomorrow.

This seems like a big test for me. I've never done a fresh 5 day transfer, so I don't know how well my embryos do going from day 3 to day 5. I know I haven't had any die off before day 3, but day 5? I have no idea. I've only had 5 that I didn't transfer fresh, and I know that at Local Clinic two out of four made it to blasts, one of which was good enough to freeze and transfer later. I've no information about the one embryo that I didn't transfer at NY Clinic because getting information out of them on anything is like getting blood out of a stone.

So anyway, I'd think I have a good chance because those that I didn't transfer were not great on day 3 anyway. But I just don't know. Is it selfish to want 3 or 4 blasts out of 5 embryos? Perhaps, but there's definitely a part of me that wants more than 2 to have survived. Somehow it seems that with only 2, I need a 50% "good" rate in order for one to be normal, which seems too high. I know it's not really 1 out of 2, it's 1 out of 5 or 6, which is a 16-20% normal rate. Gack. Even that seems like it's expecting too much.

Yup, nervous.

The new goals

Given that I now have 8-10 weeks before either the next fresh IVF or the transfer, I've decided to focus on a couple of different areas between now and then.

The first one is that hoary old chestnut, weight. I'm at my heaviest ever, and now have 50 lbs to lose before I'm at my ideal weight. Which is about a third of the way through the healthy weight for my height, so it's not like I'm trying for super-skinny. I'd decided not to diet this year, because I end up feeling deprived and then find myself bingeing, thus putting on more weight than I took off, and yo-yoing. Which we all know is not healthy. But not dieting didn't work either as I used it as an excuse to eat whatever I wanted. So now I am going to focus on tracking calories, but instead of trying to drop to 1200 calories a day, I'm going to aim at 1500-1700 calories a day. I found a handy web calculator which tells you how many calories you need to take in to maintain your weight at your ideal, which for me is about 1700. So even if I just tried to stick to that amount, I'd eventually drop down and wouldn't face the prospect of hard dieting and then trying to switch to a "new normal" way of eating. I'd eat the same way all along. [And if I did manage to get pregnant, I'd add 300 calories a day to that]. I'm going to give myself two years to get to my ideal weight (or 3 if I get pregnant), rather than the usual "I want to lose at least 2 lbs a week" mentality. That's the plan, anyway.

The second one is to have lovely clear skin. And not in the sense of acne and blocked pores, but rather in the sense of getting rid of hyperpigmentation. I have some hormonally induced dark splotches (which have NOT been helped by repeated IF treatment) and this year got my first "brown spot". And I've always had freckles. So I'm going to try out different brightening treatments to try to get that fixed. If anyone has any recommendations, I'd love to hear them. I've been trying to be all organic, but I figure that this is worth a chemical or two. I bought some new products while in Vegas, and think I'm already seeing an improvement, but that could be partly wishful thinking. I've been told several times today that I look rested from my vacation (even though I think I look crap because I didn't sleep well last night), so maybe the skin thing is helping.

The third one is exercise. I have been happiest when I've been able to run regularly but these days have knee and back issues (not helped by the weight of course). So instead of launching into too much jogging, and hurting myself and pulling out after two weeks, I am really going to follow the slow-and-steady training plans, and try to run three times a week.

The fourth one is to try to not get fired! I have been slacking at my job because I'm desperate to change careers, and am just not motivated. But I'm going to try to accept that until I get my g/reen car.d and I am able to move, this is my lot in life. So I need to suck it up and focus more on my job, knowing that it is going to be temporary. She says while typing a blog post during working hours...

Home again

Quickie post - I've arrived home safe and sound.

Five embryos are still going strong and were biopsied today. As the RE and I were trading voicemails I never actually got to speak to him, so I don't know how they look or how many cells they have. I just know that they have 5 or more cells, as that is the criteria for biopsy. But then again, I don't need to know how many cells the embryos have or how they look. I am quite zen about it all, really. I mean, don't we all know stories of crappy looking slow embryos leading to healthy babies? The important thing is the biopsy result, not how pretty or fast growing they are.

Pretty happy that I have 5 still going strong today. :)

All about CGH

I wanted to answer to a couple of your questions on CGH testing, to the best of my ability (which is not great).

I'm not going to pretend that I understand CGH fully. As far as I can tell, it is exactly like PGD, except that they test all the chromosomes instead of just 8 or 9 that PGD routinely tests. However, because of this, the results take longer to come back than PGD. Initially, they were doing the CGH testing on the polar body of the (fertilized?) egg, which is a cell nucleus that is discarded in normal development. This enabled them to get the results in time for a blast transfer, and didn't involve too much damage to the egg/embryo/whatever. However, they weren't picking up all of the problems with the embryos, because they were only looking at the chromosomal make up of the egg, not the embryo, because the polar body does not contain the combined embryo DNA. So they switched, and now, like PGD, they remove a cell from the embryo on day 3, and test that. But because the results take too long to come back to enable a fresh blastocyst transfer to be done, they freeze the embryos and transfer any normal ones at a later day.

It seems about 25-30% of women don't have a normal embryo to transfer. Which is why I signed up for two cycles, so I can have two chances at producing a normal one. If you transfer a normal one, there is a 60% pregnancy rate, and a lower miscarriage rate than with conventional IVF, which is a much higher success rate than with just throwing embryos back in and hoping for the best.

And yes, taking a cell from the embryo can damage it. But most embryos can bounce back and just divide again to replace the missing cells. I've yet to find any information about whether any normal embryos fail to bounce back - I guess there's always the chance. Likewise, the thinking is that normal embryos will survive the freeze/thaw process easily and those that don't survive weren't normal in the first place. However, there is no guarantee on that score. There's always a chance that a normal one could be irrevocably damaged and killed off when it could potentially have become a normal baby.

It is presumably a great option for embryo selection where you have a large number of embryos, as it enables you to select the normal ones for transfer. So it's definitely a good option for PCOS-ers.

So, the question is, why do CGH with only 5 embryos? Why not just transfer all of them?

Well, in the main, because it is free. I am in a CGH study, so all it is really costing me is the flight for the extra trip to Vegas. Or not, if none of the embryos are normal. I will be getting information on the chromosomal make up of my embryos for nothing. I doubt that I would do it if it wasn't for the study, because I am cheap.

Secondly though, where you are a sad sack of a repeat IVF failure, it can be useful to figure out what the eff is going on. I have transferred 17 embryos. Even if I was 43, statistically I should have had a normal one in there somewhere. So why hasn't it worked? Either they are all hopelessly abnormal and I really should hang up my ovaries for good, or I have been transferring normal embryos and there is some sort of implantation problem going on that we haven't discovered yet. This testing will help us get to the bottom of that. I mean, sure, 5 or 6 embryos is not a great sample size. There's a good chance that all these embryos will be abnormal but have it not necessarily mean that all the embryos I've ever produced were abnormal. Hence the two-cycle plan. If we test over 10 embryos, that will give a better idea that my ovaries really are shit. Or, if we find I have one or two normal ones out of 5, and the cycle still doesn't work that gives us a large hint that we really better investigate implantation issues as thoroughly as possible before doing the final cycle.

I hope it will help give me some closure if all are abnormal. It is very hard for me to give up on this whole motherhood dream. And actual proof of the crappiness of my eggs would definitely help me not to keep plowing on hoping for the best.

Reporting

The results are in - of the 10 eggs, 7 were mature and 5 fertilized normally. The RE said that there's a 6th that may have fertilized but they're not quite sure yet so they're still watching it.

So actually I have the same amount of mature eggs and embryos as last cycle, although that was out of 14 eggs instead of 10. And possibly one more embryo, but I'm not going to hold my breath for it.

I won't pretend that I'm not a little disappointed with the number of mature eggs - I'd hoped for one or two more, given that 9 seemed to be of mature size, but of course it is what it is.

And here comes the scary part - I'm not transferring any. They will biopsy any that are over 5 cells on day 3 (Monday), and freeze any that make it to a blastocyst on day 5 or 6. Then they will do CGH testing on those that made it to freeze. And I will only transfer any that are chromosomally normal. There's a big chance of having none to transfer, but the RE is hopeful that I'll have one or two normal ones. Ha. I bet he says that to all the girls! And the results take a few weeks so we're looking at a transfer in June. Or another fresh cycle in June.

So now I go home, and leave my embryos in Vegas. I'm not actually going until Monday, as I wanted to leave enough time for a later ER when I booked my flights, so I will be heading out shortly for a Starbucks. Full caff. Coffeeeeee. And a cocktail may be drunk as well today, you never know. Wait, what am I saying? There will definitely be a cocktail!

The deed is done

OK, in your best Sesame Street singsong voices, count after me...

1, 2, 3, 4, 5, 6, 7, 8, 9...10!

We got 10 eggs. Retrieval was a breeze, and I'm now back in my room having a bowl of Weetabix. Snoozing will follow shortly, I'm sure. I'm a bit crampy, but nothing unexpected.

And yes, in keeping with the pink theme, they had me wear pink socks for the retrieval. My only surprise was that the gown was not also pink, but maybe they'd have had trouble finding me if it was, as I'd have blended chameleon-like into the background.

It's a lovely day in Vegas

Does not compute.

In my long and far from illustrious IVF career, monitoring ultrasounds have been a cause of stress. What with the poor response, uneven follicle development and runaway follicle growth I often get, I am typically left coming out of an ultrasound telling myself to suck it up, that life's a bitch, and I just have to deal with what I have. Which is often fairly shit, let's be honest.

But today it appears that I have 9 viable follicles out of a total of 14. Nine! I gained a couple. They range in size from 16mm to 21mm, so they're nice and evenly sized still. None of them decided to sprint ahead, and the bigger ones kept themselves from going crazy so the smaller ones could catch up. And everybody's a happy chappy.

Like I said, does not compute. These are my ovaries???

Trigger will be tonight. They will call me early this afternoon with the time, and then ER will be on Friday. I am, I have to say, quite nicely mellow about the whole thing.

The Pink Palace

You know, the more I looked around LV Clinic today, the more pink I noticed. The waiting room chairs are pink. The carpet is pink. The desks are pink. All the chairs are pink. Even the blood draw chair is pink. And all the walls. And the lino. And the counters. The frickin' exam table. Everything.

It's like being in a giant vagina.

Yegads, it would drive me nuts if I worked there. I longed to ask the doc or nurses if the next place is going to be quite so pink, but I restrained myself. Seems a bit rude, after all, to march in and start complaining about the decor when I should be caring about their technical expertise. But really.

But hey! I went to a show last night! I got out of my hotel room and forced myself to get out in public on my own. And admit to the hordes of happy holidaymakers that, yes, I was alone, by virtue of my solo-ness. But actually I spotted quite a few people on their own - I think it helps when you see a sold out show, as lots of parties are split up, so nobody can tell who is the loser freak and who is just temporarily adrift. I saw Cir.que du So.leil LOVE, which is set to The Beatles music. Loved it! I loved Love, in other words.

Oh wait, you wanted to read about the follicles? Well, this morning they are a few 18's, a few 17's and some of the also-rans have caught up a bit. So we are pushing it another day to see if we can get an also-ran or two in addition to the initial 7, and it looks like trigger will be tomorrow, for ER on Friday. But I will be back in the morning for another look-see just in case. I thought I saw a couple on my left ovary that he didn't count - it was hard to see as it was trying to escape out of the side of my body and of course the view wasn't great as there's lots of fat and bowel in the way. But, whatever. Que sera sera.