IVF #4: RE meeting

We met with the RE today and continued to discuss what to make of the latest failure and where to go from here.

He said that our repeated failures are most likely due to chromosomally abnormal embryos. However, he also said that we make lots of good-looking embryos and that based on that (and my age), he thinks we will likely succeed if we stick with it.

He emphasized that we're not near the end of the line, even though emotionally we may feel like it. He said we should not even consider donor egg at this time because he still really thinks we have a good shot at having our own genetic child.

In terms of specifics, the RE said that my eggs tend to be almost all mature at retrieval and that it's possible they would be more likely to be euploid if we triggered a day earlier when they are a little smaller than is the typical optimal size. He also said we should definitely do co-culture again.

We also talked at length about PGD. He said we could consider doing it at this point, but he doesn't really recommend it because research demonstrates PGD results in a lower live birth rate when it is used (because of the trauma to the embryos and the possibility of false positives/negatives caused by mosaicism). He said, though, that he would understand if we desired to use it just to get a read on what's going on with the embryos (even though it would lower our chances of success) and will do it if we want to. We asked if we could transfer the best looking embryos and then do PGD on any of the embryos we don't transfer, and he said that yes, we could.

He said also that given the number of failures, it would make sense at this point to look into other potential issues impacting implantation. One possibility is undiagnosed endometriosis, another is lining issues. So, he's fitting me in for a laparoscopy and hysteroscopy next Thursday to look for endometriosis and uterine issues. He'll also do an endometrial biopsy at that time to send to a colleague at Yale who does some sort of experimental testing on the lining.

We told him that we'd consulted with the head of the famous IVF clinic in Colorado and that we were going to get a consult with the head of the other great NYC clinic just to get their thoughts. He was supportive of this and said that it made sense to get second opinions. He continued to say that microarray is just not proven at this point and that it wouldn't be ideal for us because of the paucity of blasts anyway.

So that's it. Surgery scheduled for Thursday. Another consult with the other clinic in NYC the Monday after that. Colorado on hold for now.

What a whirlwind. Reasonable plan? We're not sure. Will and I both feel that our heads are spinning. And our hearts? I couldn't even begin to tell you about our hearts.

I feel like we'd agree to almost anything at this point. General anesthesia with intubation? Sure! Stomach pumped up with gas? Sounds grand! Abdominal incisions? No problem! Need to chop off my right arm? Here, just take it now! Oh, wait...that's going a bit overboard. Unless it might help...

Mo

IVF #4, the blow-by-blow account

2/26 Cycle Day 2
FSH = 6.8, E2 = 32.7, LH = 5.47
200 Follistim, 75 Menopur
Begin stims

2/28 Cycle Day 4
bloodwork: E2 = 146, LH = 1.9
200 Follistim, 75 Menopur

3/1 Cycle Day 5
bloodwork: E2 = 207
ultrasound: Right: 2 at 11, Left: 1 at 10, 1 at 9
200 Follistim, 75 Menopur

3/2 Cycle Day 6
no bloodwork
200 Follistim, 75 Menopur, 1 syringe ganrilex

3/3 Cycle Day 7
bloodwork: E2: 522, LH = .6
ultrasound: Right: 1 at 13.7, 2-3 <10

3/4 Cycle Day 8
bloodwork: E2 = 758, LH = .725
ultrasound: Right: 14.8, 11.5, 2-3 <10

3/5 Cycle Day 9
bloodwork: E2 = 1180, LH = .954
ultrasound: Right: 14, 14, 11.5, 11, 11.9, Left: 15, 14.5, 14, 12, 11.5, 2-3 <10

3/6 Cycle Day 10
bloodwork: E2 = 1573
ultrasound: Right: 16, 13.5, 15, 10.5, 2-3 <10

3/7 Cycle Day 11
bloodwork: E2 = 2,146
ultrasound: Right: 18, 17, 14, Left: 18, 16, 15, and then a bunch o' others.
HCG Trigger.

3/8 Cycle Day 12
bloodwork: pending
ultrasound: Right largest is 19, smallest 14, Left: similar.

3/9: Cycle Day 13
15 eggs retrieved, 14 mature, 11 fertilize w/o ICSI.

3/12: 5 beautiful embryos transferred at day 3.

3/23: BFN

It's official

The beta is negative.

I just received the call from my RE. We'll be meeting with him Friday to discuss what to make of this latest failure and what our next steps should be. Seems safe to say that all three of us (Will, me, and the RE) are shocked and disappointed. I said as much to the RE and he said back in this wistful voice, "Yeah. Especially because the embryos looked so beautiful." He shared that he had feared we'd be facing selective reduction, not another negative cycle.

Amazing to me still that we could transfer five gorgeous embryos and get nothing.

The RE said that all ten of the physicians at my IVF clinic have a team meeting tomorrow and he will present my case to the group. I'm glad we'll get some other eyes and minds and opinions on the situation, although I dread that they will conclude that the situation is hopeless. Still, I guess better to find out what they all think.

I stayed home from work today, partially because I haven't really been sleeping and partially because I wanted some privacy to take this call. I would have been in the psychiatric ER today (working, not as a patient, although today the line feels a little thin) and there is nowhere on that unit where you can be alone. And you're locked in thoroughly, so it would be hard to get out (multiple doors and keys) to even have a non-private but more private hallway to talk in.

Will is just crushed and so am I. Learning that IVF #4 failed has been terrible, especially since it feels like we went for broke with the endometrial coculture and aggressive transfer. It's almost as painful as our first miscarriage. It feels like conceiving and raising our own genetic child is an increasingly distant likelihood.

Right now the toll of all we've been through in the past 19 months is reverberating in our lives and hearts, magnified by this latest blow. Shortly we will somehow begin the process of scraping ourselves off of the floor and moving forward, although how right now eludes me.

Thank you for all of your comments and support. They have meant the world to us. We feel broken and so very, very alone. Reading your words lessens our aloneness. We are extremely grateful.

Mo

Sundays of grace #7: canceled

10dp3dt. No words.

The two week wait: a pee-on-a-stick pictorial narrative

Friday, 3/13: 1dp3dt

Tested negative. So this is our baseline test. HCG is out of my system! Going away for the weekend. Will not be testing.

Tuesday 3/17: 5dp3dt
Tested negative. Implantation may not have happened yet. Feeling relieved that it's negative. A positive at this point would suggest higher order multiples, and we are not after our own reality show! Wipe some sweat off my brow. Palpable relief. Feeling confident we'll get a positive down the line. This cycle is going to work!

Wednesday 3/18: 6dp3dt
Tested negative. Implantation should be happening about now. Some people on other boards got a positive this day with twins. Still feeling some relief that it's negative because I've been so stressed about triplets or more. I know we'll get a positive any day now. Confident that this cycle is going to work.

Thursday 3/19: 7dp3dt
Tested negative. Hmmm....thought with putting in five beautiful embryos we'd have a positive by now. I mean, really, there must be at least twins in there, yes? Puzzled. Catastrophic thought that this cycle is a failure pops into my mind, but I try to bat it away. Feeling...a little less certain...but still hopeful that this cycle will work. Have broken out in hives from PIO - just like every cycle. Am miserable physically. Job offers coming in. People want decisions. Starting to feel a bit nuts. How can I make any decisions now?

Friday 3/20: 8dp3dt
Pee on stick. Take it back to bed to look at result with Will. We turn on the light and look together.It's negative. WTF?? This should be positive. According to the information leaflet in the box of HCG test sticks Will bought me, 83% of women who are pregnant will test positive at this point.

It's still early. But not that early. There's a good chance even with a singleton that this would be positive by now. And we transferred a schoolroom of embryos!!! We pull the covers over our heads. Filled with gloomy thoughts. Can barely get out of bed. Feel defeated. Try to remind ourselves, don't give up. Tomorrow it could be positive, although it isn't looking good. Maybe it's a singleton. Yes, that's it - it's a singleton!

I remember that when I went to the bathroom after transfer, I felt fluid run into the toilet and thought I saw a few tiny dots the size of pin heads in the bowl and briefly wondered if the embryos had fallen out. Maybe my uterus has been empty this whole time. But that can't happen, Mo! Or could it?

Sigh. Get up. Scratch hives, which now coat my neck, back, arms, chest. Maybe the allergic reaction keeps the embryos from implanting? I must be filled with histamines. Feel very sorry for self.

Curse the 2ww. Start praying to the Universe. Begin bargaining (note to self: isn't this one of Kubler-Ross's five stages of grief?). Try to focus on other things, which is helped some by all the work/grant craziness.

Saturday 3/21: 9dp3dt
Pee on stick at 6:45 am. Take it back to bed to look at result with Will. We turn on the light and look together.
It's negative. But wait, this is the part where I was going to post the surprise picture with the positive pee stick! This is not how the story is supposed to go!

Ninety-three percent of women who are pregnant test positive by this point, according to the damn HCG test box. And longtime readers know that I am a big believer in stats and am especially vulnerable to all forms of Infertility Math.

We aren't surprised today; we are resigned. Will and I cry together.

We also laugh cynically for being fooled into believing IVF #4 could ever work. Suckers!

We drag ourselves out of bed to get the luteal phase bloodwork required by my clinic. This feels like an exercise in absurdity. I am not going to be in the 7% of women who test negative but are pregnant. In fact, I'm pathetic, covered in self-inflicted bruises and hives. The PIO injections have not been endured to support a fledgling pregnancy; they have been another unintended act of masochism.

Feeling major AF cramps. Period wants to come. Because it is OVER.

Fuck.

8dp3dt: bargaining

Dear Universe,

I do not want to seem ungrateful for the multiple job offers and for the grant that now seems nearly approved. I have high appreciation for these things that have appeared in my life. And I realize that I've put some effort into achieving them.

Which is also what worries me. While I appreciate your recent occupational and educational largesse, I worry that it might cause some confusion on your part as to my priorities. From a quick observation, it might appear that I value my career and education over pregnancy and childrearing, but this would be an erroneous conclusion to draw.

My priorities remain the same: I, and Will, wish with all our hearts to have a family. We want this above all else.

Really, Universe, it shouldn't have to be a dichotomous decision, an either/or. After all, we are in the year 2009. But if you're feeling that I've already been given enough - or too much, even - I'd be happy to turn in my degrees, and the career opportunities, to have this one thing. Just one child. Will and I have even joked that we'll settle for half of a child at this point. But ha ha! we're kind of kidding about that, so please don't go and give us half a child!

Seriously, Universe, we could call it a fair trade: my professional life for a baby. If that's what it takes, just let me know.

So just to reiterate (and Universe, I apologize if I'm getting repetitive, but I just want to make sure I'm clear), please do not get confused by my recent luck in all areas not child-related. Don't count it against me. Although I do love my work, I'm sure I'm also trying to compensate for the lack of the one thing I wish for most, which is also the one thing I can't seem to achieve, no matter how hard I work at it.

Please, Universe, give it some consideration. We won't, I promise you, take a pregnancy or child for granted. Ever.

Sincerely,

Mo

7dp3dt: cannot compute

My carefully guarded sanity is starting to wane. Over the past week and a half, I started with a few days of excitement that I might be pregnant, moved into a phase of abject terror that we're pregnant with quints, and I have now, as of this morning, arrived in the land of absolute certainty that we aren't pregnant with even a singelton (coupled with the scary voice... and you never will be). Suffice it to say, the 2ww is hell.

After I posted a couple of days ago that I wasn't feeling anything, I promptly began to feel some pulling in my uterine area on both the right and the left (of course, immediately thinking omg, it's at least twins. akkk!). Now I'm back to feeling nothing. And I question whether I felt anything before either. Although I would have sworn that I did.

Adding to the complete craziness is the fact that my clinical internship ends June 30th and as those of you following this blog know, I have been thick in the process of trying to figure out what next year holds. I was offered one position last night, another one this morning. I am still waiting to hear whether the grant I submitted will be funded. And some of these people want an answer by tomorrow - which of course is before I'll know if I'm pregnant, and way before I'll know if I'm pregnant with two or more.

My head is simply spinning. I cannot figure out how to prioritize decisions with so much of my life currently in the land of uncertainty. Normally I proceed as though I am not pregnant, but it feels so very close to possible that I am pregnant (with twins or triplets maybe?!) that I cannot think straight at all.

Any words of wisdom?

Mo

All quiet on the uterine front

It's 5dp3dt and all is quiet. No uterine burbles, no twinging, no nada. Really trying to not pay attention, but of course I am attuned to the slightest uterine twitch or hiccup. Or rather the absence of any of these. Which is ok. I am hyperaware of it, but it is ok.

Breasts? eh. They feel like they always do on progesterone. Huge and sore. Sort of like my butt does after these past seven days of PIO shots.

And I've got a little touch of heartburn. Which is strange. I never have heartburn. Maybe it's the estrogen and progesterone? Not sure.

According to the reading I've done, implantation should occur sometime between days 6 and 10 after ovulation/retrieval, which would mean sometime between last Sunday and the day after tomorrow.

In the meantime, I'm trying to lull some of these little guys into sticking around. In my softest, most convincing voice, I whisper, It's nice here. Linger a bit. You'll like it. Stay awhile.

We'll see if any of them are listening.

Mo

Oh, Honey, you shouldn't have!!!

In a fit of romantic fervor, my husband, Will, brought home a gift for me last Thursday after the embryo transfer.

I was overcome by his gesture of love. In fact, tears welled up in my eyes, because in his choosing of this gift, it was clear that my husband is one of the most considerate people I know. It was also clear that he truly knows me, inside and out.

You might be thinking Will brought me a bouquet of peonies, one of my favorite flowers... or that he brought home a bottle of my favorite Shiraz for one last toast. Or maybe you're guessing he brought me sweet strawberries dipped in Godiva chocolate.

You might be thinking any of these things, but you'd be wrong.

Will brought me a gift more attractive than any of these. He stood there, just inside the doorway, his arms outstretched. And when I saw what he held, I couldn't believe my eyes.

Twenty-five urine pregnancy tests.

That's right, twenty-five. That's enough for me to pee on until my little heart is content.

What a guy! (Although it also struck me that this gift is a little bit like buying a pyromaniac a jumbo box of matches. Still, thank you, Will!)

Mo