January 28, 2009

My Ovaries: Neither Shocked Nor Awed

First things first: if you haven't visited MamaSoon yet, please go send her some hugs and encouragement. I thought I was disappointed with our four "no results" results, but her two-month wait ended with an even more unexpected outcome.

This whole process is so frustrating - it seems like there's always more waiting to do. In R's and my case, we're waiting on my ovaries, which were not at all shocked or awed by the increase in stims: Here I am on day 8 of the injections (8!), and my largest follicle measures in at a whopping 12 mm. Clearly, my ovaries are unphased by anything that is thrown at them, and they stubbornly continue to plod along at their own pace.

I really, really did not want to be here for two weeks again, so I'm rather annoyed that they made me come out so soon, but it is what it is. At least one of the perks of being here is better access - I finally got the embryo grading and CGH reports, and the chance to talk with someone about thawing and rebiopsying the embryos, all of which I had asked for two weeks ago but never received.

We've decided to just transfer back our four "no results" at some point without attempting to re-biopsy them. The geneticist said they've only had 5 couples opt to re-biopsy after getting "no results," and while they haven't lost any embryos in the process of doing so, it does put additional stress on them. We were leaning very strongly toward not re-biopsying them anyway, so we decided to just stick with our gut feel.

As for the rest of our embryos, here's how they broke down:

3AA on Day 5 - no results from CGH
1 on Day 5, 5AA on Day 6 - abnormal (chromosome 21 loss)
3BA on Day 5 - no results
3BA on Day 5 - no results
4AA on Day 5 - abnormal (chrom. 4 gain, 22 gain, technically considered "chaotic")
4BA on Day 5 - no results
3AA on Day 5 - abnormal (chrom. 22 gain)
2 on Day 5, 5AA on Day 6 - abnormal (chrom. 22 gain)
1 on Day 5, 4AA on Day 6 - abnormal (Turner's syndrome, which is missing the second gender chromosome)
C on Day 5, 5AA on Day 6 - abnormal (chrom. 5 loss, 22 gain, another chaotic)

It seems that others who have done CGH have had their best-graded ones come back abnormal, while the average or below average graded ones come back normal. So, I'm hoping that means at least a couple of our 3AA and 3AB ones are normal, though we won't know until we attempt to do a transfer and see if one sticks.

Despite all of the less-than-stellar "no results" results people have been getting from CGH lately, we will do it again, because at least in this case it helped us eliminate a bunch of them from transfer. It may not save us from all future miscarriages, but it probably saved us from at least a couple.

January 26, 2009

Hello, Ovaries, is Anyone Home??

I found out this afternoon that I have to be in Denver on Wednesday morning, so I'm scrambling to make travel arrangements and pack.

It's supposed to be 29 degrees for the HIGH tomorrow! 29 degrees!! BRRRRR! And 22 for the low. Keep in mind, I'm coming from 70-degree weather. My ovaries are going to freeze.

Although at the moment, they don't seem inclined to do much else, so maybe the cold temps will help shock them into action. Five days of stims, and if it's possible, I think my follicles have shrunk! Seriously, on Saturday a local RE measured only two of them (one on each side), and this morning, he didn't even bother to measure one. There was no point - they were all tiny.

So RE has decided to take a shock and awe approach: he's tripling my stims tonight. Granted, in my case, "tripling" means 225 units. Then tomorrow night it's 150 units. Still 1 vial tomorrow morning and Wednesday morning. I'll be curious to see what happens to my E2 levels, because last time my follicles stayed dormant until they bumped the stims to 150, and then my E2 went crazy and shot up from 1,100 to 3,700 in about 48 hours.

I have to stim faster this time, because I don't think my veins can handle having blood drawn for 12 days in a row again. Today was only the third blood draw, and the phlebotomist had to resort to a second stick. When I get to Colorado, I'm going to have to ask for the phlebotomist who used to work with cancer patients - she was a godsend during the last cycle. That lady really knows how to find a vein, even when there's not one to be found!

If anyone else is going to be in Colorado this week, let me know and maybe we can connect.

January 19, 2009

Ready, Set...Cycle!

Talk about going from 0 to 60 in 4.2 seconds. Last Monday was all about bad news. Today, we got our calendar for our next cycle: We're supposed to leave for Colorado on Sunday, with retrieval tentatively scheduled for Feb. 1.

I'm still in a bit of shock. When I spoke with RE about our CGH results, he said he wouldn't change anything about my protocol (Lupron, very low-dose stims). Then I received an e-mail from the nurse on Thursday saying he decided he wanted to try an antagonist protocol for the next cycle.

I don't know what prompted the change, and I don't really know anything about antagonist protocols, except what I've read briefly online. And all of that seems to indicate it's a protocol for a poor responder. Interestingly enough, the RE from IVF #1 also recommended an antagonist protocol for our second IVF. I thought he was crazy at the time. I guess I should probably start to accept that perhaps the REs really do know what they're doing better than I do.

The reason the cycle is happening so quickly (besides the antagonist profile not involving Lupron) is because CD1 decided to make an early appearance (for once!) and showed up today. So I had to scramble to arrange a baseline ultrasound and bloodwork for tomorrow, and then get my meds ordered so that I'm ready to start stims on Wednesday. Wednesday! Did I mention that I'm still in shock?

On a semi-related note...I've gone back and edited my last post. When I re-read it, I realized that the stuff I wrote about the possibility of re-biopsying the embryos and how I felt about it could come across as being judgmental. Please know I didn't mean it to be that way at all. Not that anyone has commented or sent me an e-mail about it, but I still felt it was important to go back and change it to make sure it wasn't implying anything I wasn't meaning to say.

I don't think re-biopsying them will be the right choice for us, although I can't say for sure because I haven't talked to an embryologist yet to get my questions answered. But even if we decide to transfer those "no result" embryos back without pursuing any further testing, I totally understand that others in a similar situation may make a different decision that is right for them and their situation. No judgment here at all.

January 12, 2009

6 Years, $100,000+, Hundreds of Needles, Countless Tears

And still no answers.

We got our CGH results today, exactly 7 weeks to the day from when the cells were sent off. Of the 10 embryos that were biopsied, 6 were abnormal. The other 4 were "no results."

I was prepared - as much as one can be - to be told that all 10 were abnormal. I was prepared to be told that only 1 or 2 were normal and the rest were abnormal. I was not prepared to be told that we still have no answer for 40% of them.

All throughout this process, I kept telling myself we might not get a baby, but at least we would finally have an answer, at least we would know why. But we still don't.

I suppose having 6 of the 10 come back abnormal seems like an answer, but it doesn't feel like one to me. I know the reproductive system is inefficient, I know a lot of embryos that are created are abnormal even among normal, healthy couples who don't need reproductive assistance to have a baby.

RE didn't really have much to lend to the results, either. He said if he was a betting man, he'd bet at least one of the four "no results" ones is normal. But then again, when I first counsulted with him three or four years ago, I'm sure if he was forced to bet on our chance of success, he would have bet we'd have a kid by now.

He did say they could attempt to retest the four free of charge. But that would involve thawing them, re-biopsying them, re-freezing them and then ultimately re-thawing them again if any of them are normal. That's a lot of stress to put them through, so on the off chance that one of those four is normal, I don't want to make them go through that.

As crazy as this sounds, I've never felt like a mother more than today. I feel so fiercely protective of those embryos. They're not just groups of cells - those are our babies. I will attempt to get pregnant again by transferring them, knowing the odds are it won't end well. But deliberately going through all of that, risking the heartbreak - it's not really even a choice. It's just what I imagine any mother would do.

However, before we do a transfer, we'll most likely be heading back to the clinic to do one or two more rounds of retrievals. That's because there's another wrinkle in all of this: I'm about 95% sure that my IVF coverage is going away as of June 1. Since the retrievals are the most expensive part of the process, I'd rather use my coverage for those.

RE agreed that that was probably the best approach. If we did a transfer first, I could end up with another pregnancy like the summer of 2007, where I made it to 10w5d with a pregnancy that had an unsurvivable chromosomal abnormality. If that were to happen again, by the time my body would recover and be ready for a retrieval, June would already be here and my coverage could be gone.

We will definitely do CGH again, because even though it didn't give us any answers with regard to "normals," at least it let us know some of the ones we shouldn't transfer back. However, I still need to talk with RE about exactly what kind of approach we want to take. I think I remember a blogger (please forgive me for not being able to remember who - I'm still kind of foggy brained from the surprise of all this) who had the polar bodies of her eggs tested rather than the embryos themselves. We may take that approach next time around to see if we can get more information about whether it appears to be an egg issue. Maybe that would also create less "no results" outcomes, though I don't know that that's the case, it's just a hope on my part.

Well, there is a Kleenex box keeping me company on the couch and a pizza in the oven that is soon going to be offering some tasty (albiet temporary) comfort, so I probably should get going. You'd think after six years of sucky, heartbreaking news, I'd be better at dealing with it. But it turns out that numbness I thought I'd developed to heartbreak and disappointment is only skin deep, because underneath, it still hurts like hell.

January 04, 2009

A Belated (but Yummy) Christmas Post

I had hoped to post this before Christmas, and obviously that didn't happen. But I figure better late than never, especially when it involves sweet treats.

Much like the Thanksgiving pies, I was a bit overly ambitious when it came to making some Christmas treats to give away to family and friends: I wound up with a total of 10 different things. But most of the recipes were very easy, so I thought I'd share them here:

From the upper left:
Cookie Dough Truffles - There's no raw egg in the dough, so you can scrape the bowl all you want. This really does wind up yielding the 5 1/2 dozen the recipe says it does.
Butterscotch Nut Fudge - A nice change of pace from chocolate fudge.
Chocolate Orange Cremes - Okay, technically the recipe is Orange Cappuccino Creams, but I'm not a big fan of coffee, so I left that part out. I also made another variation of this with diced up marischino cherries, cherry extract, a touch of red food coloring and finely chopped slivered almonds. When I was done, I sprinkled a little bit of the chopped nuts on the top. It gave them a polished look, and I was able to tell which was which based on what kind of nuts were on top.
Chocolate Peanut Clusters - A simple but classic goodie.
Chocolate Almond Macaroon Bars - These are very rich, so a small piece goes a long way even for someone like me who has a ginormous sweet tooth.
Rocky Road Tasty Team Treats - These are super, super easy to make, and they're delicious too. They're my new favorite bar type of dessert.

Cherry BonBon Cookies - These have a sweet surprise inside!
Mixed Nut Bars - These are quite addictive, but again, another one where a little bit goes a long way.
More of the Chocolate Orange Cremes and Chocolate Cherry Cremes are in the background.

These Mint-Mallow Chocolate Cups turned out to be my favorite. I hadn't made them (or most of the other above treats) before, and at first I wasn't sure about the combination of mint and marshmallow, but it worked very well. A couple things to note about this: I would advise making it the day you plan to serve it, because the candy pieces begin to break down in the marshmallow mixture over time. Also, I would wait until the very last minute to sprinkle the crushed candy pieces over the cups as a garnish, because they look very glittery and pretty when you garnish them, but the garnish sinks into the marshmallow fairly quickly.


P.S. I'll post more about medical stuff in the next couple of weeks, but a quick update: Today was 6 weeks since the last of our embryos were biopsied, and we don't have the CGH results yet. I started the Synthroid a few weeks ago, and it seems to be helping a little bit. (Meaning, I'm able to stay awake longer than 8 hours at a stretch, but the weight isn't falling off and running away like I had hoped.)

I have a follow-up with the endocrinologist this week, and an appointment with a reproductive immunologist in a couple of weeks. A few of you have also asked specifically what my thyroid levels are, so I'll post those after I get the new ones at the end of this week.