The Transfer

Yesterday I told you I got the call from my embryologist in the morning.  I was expecting an email, so my heart dropped, and I did that auto-pilot thing you do when you are expecting devastating news.  Fortunately, the first thing she said was "I'm calling with good news."  My heart resumed beating and she told me that all three of the morulas had made it to the early blast stage.  She expected them to be further along when we got there for our retrieval.  Apparently, the rest of the day, because I was the only transfer that day, she ran around telling everyone employed by the Fertility Center, LLC in Chattanooga that I had made blasts and showed them their picture.  It's part of the reason I love this place.  They are all so amazing and supportive.

BJ and I got to Chat-town a little early and decided to go Christmas shopping at the big mall that is not near as impressive as it was when I was 9.  What can I say?  Once you go KOP (King of Prussia) you don't go back.  As I said, we were Christmas shopping so, of course, we only bought clothes for ourselves.  I got a cute skirt and top in a size smaller than normal.  I believe in Murphy's Law and hope that I cannot wear it for a really long time...well, after a couple of weeks anyway...

It was time to go to the clinic and I was called back for an hour-long massage.  It's included in the IVF package.  So yeah I paid a lot of money for a wonderful massage with a hopefully happy ending.  At least that is the joke BJ and I've been telling each other...hehe...  Then they sent me back to the waiting room. Then they sent me to the lab for my progesterone levels to be checked.  (It's over 40 which is perfect!) Then they sent me back to the waiting room.  What was only like 5 minutes felt like an hour, but finally Susan comes to the door SMILING!  Yes, Susan, was smiling.  Last time, I don't even remember who called me back and then we had the parade of the team doing their death march to tell me, "Umm, your embryos aren't so good."

One of my embryos had become a genuine grade-able blastocyst.  It wasn't a perfect score, but it's in the category of 3AA- which is a high enough grade to consider a single embryo transfer. The three refers to the amount of the blastocyst's expansion, and it just had not had time to take on much fluid.  The first A means that the baby parts were perfect. The second A- refers to the trophectoderm, the part that becomes the placenta.  It wasn't a B, but they were lined up a little loosely.  Susan once again performed assisted hatching on them, and was thrilled to see that it was already starting to hatch itself out the hole she had made. Otherwise it may have been a 4...The other two had made progress, just not quite so much but one was still looking pretty good, so we went ahead and transferred the better of the two still early blasts.  7 other embryos including the early blast were alive and kicking. Two more had become early morulas which is what we had last time.

This is our embryo B in the morning.  It's an "OK"early blast. Its a couple hours behind  embryo A.

This is a Brilliant early blast that is also BJ's and mine. It should look like a rice cake...not bad, huh?

This is Embie B, again 3.5 hours later.  Isn't it neat how fast they grow?  It's still too early to grade but he's making progress and doing fine.

This is Embie A 3.5 hours later and she's a beautiful specimen of a blastocyst.  The outer cells (which are a little bit loose for a A, but an A- nevertheless) will become the placenta.  The cavity part that looks like crinkled paper is going to be the amniotic sack and the little ginger-bread-man looking thing in the low middle is Baby Roberts.  Best moment so far!!!! You can see at the top she's already trying to hatch out which is what you want because that's how they implant in my uterus.

****I do not actually know the sex of these embryos...this is just my silly, sexist conjecture.****  

Dr. Donesky came in with a big smile on his face which has been an unfortunately rare appearance once he starts talking about technical things.  He said this is what we expect.  "We just need one good one and still expect to see some lower quality ones. One is all it takes."  So instead of  bawling crying going into this transfer, I was happy/excited.  So happy and excited that I forgot to ask for water to drink to fill my bladder...OOPS!  I took a quick swig of what I had which wasn't much and tromped down the hall in my shirt, socks, and sheet with BJ in tow.  It all worked out ok as far as my bladder, but one of my ovaries which is still ginormous decided to be a camera hog. (Makes me feel better about aforementioned skirt purchase.)

So, it's a good thing my bladder wasn't full because they had to mash down pretty hard.  I'm pretty sure Dr. D would be very unhappy if I'd had a completely full bladder. For whatever reason the whole transfer process was more difficult this time, but Dr. D finally was happy with everything and the embies were transferred.  The key word is transferred. No one can force an embryo to implant and grow up to make a fetus. I think people sometimes assume that with IVF if you put two in you get two out, or whatever.  But this is a clear case that science can only do so much.  No doctor in the world can make you pregnant, or else I'd have the next available appointment.  After the transfer I had a much easier 30 minute wait before I got up because my bladder was not near as full.  (Remember, ladies, if you ever have to go through an un-pregnant uterine ultrasound, I am living proof that you can cheat it a little bit and be a lot more comfortable.)

So now I've got until Friday around 4pm to be lazy and get up only when absolutely necessary.  As in bathroom trips and eating.  It's a rough few days of trying to not drive myself crazy. Every twinge, and after seeing my ovary I understand why, makes me wonder 'is it happening?'  'Are these implantation cramps?' I keep reminding myself that I'm not an insane person, and that it's not normal to have symptoms this early.  Although I am still on a million hormone supplements, and my ovaries are still acting weird so even if I did, it could simply be residual effects from the stimulation.

It's not all wonderful news, unfortunately.  Susan called me later this afternoon to tell me that none of the rest of my embies could be frozen.  The blast from yesterday did progress a little futher, but the quality wasn't there.  One of the early morulas made it to blast today for a total of 4.  So, no matter what happens, this cycle was 400% better than last.  It was definitely worth trying again.  Susan reiterated that she felt good about the embryos she chose for transfer. One of my online cycle buddies found out she was pregnant this week after having nothing left to freeze out of 23 embryos.  Basically, I've put all my eggs in my one basket. So now it's just praying, hoping, praying, hoping.  And once again, let me take the opportunity to thank everyone!  I would be nowhere without all the love and support I've gotten the past several months. I am forever grateful!

Peace, Love, Prayin' and Hopin'!

Mary Katherine

Day 4 Update

We have 3 morulas.

It's not the 5 or 6 of my dreams, but the 3 that we have today, on day 4 are further ahead than the 2 early morulas they transferred on day 5 last time.

Susan changed their fluids to try to pep the others up and keep the morulas going, and we'll get an email tomorrow morning on all of the embryos progression.

I'm thrilled to have morulas on day 4.  That is a huge improvement for us.  Now I just need to hold vigil for the embryos that are still going.  I pray they make it to the blastocyst stage tomorrow.  I'd love to have one for the freezer, but  I won't be greedy.  In the end, all I need is one.  Just one good one is all it takes.

I love you my little embies!  Mommy and Daddy will see you soon!

Peace, Love and Praying for at least 1,
Mary Katherine

Fertilization Update

I'm sorry I meant to post this yesterday, but I was too stoned on pain meds to muster up the energy to blog last night.  I'm pretty sore this time for whatever reason, but frankly, I could care less about that...

Susan, the embryologist, emailed me around 9:00am to let me know that out of the 16 mature eggs 14 fertilized normally.  So as of now we are only down three embryos from last time, but as Susan says, these are "better quality."  Today on day 2 they are left alone to do their thing. Hopefully, they are between 2-4 cells and holding up better.

Tomorrow is going to be the real test.  Day three is when my last cycle's embryos showed significant fragmentation and general not-so-goodness.  They would ideally be 8 cells with anything from 6-10 cells being acceptable.

Here is a picture of my embryo babies as of yesterday...

You can tell they are fertilized by the two indentations (pronuclei) towards the middle.   One of those pronuclei is all of my genetic material and the other is BJ's genetic material.  In this picture they are getting ready to get it on and make a baby, so look away.  The stuff around them is not fragmentation but leftover cumulus cells from the follicle and egg. You have to remember we are getting a 2D version of a 3D cell so it's hard to tell what is on top of the embryo vs. what is in the embryo. They may not look like much now, but they can become pretty damn cute in another 38 weeks or so.  I think they are beautiful, now...but clearly I'm biased.  Susan says they are, "Very nice."  I'm so proud!

Peace, Love, and Quality Growth,
Mary Katherine

Egg Retrieval Update

It was a rough morning...

BJ and I got up bright and early for the egg retrieval this morning.  I was the only patient in this wing of the facility this morning so it was nice to have 3 people to talk to.  My luck apparently ran out with first attempt needle sticks today and it took a few to start an IV...oh well.  Similarly to last time I walked back to the Operating Room.  They gave me less medicine this time just in case it affected my egg quality.  So...ouch.  It kinda feels like I sat on a spear, which in a way...I guess i kinda did.  

As I was waking up, they told me they got 18 eggs.  I was devastated and had a meltdown. Jan, my coordinator, Susan my recovery nurse, and Susan the embryologist were not upset in the least.  They stuck around and comforted me.  They kept reminding me we were going for quality not quantity.  I'm so stuck on it being a numbers game.  Jan kept saying that my stimulation went so much better this time.  Embryologist Susan told me she would update me in the afternoon about the number of mature eggs.  So, out of 18...16 were mature and she used ICSI (Intracytoplasmic Sperm Injection) to fertilize the eggs.  I'll find out tomorrow how many actually fertilized.  

As a frame of reference, people go through IVF all the time with only 3-5 eggs and have successful outcomes. It's just difficult for me because it's hard to not play the numbers game in my situation when I previously had 24 eggs with no success.

Tonight I start my estrogen patches and PIO shots.  I learned that because my follicles are aspirated during the egg retrieval procedure, there is no corpus lutea left to supply estrogen and progesterone.  That is why I have to pretend I'm getting ready for male to female gender reassignment surgery with all my hormone treatments.  If/when I get released to an obstetrician, he/she will determine if my placenta is functioning well enough to back off on the hormone supplements.  

I'm holding vigil for my embryo babies.  For all intents and purposes I'm going to assume I have 16 embryos to work with.  I cannot wait to hear how they did tomorrow.  I'm really anxious to hear how they do by day 3 on Sunday.  This is when things started to go south for my embryo babies last time.

Well, I'm still feeling pretty rough, so I'm going to head to bed.  Please keep my embryo babies in mind tonight.  They can use every ounce of support they can get! Grow, babies, grow!

Peace, Love, and Quality over Quantity,

MK

Life is unpredictable...

I'm headed to Chat-town with a heavy heart. I lost a friend and co-worker last night. Jeni Sharpe, 34, mother of two amazing boys, died extremely unexpectedly. Jeni was a spark plug. She was smart as a whip, generous beyond generous, and funnier than a stitch. She was one of my first buddies at Gibbs.

Jeni only ever did what she thought was best for her students, which was a lot considering she worked with our special needs population. She opened her heart and took these children under her wing to give them not just a high school experience, but an enjoyable experience. She let them hang out with her sons and included them on weekend family trips to Dollywood or the zoo. She made sure they arrived at prom looking dapper and gorgeous. She ensured that their high school experience was full of memories despite them being a population of students that is oft ignored.

She never let politics and bureaucrats get in the way of doing what was best for her students. She turned her frustrations into what could have easily been a stand up comedy routine. Her impressions were hilarious. I always told her, "If you can't be nice, come sit with me!" I enjoyed her visits to my office. I loved working with her. Test scores, TEAM model, and TVAAS be damned, people like her make Gibbs High School. We lost a great teacher last night. A teacher that made me proud to be an employee at Gibbs High.

If Jeni could be here, I know she'd be pissed as Hell. She loved her family and had huge plans for her children. There is no lesson to be learned from this tragedy, but a reminder that we just never know. We must strive to enjoy each moment. Tell our family we love them often and be thankful for those opportunities.

Jeni would kick my ass if I didn't keep my chin up, have this retrieval done, and keep fighting this battle. She frequently told me I deserved to experience teenagers and toddlers and if I timed it right, preferably at the same time. So Jeni, here I go. Take care of my wee ones will ya? Love you and miss you!

Peace, Love and GO VOLS/HORNETS/EAGLES!

Mary Katherine

Tra-la-la

So today's results are in, and I'm very happy to tell you that all is well! My ovaries are now closer to softball size and my skinny jeans are a bit uncomfortable to wear. However, I have a huge amount of nearly mature follicles to give another days worth of stimulation medication too.

My labs were great! My estradiol was 3269, progesterone .881, and my LH was 1.46. I don't have any other labs to compare to today, because I didn't get this far last time.

My acupuncturist is thrilled.  So thrilled he let me have my cell phone during my treatment because I was so balanced...but then he took it away because I couldn't behave.

On pins and needles...

I learned a lot at acupuncture today.  My former acupuncturist practiced Traditional Chinese Medicine.  My current practitioner uses 5 elements acupuncture.  I learned that my speech style is groaning (What the hell?), I'm deep and I'm blue which makes my main element Water.  Water types enjoy salty foods, and their main emotion is fear.  We can be soft like a dew drop or violent like a tsunami...I don't really understand, but I do feel better after I go, and my acupuncturist says I am doing better and I'm more balanced.  That's all I need to know...

I'm excited to see what my embryos do this time.  It's a balance of knowing what the worst is, and giving it a go, anyway.  I'm cautiously optimistic that things will go better this time.  So here's to not triggering (the act of injecting yourself with HCG to fully mature the eggs).  I will probably get to trigger tomorrow.

I am ready to be able to make plans for the future, again.  Today, for instance, I went in at 10:00am and was told at 3:00pm that I had an appointment at 9:00am the next morning.  This is not much notice for my boss, but I'm very blessed that he is extremely understanding and supportive of the process.  I wonder how women with less flexibility go through this?  I also can't tell my own mother-in-law when I'll be having surgery.  Today, I could tell her that it won't be Wednesday, but could be Thursday.  Yesterday I told her it wouldn't be Tuesday.  It's hard to plan for dog-sitters, MK-sitters and the like. Eh...minor details.  It will work itself out...

Bottom line is I'm happy.  I'm not scared, yet. I'm not anxious.  I'm just here and very grateful that things have worked out so well this far.

Peace, Love, and Another Day of Growth,
MK

Supression check - Check!

Today was the day, and a day it has been.

Firstly, because I'm not going to sit here and lie on my own blog, I want to tell you how Negative Nancy I've been.  I cried on the phone to my mother last night for a half hour because I just knew this cycle was not going to go well.  I keep having these flashes of my mother stepping off the plane to me, in tears, devastated and unable to compose sentences again.

This morning in the parking lot of the fertility clinic, I told BJ I didn't want to get out of the car.  I said, "Let's not and say we did."  BJ replied, "C'mon, let's go."  So I did...I do listen occasionally, but it's by free will.

Before you yell things like, "It's not going to work if you don't want it," and "Your thoughts are powerful." may I remind you of the fact that positive thinking only got us to round 2 of IVF with nothing but a huge dent in our bank accounts. Would you tell a cancer patient that if they relaxed and thought positively (maybe throw in a macrobiotic diet) they would get better?  That worked so well for Steve Jobs.  (Sorry if that's too soon for my geekier friends, I hate that he's gone too. Damn granolas and their holistic bs...)  Scientifically/philosophically speaking, things are gonna go how they go just like they went how they did in August.

I was ashamed that I felt so negatively last night.  Too ashamed to tell my husband.  But I did this morning, and he told me about the Stockdale Paradox.  This Stockdale guy is pretty amazing and describes my situation perfectly.  I'm not comparing myself to a POW, or a cancer patient, but please realize I do have a disease, and I am a patient. I think that is one of the most difficult things for breeders to understand when a friend suffers with infertility.

Relaxing, head-standing, adopting-to-induce-spontaneous-conception or any other natural method is pretty much giving the macrobiotic diet a whirl in lieu of chemotherapy and radiation.   I'm not sure this IVF cycle will work.  I want to have a baby more than anything in the world.  This is my paradox and if you take the link, you'll see it's not only rational to have these conflicting thoughts, it can save your sanity.  So I read it, and now I feel better.

So much so that I am willing to share my results.

Estrogen Level:  20.0    August Baseline 37.3  Desired results <50
So I'm over-achieving in this area, but I don't think how low necessarily makes a difference so long as it's below 50.  One website says the lower you are the better your response to stims...so YAY!

Progesterone Level:  .333  August Baseline .252   Desired results <1.5
Little higher than last time, but still nowhere close to 1.5, so I think it's all good.  We want this one to stay low until after the retrieval, and then I want it at 40 by 5dpt.


LH level:  2.86  August Baseline 4.16  Desired results <7
Better, it means my ovaries are "quieter" as the specialists like to call it.  They are more easilty taken hostage by stimulation medications.


Baseline Scan:  12-15 follicles on each ovary  August Baseline 5-7 on each  Desired results 10-12
Yeah buddy!  That's potentially a lot of eggs and I just need 1! 


So, yeah, I'm a little bit excited again.  I also know I'm gonna be alright no matter what.

Peace, Love and Last One of These,

Mary Katherine

Tomorrow!

Well, tomorrow is the official start of the ensuing craziness.

I'm still waiting for the excitement...It's more anxious anticipation right now.

I don't know why I'm nervous.  Last time all my numbers were perfect.  I had an appropriate number of antral follicles and my estrogen (E2) levels were low, but in the end it did not matter.

On the other-hand, it's better than not even getting the chance.  It's just a lot scarier this time.  I feel like I'm trying to suck up enough air to last me for the next three weeks.

But I want to try.  I want this to work, and the only way to know is to take the next step.

Here we go.

Peace, Love and a Deep Breath,
MK

You must do the things you think you cannot do.

~ Eleanor Roosevelt

Ask and you shall receive...

at least some things.

Yeah, so my period finally started last Thursday so I made the call to my IVF Nurse Coordinator, Jan, took 800mg of ibuprofen and went about my day with increasing doses of ibuprofen every four hours.  The next day I received 3 phone calls back to back from Jan.

My period came too late, and as we hypothesized, I ovulate too late to wait to start my Lupron.  After a few phone calls to Dr. Donesky, his partner, and Jan, they agreed that I'll start on birth control pills.  This is a good thing because it may very well save me from the cyst draining procedure that does not require anesthesia.  Wednesday, as in 3 days from now, I'll start Lupron shots.  As the name long Lupron protocol suggests, I'll be on shots for a long time through November.  

I'm not gonna lie, I am not excited about this like I was the first time.  I'm more resigned to it. I hate that I can't make myself "think positively", and it does make me feel guilty.  It's just really hard this time to get pumped up for it.  I'm afraid I don't have anything to look forward to in the short-term.  The long-term...well I'm just up for a pleasant surprise.  It's the natural pessimist in me...prepare for the worst and be elated that you don't need anything you've prepared for.  

It's not like I think there is no chance, it's just that I don't really know what my chances are.  I know Dr. Donesky thinks it's totally a possibility.  He doesn't want his success statistics to go down any more than I want to have another failure.  So no, I don't think he's taking advantage or stringing me along as some have questioned. He's second only to BJ in men trying to get me knocked up. (If there's anybody else in that line, I'd prefer to not know about it.  Thanks! :))  There is just a ton of unknown, and if you know me at all, you know the unknown is not a place I like to spend a lot of time.  

So instead, here's what I do know.  BJ and I've really jacked up our supplement intake this past month and are continuing to do so throughout this whole process.  In addition to a new protocol, I have the whole bromocriptine-rebound thing I'm still doing which research shows has promising results.  I wouldn't be doing this again if it wasn't worth it.  I know what to expect, and all-in-all, medically speaking, nothing is too bad.  I have BJ, and he's still pretty damn amazing.

M:  Whatcha thinking now?

B:  I'm still nervous, why?  Are you interviewing me?

M: Mmm-hmm.  Do you wanna try again?

B: Mmm-hmm.

M:  What's our theme this time?

B:  "The Good Life"?

M: I think it's perfect.  I myself am trying to listen to "Jesus Take the Wheel"

B: Why?


M:  Simply for the line, "I'ma let it go."

B:  Ah...

M:  Tell me about the book you've been reading.
B: Clash of the Kings?  Or are you talking about Plastic Cup?


M: Hmm..Well let's use deductive reasoning skills...I'm pretty sure people aren't checking my blog to hear...
B:...hear about George R.R. Martin's very epic Clash of the Kings.  Well it's more interesting than my sperm count.


M:  You wanna start a blog about it and compare readership?
B:...You're pretty mean.


M:  It made me laugh.
B: Mmm-hmm


M:  So, about the much more boring book...Did you like the title?
B: How to Make Love to a Plastic Cup...mmm-hmm.  I've not read a lot, but it is helpful.


M:  Well, I thought it was funny...I love you a lot.
B:  I love you.


M:  I do think this time will be easier.
B: We'll I'm sure you're an old-hand at injecting yourself with God knows what, and I'm an old-hand at cowering in the corner while you do it.  


M:  I'll let you try this time.
B:  I tried. I didn't do well.


M:  That was years ago.
B:  Well nothing has changed on how scared of needles I am.


M: We could make an acupuncture appointment for you?
B: No!


Poor thing...the human race would have gone extinct long ago if men were left to themselves...

Peace, Love, and HERE WE GO!
MK

"The worst thing one can do is not to try, to be aware of what one wants and not give in to it, to spend years in silent hurt wondering if something could have materialized - and never knowing."

~David Viscott