FET #4 August 2011

It was summer, it was hot and I had a light work schedule.  Jumping right back on the fertility train we decided to do our last FET.  We had two embryos left.  I wasn’t sure if they would survive the thaw or not so I took it very slowly in my head.  I didn’t think any of my FET would work and I mentally prepared for the disappointment.  I was exhausted from being so UP all the time.  The roller coaster of faking positivity during treatments and feeling like shit every month was taking a toll.  So I decided to just be crusty for the final FET.  I know that doesn’t sound very nice but I was sick of it all and at the end of my rope .  Both of us just didn’t have the heart to discard the embryos.  We still needed to try these guys out.

There were a couple of changes to my protocol for this FET.  No progesterone oil shots!!  No more bruises on my bum.  We were doing progesterone suppositories instead.

progesterone suppositories 4x a day homemade by the clinic??  I am sort of judging the clinic for this.  I guess they make the profit instead of pharmaceuticals.  Again I was so over it, I just paid my bill and rolled my eyes.  p.s. the insurance wouldn’t pay for it.

prometrium 100mg 3x a day

dexamethasone twice a day

estrace 3x a day

baby aspirin once a day

fragmin shot in my tummy

I was so thrilled to be doing less needles.  I was happy to be going back to the messy suppositories.  Never again would I complain about the mess after experiencing the pain and bruising on the bum.  How could anything go wrong with this cycle I thought??  Well guess what?  The good old fragmin shot went wrong.  I’m not sure how this happened, but I am to blame as I did the injection myself. 
This of course did not happen instantly.  I did my shot, went to bed and woke up to this hideous bruise.  It was slightly puffy and very sore to the touch.  I emailed the nurses at my clinic with this picture and I was told to come in and get it checked.  Bruising is very normal with needles, however if the bruise is bigger than a toonie,  you need to get it checked in case of infection.  This bruise was about the size of a tennis ball.  The doctor checked it, the puffiness had gone down, it was still sore to the touch but  I was fine.  Just so you know, red and puffy is a good indicator of infection so do not wait please go see your doctor!  For the next few weeks I wore low waisted pajama pants not for style but for pain management and comfort.

This FET did not work and we said that we would be done with treatments.  I guess this was my last ART procedure.

Co Q10 frenzy

I saw this article in the paper today and it made me think back to my IVF cycles.  Dr R told us of some positive studies for improving egg quality with Co Q10 supplements.  I was instructed to take 800 mg a day for at least four months.  I was waiting for my surgery before our second round of IVF.  Unfortunately it didn’t work out for me, but I do have to say that my skin, hair and sleep patterns were in good shape.  I went to the dentist and was told that my gums were looking GREAT!  I was in shock.  I have problem areas with my gums from over brushing as a youngster.  The doc asked me what I was doing different and I thought about it for a moment.  I hadn’t changed my tooth brushing or flossing techniques so it must have been the Q10.  C feels like it has prevented him from getting colds too.  Come to think of it, I can’t remember when the last time I had a cold either.  This stuff is magic.

Congratulations to the mature female mice who got pregnant…   Yep still I am still snarky and sarcastic while I wrap my head around the nine ART procedures that did not work for us.

http://www.theglobeandmail.com/life/health/new-health/health-news/vitamin-rejuvenates-old-eggs-study-shows/article2175237/

http://clinicaltrials.gov/ct2/show/NCT00878124

FET # 3 July 2011

We got our test results back from our new clinic and we are both healthy.  Yup nothing wrong with us.  We should be able to make babies according to all of our tests.  Its crazy that somewhere deep inside I had HOPED for something to be wrong.  That is messed up.
Since Dr R wasn’t going to change our protocol with this 3rd FET, we decided to try another clinic and another doctor.  So we shipped the embryos up the street to our new clinic.  Yep.  C picked up a huge 30 pound canister and walked down Bay street with our five kids!!!  Dr L at the new clinic was going to give me drugs for thinning out my blood and hopefully that would help with blood flow and we would have a successful implantation.  I thought this FET would be easy peasy.  Slightly different drug protocol but trust me this was not easy.  It might have been harder on me than stimming for my IVF’s.

FET protocol

progesterone in oil once a day in my bum

dexamethasone once a day

estrace twice a day

baby aspirin once a day

fragmin shot in my tummy

I wish I took a picture of what my bum looked like but let me tell you it was black, blue, it hurt so bad and it never got easier.  The day of transfer I showed the nurse my bum and she gasped and said to my husband C, “you are doing a very bad job!!”  Apparently he was going too low on my bum and not high enough.  It didn’t matter, it still hurt like hell and I couldn’t really get a great night sleep for three months.

We waited our two weeks out and no period.  I was to do a blood test but we were on vacation for our two week wait and I thought I could wait two days before we got back home to test.  I did a home pregnancy test and it was negative.  Those tests are never really reliable so I just let it go.  In the past my period would come like clockwork.  I still hadn’t received my period or any normal PMS signs so I was beginning to think that maybe I was pregnant. My nurse told me to go to a hospital on vacation and get a pregnancy blood test done.  My shots were becoming unbearable for me and the sooner I knew the better off I would be.  I’d be happy to do the shots in my sore bum if I was pregnant.  We went to a hospital and they were to fax my results to the clinic in Toronto.  It would only take 24 hours.  Three days later I got the call that it was a negative.  I stopped my medications and shots and finished the rest of our vacation.  A few days later I received my period.

new clinic new doctor April 2011

Once I started digging deeper and researching the US clinics I kept coming across the same thing.   Blood clotting and baby aspirin.  It seems like it was the norm for the US IVFers to be taking baby aspirin and blood thinners during their cycle. I inquired with Dr R to do tests on me for blood clotting for uterine issues or abnormal clotting.  I apparently need to have three miscarriages before she would run those tests or be closer to 40…. hmmmm ok.  I did phone consults with three different doctors at three different clinics in the US.  All three of them told me to get tested on blood clotting before I do my remaining five frozen embryos.  Figure that out first because I might still have a good baby in one of those five.

At the same time I took Dr R’s advice for a second opinion in Toronto ( technically it was 4th opinion ) for some closure.  Part of the process to get retested by another doctor is to see that the diagnosis is the same and hopefully you can move on mentally down another route or stop treatments all together.  We went north on Bay street to another big clinic.  I was meeting with Dr L.  Dr L was nice and but I didn’t really appreciate his hard sell on how he could give us a baby.  I let them test me.  I also got them to test me for uterine issues.  These US doctors were making me suspicious of my uterine.  Maybe I had clotting issues.  I spent the $ 500 on the blood work just so I could wipe it out from my brain whether I was in that 15% group of ladies with a blood clotting disorder stopping all my good embryos from implanting.

Here is a list of the blood work and tests that I requested that had never been done on us before.

hysterosalpingogram

factor 5 Leidon

factor 10

factor 2 mutation

protein C

protein S

homocysteine

antiphospholipid antibodies APA’s

antilthyroid antibodies ATA’s

NK cells

K562 Target Cell Test

karyotype looks at the structure, number and arrangement of chromosomes found in a sample of cells. This test may also be called a chromosome analysis. If you have had recurrent miscarriages, or if there is no sperm in your partner’s ejaculation, the two of you should both be tested. During the karyotype test, the cells are processed and photographed to determine if there are any missing or extra chromosomes or if there are any structural changes that could prevent you from getting pregnant or cause miscarriages.

Grateful that someone was listening to me and giving me some peace of mind and sort of pissed at Dr R for not running these test.  It wasn’t like I was wasting OHIPs time and money.  We paid the extra bucks to do it.   We tested and waited for our results.  The karyotype can take up to three months to get results back.  So I started drinking alcohol and coffee in the meantime and enjoyed a mental break from all of this crap and research.

Dr consult after failed IVF #2

Dr R questioned the quality of my eggs.  She hoped it was just sperm related but now suspected combo platter of both C and me.   Booooo everyone knows its easier to get around the sperm with ICSI but getting around bad eggs.  Grrrr…  My uterus was still a question mark too.  Could I have implantation issues?  Do I have a blood clotting issue?  Probably not but Dr R had no proof.  Still no answers.

If I chose to do IVF # 3 with Dr R, she wasn’t going to change the IVF protocol or FET protocol.  Dr R said “if you were my family and if you wanted to do a 3rd IVF, I would tell you to go to the US.  There is nothing wrong with our lab and I cannot suggest a better lab in Toronto.   We just cannot keep up with what the US labs are doing. They have more money and more research.”  Dr R goes on to mention that we could benefit from two clinic in the US.  Cornell University in NYC and Colorado Center for reproductive medicine CCRM.  Both of these clinics are cutting edge with ART.  It seems like they are controlling the way ART is done across the world with their techniques and are perhaps the two best labs in the world.  Dr R says the doctor is really only important for your drug protocol but the LAB is your ticket and what really counts in the end.  CCRM created a test called the Comprehensive Chromosome Screening (CCS).  CCS looks for all 23 Pairs of Human Chromosomes.  This test is perfect for people who have fertilized embryos/ blasts but don’t make it to implantation or a baby.  CCS can test to see if the fertilized embryos are normal or abnormal.  This doesn’t guarantee you a baby but it can eliminate miscarriage, genetic issues, and avoid some of the up and down roller coaster ride of waiting and trying with each cycle.  Cornell’s creation of IVF with endometrial cell co culture is a special technique for couples with poor embryo quality where cells from the woman’s uterus are used to enhance development of fertilized eggs. Cornell refined this procedure using the woman’s own endometrial cells rather than cells from animals. Basically they take a sample of your lining from the uterus lining let the fertilization happen on the woman’s lining instead of a petri dish.  Try to get those embryos used to their mamma right from the get go.  hmmmmmm We went home absorbed all of this information.  I was on the internet researching CCRM and Cornell for days.

I got in touch with a previous patient of Dr Rs who traveled to CCRM to specifically do CCS.  She is currently pregnant and due very soon.  She was helpful about the protocol and setup at CCRM.  If you do CCS testing, you have to do a FET as you need to wait for the CCS results.   This seems to make a difference and there is some belief that waiting to do the transfer is better, they spend a lot of time on the FET with prep and meds.  In the end she spent around $30000 US on her treatments and three trips total to Colorado for both the husband and wife.  Yikes.  I went and checked to see how many aeroplan points we had.

IVF/ ICSI #2 2011

My last checkup after the failed FET, that darn polyp was still in there.  Grrrrrr  A tiny polyp. Dr R said I could surgically have it removed and then we could move forward with another IVF.  No doctor would start IVF with a polyp in there.  Dr R mentioned with a hysteroscopy procedure  it sometimes can help with implantation and now was a question mark in Dr R’s head.  Dr. R made a few calls to pull some strings to fast track my surgery. Surgery was going to be in January 2011.  Surgery went well, I learned that I have a normal shaped uterus and I ended up having a second tiny polyp removed too. I healed nicely.

In March of 2011 we decided to do another round of IVF.  Give it one more try.  We did get pregnant with the first IVF even if it was for a hot second and we were holding onto that one positive thing from the year before.  Getting myself prepared for this round, I started regular sessions with my acupuncturist, cutting out all the caffeine and sugar months ahead, getting regular exercise and good rest.  I was feeling really good.  I knew what to expect so there was no stress.

Stimming went well again.  Dr R decided since I responded so well maybe too well the last time, we would slightly adjust my drug protocol.  Puregon dose would go down from 150 to 125 ml a day.  I was concerned about hyperstimulation but also concerned that maybe this small dose wouldn’t do enough.  I can remember feeling like I would take my arm off for a successful pregnancy…….  The suprefact and ovidrel (trigger ) dose would remain the same.   In the end the change in my drug protocol didn’t do much.  By day 8 my estrogen levels were at 5306, day 10 at 13497, day 11 at 14000.  With my estrogen levels skyrocketing I began to worry.   I read that the trigger time was crucial.  Too early could give you immature eggs and too late, the eggs may be “too old” and won’t fertilize properly.  I didn’t want to hyperstimulate and I was at dangerous levels, enough to possibly even cancel the whole procedure.  Dr R decided to trigger with ovidrel on day 10.  A day earlier than my first round of IVF.  hmmmmmmm…….

Retrieval was good.  We had ten follicles.  I was a little disappointed with the number, but quickly got my head wrapped around quality not quantity.  Last time we had lots and none of them worked so maybe this one was our ticket.

During the five day wait it is so hard to keep your mind off of your embies.  You already feel like a parent waiting to hear the daily reports on how they are doing, did they fertilize, are they growing nicely, did any of them arrest?  Doctors try to prepare you for losing some embryos in the fertilization process.  The weaker eggs are USUALLY lost on days 1-3, the ones that hang on are the ones you want.

8/10 eggs were mature, 8/8 fertilized with ICSI.  Yes 100% fertilization rate. This was a good sign.

day three results of my embryos

3 embies 7-8 cell stage

5 embies at 9+ cell stage

day four results

There were too many cells to count so they were moving to blastocyst stage which is what you want.  Again a great sign.  I was feeling good, cocky almost but I had been here before so cautiously cocky.

Again we did a five day transfer, transferred two blastocysts and froze our remaining five blasts.  We ended up losing one blast on day five…

There wasn’t a two week wait this time, at day 23 I started to spot and bleed and I knew it was over.  A few days later blood test confirmed there was no pregnancy.  You can imagine the disappointment we felt.

FET #2 2010

November 2010 we decided to do another FET.  We still had five blastocysts on ice.

As we got closer to the transfer, during one of my ultrasounds they discovered the tiniest polyp.  We could stop the FET and wait until the polyp cleared or we could move on and hope the embryos didn’t implant on the polyp.  Dr R said it would be SO unlucky if one of my embryos implanted right on it. Women have polyps throughout their pregnancy and with monitoring things could be all fine.  We decided to move on with the FET and hope that those embies stayed far away from the polyp.  Fertility medications can cause polyps, and some women are just prone to them without medications.  Most women don’t even know they have them, they come and go monthly.  The only other time I knew I had a polyp was back in my IUI days.  I wouldn’t say I was prone to them but this was really bad timing for us.

We transferred two blastocysts but this time we lost two in the thaw.  Wow no more blasts.  This time I didn’t do as much acupuncture, however I decided to stick with acupuncture before and after the transfer appointments.  I find them relaxing.   We waited out our two weeks.

Another negative result.  We were down in the dumps, we were in shock.  I cried for a few days straight.  I started to panic and started researching about another fresh IVF cycle.  During my pre IVF days I always thought that it was crazy that people did multiple rounds of IVF.  Now here I was trying to figure out how we could do another round.  We did our follow up appointment with Dr. R.   Losing three out of the seven eggs is higher than normal loss rate that they usually see.  BOOOOOOOOOO not what we wanted to hear.