IVF 3.0

To discuss IVF 3.0 I think it makes sense to first discuss the protocols I was on for the first two cycles.

IVF #1 had been what is commonly referred to as the Standard IVF Protocol. I took birth control for a few weeks before it began, then antagonist (Lupron) injections to suppress my body's natural hormones. After a suppression check at the doctor's office, I began gonadotropin injections (two brand names specifically - Menopur and Bravelle) twice a day to stimulate my ovaries to develop multiple follicles and eggs. When the follicles reached a certain size, and my hormone levels reached certain numbers, I administered a trigger shot of hCG (Ovidrel was the brand) which signals the ovaries to release the eggs around 36 hours later. 34 hours after the trigger shot the egg retrieval was performed under light anesthesia in the surgery center at the doctor's office.

IVF 2.0 was different. First of all, the doctor had me take DHEA twice a day after IVF #1 to try to improve my egg quality. And because my ovaries didn't respond very well to the antagonist protocol, this time we tried an agonist protocol, which my doctor referred to as an "estrogen-priming" protocol. This time there was no birth control pills and also no Lupron. I was on Menopur again, but not Bravelle. I was also on human growth hormone, called Saizen. This is the one that I totally screwed up and cost myself $555.55 on one day. To keep me from ovulating before the follicles and eggs were mature, I was also on Ganirelix towards the end of the stimulation period. I triggered with Ovidrel again for that cycle. As you now know, this cycle was also unsuccessful.

With a new doctor at a new (to us) clinic, I was told to stop taking the DHEA. Additionally, both Mr. Sprout and I had our chromosomes tested to make sure that we were both genetically normal. We are! Even still, we decided that the next time we tried IVF we'd have any blastocysts tested to make sure that we only transfer back genetically normal embryos when the time for transfer comes.

For IVF 3.0 new doc recommended a "Microflare protocol." The Microflare protocol is a special stimulation protocol designed to optimize ovarian response in women who have demonstrated a previous poor response to a routine protocol, or who may be at risk of having a poor response to fertility medications. Well, that sounds like me! The Microflare protocol consists of a combination of oral contraceptive pills, Lupron (diluted), and gonadotropins designed to maximize the ovarian response. The term “Microflare” is derived in two parts: “Micro” refers to the use of a diluted dose of Lupron, micrograms instead of milligrams; and “flare” refers to the stimulatory or flare effect of Lupron when given this way— hence the term Microflare.

While the Microflare protocol tends to work well for other poor responders, it did not work well at all for me. Even with the microLupron, Menopur, and another gonadotropin (Gonal-F), my ovaries failed to respond to this protocol and my cycle was canceled. No trigger, and no egg retrieval. At our follow-up appointment with the doctor he said he was surprised and disappointed in the result, based on my age and all my previous test results. He did say, however, that there was ONE last protocol he thought was worth trying before throwing in the towel on attempting IVF with my own eggs.

We decided to take a break for a month or two before we decided if we'd give it one last try.

Worst. Blogger. Ever.

I just realized that I haven't updated since the end of January. That's embarrassing.

Well, there is much to tell. I think bullets will be the easiest way to get it all down, so here you go.

• January IVF: 10 eggs were retrieved, we had 5 embryos on day 2, but none of them made it to the blastocyst stage to be biopsied for genetic testing. That means we had no transfer.
• Our doctor told us that my egg quality was just no good, and said that we could only go forward at their clinic if we went with donor eggs.
• February: I had my tonsils out and we made an appointment with a new doctor who's considered the best in the country.
• March: We took a cruise vacation and didn't think about IVF for awhile.
• Springtime: New doctor said that we were still good candidates for IVF and we had loads and loads of tests done on us both before we tried an IVF cycle there.
• June: IVF #3. Next post will be about this.
  

One day at a time

Yesterday morning I had an appointment for bloodwork and an ultrasound, but before that I needed to give myself two injections at 7am. One of them is a bit complicated - you have to take 2mL of sterile water up into a syringe and then mix it with some powder in the powder bottle. Then you take that 2mL of medicine and put it into an empty sterile vial. Next you take 3mL more of sterile water and mix that in with the 2mL of medicine in the sterile vial for a total of 5mL of medicine. Then I am to take 0.8mL of that medication each morning.

I had done this once successfully last week. I had no hesitation in doing it again yesterday morning. But, something went wrong. Horribly wrong. The needle that I use to mix the water with the medication wasn't screwed all the way onto the syringe (they come attached, so I never thought to check). When I put the 2mL of water into the medicine vial to mix them together, the pressure inside the vial caused liquid to flow back up the needle and then out through the threads between the syringe and the needle. It happened so fast and before I knew it, the bottle was empty, and most of the medicine/water mix was in my hand. It was all the wrong concentration at that point, and not sterile anymore, and with no good way of me getting it back into any container. So, I dumped what was in my hand into the sink and sulked. Then I took the half-dose left from last week's mixing with me to my appointment where I figured I could ask the nurse what to do.

The ultrasound showed all the follicles in my right ovary growing well, and at the same pace as each other, which is an improvement over last time. The left ovary finally did show some follicle growth, but they are much smaller on that side than on the right. I don't know if they'll have time before the retrieval to catch up, but I've stepped up the acupuncture hoping that it will make a difference. After the ultrasound, I talked to the nurse about what happened with the medication and she said she'd talk to Dr. B about whether he thought I should buy another dose or not. She had doubts whether he would say yes since she thinks that the retrieval may end up being as soon as Saturday. I told her I was willing to buy it if he thought it would do me good, though. She said to take the half-dose that I had with me, and that she would email me as soon as she heard from Dr. B, and that there was one place in town that carried it so I could go pick it up that afternoon. Turns out, Dr. B did think it was a good idea, so I went to buy more...to the tune of $555.55. The lady at the pharmacy said, "Oh it's your lucky day! $555.55 is your total!" I laughed along with her while I thought, "Lady, if it was my lucky day I wouldn't be spending $555.55 in the first place!"

So, this morning I did the mixing again, making sure the needle was tight on the syringe, and it went fine.

I've been to acupuncture every day since Sunday but I get tomorrow off! I have a massage lined up for after work and I'm super excited about it. Things have been pretty hectic this week with work and the cycle and friends coming in town on Thursday for the weekend, so I'm looking forward to an hour of pure relaxation.

Hopefully tomorrow's ultrasound shows things still progressing nicely on the right, and a big improvement on the left!