The Call Came Early

It's Monday! I figured that from the time I woke up this morning until the lab called that I'd be checking my phone obsessively and thinking, "Why haven't they called?!?!" but that isn't the case. You know why? Because the lab called last night, that's why!

On Thursday of last week a few friends from our softball team who'd be staying in town over the long weekend, including us, decided that a 4-day weekend was a great weekend to plan a cookout. Mr. Sprout and I decided that we'd host at our house on Sunday evening. At first we wanted to host on Monday, but then we thought if the lab called on Monday with bad news, we wouldn't really want to have three other couples over for dinner that night, so we decided to host the cookout on Sunday evening instead. People came over starting around 5:30 and we were mostly just talking in the kitchen and having chips and dip, then a few minutes after 6:00 Mr. Sprout went out to the grill to put the burgers and dogs on. So there we are, the rest of us, standing around the kitchen island socializing when my phone, which was on the kitchen island counter charging, rings. And it says that it's the clinic.

So here's what ran through my head...could this be bad or good? Should I let it go to voicemail since people are here and if it's bad I'll just want to be alone? OMG!

But I couldn't just let it sit there ringing so I answered it. As the embryologist told me who she was and why she was calling I made my way into the backyard where Mr. Sprout was and he looked at me like, "Why are you out here on the phone when we have guests?" But once I mouthed who it was on the phone, he just kind of froze where he was and looked at me expectantly. The embryologist said that they "were able to biopsy and freeze 5 good-looking blastocysts for you this cycle." So then I was just like and I held up 5 fingers and Mr. Sprout was like and I heard the embryologist saying that we'll have the results in 2-3 weeks and they'll call me then. I thanked her and hung up and then we hugged and laughed and smiled (maybe not necessarily in that order) and I went back inside and joined our friends again. The rest of the evening was fun and at times I just kept catching Mr. Sprout's eye and holding up five fingers or mouthing, "Five!" and smiling.

So, for the first time in this long journey we have blastocysts! Five of them! Hopefully at least one of them tests normal and later this year we'll do a frozen embryo transfer at the clinic. And now I also don't have to spend today stressing out about the phone ringing. I do have a few questions for the lab, but I'll email my nurse tomorrow about those. I'd like to know how many of the 5 made it to blastocyst on day 5 versus day 6, and also I know that they grade the embryos and I'd like to know that information, too. I was just so flustered and shocked last night on the phone that I didn't think to ask those.

Throughout this journey I've been the more hopeful one of the two of us and Mr. Sprout has been the more pessimistic. He'd say "realistic" but this is my blog so I'm sticking with my term. However, I think after last night's news even he's feeling a bit of hope.

Three strikes and we keep on going

Since our new doctor had told us that the final protocol he thought might work was similar to the one we used for IVF 2.0, and we had 10 eggs retrieved that time, we decided to give it one last go. We planned on starting off of my July cycle but I had a cyst on my left ovary that benched us until August.

I'd kept up with my acupuncture during the time between these two cycles, and I'd been watching what I ate, and taking what the new doctor called their "vitamin cocktail." This meant I was taking upwards of 35 pills every single day. There were herbs from my acupuncturist, L-Arginine, CoQ-10, pycnogenol, myo inositol, royal jelly, Vitamin D, my prenatal vitamin, DHA, folic acid, my Zoloft since all this unsuccessful babymaking has made me cranky(crankier?), and I'm sure I'm forgetting at least one or two other things.

IVF 4.0 was another estrogen priming protocol with no suppression. I took estrogen leading up to the cycle, and then the stimulating medications were Menopur and Gonal-F. The medication to keep me from ovulating early was Cetrotide, and my trigger shot was HCG. In the beginning of the cycle, my ovaries both seemed to be responding pretty well, according to bloodwork and ultrasounds I was having done every other day or so. Then the right ovary started to lag behind a bit. I started to lose hope a little, but at my next appointment it had caught up with the left and they were still both progressing. One day when the ultrasound tech measured 7 good-sized follicles on each side, I got the call that afternoon to trigger that night and that my retrieval would be on Monday the 29th. This was exactly what my predicted calendar said. Not earlier, not later, but right on schedule.

Mr. Sprout did my trigger shot for me at 11pm Saturday night. It's intramuscular and pretty difficult to do yourself, plus the needle is much longer than the ones used for the stims. Then after midnight on Sunday I was not allowed to eat or drink anything until after the retrieval.

We showed up at the clinic at 9am and boy oh boy are those guys in the surgery center efficient. I was quickly ushered in from the waiting room and told to change into a surgical gown, some booties, and I was given a warm blanket to drape over myself on the hospital bed. A nurse came and started an IV, and I signed some release forms. The anesthesiologist came in and introduced himself and asked if I'd ever had adverse reactions to anesthesia before. When I mentioned nausea, he said that he'd put some Zofran in the mixture towards the end of the procedure. The doctor doing the retrieval also came in to introduce himself (he's not my doctor but he's part of the practice) and wish me luck. At exactly 10am a few nurses came to get me, and wheeled my bed down the hall. Mr. Sprout was taken downstairs at this point. On the way down the hall, the anesthesiologist said he was putting some "relaxing medicine" into my IV and he asked if I felt it. I said I didn't and then a second or two later I started to feel really light and floaty and told him that I did indeed feel it! And that's all I remember until I woke up in recovery.

After I'd been awake for a little while I was allowed to move from the bed to a chair, and they gave me some ginger ale and crackers. Then the embryologist came up to talk to us. He said that they had retrieved NINETEEN eggs! He also said that the sperm count and motility looked good and that they would be performing ICSI/IMSI on the mature eggs that afternoon and then calling us the next day with a fertilization report. We hadn't heard of IMSI before so we asked what it meant. He said that it's ICSI on steroids. Not only do they inject one sperm into each mature egg, but they look at the sperm under a more powerful microscope and choose the ones that have the best morphology. This sounded great to us, since we know we have a morphology issue.

Once I asked if I could get up to go to the bathroom they said that was a sign I could go home. I changed back into my own clothes and they wheeled me to the elevator, down to the garage, and to the car. As soon as we got home I went upstairs to bed and slept for about two hours. I took it easy the rest of the day and then felt fine by the next day.

Tuesday morning the lab called and the embryologist told me that of the 19 eggs retrieved, 16 were mature and that of those 16, 10 had fertilized normally. So, we had 10 embryos growing. He also said that of the other three, two had matured overnight so they would do IMSI on those two on Tuesday and call again Wednesday with an update. On Wednesday, they called and said that one of the two had fertilized normally so we now have 11 embryos in the incubator. Since our goal this cycle is to let the embryos grow to the blastocyst stage and then have them biopsied, we won't get another call about their status until Monday. MONDAY!

So in the meantime we're thinking good thoughts and at the same time trying not to think about it too much since there's nothing we can do besides wait. We have a four-day weekend and we plan on enjoying it!

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.