Sunday, August 30, 2009

we stuck the landing

Just a quick update. The egg retrieval went okay Saturday and I lazed around the rest of the day. They told me the doctor got 16 eggs, but I know you can't get too excited until the fertilization report.

Well today I am excited. Out of 16, there were 12 that were mature and they could attempt to fertilize. All 12 were successfully fertilized yesterday and are still kickin' today!

Not only did we get more total eggs than we did 2 years ago, but I also got a better fertilization rate. So whether it works or not, I'm happy to know that we made a really good try. I'm heading back to work tomorrow with a warm and fuzzy little secret.

Thursday, August 27, 2009

please don't punch me in the ovary

If you haven't seen "Anchorman: the Legend of Ron Burgundy" you are really missing out. Will Ferrel and Christina Applegate star as co-anchors who kindof hate each other.. or do they?! I especially like the part where these two hurl insults and threats at each other once the mikes go off. "I'm gonna hit you in the ovary. Yep, right in the baby maker."

Why has that quote been buzzing around in my head all day? Oh, ya.. because I have ovaries the size of oranges! And they're kindof achy.

Yes, my friends, it is trigger time! Mr. Foxy came home from work 5 minutes before it was time for my 8:20 PM shot. I was prepared to freak out at 8:30, so there's a disaster averted. Egg retrieval is Saturday, early in the morn'. I am all hopped up on estrogen - my E2 went from 1820 yesterday to a dazzling 3172 today. My highest ever! It's not high enough for anyone to panic, but they did schedule me 1st in line for egg retrieval Saturday. They call me "party ovaries".

Specifically, we may be looking at 15-20 mature eggs. Given my age there will be a fair percentage of duds and non-fertilizers, but that's why my RE wanted to push for more.
Will post an update Saturday. For now I'm very excited and pretty darned optimistic!

In other news.. the prospective part-time nanny came over today and Waffle Girl is in love! I am too. I knew she was a musician in the Old Country who is mostly cleaning houses here and has her own little girl. I was happy to learn that she runs a weekend preschool group (lots of toddler experience!) and directs the church choir, too. She will surely teach my girl to be a brilliant performer before kindergarten. Yay! I'm super happy about this.

Tuesday, August 25, 2009

stimming on a tightrope

I'm happy to report that we have a great start to this IVF cycle! Today is Day 7 of stims and I've had 2 monitoring visits. On day 4 there were 14 measurable follicles (max 11mm) and estrogen @305. On day 6 we had 22 follies (max 15mm) with E2 @1020.

For any normal infertile chick, this would seem to be an excellent situation. But, oh no, recall that I have these annoying polycystic ovaries (PCO) which can go all hinky, especially at this point. We're trying to walk the line between hyper-stimulation and under-production. Either problem can lead to a cycle being cancelled - the latter happened to me in June and it really sucked.

After 5 days on Gonal-f (150 units) Dr. Snaggletooth had me switch yesterday to the same dosage of Repronex. What's the difference? Gonal is 100% follicle-stimulating hormone (FSH) and 0% leutenizing hormone (LH). Repronex is 50% FSH and 50%LH. So what? The doc says that FSH "recruits" follicles to grow and LH helps with egg maturation. So in switching from FSH-only to an FSH/LH mix, I'm kindof slowing down follicle recruitment/growth and hopefully improving egg quality, which could ultimately improve on the awesome IVF of 2007.

Today I'm in a mild panic. As Obama would say I'm "all wee-weed up." My mind is alternating between two opposing doomsday scenarios:
  • Oh no, my estrogen is over 1000 already on Day 6! I'm going to hyper-stim! I'm going to have a stroke! And no baby!
  • Oh no, I won't have enough FSH and my follicles will crap out! I'm going to have another cancelled cycle! And no baby!

Since I can't decide which disaster will occur, maybe it's a sign that some happy medium will result. Right?! I'm back for monitoring on Wednesday (day 8) and, unless things crash and burn, I'll trigger on Thursday.

In other news.. I have an excellent lead for a part-time nanny for Waffle Girl. She's a friend-of-a-friend from the Old Country who will help teach the girl my preferred Eastern European language. She's coming over Thursday. Hope the girl likes her!

Saturday, August 22, 2009

flashback 2007 - best. IVF cycle. ever.

As we get further along with our current round of in-vitro fertilization (IVF), I am fondly remembering IVF#1, which led to the production of our beloved Waffle Girl. Below I offer you a cropped version (Days 1-4 are omitted) of the best IVF cycle ever.

I was a month away from my 37th birthday. We only needed a low dose (150 Gonal-f) as my ovaries had proven their eagerness to grow follicles in 4 failed attempts at artificial insemination. I've been sortof meditating on this chart, hoping for a similar outcome this time around.

We did the trigger shot on Day 9 and then egg retrieval on Day 11. The rest unfolded thusly:

  • 13 decent-sized follicles
  • 11 mature eggs
  • 7 fertilized eggs
  • 5 blastocysts (blasts) on Day 5
  • 2 blasts transferred on Day 5
  • 3 unused blasts observed 'til Day 6, but they weren't "keepers"

As fantastically awesome as this April 2007 cycle was, the ideal would have been if we'd retrieved a few more mature eggs and maybe had some blasts (i.e. "frosties") in reserve. If we had some frosties, then the current fresh cycle wouldn't be necessary. This explains why Dr. Snaggletooth started my ill-fated cycle in June 2009 on a higher dose of meds. He figured I was 2 years older and would need a little more of a push. It turns out that my ovaries went into overdrive pretty quickly. I guess they, like the rest of me, are so enamored of Waffle Girl that they jumped at the chance for a sibling. We had to cancel the June'09 attempt and are now in the thick of a do-over - IVF #2.

Today is Day 5 of stims. I went in for monitoring on Saturday and will go again tomorrow (Monday). I'll post an update once I have a sense whether IVF#2 is living up to the glory of April 2007.

On a related note, I saw an interview on CNN this morning that made me a little annoyed. This guy was blogging about his cancer treatment, including "embarrassing details". Why one should be embarrassed about anything related to a life-threatening illness is beyond me. CNN had an on-line poll asking whether blogging about the detail of his treatment was okay or is it TMI. (?!) As if anyone is forcing you to read this guy's blog! Some people just don't get it. Well, I say more power to him. He's in good company with all the infertility bloggers who get into the details of their cervical mucus, icky digestive problems, etc. You chicks keep posting and we'll keep reading.. and sending sticky vibes and other weird things!

Thursday, August 20, 2009

at last.. gonal for my gonads

Score another one for the educated and assertive patient!

After the latest tiniest delay (see my last post), the clinic called me Wednesday and the conversation started with the nurse saying "You're right." Oh, that's music to my ears. At Monday's appointment, Nurse Bungler had indeed put me on too high a dosage and for too many days without observation. After we sorted out the details, I finally started meds on Wednesday night. I'm scheduled for my first monitoring visit on Saturday. Here is the rough timeline:
  • Aug. 19-23, 5 days on 150 units Gonal-F (stims)

  • Aug. 24-27, 4 days on 150 units Repronex (stims)

  • Aug. 29 egg retrieval (ER)

  • Sept. 3 embryo transfer (ET)

  • Sept. 12 pregnancy test (beta)
For the next week-and-a-half I am concentrating on growing a superb batch of eggs while not going overboard into hyper-stim land, landing in the hospital, stroking out, etc. Despite the nurses' latest attempt to kill me with a double-dose, Dr. Snaggletooth has always been careful to keep me on the lowest level of stims and I've never a case of hyper-stimulation (OHSS).

Have a wonderful weekend, everyone. Think happy thoughts about my ovaries.

Tuesday, August 18, 2009

would you believe.. another teeny weeny delay

It's not a big deal: one more day on Lupron and starting stims tomorrow instead of today. But the reason for this one is a doozy.

As a followup to my previous tips on "what can you do to avoid doing an IVF" (see post: here's a new tactic, proven effective by me:
  • Surround yourself with bunglers: choose a clinic where doctors and nurses fail to communicate. This one won't buy you much time. Even the most inept IF professionals will eventually get on the same page and figure out what your Gonal-F dosage ought to be. It's good technique in a pinch, though, in case you have a hot date or something.

At this point, any sane reader would think I'm making this stuff up. Oh, Lordie, if only it were so. Here's what happened: My baseline ultrasound/bloodwork yesterday was okay. The nurse sent me home with instructions to start stims on Tuesday (today) and come in for my first monitoring on Sunday. It didn't hit me until last night that that's a freakin' long time for me to be on stims without an office visit.

Dr. Snaggletooth always puts a note in my file that I'm a patient to "watch closely" due to PCO and risk of hyperstimulation. On my 1.5 previous cycles (one was cancelled) my first monitoring visit was on Day 4 or Day 5. This time Nurse Bungler had me scheduled for Day 6. What part of "watch closely" didn't she understand? Oh, and BTW, she had me down for the same too-high dosage that led to my threatened hyperstimulation in June, cancelled cycle, etc. etc. I didn't realize just how messed up this plan was until I went home and compared it against my delightfully successful 2007 cycle and tragically lame June 2009 cycle.

So, long story short, I called today to complain/clarify and the nurse couldn't get a hold of Dr. Snaggletooth to straighten things out. Oh maybe she would have had better luck if she didn't wait until almost 4 pm to call the man! So the nurses conferred with each other and told me to stay on Lupron another day and wait to hear back tomorrow after they talk to the doc.

This was the shortest of my IVF delays but definitely the most disturbing. I trust Dr. Snaggletooth and think he has good judgement. But from here on out I'm going to be the bitch that second-guesses everything the nurses tell me and ask for confirmation from the doctor. Hopefully they'll get sick of it and opt to cut out the middleman.

In other news.. the Stirrup Queen listed my blog on her blog, thus putting me in touch with some fabulous infertile babes! I look forward to comparing notes with you, offering support and, of course, wishing you a short stay in the world of infertility blogging. Toodles!

Friday, August 14, 2009

for some reason i'm taking a drug for prostate cancer

If you know the first thing about fertility treatments, you know that we take drugs, a lot of them, specifically hormone shots, to stimulate egg production. This is something that we all vaguely understand just from being out in popular culture.

The first time Mr. Foxy and I did IVF back in 2007, we were surprised to learn that the first step in an in-vitro cycle is actually to take birth control pills for a month. That seems to be pretty much the opposite of what you'd want. But the logic is there - the docs need to control and regulate your hormonal cycle before they hijack it in the later phases of treatment. So you want me on the pill for a month? Okay, whatever. And then we'll get to the crazy hormone shots that we've all heard of.

But the really weird part about IVF is that, after a month on the pill and for the week before you start on egg-stimulating shots, you take this stuff called Lupron. You get your package of Lupron (leuprolide acetate) from the fancy pharmacy for infertile ladies and a couple paragraphs into the "information for patients" insert you read this:

"When you inject leuprolide acetate, the normal events that lead to sex hormone production are interrupted and testosterone is no longer produced by the testes."

Whaaah? Don't I want my testes to keep producing testosterone? Oh wait.. I don't have testes! Why am I taking a drug for inactivating one's balls?

My friends, it turns out that Lupron was first approved by the FDA for treatment of advanced prostate cancer. It is also used in treatment of breast cancer (another hormone-responsive cancer) as well as estrogen-dependent conditions like endometriosis. So whether you're a dude or a chick, you take Lupron if you need to shut down your 'nads. It has even been tested as a treatment for reducing sexual urges in pedophiles!

That's where I am this week. I'm putting my nuts into the deep freeze. Okay, to be more precise I'm putting my ovaries into a temporary coma. The side-effects of Lupron are the same as symptoms of menopause. My estrogen levels are crashing and so I'm getting headaches, tiredness, and may yet have some hot flashes. How I'll notice this with a 90 degree weekend, I wonder.

Another thing that used to have me perplexed is why I must keep taking Lupron after the follicle-stimulating hormone (FSH) shots begin. I just figured this out today. The doctor needs to dose up my ovaries with a specific amount of drugs that he prescribes without my own body adding some unspecified amount of hormone into the mix. Dr. Snaggletooth wants to know exactly how much FSH is in my blood, without any meddling from my own pituitary gland. Cool.

Anyhow, the Lupron shots are just a little insulin-type needle.. it easily goes into my belly fat. Time to load one up and get ready for bed. Have a great weekend, everyone!

Wednesday, August 12, 2009

so much for the fast track

My last post was a trip down memory lane, a recap of the 3-1/2-year odyssey we went through to conceive baby #1. Once said baby was properly gestated, birthed, grown a little, and finally weaned, Mr. Foxy and I got busy working on baby #2. By "working" I mean counting the days until we could get a referral back to Dr. Snaggletooth.

We rolled back into his office in March of this year. Happily the good doctor told us that we wouldn't need to mess with those silly IUI's and could go straight back to IVF. He also told us that insurance will cover 2 fresh IVF cycles, as opposed to 4 cycles allotted for a first child.

Learning that we could do just 2 IVF attempts was kindof a relief. It meant that our infertility journey has a few more steps to go and then a very definite ending. We want to have a second child, but we really could be quite happy with the one. I just wanted to be done with it, one way or the other.

So how hard can it be to get cracking on an IVF cycle?

Let's put it this way.. what can you do to avoid doing an IVF?
  1. Disorient your doctor: have totally random menstrual cycles. They can't start your meds if they don't know where you are in the cycle! You can blow a few weeks by making it look like you might ovulate, but then you never get your period.
  2. Create a diversion: have a very short-lived positive pregnancy test. Surprise everyone with an unexpected HCG result. Give the impression that there might be a miraculous so-called "natural" pregnancy. Waste a few days on follow-up HCGs to confirm that there's nothing there. Then repeat #1 by failing to get your period again.
  3. Fake out your doctor: threaten ovarian hyper-stimulation, get cancelled. This is a fantastic time-suck. Actually start the IVF cycle, including 1 whole month on birth-control pills followed by 2+ weeks of ovarian suppression, then stimulation. Right when it looks like your ovaries might explode, your doc will put the kibosh on the whole thing. You basically went through 75% of an IVF cycle with nothing to show for it. Then of course you repeat #1 for a couple more weeks of limbo.
  4. Nuclear option: get an ovarian cyst. This one is totally unpredictable and can wipe out months of time. There's no way of knowing how long a cyst will hang around. Your doctors are stumped about whether to "wait and see" or take action by aspirating it.

To be honest, my ovaries failed to show true commitment to tactic #4. I had a 30mm cyst which within a week had fizzled to less than 10mm.

I'm done with the birth-control pills and am about to go take another Lupron shot. We are fully into ovarian suppression mode. I'm scheduled for baseline bloodwork/ultrasound and stims on Monday. That leaves me with 5 days to come up with some asinine way to derail this puppy.

Oh, what the heck.. let's go ahead with it!

Tuesday, August 11, 2009

the long and annoying road to baby #1

Here's a recap of the 3-1/2-year journey that Mr. Foxy and I took to get pregnant with Waffle Girl. I do not recommend this course of action to anyone.
  • We got married in 2002 when I was 32. I was on the pill at the time, as I had been for many years due to irregular periods and suspected polycystic ovaries (PCO).
  • After our 1-year anniversary, I went off the pill.
  • 6 months later, Spring '04, I got a referral to a reproductive endocrinologist (RE) and the prodding begins! Our first appointments were pretty standard stuff, but then..
SURPRISE! I have two blocked fallopian tubes!
  • Well, I never expected that. The RE gave me two options: a) go straight to in-vitro fertilization (IVF), which would bypass the tubes or, b) get laparoscopic surgery to clear the tubes and then do intra-uterine insemination (IUI).
  • Despite being a total science geek, I was reluctant to go to IVF. Instead we opted for choice B. I went in for surgery in Spring '05 and then..
SURPRISE! My tubes weren't really blocked, after all!
  • While poking around my abdominal cavity, the RE confirms that the ol' tubes are just fine.
  • For the rest of '05 we occupied ourselves with 4 IUIs which of course didn't work. I think IUIs are bunk!
  • Finally, I'm mentally ready to try IVF in December '05. I have good insurance and I live in a state where all infertility coverage is mandated. I'm ready.
SURPRISE! I'm on an insurance plan that is administered out-of-state and they don't have to follow the IVF coverage mandate!
  • This was the pits. I could change over to another insurance plan that was administered in my home state. But I had to wait 1 FULL YEAR to make the switch!
  • Then in early '06 my new insurance plan kicked in and I was referred to a different clinic. At this point I didn't mind the switch and just wanted to get moving again. I took the first available appointment with the least popular, worse bedside-manner RE they had.. let's call him Dr. Snaggletooth.
  • Ever the realist, I was prepared to do 2 or 3 IVF cycles. Despite the myth that IVF is the fertility magic bullet, I knew that it wouldn't necessarily work the first time.
SURPRISE! We got lucky on IVF #1.

Yada yada yada.. we have a daughter now.

By the time the girl was weaned in early '09, I was 38 years old. We knew it was crunch time if there were to be any siblings. So I got referred back to Dr. Snaggletooth as soon as possible.

There would be no dillydallying this time. Straight back to IVF.. or so I hoped. Next time I'll tell you just how many ways and just how long an IVF cycle can be delayed.

Sunday, August 9, 2009

what's in a name?

"Why 'the infertile breeder'?" you may be wondering.

Let's break it down y'all:

INFERTILE, according to Merriam-Webster -
adjective: not fertile or productive; especially: incapable of or unsuccessful in achieving pregnancy.

BREEDER, according to Urban Dictionary -
1. noun: slang term used by some childfree people for one who has a child.. thinks the sun rises and sets for their child/ren.
2. noun: (offensive) a heterosexual person. Formerly this was an insult used by the gay community; it is now used mostly by straight people in a lighthearted vein to (mistakenly) show that they are down with gays and familiar with the culture.

Put it together and you get the oxymoron that is me. Think "jumbo shrimp" or "airline food".

Mr. Foxy and I are are technically, medically infertile. Yet we have a cheerful little girl stomping around the house. So we're kindof fertile.. with a bunch of medical help, at least. And I can ironically call myself a "breeder", like the aging Gen-X-er that I am, mistakenly thinking that I'm hip to the current street lingo.

Post #2 will describe the 3-1/2 year slog we endured to get pregnant with the girl who wakes up every day demanding waffles.