Round 4

I had my suppression check on Tuesday which everything turned out good so I was able to stop the bcp.
Tonight was my first night starting the shots again, 10 units of lupron, which will be twice a day starting tomorrow and then on Sunday the gonal-f will be added twice daily.

The good news is that I don't have to go back for monitoring until next Friday (of course they following week I will likely pay for this).  Another good piece of news is I looked at my drug bill and found out the lupron only cost $15 instead of $30 so this cycle is only costing $75 instead of the $90 like I had planned (of course the bcp added on another $15).  Really hoping that I am pregnant and it stays before our insurance renews in July.

I did something I shouldn't have yesterday.  I went out shopping with MIL and a brought a bouncer seat.  It was only $5 so I tried to justify the cost that if we don't conceive I can sell it and regain the $5.   However my MIL wasn't too impressed and said I was jinxing myself buying baby stuff before we have a baby.  I know it is an old wives tale, but probably holds some truth since infertiles have much more time to hunt and buy baby stuff.  I mean if  we weren't IF we probably would have already had another child or at least be pregnant before I even thought of buying anything. 

Reading

Below is my reading from Cheri

They are telling me BOY and JUNE so this is either birth month, conceive month or the month you find out in

They are showing your son as someone who si always going to give it his best. They show him as someone who is always going to have no problems with volunteering his time and never even questioning what its for, or if he would ever get anything in return. Hes just this adorable kid who people seem to love being around and hes pretty care free. Not one to get involved in dramatic situations. He seems to always have a good understanding of what is going to happen next, and be prepared. Almost like he has his own intuition that helps him better prepare for situations.

When ti comes to your son, they show him as someone who is always going to love to dance. They show him as someone who is charismatic and really whatever he does, people seem to take notice. Hes not one to try and grab attention or even take away any ones spotlight, it just seems to naturally find him!

Your son is someone who I would consider to be very smart. he loves variety though and would rather have the opportunity to try new things than being stuck in the same "boring" job each day. You are going to see him to prefer to be social as well. Hes just this easy going person who seems to have a good way with people and finds opportunity without having to look for it.

When it comes to career paths, they show him working in an office related position. I am seeing this being linked to something in human resources and employee conflicts. They show him having additional training and this is a very large facility.

When ti comes to marriage I am seeing him closer to 26. They will have two girls of their own.

Not sure what to make of this.  Happy she didn't say you will not have any children, but looks like we will be doing another ivf after this one since the month doesn't add up.  Guess I should be happy she at least said June instead of some month in the fall.

She has been right on my last two pregnancies so I do have faith in the reading.  Anyways it gives me hope and that is what I was mainly looking for.

Insurance debate

So I have been worried about what is going to happen in September when dh quits his job to go back to school.  Right now we have fertility coverage through his insurance at work.  This is the only reason why we needed the insurance - dh and dd both have masshealth as secondary insurance and once I get my citizenship complete I will apply for masshealth as well.  Unfortunately masshealth doesn't cover infertility so we are left trying to decide what to do in case we need to cycle again after the summer.
It sucks being IF that we even need to think about this and pay tons of money when we qualify for free insurance through the state.

So after much hunting I have discovered that most likely our insurance will end at the end of the month he quits.   So if dh puts down a quit day of September 1 we may get the insurance until Septemeber 30.  Well I told dh this yesterday and we got into a huge fight (the neighbors even called the cops) because dh wanted to leave mid August - not really for any reason - just wanted a 2-3 week break before starting school.  I told him there is no way we can afford him taking half a month off (we already are going to be in the red in the summer because all our savings will be used up this spring).  Anyways dh wasn't happy to hear this and though I understand how much he hates his job, if it wasn't for me helping him he wouldn't even be going back to school in September (he would still have loans in default and will be struck at his low paying job for life).  I really wish he would think about me and dd instead of just only himself all the time.

Anyways, I told him that this won't be a problem if his school's plan will cover me and dd.  I am not sure if it does or not.  Under faqs it says to look at the school's insurance policy and it doesn't say anything about covering dependents, just how to get out of the student health insurance.  I guess it isn't a question they get much since most students are young 20 somethings and don't have a wife and kid already, instead they are more likely to be a kid themselves and covered under their parent's plan.
Hopefully we can get some answers on this soon because this will be our cheapest option.

Other options I can look into is continuing his work insurance through COBRA, however this will probably be over $1000 a month since it is for all 3 of us.  Not really worth it, but is cheaper than if we have to do ivf again.  The good news about COBRA is that it does have 60 days to join so if I was pregnant by September we can hold off and then only sign up if I lose the pregnancy. 

The other option is to buy private insurance just for myself since I am the only one who needs ivf.  This will be around $500 a month and should cover ivf since we are in MA.   Only issue with this besides the price is that there may be a 6-12 month waiting period and if they refuse previous conditions.    Not sure if it is true for MA because of the infertility mandate but I know other places run into this problem with private insurance refusing to pay for ivf if they have already been diagnosised infertile before joining.

Ding Dong the witch is here

Well the heavy spotting turned to flow last night at 9 and since then I have been bleeding heavily and in a lot of pain.  So guess I was right with calling yesterday cd1.  Of course it sucks since I have to take dd out all day today for therapy.  I was home all Sunday and Monday, why couldn't AF have come then?

I popped some advil.  I know it is wrong, but it is seriously the only thing that works for the pain.  I figure since ER is around 4 weeks away that taking some advil now won't be an issue.  I mean look at all the women that take nsaids (and things worse) for weeks and months (sometimes even being pregnant and not knowing) and none of them had issues with the drugs intervering with conception.

Cd1 or spotting???

You would think I would know this by now after having 350 periods, but I do not know what to label this day.  I started spotting last night at 9pm, after having no sign AF was on her way.  I thought good, here we go.  I usually spot for 2-3 days before AF and it is usually pretty clear the difference between the spotting and the actual period.   Well not today.  I had a bit of specks on a pad overnight so I figured okay since it reached the pad it is day 1.  Well the blood hasn't gotten any heavier than that.  Usually on cd 1 I have heavy flow with clots, not a few spots on a pad through out the day.  So I called the doctors to tell them I think AF had arrived, but I wasn't sure. 

30 minutes later the nurse calls back all cheerful, saying "so this is cd1".  I don't know why she always acts so cheery when she calls to report this.  It isn't like getting my period is a joyish occasion.  Anyways I reiterate that I wasn't sure if it was cd 1 or not because it is mostly spotting, but is heavy spotting.  She then says spotting isn't cd1 so what is it.  This is why I am calling you!  Anyways, I try and defend my calling by saying that some day get onto a pad so I am calling it cd1.  Anyways, really what does it matter, it isn't like I am going to do fsh testing.

So anyways I ask her if I should start the pill tonight and she says no you need to come in for a pregnancy test first so that will be done on cd3 (Thursday).   Now here is the thing, the nurse that called yesterday with my instructions told me I didn't have to do any testing before starting the pill, but just to come in some time this week for the amh test, which I booked for Friday since dh was off.   I even asked that nurse if I needed to go in on cd3 for blood and she said no, so now I am being told that yes I do.   Not to mention the fact that they have to do a pregnancy test when they took my eggs and I didn't have a transfer.  How the heck can I be pregnant ???  I am seriously glad I don't have to pay each time I go in there (besides the $20 in gas) because really RE are the worst with doing useless and repeated testing.   I can't count how many times they have checked my blood for hcg, or done STD testing on us, etc. 

Anyways my nurse today said they will move the amh test to Thursday from Friday so it will be drawn when they do the hcg and then I should start the pill Thursday night.   Hopefully my period comes in full force tomorrow so I don't have to call back there and tell them I got the dates wrong.

Oh and speaking of doctor offices being stupid my nurse today on the phone then says for me to send in my pap results.  At first I was wondering if I heard her correctly, so I asked her to repeat what she said.   Yep, that is what she said.  So then I wondered if she has me confused with someone else.  I did my pap the end of January and the doctor send it over.  They should have got it before I cycled last, in fact I know they would have got it because otherwise they would have bugged me for it everyday throughout the cycle since they said I couldn't cycle without it.  I told the nurse this and then she says that they never got it and maybe my obgyn forgot to send it.  Now I don't know what to think.  Why tell me this now 2 months later and why is it my problem.   I am getting sick and tired of dealing with insurances and getting all properal referals period then to have to worry about doctor offices not doing their job.   I already have enough of this problem with dealing with all of dd's medical expenses and now getting a bill from children's yesterday saying my insurance (and dd doesn't just have one insurance, but two) won't pay because we didn't get authorization even though her pedi sent a referral.  I can't stand it and it seems everyone points to the other party and I am left being the one struck to pay and clean up everyone's mess. I'm sorry, but I don't have time for this.  I am not going to contact my obgyn about the pap.  I already have enough of a problem trying to sort out all of dd's medical issues as it is.

Waiting in limbo

So today is 11 days past my ER.  I should be doing hpt right now.  Instead I am sitting here waiting for AF, which still has shown no signs of starting.  At least in a normal cycle I would be spotting right now.  Can't believe I am actually wishing for AF and the spotting to start.  The trigger should be out of my body by now so not sure what is holding up things.  Unfortunately until AF comes I can't move on.  Which is really depressing because I could have been pregnant by now, instead we are looking at least May to find this out.

RE's plans - not happy

So my RE called today with the conclusion they came up with yesterday in regards to my cycle and what to do different.   Before she called I made a list of what I would like to see done differently.
I believe I stimmed fine, despite being a bit long, but I had good follicle number and estrogen at trigger.
I believe everything went down hill there.  Yes there was probably some poor quality going on as showing by my poor fertilization report, but I believe if we would have got more eggs we would have had a few good ones to transfer.

So what I wanted was the following:
1. double trigger dose
2. trigger with lupron as wells as hcg
3. test lh and hcg day after trigger
4. give hcg IM instead of SQ
These 4 things I believe would help prevent me from experiencing empty follicles again.

I also had a request to hold off introducing menopur until day 5 and increasing gonal-f originally since there is a theory that LH at the start of a cycle can negatively affect egg quality.

Well things didn't go so well when the doctor called.  She says they think it is best to change my protocol from the antgonist to the micro flare.  I couldn't believe.  I can understand changing the protocol if I didn't respond to the antagonist, but I did.  I had 11 follicles and 1425 estrogen.  Yes I wasn't the best stimming, but I really don't feel like that is why the cycle failed. 

When I told her that I believe the problem was the trigger she didn't want to believe me saying that I had a normal amount of hcg in my blood.  THEN WHY DID I ONLY GET 4 EGGS!  I asked if I can just double the dose for next time and she said no because 10 thousand is plenty and I had a normal amount.  I then asked if I can trigger with something else, but this was thrown out since she is changing my proctocol.  You can only trigger with lupron if doing an anatgonist protocol.  Great, another reason why I am pissed with changing the proctocol.

I told her that I am scared that this will happen again and I don't want it to happen again.  She said the same, not like it matters much to her.  If our ER fails again we waste another few months as well us tons of money. 

When the conversation ended I wasn't very happy.  She did call me back a little while later and said that I can give the trigger IM instead of SQ next time and ER can be done at 37 hours instead of the normal 36 in case the trigger needed a little bit longer to work.  Guess someone did a little bit of research after our first conversation.

Anyways I really don't know what to think. I have been googling about the MDL proctocol all afternoon and there seems to be mixed emotions on it.  It is designed for poor responders (of course that is poor responders to the long lupron protocol, not sure how it compares to the anatgonist) and though some people responded great on it other people had their worst cycle ever with it.  I just feel like this is a big risk this clinic is taking with changing my protocol and I don't like taking risks.
I also don't have all the time in the world to be a guinea pig to try different meds on to see which one works the best.

Need some hope

I contacted an internet baby psychic last night.  I know many people think it is a waste of money, but I just needed to hear from someone that things will work out in the end.  I have used this psychic twice before and she was right both times for my previous pregnancies (more than just chance) so I feel confident in her ability, even though she properly costs more than the newer psychics on the market.

For example, I received my first reading March 2009 just after we found out that we would need to do ivf.  She said I would conceive, find out, or give birth in April and it was a girl.  Well I had my ER on April 17 and found out I was pregnant on April 29.   That baby died at 8 weeks but after the d&c found out it was 46xx.

After my m/c I wrote back to the woman telling her the results.  She told me that my next ivf would work and she saw the month September and it was b/g twins.   We did ivf in August, found out I was pregnant end of August, and found out it was twins in September.  Though our son later ended up dying, she was originally right.

When I was preparing for ivf #3 I purposely chose not to recontact her.  I didn't want to hear if things would not work out or that it didn't add up to our ivf timeline.  Maybe this was a good thing since the ivf didn't work. 

Now however I need the hope.  I won't stop a cycle if it doesn't add up with what she says though, I just need to have some reassurance that all this isn't in vain.

The morning after

So I had to get up at 5 this morning to pee, should be happy it is getting later each day, and after 1.5hrs have given up on being able to fall back to sleep.

I have come to a few conclusions.  I believe my cycle failed due to the trigger not working properly.  If it wasn't for all those empty follicles I should have at least some embryos make it.  Of course there is also the question on why my embryo quality sucks so bad for a 33 yo.  2/4 fertilization is normal, but it is not normal to have embryos die at 1 day old and our only 2 did.   A similar thing happened with my previous cycles, though we had more embryos so 2 good ones at least made it past this point.  I mean there are women that only get 1 or 2 eggs and make it to ET and some even get a baby out of that.  At least with most people their embryos don't arrest until after day 2.  Mine don't even make it that far.
I don't know why and it is hard to find information out there since it is so rare for embryos to arrest that early, like I said most arrest between day 3-5.  I did find a couple of posts from some women who had arrested at the day 2 stage, but never the day 1 stage - I mean this means my embryos didn't even cleave once.   The only thing I can find says that before day 3 it is an egg problem since the egg should make an embryo to the 8 cell stage and then the embryo's genome is turned on.  I don't know how true this is, but it sucks because we originally started ivf for mfi only, all my tests were good.

Anyways I have decided a few things for next time.
1. I believe taking menopur from the start was wrong.  Though most doctors believe LH is needed most do not believe it should be given in the first few days of stims.  In a natural cycle, only FSH is secreted which helps recurit that cycles follicles to grow.  Once the follicles start growing, LH is also released in tiny amounts until the egg is mature when it surges quickly to cause the final maturation.
There have been reports that LH given early can cause bad quality and now that I think about it might also be a reason why the trigger wasn't effective.  Since the LH surge can not happen in ivf they use hcg to minmic LH to cause this final maturation that is needed.  Maybe my eggs didn't respond too well to the hcg because they have been exposed to low amounts of LH from the start.
My first cyle I was on LH (repronex) but it was started on day 5, while my 2nd cycle I was not on any LH at all, just gonal-f which is purely FSH, of course that cycle I didn't start the anatgonist until my lead was 17 and my LH was starting to rise so I was exposed to a bit of LH -it was just in the natural form. 

I am going to ask my doctor about this point and have decided that either way I am going to avoid menopur for the first few days of stims.   So if she says to be on 450 gonal-f and 150 menopur again I will take 600 gonal-f only for the first 5 days and then after the first u/s and bw go down to 450 and add in the menopur.  This way I will be getting the 600 units of FSH that I need, but avoiding the additional 150 units of LH at the start of the cycle.  I will also save myself $30 because I wouldn't have to buy more menopur since I have 24 left over vials from last time and stimming this way I will only need to use 16.  Also I have more than enough gonal-f to do this as well.

2. I believe my biggest problem with my last cycle was because of the empty follicles.  Now I don't know if this was a trigger problem or just a really poor egg quality problem.  I also don't know how aggressive the RE doing the ER that day was with trying to get the eggs.  Normally eggs are removed from the follicle by aspiration, however if that is unsuccessful than sometimes they will try repeatly flushing the follicle.  I don't know if this was done with me or not.  I would guess that they didn't spend a lot of time since they are probably on a strict time limit on how long to do ER for (which shows by my ER happening right at 9am).   A 15 min ER slot may work for most women, but when there are complications like in my case I would expect them to spend longer to try and get those eggs than just give up.  Like I said I don't know what was actually attempted here, but will be one of the questions I will want to ask my RE to prevent this from happening again. 

Another theory is maybe I need more time for the trigger shot to work.  I don't know if this theory holds true for me because I didn't have this problem with my first two ER.  Anyways normally ER is done at 36 hours, but there have been recommendations to hold off a couple more hours to get the trigger more time to work.  Of course with this you run the risk of ovulating before ER, though everything I read says ovulation happens 38 hours or later from the time the trigger is given, so maybe this isn't that much of a concern.

I will be asking what to do differently about the trigger though.  Should I double the dose of the trigger, should I give it somewhere else in my body (there is a theory that obese women should use their arms instead of their stomach - not sure if this will work with me though because my arms are big too. I do have a belly, but not as large as you would expect at 226lb, however when I triggered my first two cycles I had a flat stomach and weighed 40lb less)?  And lastly I use another drug to trigger instead of hcg. Lupron can be used to trigger if using the anatgonist proctocal because it reverses the action on the anatgonist that is blocking the LH surge.  It is usually given to women with very high estrogen and when the risk of OHSS if given hcg.  However it is another option I can use to see if that is more effective instead of the hcg. 

No ET

We won't be having ET tomorrow.  Just got a call from the nurse that out of my 4 eggs only 2 successfully fertilized and they both died. 
Unfortunately dd has her party this afternoon so I have to try and put on a happy face for that when I really feel like crap.
Surprisely I took the news better than I thought I would.  I knew this was a big possiblity with only getting 4 eggs and it is much better finding this out now then 2 weeks from now or getting pregnant and m/c months from now.  At least this way I can save myself the progesterone and estrogen so I will only need to spend $120-135 for more meds to cycle again. Just mad that dh used all his vacation days for this cycle and we have nothing to show for it.

4

So out of my 11 large follicles on Tuesday (my best follicle scan to date) I had my worst ER result.  Only 4 eggs were retrieved.  Needless to say I wasn't happy.

Going to the clinic today I was worried about many thing - the weather, the roads, the traffic, being late, dh not producing.  The one thing that I was not worried about was getting a low egg count.  We got up at 5, left at 5:30.  It was just rain for the first hour of the drive, and then snow just at the end and though the traffic was busy we must have just been ahead of the morning rush so we didn't get stopped once. 
We arrived at the clinic at 6:45 with an ER time for 9, and a scheduled arrival time of 8, so we were very early, but that didn't matter because we were there.

So when I woke up and they told me there was only 4 they had to draw my blood to check the hcg level thinking the trigger may not have worked.  I seriously doubt it would be this since this is my third cycle and I had no problem with trigger the last 2 times.  I did notice this time though that I didn't have many symptoms after the shot, but I read that that is very normal.  My last ivf it was like night and day and it was the start of 9 months of night peeing. However this cycle I was peeing frequently since a few days into the cycle so it wasn't something that I was able to notice a change with.  I guess it would have been good to do a hpt yesterday morning, but I just didn't see the need to waste money on one just to see a false bfp.

Anyways I read online that the most common cause of empty follicles is due to bad eggs.  That normally after the hcg or lh surge the egg undergoes meiosis halfing the chromosome number and it also secretes an enzyme to become looser from the follicle wall.  The theory is when the egg is bad (meaning it probably is not chromosomally normal) it doesn't loosen from the wall and therefore is not able to be retrieved despite repeatly flushing at ER.  Unfortunately if this is the case there is nothing that really can be done to correct the problem.  Sometimes using a different protocal or doubling the trigger, or using a different trigger can result in a better response, but not always.  I think this is the biggest worry.  Even if we change things for next time and despite things looking great on the u/s and bloodwork that we can still get a poor response at ER.

Anyways right now I am just hoping these 4 are all mature and fertilize and grow.  I won't find out anything for another 2 days so praying that the report that day will be a positive one (despite our poor response today) and that we will have at least one good (hopefully two) embryos to transfer on Sunday.  And here to think that I could have gotten to do a 5dt if they would have been able to get all 11 eggs.