Fertilization report

Months of preparation and we were finally ready for egg retrieval yesterday.  Going into the retrieval, we knew that I had 11 follicles, but the number of eggs within those follicles could not be predetermined.  So, I went in with my new pink socks (a thing among CCRM patients), ready for whatever was to happen.

  When I woke up from the procedure, Andrew was there with a smile on his face.  He already knew how many eggs were retrieved--10!  That's a good number for me.  Embryology came in to speak with us and confirmed that 10 eggs were retrieved, and that they would attempt to fertilize those eggs within a few hours.

This morning I received a call from the embryology team with the fertilization report.  Of the 10 eggs retrieved, 6 were mature, and 5 of those mature eggs fertilized.  Again, this is a good number for me (considering that in our first round of IVF we had 9 eggs retrieved, with 7 of those eggs mature, and only 3 eggs fertilized).   So, it was good to hear that we have 5 embryos to work with.  But, it was also good to hear that they were trying to grow the other 4 immature eggs out to maturity in the lab and would try to fertilize them today.  We will get another call tomorrow with that fertilization report.  That will be last call we get until next Thursday, which is when the embryos will hopefully reach blastocyst, and then all embryos will be genetically tested and frozen until my body is ready for the transfer.

Stimulation, round two

I've been "stimming" for over a week now.  This means that I've been getting several injections each day, which stimulate my ovaries to produce follicles, which will hopefully have a mature egg once egg retrieval comes around.  This is the second time we've been through this, so we knew what to expect--bloating, cramps, moodiness, headaches, sleep deprivation.  The one thing we didn't expect--a prescription for Viagra.  For me.  That's right, I am now taking Viagra.  Apparently, the Viagra helps the stimulation meds be more effective.  I'm all for it if it's going to give us a baby.

After a few days on the "stims" I had a ultrasound and blood work to see how my ovaries are responding to the meds.  That ultrasound found that I had only 8 follicles--6 on the left, 2 on the right.  My right ovary has a large endometrioma, which is ovarian endometriosis in the form of a cyst.  The endometrioma is preventing the ovary from cooperating and producing follicles.  This leaves me with fewer than average follicles.  We were disappointed, but we also know that, in the end, it only takes one.

The few and slow growing follicles prompted the Viagra prescription.  By the second ultrasound, I had 10 follicles--8 on the left, 2 on the right.  However, many of them were still slow growing.  We only had three that were growing at an almost normal pace; the others lagging behind.  At this time, the nurse said one of two things could happen.  One being that the doctor could recommend retrieving the largest follicles at their appropriate time, which means that the smaller follicles will not be mature and cannot be fertilized (this would leave us with approximately three eggs).  Or, the doctor could recommend stimming a bit longer to grow the smaller follicles more.  However, in this case, we risk losing the biggest follicles and mature eggs, and stimming for too long can result in poorer quality eggs.  We knew we wouldn't have an answer until the next ultrasound and blood work.

Today, I had my third ultrasound.  I now have 11 follicles--8 on the left, 3 on the right.  The growth patterns indicate that I will likely be ready to retrieve on Friday, and that we may only get 8 mature eggs from the 11 follicles.

While eight sounds like a great number, it's really low, relatively speaking.  The attrition rate could knock us down to 1-2 embryos (just like the first round).  Not every mature egg will fertilize, not every fertilized egg (or embryo) will make it to the blastocyst phase, not every blastocyst will be chromosomally normal.

Once the retrieval happens, we will learn within 24 hours how many eggs were retrieved, how many were mature, and how many fertilized.  We will then have to wait five days to learn how many embryos grow to the blastocyst phase.  The embryos that make it to that phase will then be genetically tested to "weed out" the non-viable embryos.  We will have to wait 2-3 weeks to learn how many embryos we will have from this process for transfer.  Once we know that number, we can start prepping my body for the transfer, which will unfortunately take another 6-9 weeks.  We have been advised that our transfer will likely take place in December.  It's going to be a long wait, but will hopefully be worth it.  What a wonderful Christmas present it would be :)

Moving forward, round two

This round of IVF feels so much different than the first, in many ways.  We were so naive in the first round, thinking that all the work and money we put into it would give us a happy ending.  But, on May 1st, Chase's second birthday, we found out that we were wrong.  I think this is why I don't feel excited about this second round.  We haven't even been celebrating the small steps and progress we've made in this second journey.  We just want to get it over with.

"Get it over with."  I know that sounds terrible, but the process is grueling.  In the first cycle, I gained a lot of weight, I was emotional, and (Andrew would probably say) I was extra grumpy.  It's a series of highs and lows.  The medications and hormones are hard on the body, but are needed to retrieve the eggs and support a pregnancy.

"Get it over with."  We have our eyes on the prize, as the saying goes.  We are anxious to get through the brutal stimulation phase, the waiting-while-our-embryos-are-genetically-tested phase, and the transfer phase.  We want to fast forward to the date when we will find out if this was a successful round of IVF.

So, where are we right now in the cycle?  Well, after all the work up and testing and a surgery to correct a problem with my fallopian tubes, we are ready to rock and roll.  Last week, I started on some priming medications, and yesterday an ultrasound and blood work found that we are ready to start the stimulation phase.  For the next 2-3 weeks, we will be in IVF prison.  I have several injections that need to be administered at very specific times during the day.  Lupron has to be injected every 12 hours; right now we are on a 7am and 7pm schedule with that medication.  Menopur has to be injected in the morning, Follistim has to be injected in the evening, and Dexamethasone has to be taken at bedtime.  We either have to be home at the exact times that these meds are needed, or we have to take them with us wherever we go.  The latter is challenging because some of the meds have to be refrigerated (and sanitary conditions are needed).  Regardless, we are ready!

Those of you that donated to our online fundraiser helped us get to this second journey.  All of the money raised was used to pay for the initial work up and testing as insurance didn't pay for it all.  We applied for a grant, but were told that the committee won't meet until November or December of this year to determine if we are eligible.  We were finally able to take out a substantial loan, but this loan does not cover the total costs.  We are still fighting to pay out of pocket for the expenses while simultaneously making biweekly payments to the lender for the loan.  We initially estimated this round to cost $30k, but we are already over that amount and we aren't done paying yet.

This is our final attempt to build our family.  Financially, it has to be.  By the end of this year, we will know if Chase will be an only child or if he will have siblings.  

Post op

The long process of "IVF workup" is finally coming to an end.  All of my labwork came back normal, meaning that there are no deficiencies or blood clotting disorders.  My genetic screenings also came back negative, which means that I am not a carrier for any genetic disorders.  The uterine biopsy revealed that I have the necessary receptor cells for embryo implantation.  All good news!

The final step was to have at least one fallopian tube removed because it was retaining toxic fluid, which would destroy an embryo.  I went in for surgery on Thursday of last week.  We knew that one tube would be removed, and that there was a possibility of the second tube being removed depending on what was found once my pelvic cavity was cut open.

When I awoke after surgery, my doctor came in to talk to us.  I think he was floored by what he found, but it was really no surprise to us.  He was not able to remove either fallopian tube.  He said it looked like someone dumped a bottle of Elmer's glue inside of me because all of my organs are glued together.  He said it took him some time to even figure out what was what in there.  My tubes are buried in adhesions and glued to my bowel, which is glued to my uterus, and so on.  This, of course, is all due to endometriosis.  My doctor said that if he would have tried to separate anything it would have turned into a major surgery with potential complications (i.e. perforated bowel).  He was, however, able to ligate both tubes, which he found necessary to proceed with IVF.

It's kind of funny when you think about it--most women have their tubes ligated to prevent pregnancy, while I had my tubes ligated to increase my chance of pregnancy.  Of course, now our only hope of conceiving is through IVF.  We will never experience the miracle of natural conception again, but we can still have a miracle baby with the help of IVF.

Now we wait for my next cycle to start.  Once that happens, we will receive a calendar from our nurse, which will instruct me to take certain medications at certain times.  We will once again go through the priming phase and then the stimulation phase (lots of injections) before we get to egg retrieval.  If everything goes as planned, we could be pregnant by the end of the year.

Sad, but true

We have finally completed all IVF work up and testing.  Yesterday was the last of it.  I had an endometrial biopsy for Integrin, which will determine if I have the receptor cells necessary for embryo implantation.  I didn't know what to expect going in for this appointment, but it turned out to be a short uncomfortable procedure.  The doctor placed what looked like a plastic straw through the cervix and into the uterus, and scraped the inside of the uterus to obtain cells.  It felt like the worst menstrual cramps you can imagine.  But it was over pretty quickly, and now we wait 2-3 weeks for the results.

In the meantime, I will undergo a third laparoscopic procedure in which at least one of my fallopian tubes will be removed.  This is scheduled for August 6th.  Sadly, this is not deemed medically necessary in the eyes of our health insurance, so we will have to pay out of pocket for this as well--another $4,250.

The fees associated with infertility treatment keep piling up.  After the first failed cycle and going through the second cycle, we will have spent over $60,000--just to TRY to have another baby.  We are stressed and exhausted.

And, as I sit on the sidelines watching the many people around us celebrating their pregnancy, birth, twins, etc., my emotions are running high.  When people ask me "how are you," I smile and say "good" because it is an easy and polite response.  But actually, I'm feeling quite the opposite.  We are two years into this infertility hell, and tens of thousands of dollars are out the window.  I live this every single day.  There is not a day that goes by that I don't think about how badly I want to grow our family, hold another miracle baby.  It is Chase's smiling face and Andrew's strength and optimism that keeps me going.

I wonder what it must feel like to just decide to have another baby and then actually have one, without any struggles or complications.  Even to get to Chase (our two year old son), we had to go through a surgery, the agony and heartbreak of a miscarriage, and several months of trying.  And now, my reproductive health is worse.  I just want to have the choice and ability to grow our family.  We are hoping that Dr. Schoolcraft at the Colorado Center for Reproductive Medicine--one of the best in the world--can help us make our dreams come true.

    

Moving along...

As we continue with our IVF work up, the many emotions are hitting us again.  Yesterday, I received the call from our nurse confirming that my left fallopian tube will not be cauterized, but completely removed.  The HSG--xray of my uterus and fallopian tubes--showed that both tubes are blocked, and that the left tube is retaining fluid that becomes toxic.  Our new doctor has recommended that the tube be completely removed because of the toxicity risk to an embryo.  I will undergo a third laparoscopic procedure for this, and we are trying to find out if our insurance will cover it before we schedule the procedure.

On a positive note, my repeat doppler showed normal blood flow throughout the uterus without any caffeine in my system.  This is great--no further work up needed on that end!  Now, I just need to have the endometrial biopsy, checking for receptor cells that help an embryo implant.  That procedure is scheduled for next week.

We got the results back from Andrew's semen analysis.  Once again, he topped the charts in every category.  In fact, he has 5 times the average number of sperm.  If I didn't have endometriosis, or some other condition causing infertility, we could easily have the large family we hope for.

As we near the end of our work up, the large sum of fees is due to our doctor in order to proceed with the second round of IVF.  Just as before, we are looking into financing and grant opportunities. Today I am applying for a grant through Kids for Kyla at kidsforkyla.com.  Wish us luck!

IVF work up

After our initial consult with Dr. Schoolcraft, our new specialist, we decided to get a jump start on round two of IVF.  On Tuesday of this week, we started our work up and attended an orientation.  The room was filled with other couples from around the world going through their own infertility struggles.  We now know that THIS is the place to be.  While we are not 100% confident that we will have another baby, we are 100% confident that our new doctor will do everything it takes to make it possible.

My lab work so far has indicated that my ovarian reserve has decreased since our last IVF cycle.  My AMH is now 0.9, below average for my age.  An ultrasound found 8 resting follicles on my ovaries, while 12-13 is normal.  Although these numbers are low, our new doctor is confident that we will still get a good number of eggs from retrieval.  And since we made a child before, we should be able to get at least one normally fertilized egg--an embryo.  If we are lucky to have multiple embryos, our doctor will transfer two.

On Tuesday, I had a hysteroscopy where a microscope was inserted into the uterus to look for scar tissue, polyps, fibroids, etc.  I am happy to report that everything looked normal.  However, I still need to have a biopsy of my uterus to determine if I currently have the receptor cells needed for embryo implantation.  That biopsy has to take place at a certain time in my cycle, but I will likely have it done within two weeks.

Today, I had a hysterosalpingogram (HSG).  This is an xray of the uterus and fallopian tubes with injected dye.  I had this imaging done before, in May of 2014 by our previous fertility specialist.  She was not gentle with the procedure and I was terrified to have it done again.  I explained this to our new doctor, and he prescribed me Percocet to get me through the procedure.  However, it completely backfired on me.  I'm not used to narcotics, so this drug had me feeling very loopy, and I threw up three times before the HSG was done.  Not pleasant for me, and probably not pleasant for the lovely nurse and technician that were with me.  But, this HSG was so much better than the first one.  It wasn't painful and the equipment used was much more updated.  The results?  Both tubes are completely blocked again.  But, I am suspicious that they are both blocked in the exact same places as they were before--right tube blocked proximal, left tube blocked distally.  When these same results were found in May of 2014 by our previous doctor, I underwent surgery in which she claimed to clear both tubes.  So, is it a coincidence that both tubes are completely blocked in the same manner as they were before?  Something we will discuss with our new doctor at the next consult.  But, with these results, we now know that there is a good chance that the first IVF cycle failed because of the tube blockage.  Since the left tube is blocked distally (at the end, closer to the ovary), it fills up with fluid, which has no place to go except back down the tube and into the uterus.  This fluid is toxic and can destroy a thriving embryo.  We will never know for sure, but this is a probable cause for the failure.  To prevent a future failure, my tube (or tubes) will be cauterized to prevent the flow of toxic fluid into the uterus.  In a way, this makes me really sad.  Once cauterized, I'll never be able to use that tube (or tubes) again.  But, on the other hand, I can't use them anyway since they are blocked from scar tissue and adhesions that result from endometriosis.

Andrew and I have a lot of lab work that we are still waiting to hear back on -- genetic testing, semen analysis, general lab work, etc.  Tomorrow, I go back for a doppler of my uterus to ensure normal blood flow.  They tried to do it on Tuesday with the ultrasound, but I had caffeine in my system, which affected the doppler results.  We could see the way the blood was pumping so abnormally through the uterus, and it was a real eye opener.  I don't consume large amounts of caffeine, but what I do get from chocolate, coffee, and tea could affect a baby.  For that reason, I am completely cutting out caffeine during this cycle.  If the doppler is still abnormal tomorrow, without any caffeine, I will likely go through acupuncture again to get the blood flowing normally.

Once all of our results from the work up are in, our doctor will develop our IVF protocol.  It will likely be as aggressive as it was before, meaning a lot of medication to stimulate the ovaries.  We have already decided that all of our fertilized eggs will be tested for chromosomal abnormalities.  Since we have already failed one IVF cycle without chromosome testing, it would be wise to ensure that a future failure is not due to a chromosomal abnormality.

We knew that treatment with this new specialist would be more expensive, but we are willing to roll the dice.  While our last cycle with the previous doctor totaled around $20k, we are now looking at $32k, which includes the large amount of medications I will need and the chromosome testing of the embryos.  It's very scary to take another chance, but we just can't put a price on having a baby, and we are not willing to give up yet.  Hopefully, we will be pregnant by the end of the year.