Tuesday, June 29, 2010

Moving ahead: onward and lupronward


I called CCRM and set up the transfer calendar yesterday. No matter what happens with the 7 blasts from the current cycle, we do have the three wonky-but-chromosomally-normal blasts from IVF #6, so we're going to proceed to transfer no matter what and will just transfer the best ones.

I had been debating whether to give myself a month off before moving ahead. Because I'm tired folks. And worn down. And really sick of how long and drawn out this process has been. Dr. Schl. wants me to go on depot lupron for two months due to my endometriosis and the idea of injecting that stuff during the height of a particularly brutal New York summer just isn't getting me excited. But when I talked to the nurse, we calculated that if I start the lupron RIGHT NOW, I will be able to transfer the blasts approximately Oct. 3 (30 days of depot lupron + 30 days of depot lupron + 1 week birth control pills + 6 weeks to build lining back up).

And, um, that already seems like forever from now, and I cannot even imagine dragging things out until November.

So start now it is. Today is Day 3 of my period and the lupron should arrive tomorrow. Poor Will. My mood hasn't really recovered from the IVF cycle and my sky high estrogen yet - heck, the all-over body rash hasn't even had a chance to go away. I fear that adding lupron to the already surly mix of hormones will result in one grumpy hot-flashy Mo. One who will be not so fun to live with.

At least I can say with confidence that we've been through worse (there's always a silver lining if you look hard enough). I'm trying to get my exercise and eating routine back on track, which should help immensely with mood state and energy levels.

Here goes nothing. To say we are nervous about this transfer doesn't even begin to describe it. But damn I'm ready to get this show on the road already.

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Friday, June 25, 2010

IVF #7: Day 7 blast results


One more blast joined its "siblings" today - a 4BB. And everything shipped out for testing.


So ultimately we've got a total of 7 to work with - same as last cycle. Now if the same number turn out to be normal, we'd be thrilled. But we'll be happy with one or two normals too.

Hopefully in there somewhere is a real live take home baby or two. That's the bottom line. It doesn't matter how many blasts we have or how many normals there are as long as whatever we get sticks and grows and can be delivered and join our family.

Please?

We are so ready to have a family.

Mo

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Thursday, June 24, 2010

IVF 7: Day 6 blast results


I finally heard from the Denver clinic at 7pm EST - and boy do they have timing.

By around 6:30pm, I had given up on them reaching me at the office, forwarded my phone to my cell, and left to attend my work-related cocktail party. The head of my department had just begun introducing the various faculty in my department to the new intern class. She gets to me, says my name and begins a short introduction about my clinical and research work and guess what - THIS EXACT MOMENT is when the Denver clinic finally decides to call. So I'm standing there with a group of like 50 people looking at me and my phone begins ringing. I don't want to walk away, but I'm not about to "reject" the call either....talk about awkward! I ended up turning beet red and walking out hastily to make sure I got to the phone in time.

So anyway...the news...

It's not great.

But it's not completely terrible either.

Out of 18 fertilized embryos,

we have 6 blasts to biopsy. And of those, we were told that one is of "poorer" quality (e.g., grade 3BC), so less likely to make a baby if it turns out to be normal.

The other five were graded as follows (using this blast grading system):

6BA
4BB
3BB
3BB
3AB

There was also one that was a 4CC that was such poor quality they didn't even biopsy it. Basically no inner cellular mass or trophectoderm.

All the remaining embryos are still in culture and they will check on them tomorrow and see what they can salvage of those. At this point, two are early stage blasts (so maybe by tomorrow they'll be ready to biopsy...), three are morulas (which is usually a day 4 embryo) , and two are grade one blasts of poor quality (so probably toast). Four more are still cleavage-stage embryos, which basically means they have arrested.

Phew, follow all that? I'm not sure I did.

More news to come on Friday. Here's hoping the cohort grows a bit, because we need every single chance we can get. Ugh. This is not for the fainthearted.

Mo

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In which my anxiety gets the better of me


Anxious thoughts have begun spinning around in my mind as this week has progressed. They seem to be dividing as fast as my embryos (hopefully) are.

Thoughts like:

What if the embryologists forget to culture my embryos to day 7?

Maybe I should call to remind them.

If I call to remind them, maybe it'll annoy them and then they won't do as good of a job.

But maybe if I don't remind them they'll forget entirely.

Maybe if I call to remind them it'll piss them off so much they'll spit in the petri dish out of spite or something, like a waiter spits in your soup if you're a bad customer.

That's silly! They wouldn't do that, but still, better to not annoy them.

Except that they might forget. What if they forget? (repeat loop, starting with thought #2)


Today is Day 6 after my egg retrieval. Gulp. I am covered in a rash that is either the result of my sky high hormone levels or an adverse reaction to one of the medications I am still taking. Which is unfortunate because I have to go to a work-related rooftop cocktail party in an hour and my chest and neck look like I've been attacked by a swarm of bees. Since it's pretty hot outside, covering up is not so much an option. Despite that, I'm going to wear a light sweater anyway. I don't want to frighten people, for gosh sakes! But anyway, I have bigger issues to worry about.

Like what's going on with my embryos!

I ended up caving and emailing the wonderful genetic counselor earlier today (can we all say reassurance seeking?). And she spoke to the embryology lab on my behalf. I didn't really think they'd spit in the petri dish if I bothered them, but why take the chance?

So the lab told the wonderful genetics counselor that:

(1) They do remember and will culture to Day 7 if needed and

(2) They are working on my embryos RIGHT NOW!!! and will call me by the end of today with an update.

Gulp. Gulp. (breathe) (scratch) Gulp.

Mo

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Wednesday, June 23, 2010

The 100 club

Dear Mo's ovaries,


Congratulations! We'd like to inform you that you've been inducted into the '100 Club', an elite group of those who have produced more than 100 eggs for IVF!

That's right! You probably haven't been counting, but over the last seven IVFs, you've produced 110 eggs!

22 + 11 + 12 + 15 + 6 + 19 + 25 = 110!!

Good work! Boy, we bet you are tired!

Unbelievably, despite your productivity, you haven't created a single live baby, but maybe one will be coming later this year. You never know! And hey, you seem to be getting closer than you ever have, so chin up!

100 is a momentous IVF retrieval milestone. In recognition of this accomplishment, we here at Egg Retrieval Clearinghouse recommend that you go out and celebrate big time. Your laminated Certificate of Achievement will be arriving separately in the mail.

Congratulations, Mo's ovaries!!! You two are champs!

Sincerely,

Egg Retrieval Clearinghouse, Ltd.


Tuesday, June 22, 2010

Day 3 report


I finally reached one of the embryology elves on the phone today and got an update, although they were a little vague on the details. These folks are hard to pin down this time around!

Apparently 17 of the 18 embryos that fertilized are still in the running and "most of those" (??) are 6-8 cells and grade 3+ to 4 grade quality. Four are less good quality (3 or 3- grade). The embryologist I spoke to didn't say how many of the embryos are less than 6 cells (but hopefully not many!)

None of the three immature embryos matured in vitro. Which I wouldn't care so much about except that in IVF #6, our one blast that came from an in vitro matured egg was our "most" normally developing, chromosomally normal embryo, so I was really rooting for those immature ones. Ah well.

Next info will come on Friday (day 7), when things are all over. Gulp. They promised me they will try to culture to day 7 if the embryos aren't at blast stage yet but are still dividing. Here's hoping they remember!

This is where the waiting gets harder for me. Our embryos tend to look great at the day 3 stage and then fall off a cliff between day 3 and day 5-6.

I will try to remain in my zen place. Nothing to do now except wait. Wait and hope for the best.


Anxiously,

Mo


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Monday, June 21, 2010

No news is no news


No word from the embryology lab on our day 3 update, despite a call to try to stir up some news (so much for the "big note" on my chart!).

Hmmmph. They must be busy working or something.

Hopefully we'll hear word tomorrow on how the Denver 18 are faring.

Divide well, my little ones.

In hyperstimulation news, I think things are under control with all the preventive measures being taken, although I feel pretty crummy, I have to say. Bloated, uncomfortable, and downright exhausted. This will pass quickly, though, I'm sure.

I keep having the thought that Will and I have done our part in all this, given it everything we've got. There's a big feeling of peace in this. And the sense that having put in everything we've got, now we can lie back a bit, let my body heal, and let the lab work its magic.

Ms. Moxie comes back tonight from her training/boarding place. She has been thoroughly missed and it will be great to have her home. Nothing better than having a warm boxer puppy nuzzle up against a tender post-retrieval stomach. A warm boxer puppy does a body good.

Mo

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Saturday, June 19, 2010

Fertilization report: IVF #7


Thanks for all of your well wishes on our retrieval. We were thrilled, just thrilled at the news, and we really appreciated your excitement on our behalf.

We started this morning off with another ultrasound. With my E2 at 7,300 the day before retrieval, they were worried I would have fluid accumulating in my abdomen from OHSS. All looked good so far. To try to stave off OHSS, they have me drinking lots of fluid, taking in lots of salt, continuing Centrotide shots for five days (this is pricey without insurance!) as well as taking vaginal Cabergoline (a dopamine agonist), which apparently is being tested in phase III trials for its potential ability to reduce OHSS incidence/severity.

After the ultrasound at 7am (ouch!), we did some sightseeing and when we got back to the room, I was one tired Mo and promptly fell dead asleep until Will woke me up just a bit ago and said no more napping. I think I could have slept for hours more.

We heard from the embryology lab this morning around 11:00AM. And so far, the news is very good. The Denver clinic seems to keep on delivering for us. Keep it coming!

As you know, yesterday we had 25 eggs retrieved (an all-time record that beats our first IVF cycle yield of 22 -three years ago - by a comfortable margin).

Today we found out that of the 25 eggs retrieved, 22 were mature.

And of those, 18 fertilized!!! Which we think is awesome news! They used ICSI and the embryologists seemed to think one more might fertilize from the bunch...not sure why it's lagging. Eighteen fertilized is also a record for us. The most we had previously was Denver's last cycle (#6), in which we had 16 fertilize.

At my request, the lab were still watching the three immature eggs and if any matured would be attempting day 2 ICSI on them (they said that would happen around 2pm today, so fingers crossed that one egg or a couple more matured).

The embryologist shared that there is a "big note" on my chart that said to attempt in vitro maturation on all immature eggs, to call me on day 3 with an update (something the Denver clinic isn't routinely doing for microarray patients anymore), and to try to culture to day 7 for blasts if need be. I love this place. I love that they get it, that all of our normal blasts wouldn't exist except for their willingness to mature in vitro and culture to day 7. I know it is extra work for them, and highly appreciate their willingness to go the extra mile.

So we've cleared a few hurdles already: retrieval (phew!) and fertilization (double phew!).

Next status update on this cycle will be Monday for the day 3 report. We'll see how our 18 little guys (18!!!) are doing at that point.

Still feeling pretty weary. But happy. Definitely lots of happy here in the Mo and Will hotel room. We fly home tomorrow. It will be good to get back to New York.

So far everything is going as well as we could have hoped. We are so grateful.


Mo

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Friday, June 18, 2010

Thursday, June 17, 2010

Never a dull moment around here


Above is a view of my bedside table here at the hotel, a little sneak peak at what Mo is reading. It's not a bad read really, fairly clear and not talking down so much to the readers, which is a little unusual in the fertility book arena. After everything we've been through and my exhaustive research tendencies, we know 99% of what's in its pages, but there's an occasional nugget of new information. I didn't mean to pack it but somehow it ended up in my backpack, so seemed right to give it a brief perusal before our most likely final IVF cycle.

Despite the calmness implied by the picture above, today felt like a bit of a roller coaster. The day started off with a dramatic "IVF physical" (whatever that is), in which a nurse practitioner freaked out that I had cancer 11 years ago and have had a cough for a few weeks (it MUST be a recurrence! not) and threatened to cancel the retrieval unless I got a chest X-ray. Which I was really opposed to doing for three reasons:

(1) I've had more than 30 CT scans and PET scans (can we all say five miscarriages and more radiation exposure than a Hiroshima survivor - no joke)

(2) right now, after the HCG trigger, is when the eggs shed their extra set of chromosomes going from 46 to 23, and this is when many sequencing errors occur, so the LAST thing I want to do is add even a miniscule amount of radiation to this already tricky mix, and

(3) a chest X-ray isn't going to show anything anyway, so it's just pointless.

After much anxiety and handwringing, around 4:30pm, we finally heard from the nurse that we're good to go. Phew. Big drama for nothing.

The only other news is that despite coasting for a day and taking two shots of Centrotide, my estrogen has shot back up to 7,300. The nurse said she was checking with Dr. Schl. to see if I need more medication prior to or after the retrieval to deal with hyperstimulation issues. Fine, whatever. Not worried about that, as long as the retrieval goes forward.

"We expect to get a lot of eggs tomorrow," the nurse said to me.

God, I hope so.

And may all be quiet until then.

Mo

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Wednesday, June 16, 2010

Triggering tonight


with retrieval set for Friday.

Ultrasound this morning showed bunches of follicles all jammed up against each other. The ultrasound tech asked how I'm feeling and I just said fine. So then she said, "Aren't you sore? Don't you feel bloated?" Well, matter of fact, yes I do, but didn't think to mention it really. She seemed surprised by my blase attitude about the discomfort. In my book, the ovarian discomfort is a good thing. I'll take it, hands down, no complaints.

Will and I spent the day in Boulder and the surrounding area, hiking in the foothills in Chautauqua Park and dining at a great Northern Italian restaurant called Frasca. Their chefs trained at French Laundry in Napa Valley. Mmmmmmm....Off to bed early with HCG scheduled for tonight at midnight. IVF physical and bloodwork tomorrow but otherwise a low-key day medically.

This is it. No turning back now. Oh, please let all of this be worth it.

Mo

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