IVF#4 Follicle Check #3 (day 10 of stimming)

Woke up this morning to a layer of ice all over the streets and car. By the time we had to leave for the trip to our RE it got better but I was pretty nervous about travel on the road. Thankfully it was good there and back home. Check up went ok, was disappointed that it seems I have less follicles then in the past and my RE wants to go a extra 2 days to let the one's I do have grow more. Thankfully a follower of my blog was kind enough to send me two LH shots or I'd be sunk as I did not have enough meds to go 2 - 3 more days. So thank you so much for that. My RE reminded me I am also 2 yrs older and 40 now so for my age I am doing well. I just worry that with 1 out of 6 embryo's for someone of my age only being normal we won't have enough follicles to get to that 1 good one. Talked a bit about how many to transfer still up in the air will have to see how they fertilize and how many get to blasts this time around. We still have our two frozen as back up.

Numbers for Today:
Estrogen 732.2
Progesterone 0.94
Right Follicles - 18.24, 17.37, 16.92, 14.62, 12.26, 10.66
Left Follicles - 17.4, 17.12, 16.6, 16.4, 15.23, 15.23, 14.15, 12.93, 11.05

I was told when I started IVF that we would be using Lupron to trigger and they would be giving it to me didn't need a prescription for trigger, then they mentioned using Ovidrel the other day now. I figured no problem I got two shots in the fridge. I just checked my two shots expired on 7/2013. I emailed them tonight to tell them and it's too late to get them thru my mail pharmacy and I don't know if I can get them at a local pharmacy now or not. Talk about stress right now not having meds I need. Now I just hope we can get a trigger shot in time. Mad at myself for not checking expiration dates sooner this week but then I didn't think I 'd need them either. UGH!

We go back Sunday for next follicle and blood check and then from there he thinks we will be a go for ER on Christmas Eve day now. I know my dh was not happy about that as we had planned for Sunday or Monday at the latest and his side of the family all gets together on the 24th this year for the Holidays. I told him I will just have to go anyway that ER is usually early in the morning and your out by noon or so and I can just sleep the 4hrs trip to his Mom's and will do my best to do Christmas and survive somehow. We have not told his side we are doing a IVF cycle and don't feel the need to. It will be difficult for me for sure going from surgery to yay it's Christmas when I will probably be tired, sore and want nothing to do but be in bed. I wish it had not timed out this way but it did and not much I can do but go with the flow and pray God provided the strength to get through.

I am pretty much exhausted. I have Sat. to recover from all the trips this week and plan on wrapping up Christmas gifts, catching up on laundry and maybe do a bit of cleaning but overall I need to just sleep!

Isaiah 40:31 Amplified Bible (AMP)
31 But those who wait for the Lord [who expect, look for, and hope in Him] shall change and renew their strength and power; they shall lift their wings and mount up [close to God] as eagles [mount up to the sun]; they shall run and not be weary, they shall walk and not faint or become tired.

12/21 Search for a Trigger Shot:

Took us ALL DAY but I got the two shots - we had to drive an hour to a Costco only place with them. Insurance would not cover it cause I didn't get pre-auth for it so I had to pay over $200 for them - I am so upset that I cost us money for meds and gas we did not have.

Finally getting to sit down and I am so tired I can't see straight and am feeling dizzy but I have to do bills and a few other things that I did not get done today cause of this situation.

Snow storm rolling in tonight so getting to the clinic in the morning is going to be a challenge, talked to them today and they said if for some reason we just can't to call and they will try to figure out a plan of action, will this all timed and being this close to ER time it may mess everything up, so please pray that we get there and home safe. Will take our Jeep so that will help some with 5-9inch of snow but it's still a long way from us to the RE and back. Scott figures we will have to leave here by 6am at the latest to give us enough time to go slow there.

Honestly can't handle much more. I kept getting told this week all in God's timing and I am like well if his timing is not now then it's not going to happen for us, we don't have anymore resources to keep going and I am burned out. All I've wanted is to be a mom for so long that to hit the end with very slim chance of this IVF working and trying to cope with the emotions of having to move on if it don't is bringing me to a all time low.

IVF#4 Intralipids - Blood Flow Ultrasound RI Visit

Two Long days in a row and still more to go till transfer day. Yesterday we went to Coram Infusions so I could get my Intralipids IV done. Takes around 2 to 2 /12hrs plus travel. It went well no side effects or anything. Now it can go to work and start lowering my NK Killer Cells in anticipation of transfer day.

Today was my Blood Flow Ultrasound and follow up with Dr. Kwak-Kim's office. Took us 10hrs to go there, do my apt and get home. I am so tired of being in the car. 

Doing a load of laundry and relaxing for a bit then off to bed to be up early for another trip to the RE on Friday. Only issue is ice or snow is coming tonight now into this weekend so could be bad roads for traveling kinda nervous about that. Should be RE tomorrow then Sun then egg retrieval Monday depending on what they find tomorrow.

My apt today went great, my lining is already over 9.28 and it's never been that thick when they u/s me there, also nice 3 layer, no cysts nothing all clear, blood flow was 57 needs to be under 60 so it's still good, blood flow in zone 2 too. Went over meds will up my predisone after ER to 30mg and 2 Lovenox a day after Transfer. If or I should say when this one works I have to come back as soon as I can for a blood flow u/s to keep a eye on it make sure it's still in normal range. They didn't count follicles left that for my RE but she said there is quite a few on each side.

Feel a little more hopeful with such a good report from them today. :)

IVF#4 Follicle Check #2 (day 7 stimming)

Ultrasound and Blood work this morning. Had some follicle growth to start to measure today. My lining looked excellent it had a really nice 3 stripe layer going on which was missing in my FET's. I did get concerned when they mentioned we need to keep my progesterone under 2 and if over 2 on next check on Friday they would suggest freezing embryo's and doing a FET later. I kinda looked at them and was like we can't afford to go into Jan. Only reason we are doing this IVF is cause we could get it in this year and not go into a new deduct etc. It's like I understand freezing methods are better and they also talked and came up with a better FET plan for me going without Lupron and having me cycle where I would ovulate and use more of my natural hormones instead but I need to get to transfer this cycle this month we are so tapped out right now I can't see us coming up with another $6800 and travel to go again next year. Got really worried now about this all working out for us.

*My progesterone on my other IVF's 2yrs ago first one was above 2 it was 3.30, second one was 1.72, third IVF was 2.07on trigger day.

IVF#4
Left side follicles: 13.34, 12.82, 12.08, 11.76, 11.64, 11.08 < 10mm 0 to 2  
Right side follicles: 13.94, 12.58, 12.34, 10.14 < 10mm 0 to 2

Estrogen
IVF#4 - 316.3
Progesterone
IVF#4 - 0.69

This was my follicles on Day 7 from my other 3 cycles and my blood work. Is interesting to compare them. Not sure we will get as many eggs this time around will have to see.

Follicles
On Day 7
IVF#3
L - 14.75, 12.7, 12.22, 10.54 < 10mm 3 to 4
R - 13.24, 12.94, 12.57, 12.12, 12.05, 11.98, 11.27 < 10mm 5 to 7
IVF#2
L - 15.68, 13.92, 13.88, 13.58, 13.54, 12.49 < 10mm 3 to 4
R - 15, 13.74, 12.57, 12.36 < 10mm 5 to 7
IVF#1
L - < 10mm 5 to 7
R - 10.09 < 10mm 5 to 7

Blood work Day 7 
Estrogen
IVF#3 on day 7 - 147.5
IVF#2 on day 7 - 643.4
IVF#1 on day 7 - 200.6

Prayer request is that my progesterone stays below 2 and we get to transfer day with some good embryo's.

Plan for the rest of this week's IVF is Intralipids IV on Wed. Thurs. I have a apt. with my RI Dr. Kwak-Kim for a blood flow ultrasound but the weather is not looking good for that day snow, icy mix is forecast, not sure if we will make it to my apt. which sucks as I really need to know their opinion and if the Lovenox is doing the job. Hope the weather changes so we can make the 3hr one way trip there and home safe. Friday is my apt. with my RE for follicle check again and talk about when to trigger, egg retrieval. I did ask if we where going to use Lupron or the two Ovidril shots I have and sounds like we may go with the two Ovidril will know more next apt.

Stimming is going ok. I am starting to get really sore. Every bump on the road to the RE and cough or jerk I can feel my ovaries like they are going to explode already and I still have a few more days to go. Almost forgot how this felt and the over tiredness of it all. Have not had much time to get in extra sleep with getting ready for the holidays, running HBW and doing orders and taking care of my dh from his surgery. We had his second follow up apt today and he's doing well but still a ways to go for his shoulder to heal. Need to get some rest tomorrow in between wrapping gifts and house cleaning want to finish that as I know by this weekend I won't want to move with these follicles getting larger. I am sure I will be so ready to get the eggs out by this weekend. ER is looking to be Sun or Mon estimated so far. Nervous about that part going thru it all again and feeling ok to still see family for Christmas Eve. We have not really told anyone we are doing IVF again feel like it's just better to keep it to ourselves we get to may questions etc. so hope I feel up to traveling the day after ER or not sure what we will do.

Well will update again after Intralipids. Got a movie to watch for the 2hrs of sitting there on Wed.

Continued prayers that God finally blesses us!

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*Doing some research on why progesterone levels need to be lower before trigger as this is the first I've heard of it today:

1. The progesterone level needs to be below 1.5 (1.7-2 depending on the lab) before trigger (or ovulation). When you trigger (or ovulate in the natural cycle) the corpus luteum (or the follicle in the ovary) will start to produce progesterone. This progesterone tells the uterus to get ready and within 3 days it will be ready for an embryo to implant. There is really only a small 3 or 4 day window there for the environment in the uterus to be perfect! Higher amount of progesterone exposure to the uterus too early make for an undesirable environment for embryos to implant during a fresh cycle.

2. Progesterone is the hormone that creates the chemical balance in the uterus that makes it the perfect environment for implantation. You do need progesterone, but you need it only a certain amount and certain times.

You do need progesterone, but you need it only a certain amount and certain times. It is a bit confusing to read about progesterone level on the internet, because most places are from the US where they use the old British units and the levels are totally different from the Canadian numbers , where the SI metric system used. ( 1 ng/ml =3.18 nmol/L)
This is the normal ranges:

follicular phase (before ovulation) below 5.0 nmol/l in Canada( <1.5 or 2 ng/ml US)
luteral phase (after ovulation) between 15.00 and 90.00 nmol/l inCanada ( or between 2 and 28 ng/ml in the US)
1st trimester : 30-150 nmol/l in Canada ( or 9-48 ng/ml in the US) ( Here 1st trimester really refer to the time after you have your missed period)
2nd trimester: 50-450 nmol/ l in Canada ( 47-147 ng/ml in the Us)
3rd trimester: 175- 650 nmol/ l in Canada ( 55-200 ng/ml in the US)

Practically progesterone should drop almost to close to zero when the uterine lining sheds and you get your period. On the baseline (CD3) and during the stimulation it should be below 5 ( very often US sites refer to be below 2, but because of the different units used). Normally when we ovulate a single follicle release an egg and the follicle became a so called corpus luteum, which starts to produce progesterone at that point. Progesterone level increases at a fixed level per day ~ 2-5 nmol/ l. Normally progesterone is not produced before ovulation, and this timing ensures the perfect level at the time of implantation. Around 1 week after the ovulation the progesterone level peaks, and start to drop unless implantation occurred. When it drops to a very low level as a response the uterine lining shreads and you get your period. When implantation occurs the body keeps producing progesterone. 

During IVF women often get extra progesterone support, because the stimulation can mess up things and you may or may not produce enough progesterone on your own. Usually this level won't be too high even with the added support, UNLESS you already have high level before ovulation.

Usually the too low level of progesterone is the problem. If the progesterone is not high enough the lining starts to deteriorate and the women may miscarry.

3. ARTICLE 

IVF#4 Follicle Check #1

Today is cycle day 5. AF is still hanging around some which normally is gone by now but maybe due to taking the provera this time around.

First Follicle check this morning. Left side had around 11 and right side around 7 under 10mm follicles so around 18 total so far. Dr. said I am responding well again to stimulation. My estrogen rose from 45.8 to 86.7 and progesterone of 0.25 all good. My TSH was well under to was like .7 so that also is great.

Continuing with 450IU of Follistim at night, 1 Centrotide and/or Ganirelix shot in the morning, and 1 Lovenox 40mg at night along with the rest of my supplements etc.

Next Follicle check is Monday, then probally Thurs then Sat. estimated egg retrieval for the 23rd and transfer on the 27th.

I go Wed. Dec. 18 to Milwaukee Corum Infusions to do my Intralipids IV and then Thurs. Dec. 19th to Chicago to see Dr. Kwak-Kim and do the blood flow ultrasound, blood work, follow up etc.

I've been feeling pretty good so far, just the normal bloating and pressure is starting in and very tired, few mild headaches all to be expected. I almost feel like doing a fresh IVF is less stressful than a FET. It goes faster too less waiting time from start to transfer.

Giving it all I got and trying to remain hopeful.

(1 in 6 embryo's in a 40 year old are chromosomal normal - 35% chance mc - makes me wonder if we even have a chance - also makes me think about how many we should transfer in the past we have done 3 maybe we need to do more than 3)
Great Video on IVF

IVF#4 Baseline

Baseline visit today. Trial transfer followed by ultrasound. All looked good. Blood taking was not fun I don't know why but they always struggle to take my blood in one poke, took 3 this time. :(

Estrogen is at 45 so we are good to start. Did my cetrotide shot earlier today then follistim 450IU and lovenox shots tonight. Didn't know if I would remember how to do the follistim pen but it all came back once I got it out and ready to go.

Hard part is remembering I now need to drink 3-4 liters of fluids to help while stimming and to up my protein intake next 12 days.

Friday morning I go back for first follicle check so we will see how it goes hopefully we will have some activity by then.

Never heard back from Dr. K to see if she would still monitor me even though I did not get down to IL this time. Think for now I am on my own. May have to go to my family Dr. and do my thyroid and chem panel next week if she does not reply. 

Other than that was a pretty normal day for also being my 40th Birthday. Spent the afternoon with my hubby watched Despicable Me 2 and he made dinner and got me a cake. :)

IVF #4 BEGINS :)

AF is finally here. Showed up this afternoon. Called the clinic and set up baseline for tomorrow morning. Think AF is going to be nasty this time around, been sick since yesterday, nausea, diarrhea, sure the provera is going to clean me out. I don't like doing baseline while you have AF that part is uncomfortable but I am SO HAPPY we can get things going. And tomorrow is my 40th Birthday too IVF#4 here we go.

Have to go this cycle without the PGD testing as it was denied and my insurance denied 5 more cetrotide so we will have to mix cetrotide the 7 they allowed me and the 5 ganirelix I already have. But at least we can get this all in before the 31st so only out of pocket is to freeze any embryo's that make it to day 6 and of course gas travel to the RE etc. Hope I can do a few acupuncture too this time around will have to see what the budget allows.

Looking at estimated er on Dec. 23rd and estimated transfer on Dec. 27th. Tomorrow if baseline is good, I will start in on Lovenox blood thinner, Follistim for stimming (makes the eggs), and one of the LH shots (prevents ovulation), and up my predisone to 20mg. Already on baby aspirin and tons of supplements yet. Doing intralipids IV again this cycle getting that set up for a week from now. 

Not sure if I am ready for this all again it's a lot to go through just for a chance but I know if we don't try we never know if it will work. Thankful my husband can drive some now after his shoulder surgery cause I don't do so good in WI snow and him being off work we don't have to worry about that part. 

Well everyone wish me luck and keep me in prayer this is our last shot at this. Praying this is it!

Still waiting for AF

CD 30 and Day 10 of taking Provera, no sign of my period yet. Still waiting. With the PGD testing denied feeling pretty hopeless that this IVF will even work, no way to know now if any of the embryo's we make are any good. Don't get why nothing works out in our favor. Been a struggle and fight to get my IVF medications. I had plenty of Follistim left but I needed the medication that prevents ovulation while stimming. My insurance changed how they do things and I had to go through a whole process of pre-authorization got that all done and then the insurance nurse will only approve 7 of the 12 cetrotide shots when I need 12, to get 5 more I have to do the pre-auth all over again. It's like daily calls between my insurance and my clinic to get this done all before my period. It's been beyond stressful and hard to not get depressed right now. Dealing with infertility is hard enough without also fighting your insurance for coverage. Tired of it all, really feeling like even though I push and fight to get another chance that it won't work for us anyway.