IVF#4 Embryo Update 2 (3DPER)

Was a nice day. Went and got a haircut as mine was getting kinda long. My regular lady is out so I had another one not sure if I like how she cut it lol. Then I went and had another Intralipids IV infusion done to keep my NK killer cells lowered this afternoon. Doing that took up most of the day by the time we drove to Coram and I sat there while it dripped. Think we arrived at 3pm and left close to 6pm. I am glad I went and had a second one done as with the cycle being pushed a little longer it would of been over 10 days since last lipids and I just was not feeling good about risking my NK killer cells going up before transfer day.

I did get a call from our clinic, was a message when I got home, that we have 11 embryo's of which 8 are still on track to grow to blasts. They didn't tell me much more than that like grades of them. That I don't know yet.

I guess I am at peace about it right now. I know I have done everything possible to make my body ready for transfer treated everything we could and I had prayed that we would have quality over quantity as that was most important so hopefully somewhere in that bunch is our one. Got to let go and let God only he can create life.

Still unsure how many to transfer struggling with that yet? Don't think we will know for sure till Sunday morning when we arrive and we go over how the embryo's are doing which one's look the best. 

One more day to wait, have a long list of chores still to be done so hoping to get to bed and up early to get things done. I am so much more tired while on the PIO shots though it makes it hard to want to do anything but sleep. The one this morning was torture as my hips are already getting sore from them. 

Hopefully the clinic will call again tomorrow for another report on the embryo's and how they are looking.

IVF#4 Embryo Update #1 (2DPER)

Egg Retrieval was 2 days ago now. Did not hear from my clinic yesterday but figured it was cause of the holidays. Was getting worried felt in my gut maybe things did not go so well. RE just called. Out of 29 eggs only 10 where mature and only 8 fertilized and are growing. The 8 we got look good but he wanted to know if I wanted to do transfer tomorrow or wait till Sat. for a 5-day. Said it was up to me as their protocol is 8 or less they may do a day 3 instead of a day 5. Also said it was probably due to my age lack of mature eggs. Don't know if it's that or what happened? Can't help but wonder if we missed something with my stimming plan.

I said we would wait as it does not make sense to transfer unless they grow to day 5 to see which one's are going to be the best. We do still have 2 frozen as back up so if nothing else we transfer those 2 if they un-thaw ok or we transfer a combination of those 2 frozen and 2 fresh?

Just really bummed out right now. They will call tomorrow and update me on how the 8 we got are doing, a lot can happen between now and tomorrow, they can keep growing or we can lose some or all of them. 

This IVF is our last shot at becoming parents so if it does not work that's it. I can't help but feel it is not going to work, my RE just didn't sound that hopeful to me on the phone. Scared, nervous, upset, anxious all rolled up in one. Lord please keep those 8 embryo's growing and dividing and make it to day 5 and be of good quality!

Right now transfer is planned for Sunday morning at 7:30am which means we will have to be there at 6:30am. Also looks like the other RE is going to do the transfer not my normal RE. 

IVF Cycle Comparisons:

#1 Cycle: 32 eggs - 20 fertilized and were mature - Day 5 Transfer of 1 full blastocyst and 1 almost. 2 blastocysts on day 6 frozen - Results: Chemical pregnancy/miscarriage

#2 Cycle: 18 eggs - 14 where mature and I think it was like 10-12 that fertilized - Day 5 transfer 3 almost blastocysts transferred on day 5 - none made it to day 6 to freeze - Results:BFN

#3 Cycle: 28 eggs - 20 mature  and fertilized - Day 5 transfer of 3 blastocysts 2 where expanded and 1 full  - Froze 5 on day 6 - Results: Chemical Pregnancy/miscarriage 

#4 Cycle: 29 eggs - 10 mature and only 8 fertilized

IVF#4 Retrieval Day

Finally made it to retrieval day. Was a little behind getting out the door this morning to the clinic as I also had to get things packed and in the car for also going up north to see my husbands family for Christmas Eve get-together. But we got there on time even a little early at 8am. The got me set up in my room and changed, IV in. My husband didn't come back till later they had him wait in the waiting room till they where ready for his part then took him to a room for his sample. Wheeled me in the operation room around 9am. Got me set up in the wonderful stirrups that are so fun for my back to be in. They wrap your legs all up and get sterile cloths everywhere. Dr. came in and did my catheter and started sterilizing the area before I was out. I don't think they gave me as much meds in the past as I do remember some things and they said I dozed in and out. I kinda heard them say we got 20 eggs then I think I was out till they where waking me up in my room and saying Scott was coming in. The nurse then told me the lab tech said the final count was 29 eggs, she said when she was looking at them during retrieval many where nice and juicy looking, her words lol. Tomorrow we find out how many where mature, how many fertilized (doing ICSI again). I think my RE was surprised we got so many cause he estimated 16 last ultrasound we did. I don't know if I was as suprised as even though I am now 40 and it's two years since we did a egg retrival all my testing came back well. Our first IVF we had 32 our second 18 and third we had 28 so having 29 with round 4 is great but does not mean much. Over the next 5 days many will not make it that is normal and just how IVF works. Just need to pray that this time the quality of the embryo's is outstanding cause of all the extra things I've done and there is one embryo in there that will stick and stay this time.

After we left the clinic around 10:45am I was starving so we stopped for Chicken for lunch. Then I slept in the car while my dh drove up north to his family we got there in record time and where able to be there before dinner to visit. Just got back to our hotel room around 11pm and it's all hitting me how tired and sore I am . I did drink like 3 liters of smart water and 2 liters of regular water and ate some chips for salt to help head off any issues. I think the meds for putting me under are messing with my tummy some and hope they flush out soon. I can not wait to get on the road tomorrow and get home and in my own bed to rest up for transfer day. This part and waiting for numbers and after transfer are so nerve wracking.

12/25 - Christmas Day 
Never been happier to be home. The hotel last night was hot woke up sweating to death, dh says it's hormones lol as he was freezing. Beautiful Christmas morning with snow falling lightly. I've been suffering since last night with gas pains and constipation from the anesthesia meds really bad bloated up, it sucks. I just took a big glass of prune juice and miralax in hopes it cleans it out and settles this down. Been drinking a ton but it's like I am retaining it so don't know if I should really keep drinking more or what right now. Ate some salt in case that help. I hope we hear from the clinic tomorrow am anxious to know what is going on. I think they called while we where gone today but left no message :( . Kitties where happy we came home, happy to eat too lol. Watching the Bible on history channel and chilling out. Two days to recover and get some house cleaning done before transfer day. So nervous not sure how many to transfer, would be so wonderful if they would get to 5-day expanded or hatching that is the best quality, still thinking about doing 4, this just has to work.

IVF#4 Follicle Check #4 (Trigger Day)

Woke up this morning to a white out of snow everywhere. Think we got  6-8inch. Very thankful we have a Jeep with 4 wheel drive or I don't think we would of made it to the clinic. As it was it took us almost 3hrs in the snow going slow to get there was about 15min late but they understood. Left this morning at 6:00am got home around 11:30am went and had lunch and I came home and passed out for most of the afternoon felt so good to sleep and rest.

Check up today went great. :) After 12 days of stimming (doing shots to stimulate ovaries to produce follicles) we are ready for egg retrieval.

Estrogen
1341.1
Progesterone
1.56
Lining was around 10

Follicles Left: 21.28, 20.92, 19.72, 19.54, 18.39, 17.94, 17.52, 15.18, 14.79, 14.72 < 10mm 5 to 7
Follicles Right: 23.41, 20.07, 19.52, 18.93, 18.9, 12.7 < 10mm 8 to 9

RE said he expects to get at least 16 eggs this time around and thought that was good numbers. I think out of all 4 IVF cycles I have the biggest follicles on the last day before trigger this time. You want them to be over 18 for best maturity.

Progesterone has stayed under two YAY! and estrogen is doing well too didn't get too high. So as long as we have embryo's that fertilize (doing ICSI again) and get to day 5 we will get to transfer fresh one's. I still am undecided on how many to transfer if I want to push it and go with 4 this time around as we know that only 1 in 6 will be normal in someone of my age with PCOS and we could not afford the PGD genetic testing on the embryo's that would of helped us rule out which one's to transfer. Praying on what to do.

Tonight at 10pm I do trigger, two shots of Ovidril HCG 250ug each shot so 500ug total, to help mature and get the eggs ready for retrieval. I did question if that was enough as my BMI is 34 and it suggests online doing 3 shots with BMI over 30? Hoping I won't get too sick from the triggers, in the past I have gotten sever cramps the night of trigger.

IVF hCG Trigger

The hCG trigger injection is one of the most critical parts of the IVF medication protocol. After the eggs have been stimulated to grow and develop, the hCG trigger is the final medication given before the egg retrieval.

The hCG trigger has several functions:

• Induce final maturation of the eggs
• Cause the resumption of meiosis
• Loosen the egg's attachment from the follicle wall
• Allow for the timing of the egg retrieval

Tomorrow I get a break from all shots including the Lovenox as I am to hold that till after surgery. I will be glad to not have to poke myself with something for one day. Although the PIO shots are coming up next and I am not looking forward to having to have my husband poke me in the hip again I hate those shots.

Retrieval will be Tuesday at 9am and my RE thinks we would be out by noon at the latest so we may then drive up north another 4hrs to be at my husbands family get-together on Christmas Eve. I'll just sleep in the car. Tuesday my husband also has to do his thing in a cup, been giving him Fertilaid for men to help his swimmers RE said supplements can't hurt so hope it helps him have some good numbers.

Transfer will probably be Sat. Dec. 28th be a 5-day. Praying now I can make it through egg retrieval the holidays, get some rest, lots of great eggs and embryo's and some good blastocysts. Praying we have the best blastocyst's ever for transfer day.

Medications day of transfer, start in on antibodies for 5 days, Estrace pills 4xday, PIO shots 2CC in the morning and 2 Progesterone Pills at night. I am suppose to hold on the Lovenox and start day of transfer but am nervous about stoping it for that long. My RE said it's ok to do baby aspirin day after egg retrieval already so not sure why my RI said no Lovenox other than they said it's better to not risk bleeding, going to ask my RE see if he has opinion on it if I can start it again day after then stop night before transfer maybe. Just don't want to risk my blood flow going down when it was borderline normal the other day on the shots.

Dear Lord, the pain of infertility is so deep. All of our lives, we dream of being mothers, of raising children with loving hearts to do your will on this earth. Month after month when that dream does not come true, it so painful, Lord. We feel like our dreams die each month with empty arms. Please guide us to trust in your plan for us. We desperately need you in our lives. Thank you for all the blessings we do have, knowing through you all things are possible. Amen

Our view of the snow in WI leaving to the clinic this morning. Thank you Lord for getting us there safe and home today!

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!

-----------

*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