Wednesday, October 31, 2012

Day 12 scan results

First...I'm utterly blown away by what Sandy has wrought. It hits very close to home because had I still been in back in the US, I would have been at the epicenter of this clusterf*uck-  lets just say the building I lived and worked in has featured prominently in the news and a lot of my colleagues and friends have lost years of work. I was also reading about many, many women who had retrievals scheduled early this week--I really hope to god their clinics managed to make it happen. 

I'm thinking about all the people who lived in NYC/NJ area--I hope you all stayed safe, with your homes intact, and hopefully, managed to keep power. 

At my end of things, its looking slightly better, but definitely getting harder and harder to predict.  On day 12, I had my 3rd follie scan and  first E2 check. My estradiol levels were 2200 pg/ml, but since we are not testing regularly, it does not tell us much. maybe another version of me would have wanted more information and regular testing but right now, I'm content to wait till retrieval to see what will happen.

I had around 6 follicles so huge my RE did not know what to make of them---in the 18-25 mm range and a bunch of smaller follicles around 10-15 mm range. I have asynchronous follicle growth, with 2 groups, in other words, and my doc was not happy about that.  I'm going to be kept on my meds till day 14, with a trigger on day 15, with a hope of making some of the little guys grow.

I'm refusing to make a call of whether we should do the biopsy and CGH  microarray untill I have some inclination of  many Day 3 embryos I will end up with. 

But right now, I'm in pain. I've responded a little better (big maybe) to the menagon, which I restarted on day 9, but its turning my body into one big ache, whether given IM or SC.  I have to be reacting to a component in its preparation- the pain begins around 5 hours after the injection and settles into a deep sore ache which  has not gone away yet, even from my injections over 3 days ago.  My respect for the people who take shots, from time of IVF and continue taking them for months, with the PIO and the heparin, is now immense. It takes giant balls--I take my hat off to y'all!

Sunday, October 28, 2012

CD 9 follie scan---MEH

I started out with 6 AFC on my right ovary--on CD9,  3 of these are appropriate size,synched up follicles and another 3 are giant (around 18 mm), looking like cysts. In my left ovary, out of 7 available AFC, only 3 are growing (correct size, synched up), one is a straggler, and nothing happening with the other 3. Its interesting-  at least 2 of my  3 pregnancies have come from my left ovary. The one time I failed to get knocked up, it was my right ovary in play.

Overall, this leaves me staring at 6 possible follicles which could yield eggs.  I'd go get a drink (or several), but there is no chance of that till egg collection, at which point I'm done for this cycle(YAY!). I'm coming really close to being called a poor responder (I looked up the definition, they also factor in estrogen production). I've been having mad EWCM since CD7, so hopefully, my E2 levels will not be shabby. Oh, please dear god, please.

The only thing I got a gold star on was something that will not even be in play, apparently, my lining (like every other time I've been examined by the dildo cam), was gorgeous. I'm like a shitty egg donor candidate, but with amazing surrogate potential, atleast till implantation point. Oh, the bloody irony.

I have not written this off yet---there is every flavor of IVF I've read about. The ones where you get a gzillion eggs and inexplicably end up with like 3 good embryos, the ones where you get 4 eggs and end up with the same, and then there are the perfect ones who make like 25 eggs and end up with like 10-15 freezable embryos. Right now, I'm hoping and praying with everything I've got that if I do end up with 4-6 eggs (super likely), they are atleast decent quality.

Surprisingly, I have not gone all gloom and doom--- I'm more like, MEH, whatever happens, happens. My doc asked me how I was doing and I told him I'm comfortably numb- which really is true. I should be more upset about all of this, but I can't bring myself to be, and that is a good thing, right? Why get upset about something you have zero control over?

My meds doses have been increased- I'm back to menagon  now since I was doing not so swimmingly with the Gonal-F equivalent (Brand name here is Foligraf). Problem with menagon, no matter how you give it(SC or IM)- the injection site keeps hurting. Otherwise, other than heartburn, I'm mostly fine. Aanybody have heartburn with IVF? Mine responds well to drugs, but I really hate taking them, given that I'm always illogically nervous about what they may do to my 6 precious possible eggs. But right now, ranitidine and Omeprazole are lifesavers.

Also---I'm just hearing about Sandy- stay safe, all my east coast friends!

Tuesday, October 23, 2012

IVF # 1---Not off to the most stellar of starts.

I'm on day 5 of my cycle and I had my first follie scan yesterday. It wasn't something that made anybody jump up and down with joy, my AFC was 13.

2 years ago, my AFC was 30 and above. Then I discovered I was vitamin D deficient and I started supplementing, which pushed my AMH considerably. But last year, I had already noted that my AFC had fallen, to around 16, and I also discussed the possible relevance and possible mechanism behind this drop in this post.

Back then, when I was not planning IVF, this was nothing to be bummed about-- I had assumed that my super high AFC for my age reflected my PCOSiness and any deviation from this was a GOOD thing- I thought, maybe decreased quantity might go hand in hand with improved quality, given the finding that women with PCOS have high AFC and can make many, many eggs, often of crappy quality. But since then, I've had one failure to achieve clinical pregnancy and another loss due to aneuploidy, so ummm, it does not look like things have gotten better???

Now that I'm staring IVF in the face, an AFC of 13 is 'not good news', especially when you've come from a much higher number--- it reflects a decreased potential, the best one could hope for is 13 eggs, and in reality you will get less, and you will have fewer than that number fertilize and even fewer that keep going till day 5.

My RE was pretty upset, he still had my AFC of two years ago in his head. While I'd gone in with a daydream of around 20, realistically, I knew I was going to get something in the vicinity of 16, and moreover, I was aware that the metformin I was taking could drop the numbers a touch-- there are a few studies that show that metformin can reduce AFC. So no surprises for me.

I started laughing when my RE finished the scan and he was shocked by my reaction-- he asked me why I was laughing-- I remember thinking it was a preferable reaction to crying.

The scariest part is, I really may have to give up on doing CGH microarray if we get only a few embryos that go past day 3,  for anybody who has done this- how many embryos did you have? My RE puts the cutoff number as 10, and that is a really tall order with an AFC of 13.

This presents so many dilemmas- if I can't do screening--then what? I don't know what percentage of my embies would be aneuploid, and its a very, very scary place to be in, for somebody who has lived with RPL.
Most people get around this by transferring multiple embryos---I really am terrified about transferring 2 embryos and the higher risk pregnancy of twins and the many, many higher risk scenarios that could occur.

Ironically, my number of 13 is in normal range for an Indian woman of 32, according to my RE. I've somebody who is SUCH a grey zone fertility-wise-- I've gotten pregnant out of 3 out of  4 attempts, by nothing more than un-medicated IUIs, which would make one think I'm a fertile frickin bunny till you realize I've managed to lose all of them.Then my AFC is all over the place--does my drop from 30 to 13  have nothing to do with weird vitamin D physiology and instead indicate a sharp drop in fertility?? I have no idea how I'll respond to superovulation inducers...and things have gotten off to a not good start.

Another thing that is an area of contention for me: My RE wanted me to try menagon (which is urine-extracted FSH with a little LH). I freaked out when it was given IM, and indeed, when I took it for the first time, 24 hours later, I still have injection site soreness. So instead my RE said I could take an equivalent of Gonal F(synthetic FSH), no LH, which is given subcutaneously, which was what I was looking for, being a wimp and all. I took that today, I tolerated it fine-- only thing I'm worried about, there is no LH. Here is a theory that some, but not all docs believe in, that a little LH makes follicle development better so they give Gonal F with luveris(synthetic LH). I'm wondering if I should ask for this, for my own peace of mind if nothing else....any opinions anybody?

Monday, October 8, 2012

Questions on IVF and supplements (updated at the end)

I begin IVF in roughly 10 days, on CD1.  I was going to take the CCRM cocktail (see below). This was the list I got by googling.

Folic Acid 5mg 
Myo Inositol, 2 grams, twice daily
Melatonin, 3 mg, bedtime
CoEnzyme Q10, 200 mg, twice daily
L-Arginine, 1000 mg, twice daily

Note: the original posted list also included DHEA for poor responders, which I'm refraining from, since my natural DHEAS levels are super high.

I'm already taking the folic acid, but I'm fuzzy on when to begin the rest. I know people are prescribed different IVF protocols, that complicates it even more.

Slightly veering off point: I've been trying to understand how lupron (GnRH agonist) is used, and my understanding is what you can achieve with it depends on the timing and duration of administration. If anybody wants to take a stab at explanation of the different ways in which lupron can be used in IVF, go for it!Also, if anybody knows of a good website/resource that explains the different IVF protocols available and what they can do, and who they are tailored for, that would be AWESOME. I've been confused by what I found, and that is rare for me!

In my case: I start Lupron from CD1-3, then followed by menagon (FSH with a dash of LH) from CD3-9, and eggs will be harvested a few days later, if all goes well.  Can anybody tell me what this protocol is called? Is it the micro flare?

I'm planning to start my cocktail on CD1. Should I be doing it before? If you were a CCRM patient, what instructions were you given?

I'm also being smart (or stupid) in taking a mini-holiday before starting this-- I head off to Singapore and Indonesia this week! And then, the games begin. I'm not really afraid, I'm excited. One way or the other, this is going to tell me a lot about myself, and that is information I really, really want.

Update: It turns out I've asked this question just a little too late, apparently, yes, CCRM does tell you to take melatonin and argenine PRIOR to the IVF, but tells you to stop during the IVF itself (ie, at the time of GNrH agonist administration). I'm confused if the same does hold true for CoQ10, there appear to be a lot of people who have taken it during medicated IUIs---will read up on IVF.

However,  just FYI, I've seen a study where patients which have prescribed melatonin + myo-inositol DURING the IVF itself. So it can be done. The rationale for melatonin is that it can help minimize free radical damage, which is perfectly plausible in theory.

Also, L-argenine administration may be detrimental during the actual ovarian hyperstimulation, according to this study, which makes sense, because it may result in increased nitric oxide (ie a free radical) buildup.

Monday, October 1, 2012

"You are hell bent on ruining your life"

I've been hearing a lot of that lately. Its coming from my mom and dad, when they talk about my insistence to have a baby as a single mom, and raising that child all by myself.

We've been doing the arranged marriage circuit(since I'm still open to either the Plan A or Plan B route of family building). We flew down to City X and met a guy my entire family literally drooled over- highly respected, very rich, very accomplished. and capable. I liked him too, he was nice, kind and easy to talk to. But I was not attracted to him in the slightest and he wanted to live in India, which, definitely, is not something I want to do for the rest of my life. I said nay, and basically, got the "You are hell-bent on ruining your life" spiel.

Its not like single mothers ruin their lives. They do have a difficult time of things though. But that lifestyle is utterly alien and terrifying to my parents. I can't even begin to convince my parents that everything will be ok, if I go that route because life comes with no such guarantees.

My parents keep telling me I can easily have it all...a father, grandparents for my baby, a superb support system, everything,while simultaneously reminding me of what I'm robbing my child of, by going the single parent route. Its the old argument, made new again, and I'm getting hit with it constantly. And its not even like I can dispute any of the above-- if I go with plan A, I can still give my child a better life than as a single mom.

But if I just agree to marry just anybody for the sake of avoiding single parenthood, it could end disastrously. My parents are convinced it would not be so, and they are coming from a culture where people married each other with little introduction, and in many cases, built successful marriages based on camaraderie and a mutual respect. It is not enough for me.  But who knows, if I forced myself down this path, it may even end well. 

The good (or bad) news is I can't force myself to marry just for the sake of marrying. And there has been so much arguing just to get me to do just that (as long as I can respect the guy!). Yet, to give my parents credit, they hate what I'm doing, but are helping me with it nonetheless.

Right now, its this cauldron of guilt, fear and whatifs I'm swimming in. I don't know what I should do, but I know what feels wrong--- I'm steering clear of that. But its not easy at all.