A lone contender

Its been an incredibly tough few days. I'm still not over how my cat died- the violence and the wrongness of it. And I miss her so much-- I've had multiple pets in the past few years- I had a cat when I was a student, and when I moved, I found her a good home and kept tabs on her for a couple of years, but letting go of her, while not easy, was possible.I've lost an another dog and cat which were family pets and while those losses tore me up, it was nothing like this. I never bonded with any other creature the way I bonded with H. I could not imagine parting from her, so I never even considered trying to find her a good home when I left New York, even though bringing her across oceans was not easy, neither for her nor me. In the world of a gzillion cats and dogs, she was special. This is really, really hard.

 Now, to the part I'm sure some of you were wondering about--my IVF cycle. In the end, I only had 4 mature eggs. 3 of these fertilized to form 2PN embryos. One embryo arrested immediately, started up again, arrested at the 4 cell stage and stayed there. The second looked perfect (Grade 'A') on day 3, but started stalling on day 4. The 3rd, met all of its developmental benchmarks perfectly, compacted on day 3, morulated(??) on day 4 and was a 'gorgeous' 3AA blastocyst on Day 5, at which point it was frozen.

So---all that, and I end up with what I would have ended up with in an IUI anyway- one great looking embryo, my sole contender.  Since we had only one, we could not even think about comprehensive genetic screening- we have to transfer this one, and pray. We are currently on the surrogate recruiting portion of this program.

A detailed postmortem of my IVF cycle is badly needed, with all the following questions:
1) Am I a poor responder to superovulation or was it the combination and timing of drugs which was not optimal for my system? On CD9, I had 6 synched up follicles, which, I suspect, gave rise to my 4 M2 and 2 MI eggs.  At that point, we switched to from Foliraf (recombinant FSH) to menagon(Urine extracted FSH + LH), upped the dose of stims, and on paper, based on E2 and follicle size, I responded, but most of what came then were immature eggs. So all of that later stimulation, and waiting for the last follicles to respond, *may* have been futile. .As my doctor said, this is gambling to a extent- we did, and we lost. If we had aimed for just 6, and triggered me sooner, would these 6 eggs have been better?
2)My follicles were probably not synched up, whatever that means. Here is a question for you all- does a long lupron or BCP protocol help? I have to go back and look at my baseline ultrasound, but I remember thinking that the follicles in one of my ovaries (the right one) looked larger, and those just turned out to be cysts. 

Anyhow, all of these are things for the future. I pray I will not have to do another IVF and  my one blastocyst turns into a take home baby, But I have to say, my odds are much, much poorer than I thought they would be at this point. I'm so down, for so many reasons. The unimaginable result of this cycle. The massive fight I've had with somebody close to me that near shattered me yet again, just when I thought I'd started to recover from my poor cat's loss. Issues with living in India-that is what triggered that fight. And still, by far the most painful, the loss of my cat.  This is the roughest time I've had in a while, almost on par with the darkest period in my life, the weeks after my first loss. I have not been able to stop crying for the past 2 days and this morning, just in passing, I thought about anti-depressants. I NEVER think about anti-depressants, not even during the worst times of my life so far, so that was a shocker. But- if nothing more comes along, I will mend and get over this. I'm really praying for some kindness from the universe right now.

A time of horror

I had my retrieval last night. They got 11 eggs, so that did not seem too shabby.

I came home, was given Lyrica by my mom and went straight to sleep. Around 3 am, my parents woke me up. My cat, who likes to hang out in our garden (only at night, she is so contrary), which is gated and fenced, was attacked by feral stray dogs that came in through the gate somebody left slightly ajar. My dogs, who were inside the house started barking and my dad and housekeeper rushed out,chased the dogs away,  to find her mauled and barely alive. They bought her in and 10 minutes later she died.

This was a cat I'd rescued from a shelter. I  formed such a deep bond with her that when I left the country, I bought her with me, to keep her safe and give her a good life. It took her a while to get adjusted- which she finally did and now, this happened. I could not keep her safe, I feel so guilty and I'm such a mess emotionally, I can't believe she is gone, I have not been able to stop crying since I woke up this morning.

To add to the misery (that is all that seems to be on the menu for now), I got the fertilization report- out of the 11 eggs, only 4 were mature(in the M2 stage), and 3 out of the 4 fertilized.  None of the 2 M1s fertilized, and from the 4 immature eggs, which were put through in vitro maturation, one made it to M1 and was injected with sperm today.

So at the very best, I may end up with 4 blasts to freeze on day 5, but I doubt I will be that lucky.

My RE is baffled-my case is so, so weird. He says he will do another IVF only if something changes with my AFC or AMH, but right now, I am a shitty responder to superovulation, apparently.

The best thing for me would be to try again naturally- I've gotten pregnant 3 out of 4 times. But I'm done with that- I can't handle another loss.

I'll figure out what to do later, but right now, I'm shaken and saddened to my very core. Out of the two horrible things that have happened today- If I could make  the universe fix one of these 2 things, it would be what happened to my poor, poor cat.

When the universe hurls crap at you, boy is it generous.

Triggered!

I got the first piece of good news this cycle so far yesterday- my estradiol (E2)went up from 2200 (pg/ml) on CD12 to 3521 48 hours later. My ovaries are filled with largish follicles. We did not bother measuring anyway- we could tell that many had increased in size from 2 days ago, but there are no foolproof indicators based on size of whether a follicle has an egg, and a mature one at that.

An E2 of over 3000 is considered decent territory for an IVF response, but when I asked my doctor of how often E2 levels can predict mature follicle number (assuming each follicle produces between 200-300 pg/ml of E2)--he said--75 % of the time. So yeah, its always a crapshoot.

He did say that, barring my lowish AFC(13) for my age, my response has been 'textbook'.

So I triggered (with 5000 units HCG) this morning. And unfortunately, something happened. The injection is given IM, I asked my mom to give it in the hip area, bad call. As I was getting it I felt the muscles in my leg seize up. 4 hours later, I'm limping horribly and can't sit, and nor can I take any muscle relaxants/anti-inflammatories. Spending the day in bed---not as enticing as it sounds, unfortunately!

Minor issue though-egg collection is tomorrow evening, and I hope that brings good tidings. Wish me luck!

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!

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!

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?

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.

"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.

Aneuploidy as a cause of recurrent miscarriage

My RE sent me a study on aneuploidy (=abnormality in chromosome number) as a cause in recurrent pregnancy loss, and it was a fascinating, yet difficult to grasp read, as far as significance went.

They started with this statistic -- the prevalence of fetal aneuploidy in women in sporadic miscarriage (ie have loss(es) interspersed between live births) is around 76%. In women with recurrent loss, it is much lower-- around 50%.  This means that with recurrent loss, there is possibly greater contribution of factors other than a genetic abnormality in the embryo. Yet, fetal chromosmal abnormality still prevails as an important cause---around 50%.

They then subdivided by the patients based on presumed issue, such as as anti-phopholipid syndrome (APS), uterine abnormalities, abnormal karyotype in either partner, hypothyroidism/Diabetes/PCOS and then looked at incidence of fetal chromosomal abnormalities.

As expected, when either parent had a abnormal karyotype, they produced a very high number (over 75%) of aneuploid embryos.The APS and hypothyroidism/Diabetes/PCOS groups held steady with around 50 % of examined embryos being aneuploid. The uterine abnormality group had a much lower percentage of aneuploidy, around 17%.

The point the authors made conclusively- aneuploidy is a significant, but not sole,contributor to pregnancy loss, even of the recurrent variety.  But here is the question I want answered---do certain conditions or gene mutations predispose to a higher rate of aneuploidy?We all know advanced maternal age increases aneuploidy. However, the average age of women in this study was 32 years.  What are the other factors?  Does PCOS, for example, make the mother more prone to producing aneuploid eggs? Or do they just have 2 separate issues (the second of which-- the cause of the aneupolidy) is unknown?

I've done many pubmed searches trying to link issues found in me (such  PCOS, PAI4G and the MTHFR C677T) mutations and increased aneuploidy.  Turns out, there have been people trying to study the same.

The only semi-tangible thing to show up is the folate connection. The MTHFR 1298C mutation (but not the C677T) mutation has a link to an increased incidence of fetal aneuploidy. Interestingly, multiple other studies have reported the same, they see an association with the 1298C but not the C677T mutation and various single chromosome aneuploidies.

Furthermore, many, many studies show that low folate levels increases chromosomal abnormalities in cells of the immune system.  But what about germ (sperm and egg) cells?

A smart study looked at the effect of folate supplementation on aneuploidy in sperm (something that is so easily studied!), and basically found that increased folate intake decreased sperm aneuploidy. 2 important things: folic acid could possibly decrease risk of aneuploidy in eggs as well, and women, make your husbands take that 5 mg dose!

BUT--- whatever the road to it, aneupoidy is a major contributor to pregnancy loss. One statistic that knocked the carpet out under me was the finding that 40% of all IVF-generated embryos (even in younger women) are aneuploid. Is this true even of the natural process?  Is that why so few natural tries end in a clinical pregnancy?

I was recently pointed me to this study by a couple of people (thank you!)---Super-fertility’ may explain some miscarriages, BBC News has reported. It says that the wombs of some women are ‘too good at letting embryos implant’, even those that are of poor quality and so which should be rejected.   

Basically, if you take the assumption that the natural rate of aneuploidy is as high as that in IVF, and combine it with the above study, then, well, that would explain a lot, including what happened with me. Heck, maybe my aneuploidy rate is even higher than 40%, but my uterus is a champ at implanting any and all comers.  Or not. Who the heck knows?

Preparations..

Thank you all, everybody who responded to my last post, especially the final comment on surrogacy.

I've been a terrible blogger, so much so that I have not even been reading all the blogs on my list. As far as life goes, I feel like I'm on a treadmill I can't get off, I'm running, but am making little progress.

To catch you up on the TTC journey, a bullet list may be best

• If we can, we will go with CGH microarray for all generated embryos. Our only viable candidate for testing looks like it may be Bluegnome, based out of England, that offers this test for aneuploidy testing.  Bluegnome has developed the technology and is trying to distribute and train labs all over the world to use it. Here, there is the question to be pondered : I can try to ship frozen biopsy cells to England, or to somebody who now offers this test in India, an embryologist in Delhi.  Obviously, it would be far easier and cheaper to send the cells to Delhi, as opposed to shipping to England. But, I'd feel more secure if somebody who had done this test a gzillion times before does it. But then, this technology has been designed in such a way that using it, and obtaining interpretable results is easy. The scientist in Delhi has gone and trained at the Bluegnome facility in England.  Bluegnome's Indian partner offered me both options, but strongly pushed the Delhi choice. I have not decided what to do yet- right now, as long as I can test the embryos, I will rest relatively easy.
• I met with my doctor and got the details of the IVF protocol which will be used in my case- 3 days of suppression, using Lupron (a GnRH agonist), CD1-CD3,  followed by starting menagon (which is a mix of FSH and LH), on  CD3-9 (I think it ends on day 9). This was a very pleasantly short protocol, and I hope it works for me.
• I met with the lawyer to take the first first step of the surrogacy process. I want to recruit 2 surrogates, with a single embryo transfer per surrogate. Since I will be freezing the embryos down, this should be logistically simpler. I'm totally ok with ending up with 2 kids, as long as they did not undergo the risks that come with a twin pregnancy. I'm getting 2, because I fully anticipate that atleast 1, or both of them will fail, and I just want to move this process fast.
• I started metformin.I'm entirely unsure if I need it, but right now I'm going to go with the empirical method. I'm been on it for around 4 days now,  at a 1000 mg for the past 2 days. Apart from a slight headaches (god help me if I skip or even delay any meals) and the mildest of heartburn, no side effects at this dose. Interestingly, I've been having issues with acne (mostly on the body, rarely on the face), but both seem to be subsiding after I started it. I'm  contemplating going up to 1500, but the headaches are off putting.
• I've also finally started a high dose (5 mg) of folic acid. Since my homocysteine,which needs to be cleared either by folate or vitamin B12 had been low(and still was), I had never considered that therein lay a possible issue, but it may well have been, since I have one copy the C677T mutation. Note: The reason my homocysteine was not high may be attributable to my extremely high vitamin B1-2 levels. Everybody is worried about high folic acid supplementation masking a B-12 deficiency, I wonder if I had the reverse issue.
•  I have to get the swimmers shipped. While I still want to try with the donor I've used in the last tries, I'm wondering whether I should ship another donor, as backup if need be. But its so very hard for me to actually decide on another donor, lets hope I can find somebody else I feel comfortable with.  Also, lets face it, at this point, its all a game of russian roulette. My donor has been excellent at getting me pregnant, and seems to be very, very good with hordes of other women, none of whom have had issues with pregnancy loss. A new donor would be a completely unknown entity.

So much is being done, such drastic measures are being taken and yet, when I think of my chances for actually succeeding in all this, I have to be honest, I've lost all faith that anything will work. I think that is because I still can't understand why things have failed, over and over. How can they have failed? Will this trend ever reverse?

Is it my biology? Is the issue in my eggs, manifesting in a high rate of aneuploidy?I've got a big, speculation-filled post brewing in my head about the many roads that can lead to an increased rate of aneuploidy, which appears to be a prevalent cause of pregnancy loss. Good, if complicated paper on the subject, I'm still trying to fully understand it. Post coming up if I succeed.

It also comes down to faith. Does the universe not want me to succeed right now, not because it wants to punish me, but because it has an alternate plan for me? I honestly don't know anything anymore. 

I want to do IVF the next cycle- since I'm CD2, that is approximately 30 days away.  Exciting, yet terrifying times!