It's Time for Cetrotide

E and I got so much accomplished this morning! We had a really tight schedule and just managed to fit everything in before he had to go off to work but we got to check a bunch of things off our list. As usual, my first task was this mornings injection - 4 Menopur to the right of my belly button and 1 swallowed dexa. Couple that with a shower, feeding the poor starving cats and dogs (2 had been fed only 2 hours previously while the others hadn't eaten since dinner, you know, a lifetime ago) and we just barely made it out the door in time to get to our vial pick up.

Just like last time, CA Cryobank was perfectly prepared. Our vials were waiting for us in their filled transport tank and I was in and out of there in under 5 minutes. We confirmed our donor number, the number of vials we were picking up (3), and signed the paperwork promising to return the tank, a errand I need to remember in the next couple days.

With our pick up complete, we headed straight to SCRC. They were really, really busy this morning but their lab tech D was ready and waiting for me. He took the tank to hold on to so I didn't have to lug it around to different rooms and I went in for my ultrasound first.

Today is day 7 and I had to look back through my notes to compare apples to apples but it looks like we're in almost the exact same place this cycle as we were last cycle. We saw NINE lovely follicles, eight maturing together between 10-13mm and one that was just a bit under 10. I am thrilled to tears with these numbers, even if it's likely the 9th one may not mature in time for collection. It's still way better than I was expecting and I am so hopeful that these eggs turn into healthy, viable embryos. Grow follies, grow!

After the ultrasound I went to get my blood drawn and chat with lab tech D. D is awesome, he had all my paperwork ready for me to read over and sign for SCRC and Reprogenetics, the vials for my estradiol and PGD probe sample ready to be filled and he managed to hit the vein in my arm in one go. I was just resolving myself to do all my blood draws from my wrist but now that I know D is such a rock star, I will be sure to ask for him again. He got a direct hit, perfectly into the vein and had those 3 vials filled within seconds. I am so, so appreciative of good techs.

D is going to be sending out one of our donor vials and two purple topped vials of my blood out to Reprogenetics today. I haven't received the saliva kits for my mom and sister yet, so getting those and sending them out is next on my list of to dos.

I also got my marching orders for my medication and it is time to add in my Cetrotide injection. This brings my daily total up to 4 injections, and since I've already done my morning shot, unfortunately means I'll be doing 3 in one sitting. This messes up the careful balancing act of rotating injection sites that keeps me from getting bruised and sore, I was hoping to balance it out to 2 in the morning and 2 in the evening but once you start at a certain time they prefer you keep it at that time. Ugh.

I've been doing:

• 1 Menopur in the morning to right of the belly button with my dexa pill
• 1 Menopur in the evening to the left of the belly button
• 1 Omnitrope in the evening high and to the right of the belly button, though I have done the left once or twice

I've found that even if I do one shot high and one shot low on the same side, I end up having to pinch over a fresh injection site to get the other site which isn't fun. Since it looks like this injection is supposed to go into the belly as well, I'm thinking of maybe trying it lower, below my belly button and somewhere in the middle.

An injection site diagram. I use both Menopur sites every day and change up the HGH sites. I'm thinking the Cetrotide should go down at the bottom.

It's hard to believe that I'm running out of injection sites, especially given how large the injections are making my belly -_- I'll have to give it a shot (ha!) tonight and see if I can pick a good spot that doesn't overlap with any other sites.

Vials Ordered!

Today we were able to check off another thing on our IVF checklist - we officially ordered our donor vials! The doctor in charge of PGD at SCRC has started coordinating with Reprogenetics to get our genetics package ready to go. I was going to ask for a blood draw for PGD tomorrow when the phlebotomist is already doing a draw for estradiol but the PGD doc said no. He'd rather send all our genetic material at once, and since he doesn't want to ship our package on Friday, he asked me to come in and get it done on Monday. 

He's also ready for our donor DNA so we went ahead and placed an order for 5 vials. We're going to pick up 3 of them on Monday morning and hand deliver them to SCRC ourselves when I get the draw done. That way he can send our vial and my blood sample in the same package - I might even try to get my mother and sister's saliva samples in the same box but I don't know if the kits will come in time. The other 2 vials will be stored at CA Cryo in case we need them.

I realized I never got a good shot of the EU Menopur mixing needle so I snapped another shot this morning. This was the first batch I'd mixed entirely via needle and it did take longer than it does via Q-Cap. It also seems to get more bubbly which means I spent more time tapping out bubbles and waiting for each vial to settle. 

EU Menopur and mixing needle

The EU Menopur vials are the slightly larger vials with the blue caps. From left to right, you have the 3ml syringe, the mixing needle and the little injecting needle. The mixing needle is really flexible which means you can get into those corners to get every drop, but you do have to do a lot of wiggling and sucking to get everything.  More than once I ended up with bubbles on the bottom and had to empty the liquid back in, swirl and tap out the bubbles, and then draw everything back up. It takes awhile to mix a lot of vials. 

As for the HGH, I had good luck with the Omnitrope last night and managed to not bruise myself! I did my injection a little closer to my belly button and aside from the heat and soreness that night, there's no other sign of injection besides the tiny pinprick. I'm about an hour away from prepping this evenings injections and will hopefully continue the good luck!

Day Two of Stims!

Today was day two of my stim injections and I think I'm finally getting back in the swing of things. The first day was a little tough, I felt unexpectedly nervous and my heart was pounding in anticipation of the Menopur burn. It was pretty much exactly as I remembered it though, and by this morning it felt routine again.

Now that I've tried a few of the new medications for this cycle, I'm starting to get a feel for how everything works in practice. Thus far:

• Omnitrope (HGH) - this is one bubbly sucker. The solution is really fragile, you're not supposed to shake it and it bubbles at the slightest provocation. This can be a pain in the ass but since I got the cartridge vials and not the 5.8 vial I'd have to mix like the Menopur, I'm not complaining. I have to draw it back and inject it with the same needle which does dull it slightly, and I do have a small bruise at my first injection site. I also have some heat and soreness at my injection site this evening but I can't tell if its from the Menopur or the Omnitrope since I injected them on the same side. I do morning injections (4 Menopur) on the right, and evening ones on the left (4 Menopur and 0.25 HGH). I might switch things up tomorrow and inject the Omnitrope on the right to give my left side a break.

The cartridge vial is so skinny, but you can still draw pretty well from the rubber stopper at the top.

• European Menopur - I decided not to use the glass ampoules that came with the EU Menopur since I have a ton, like 5 boxes, of the sodium chloride vials left. I tried to give the Q-caps a shot and they do fit on the EU vials, but the rubber stopper in them isn't ideally shaped to extract all the liquid. I have to use the big mixing needles to get every last drop and it takes a bit longer to do. I also had a nervous scare when I combined cold sodium chloride with room temp EU Menopur powder and it turned instantly cloudy. Cloudy Menopur is supposed to be bad Menopur but since it cleared up after about 30-45 seconds, I deemed it okay.

You can see the hole in the rubber stopper is only in the center of the stopper, which means liquid can pool around the sides. The US vials have a long slit to better capture liquid from all sides.

I can already tell my belly is going to be bruised and poked and sore once this cycle is over. Three - four injections is a lot for a day and I'm going to run out of places to stick the needles since they all have to be injected in the same area. I can't rotate between belly, thighs, butt, etc, they all go into the same section of my lower belly. Owie. 

IVFMeds.com had good news, my second package finally shipped! It ended up going out two days later than it was supposed to which necessitated 2 more phone calls to customer service asking why I hadn't received tracking info yet. I would have liked it to go out sooner but if it travels like the first one did, I should have it in time. The customer service rep also said that if my medication didn't come in time, they'd reimburse me the difference between their cost and the cost of the vials I'd have to buy locally. It was a really nice offer but I'm hoping I won't have to take them up on it.

I also got a good convo in with Reprogenetics and they've put my blood and saliva kits into the mail. I have to send in a vial of my blood, a saliva sample from my mother and my sister, and a single premium IUI vial of our donor. They were originally requesting two vials (~$2,000) but their lab agreed we could go with one since these are really high yield vials instead of the low yield kind they'd usually be sent for PGD. That saves me an extra $1000 which is excellent, every little bit helps!

Go, Baby, Go!

IUI number 2 is complete and I feel super psyched and so hopeful about this cycle! It's been a long day for E and I, we had to be up early to meet the nurse at 8:30am to deliver our cryotank. She took my vitals, had me sign the consent form and then gave us about two hours to kill. Since we didn't want to sit around in the waiting room, we drove to the nearby coffee bean and had some breakfast. I'm absolutely in love with their chai latte with almond coconut milk, it's delicious :)

After breakfast it was back to the waiting room to wait some more. They were running really behind today and had a ton of patients to see. We finally went back to a room and Nurse C joined us with her  trainee nurse, Nurse M, who will be replacing Nurse C when she retires.  She's really nice and I enjoy her bedside manner a lot, but she's not quite as good as Nurse C. Nurse M put my speculum in wrong, OW, and Nurse C had to reposition it and take over the IUI later when Nurse M couldn't get the catheter in.

Before we got down to business, Nurse C asked us to confirm our donor number and make sure everything was labeled correctly. Our count this time was phenomenal, 148 million with 70% motility post thaw! Last cycle was only 50 million with 50% motility so I'm feeling much more confident about our swimmers this time. Come on boys (and girls!), you can do it!

Our tiny vial, this thing cost $850

Nurse M tried to insert the flexible catheter but seemed to have difficulty with the internal portion of my cervix. It was pretty uncomfortable, though not painful, to have her poking around and I was relieved and felt much better about Nurse C taking over. Nurse M had the speculum jammed straight in, instead of following the natural curve of your body, and I didn't realize how poorly it was positioned until Nurse C adjusted it down and my legs dropped like 6 inches. She swapped the catheter out for a stiffer one, popped it right in on the first go and said

"Here we go! There go your little guys, and gals!"

This time, we chose to inspire our swimmers with the classic 80's movie soundtrack of Look Who's Talking while I laid with me knees up for 30 minutes:

I hope they were inspired by the Beach Boys to follow the trail leading them towards all those eggs. I was a little worried about when I would ovulate and whether it had happened or not, I know many women say they can feel ovulation when they are releasing multiple eggs and I hadn't felt anything. Nurse C told me not to worry about it and she was right, as I'm typing this now at 6:30 I can feel definite uncomfortable cramping on the side where I have 5 eggs. It's starting to hurt so I'm hoping those follies are all rupturing and releasing their eggs!

After the IUI, E and I went and stuffed ourselves at The Smoke House. It's a decent steakhouse, not super high end, but full of that old school-red-booth-dim-lighting steakhouse charm. I had a little fillet with mashed potatoes, spinach and insanely delicious garlic bread while E had BBQ ribs and chicken with mashed potatoes and corn on the cob. It was indulgent celebration lunch, a little off diet, and it filled the time gap between our IUI and my acupuncture appointment. We used to go all the time for celebrations when we lived in The Valley and now I drive past it on my way to acupuncture and long to stop and order that garlic bread. I was so glad I got my fix at last :)

With my tummy full to bursting and my eyes heavy, acupuncture was wonderful as usual and I slept from 2:00pm-3:30pm. S is feeling really good about this cycle too and told me that Dr. K called and asked her what on earth she was giving me to grow so many follicles so big! I love that my whole team is so supportive, it makes me feel well taken care of. While I was asleep with my needles in, E went down the street and treated himself to an ass kicking 60 minute massage where they bent and twisted him like a pretzel until he felt amazing. I'm going to have to go and try this place myself at some point, he gave it a glowing two thumbs up. 

I start my most hated Endometrin on Thursday and thus begins the dreaded two week wait. My blood test is scheduled for Sunday July 6th and I can already tell I won't be able to wait to test this time. I have acupuncture again tomorrow to help the egg and sperm find each other and then another session on Friday to help encourage implantation. I'm trying to focus on work to keep myself busy while also being careful not to stress or overexert myself. The gym is off limits, I'm not supposed to lift heavy things and I've already been tested today when I went to move a piece of furniture and realized it fell under the category of "things I shouldn't be doing" ugh. 

It's going to be a long two weeks to find out that this cycle was a success. I really think we did it this time!

Clear to Trigger!

We are a go for triggering tonight! I will be taking my Ovidrel at 10pm tonight and then I'm done with injections! I love that the syringe comes pre-filled, it's such a nice change to not have to mix a million little powders.

Ovidrel ironically next to my eggs

We need to be at Kaiser for our IUI at 8:30am on Monday so they can start prepping the sperm. Whether you give a fresh sample or a frozen one, they need to assess the sperm for washing and confirm that the counts are sufficient. The IUI itself will probably be around 10:30am and then I'll be heading to an acupuncture appointment to encourage those swimmers to swim, baby, swim!

We have our sample on ice, ready to go and I'm definitely feeling like the time is right physically. I finally have enough estrogen in my system to get some decent, trackable EWCM and I'm actually debating taking an ovulation test tonight before I trigger and tomorrow to make sure I'm not ovulating too soon on my own.

OPK Cheapies. I still have toooons of these from TTC naturally

I might be extra bold this cycle and test out my trigger to see how quickly it leaves my system. I'm feeling really good and positive about this attempt and I might be up for testing a bit early this time! I just want to make sure I won't be getting false positives from the HCG in the trigger.

Send good vibes and positive thoughts to my follicles for me, I need these little buggers to yield healthy, unaffected embryo(s)!

E2 Labs and Ultrasound

I had my ultrasound and labs this morning and the results were mixed. The good news is that we saw at least two little follies growing, one about 12mm and the other around 11mm! Two potential chances, I'm over the moon. There was also another follie that looked a little bigger but it wasn't quite right, the opacity was somewhat off or weird, so we're not holding our breath for that one. Two is still awesome even if its not the 4-6 we would have liked.

The not so great news is that my estrogen is still low. It was only 68 on Stim day 5 so I'm upping my dose of Menopur to the even more impressive, dun dun dun! 5 vials per day. We didn't start off on the max dose so we could move up if needed and that's what we're doing. Unfortunately, the initial egg recruitment is already done so we aren't likely to get more follies than those already there. She did see 4 more smaller follies on one side, but it's unlikely they'll grow big enough to ovulate for our IUI. The med increase also means we probably won't have any left over for IVF if this doesn't work. Fingers crossed it works!

5 Vials of Menopur is $287.60 per day. Ouch.

E and I also went ahead and ordered our vial of premium IUI quality sperm! I'm pretty excited to actually have a chance at getting pregnant this month since it will be our first opportunity to really have a shot. We pick up our swimmers on Tuesday in preparation for our IUI on tentatively Wednesday or Thursday if everything goes okay.

The next ultrasound is Monday so I'll have three days of 5 vials per day under my belt by then.  Please send all good vibes, thoughts, energy, etc to my little follies. In the meantime I'm going to acupuncture today and will ask her to do everything she can to get my lining thicker, my estrogen up and my follies healthy. I need those babies to grow!

Rolling the Dice, Fingers Crossed

After much discussion, some tears, and a whole lot of wallowing in self pity, E and I have cleared our heads, discussed our different options and decided to roll the dice. Beginning with my next period, we are going to be attempting IUI.

We went with this incredibly scary decision for a number of reasons.

Success. For starters, this is our best chance. People with Fragile X Premutation infertility don't respond well to the stimulation hormones required for IVF, so I am unlikely to produce many eggs for PGD testing. Most have better luck getting pregnant naturally, or with IUI as long as their ovaries are still functioning. I'm not entirely sure why this is. With the extra methylation of my CGG repeats, it could be that the protein necessary for ovarian stimulation is being used up by extra mRNA :/  My FMR1 gene is still functioning just fine since I don't have Fragile X, I have normal brain develop and am intellectually normal, but there's definitely some deficiency in my ovaries.  I'm hoping that since I'm still ovulating without assistance that my ovaries will oblige me and respond at least decently to the IUI drugs.

Cost. It feels horrible to be basing fertility decisions on money, but there's no way to get around the cost of IVF. Given my likely poor response to stimulation, we'd probably have to do IVF, or at least mini IVF, several times. Although Kaiser will cover PGD, it will still run us 20-30k per cycle.  Mini IVF would be less expensive, but we'd only get 1-2 eggs per attempt and 50% of them would probably be positive for Fragile X. Kaiser will cover unlimited IUI attempts for us, although the national average is about 4 attempts per pregnancy and most people don't try more than 6 times if they're unsuccessful. If IUI produces no results after several attempts, we will still have IVF in our back pocket and USC Fertility will give us a 20% discount because we're Kaiser members.

Information. Even if IUI doesn't work, I'll be taking the drug Menopur which is also used for IVF. Given that it takes awhile to figure out the right combination of hormones to stimulate ovarian production, IUI will give us a lot of information on how my body responds. Although we're only trying to stimulate one or two eggs with IUI, it would be nice to know if my body can be stimulated to make more so we'd have more for PGD.

(source)

On the flip side, we're taking a very big risk with IUI. We have a 50% chance that if it works, our baby would have Fragile X and we would have to terminate. Since we won't be able to do any testing on the embryos beforehand, we'd have to rely on CVS testing at 10-11 weeks. The cells would then have to be cultured, which could take up to two weeks, and then tested which could add another week. We probably wouldn't have an answer until 14 weeks and then we'd either get good news or bad news. Our RE has suggested that we schedule a termination in advance to make sure we wouldn't have to wait even longer in case the news was bad.

The notion of terminating a desperately wanted baby is terrifying. I'm a strong supporter of women's rights and fiercely pro-choice, but I never thought I'd be in a position where I'd have to make this decision. We spent so many years carefully trying to avoid pregnancy, and if we'd been 16 and stupid I think we would have terminated without guilt because it would have been the right decision. At this point in our lives I naively assumed that we'd be taking home any baby we got pregnant with, when the reality is that 50% of the time we won't be.

I'm also not sure how many terminations I could endure. I know other carriers of horrible diseases often undergo several terminations for medical reasons, but if IUI works and we have to terminate the baby, I'm not sure if I could try IUI again. It would still be our best chance for getting pregnant but I just don't know if I could take that chance again. I really hope we won't have to.

Genetics Expanded

After waiting two months for an appointment with a genetic counselor, E and I finally got in to see one this morning. As expected, they had the results on E's second genetic screening which confirmed his diagnosis of Y chromosome infertility due to an AZFb microdeletion.

They were fascinated with E and the fact that he has any sperm at all. With his genetic profile, he shouldn't be able to produce any sperm but has still had counts as high as 23 million. I would have liked to talk about the particulars more, but ultimately the end result is same, 20 million or 2, his non-motile swimmers are not usable.

The counselor got more info on our families but couldn't really suss out why we both have fertility problems. For a multitude of reasons, both our families are fairly small, and with such a small sample size it's tough to draw good conclusions. We can assume that E's infertility occurred de novo, as a fluke, while mine is still unexplained. They're testing me for fragile x syndrome as a last ditch explanation, since my family consists of all girls for two generations, but it's fairly rare to have a completely silent carrier and I don't have any of the symptoms or markers for the disease aside from my lack of eggies. E was almost late for work so I couldn't get my labs drawn today and will have to go back.

The counselor was really analytical which I appreciate, I approached the situation in the same manner and it made it really easy to connect with him. He understood my desire to have 5 years of egg fertility data to look at before making a decision (sadly impossible) and suggested we come up with a wall sized algorithm to predict all possible choices.  We went over pretty much every situation from E's sperm and my egg to egg and sperm donors. I think we have a somewhat solid plan of action.

**The Plan!**
1. Get my labs done for Fragile X and possibly CMV antibody. CMV antibody status is important for picking a donor. Done!
2. Decide if E is going to have the stimulated semen analysis to confirm for sure that his sperm is unusable.
      a. If E's sperm can't be stimulated, we go with a donor
      b. If E's sperm can be stimulated and is usable, we begin proceedings for IVF with ICSI
          - If E's sperm is usable, we will gender select so as not to pass on the mutation
3. Assuming E's sperm is unusable, we need to pick the donor. I want this to be mostly E's choice. I'm thinking a local sperm bank would be best so we can order the day before it's needed and courier it over.
4. Purchase donor sperm. We need to decide how many vials we want and how many will be stored.
5. Decide whether we're doing a stimulated cycle to see how I respond and try to get a better idea of my egg reserve, or proceed directly to a medicated cycle and IUI
6. Proceed with a medicated IUI cycle
7. Hopefully get pregnant!

While I definitely still have that I might cry sensation at the back of my throat, I am feeling a little better and more prepared. My biggest concerns are that I might be pushing E and not allowing him enough time to grieve. I've been really waring with myself on what we should do next and how we can balance my time crunch with his coping and emotional well being. Today, the genetic counselor said something along the lines of "people take fertility for granted, like gravity. It's just something that's there. But the reality is that for many people it isn't". I talked about how, cost aside, I wished our rolls could be reversed because I don't care about being genetically related to my child but E does/did.

Although we already knew it, the counselor said that not being able to have biological children is horrible and devastating and may always hurt, but that's normal and okay. I think that really helped E to hear this since he's been struggling with the idea that he may never be 100% okay with not having  genetically related children. I think he understands now that it's okay for that to always hurt a little, but it doesn't have to prevent us from having a family and kids that are his in every way that matters. He doesn't have to be thrilled about it, he just has to be at peace with it. I told E the only things I need him to be 100% on are 1. That he still wants children and 2. The donor we pick. As long as he's sure about these two things, I think we'll be okay.