Our Probe Is READY!

Yesterday morning, I went ahead with my plan to phone Reprogenetics to get an update on our probe. I can never manage to catch someone at their desk so I left a message and waited for a call back. They're usually pretty good about returning calls and it only took a couple of hours for their New Jersey caller ID to pop up on my phone.

My rep for our probe process wasted no time in telling me that our probe is DONE! It's ready! We were originally quoted 6-8 weeks but it ended up being less than 4 weeks from the date they got our samples to the date of completion. I was so surprised, this is wonderful news :) I was anticipating a deadline closer to the 8 weeks and was worrying that we wouldn't get results in time to go right into a FET.

Once we conclude this cycle and the lab has received all our biopsy samples, it takes 15 calendar days to get PGD and aCGH results on our frosties.  Those will be two loooong weeks and I'll probably be going crazy but I know we'll get some good results.

(Source)

This is an example of Fluorescent In-Situ Hybridization, or FISH, a quick result type of PGD that we can't use for Fragile X but that is super cool to look at. This one is for muscular dystrophy. Embryo C is a normal male embryo, I believe the light pink is Y, the dark pink is X and since there's only one X in a boy, a single green dot for a normal chromosome. D and F are both normal female embryos, two green dots each, one for each X, the two dark pink dots. A shows a female carrier embryo, one of her chromosomes is affected but the other is okay, two dark pink dots and a single green dot, and B and E show affected male embryos, no green dots.

Hopefully we will have lots and lots of healthy embryos from both cycles but first we need a nice, big haul from this one. I just started up shots again today, this time 4 Menopur and Omnitrope in the morning and 4 Menopur in the evening. Every time I start up another cycle, I forget how much the Menopur burns!

Lucky Break on Meds!

Unlike my last package of IVF meds, todays package came bright and early at about 10:30am! It had the remaining 43 vials of Menopur I'll need for this cycle, all well packed in bubble wrap. I even got an out for delivery notice from IVFMeds.com letting me know the package would be coming soon.

MeRopur!

I emailed their customer service Tuesday night asking about Meropur vs Menopur and their rep called me Wednesday morning. Instead of emailing, he wanted to explain to me personally that they were in fact the same drug by the same company, Ferring. IVFMeds sources their Menopur from several different countries in Europe and as I thought, this batch happened to come from Italy. Thus far, I'm once again impressed with their quality and customer service.

With my Menopur safely in hand, it was time to move on to my Kaiser order! I called them on Tuesday as well to confirm that my prescription was ready for pick up and got the all clear. So I climb in the car, battle through traffic, find a lucky street parking spot, and stand in line. I get up to the counter to pick up my "ready to go" prescription and surprise! it's not ready. The tech tries to tell me that he doesn't have it at all, I insist he does, and he agrees to get everything together if I don't mind waiting.

So I wait. And wait. And wait some more.

He finally calls me up to the counter only to tell me sorry, he doesn't have my Omnitrope. Le sigh. Again, I insist that he does have it, remind him that I got confirmation that it came in, and he's still insisting that he doesn't have it when another tech walks by and says hey, isn't that in the fridge? Oy. So he finds the Omnitrope, huzzah!, tells me he needs to write it up and I need to wait some more. Okay, I'm good with more waiting. And waiting. For another 20 minutes.

This time I get called up to the counter by a different tech, they go through my prescriptions and surprise! they don't have my big mixing needles. She can't seem to figure them out, apparently 22 gauge needles in the same quantity as the other needles is a complicated request, and she eventually decides to just make a new script for them. So again, I wait.

About an hour after I get there, the pharmacy eventually gets everything correct and ready to go! A third tech started scanning all my items, rang me up, and asked for my card to swipe at the station over so I didn’t immediately see the price. When she handed me the bill to sign I just about died - it was only $30!!! Whaaaaat???

My $15 Omnitrope!!

My last Omnitrope order ran me over $300. Whatever they did differently this time, my medication rang up as covered!  I kind of froze because it seemed too good to be true, I didn't want to draw attention to the price in case it was a mistake and I didn't want to pay more so ahhhhh I just signed the bill, took my bag and hightailed it out of there! I don't know how it happened but it was so worth the wait and I am so grateful to whatever they did to get my meds covered. This process is running us a small fortune and every little bit helps!

Cilly and Fuckie confirming via bodily inspection that I have removed all items from the bag

Cleared For Round Two!

While sitting in traffic on Thursday afternoon, I noticed that I had finally started to spot! Yay, progress! I know my body pretty well and I could tell my period was definitely about to start so I called up the clinic. The nurse I spoke to said that many women spot for a week before they actually bleed and she couldn't make my appointment until my period started in earnest. The clinic closes early so when my period showed up right on time a few hours later, I had to wait until Friday morning to make my CD2 appointment. Since Friday counts as CD 1, that puts 11 days between trigger day and CD 1 which is pretty much my standard luteal phase. I almost couldn't believe it, even with all the hormone injections and the retrieval, my body is still running on it's regular schedule. Apparently there's no screwing with this body clock.

So, Saturday morning rolls around, bright and HOT, and E and I find ourselves back at the clinic for for another round of labs and ultrasound. The baseline ultrasound is probably my least favorite of all the ultrasounds. I'm bleeding, crampy, sore and the whole thing is messy and gross no matter what I do. Luckily, there's no follicle counting to prolong the ultrasound so it was as short as it was uncomfortable.

When the ultrasound was done, the tech was able to give us the best news possible. My ovaries look like they're completely back to normal, no more swelling,  and we are officially starting IVF round two! I was hoping Dr. D had aspirated that tiny cyst on my left ovary, he thought he might have gotten it too because one "follicle" over there had dark blood, but it was still there, stubbornly stuck in place. Little bastard.

A different nurse than usual called back to say that she's writing up my calendar now and I can start planning to order my meds. I didn't get an official calendar last time though I realize that most people do. I'm not sure how useful they are considering that everybody responds differently and every cycle is unique but I'll take it if she wants to write it up. Ultimately, it will come down to how my follicles grow and develop but I'm planning on ordering enough Menopur for 11 or so days and enough Cetrotide for 5 days since I was one short last time. I ended up having extra Omnitrope but it's because my nurse calculated the dose wrong. She told me to take 0.25cc of the 5mg/1.5ml but it should have been 0.37cc. I'll correct the dose in this cycle and maybe we'll get even more embryos :) Here's to hope!

Maybe Mature?

Tomorrow morning I'm going in for what is hopefully my last ultrasound and blood draw to check on the follies before I'm cleared to trigger. I was doing a little more research and it looks like Cetrotide can slow down follicle growth, which sort of makes sense since it's designed to prevent premature ovulation. It's probably why these follies didn't exhibit super growth from day 7 to 9, which is also a good thing since slow and steady wins the race in quality follicle development.

As of today I'm officially out of Cetrotide and the Omnitrope syringes as well, so I'm going to need to make a trip to the pharmacy to pick up one more Cetrotide injection and syringe for tomorrow night. If the follies need a couple more days of growth I will suck it up and deal but my poor belly is so, so ready for a break! Four injections is really a lot to do every day and my belly is starting to show the effects. 

I knew yesterdays injection was a bad one as I did it, and as expected it left a nasty bruise. I snapped a gross photo of it for your viewing pleasure in case you were wondering what injection site bruising looks like. In the upper left corner you can see two "good" injection sites where only the needle mark is visible. Then, obviously, there's the big nasty bruise from the shitty Cetrotide injection. Ugh.

Nasty Cetrotide bruise is nasty.

For tonight's Cetrotide injection, I ditched the included syringe and used one of my extras. It was still a pain to mix since it doesn't dissolve well,  but at least I was able to prime it correctly. I'm also not at all a fan of the below the belly button injection site, there has to be some sort of acupuncture point or meridian there since the needle zings and hurts every time it goes in. The lower right/left and upper right/left are much less painful to inject into so I'm definitely changing the site for tomorrow. My belly needs a break!

I've got everything crossed that the appointment tomorrow goes well. Come on follies, I need you to mature! And contain healthy, mature, fragile-x free eggs, that fertilize perfectly and grow into healthy embryos. Positive thoughts!

10 Fabulous Follies!

This mornings appointment yielded even more good news - I have ten wonderfully growing follicles! TEN!

ohmyfuckingholyhellmindofficiallyblown

I'm not sure if the ultrasound tech was counting the left over cyst as one of the follies though, I had a new tech today and asked her about it. She was a really nice, positive and gentle tech but she tried to give me a bit of a lecture on how all follicles are cysts -_- I asked again specifically about the SIMPLE cyst, the opaque little circle, not the dark, clear follicular cysts, and she said it might have shrunk down so much that it looks like a regular follicle. I left it there but I just can't believe that I have 10 legit follies after being told I should never expect more than 3. It seems too good to be true.

They seem to be growing more slow and steady this cycle than they did last time. Last cycle they jumped from 13 to 19mm from CD 7 to CD 9, with a decrease in medicine, and this time the largest follie was still only ~16. This means I'm on the hook for at least two more days of stim injections but I think slow and steady growth is a good thing.

As I understand it, a mature follie is 18-20mm and several of mine were still 10-12mm. I know we won't be triggering until as many of them as possible are in that range. When Dr. Danzer called today he said he thought I might be on track for a Saturday trigger and a Monday retrieval, so my next appointment is Friday morning.

I've also read that larger follies are better quality in "younger" women (under 35) but poorer quality in "older" women (over 35). The big question is - do my ovaries make "young" eggs or "old" eggs? Do they act like 27 year old eggs or does the premutation make them older/poorer quality? What is the ideal size for 27 year old, premutation eggs? If they're all committed to growth, they should grow 1-3mm per day so that lead follicle could potentially be 22mm after two more days of stims. I guess we'll just have to see!

Cetrotide, Menopur and Omnitrope

In the meantime, it looks like I'll be enjoying my 4 injections per day for a little bit longer, including the wretched Cetrotide. Every time I inject it I dislike it more and more - this last shot was ridiculous, it wouldn't prime and I wasted a ton of drops and still had a bubble that wouldn't get out. I'm actually thinking of using a different syringe all together for tomorrow and just chucking the glass one that you're supposed to use. Definitely not worth the hassle.

Itchy Sitchy

Today was day two of adding in Cetrotide to my IVF protocol and I have to say it's not my favorite medicine. I've been pretty lucky to only experience a few side effects from the various meds but the Cetrotide is one of the most annoying.

Thus far, I've had:

• Head aches -  I can't tell if these are from the Menopur/Omnitrope or from the insane heat we've been having. I've only had two that were really unpleasant and I'm trying to drink a ton of water in case it's the heat since I can't take Advil
• Cramps - These I think are mostly from my period take two, the withdrawal bleeding you get after you stop birth control, but I've had twinges after every injection as well. They're more in my uterus than my ovaries so who knows what is causing it. My bet is on the Menopur. 
• Numb toe - This one is definitely the Omnitrope. One small section of my right big toe went numb, it was the weirdest thing. I had no idea it was a common HGH side effect.
• Sore joints - Again the Omnitrope. Mostly my right knee and it's only been a couple times, another common side effect.
• ITCHING - ding ding ding, we've reached the Cetrotide! The Menopur burns while you inject it, but the Cetrotide itches for at least an hour after. The problem is the itch is under your skin so you couldn't scratch it even if you wanted to scratch a fresh injection site. Gah. 

Tomorrow is day 9 of stims and I'm hoping these follicles are going to be nice and mature at tomorrows appointment. We only needed 9 days of stims for our last IUI cycle and thus far these follies have been tracking my last cycle almost exactly. Plus, my belly is covered in track marks and despite it's ample and expanding girth, I'm running out of injection sites!

Our protocol now looks like:

CD 1: Nothing
CD 2 - 14: BCPs
CD 15 - 17: Nothing
CD 18 - 22:  600IU Menopur (2 injections), 0.25cc Omnitrope (1 injection) and 1mg Dexamethasone
CD 23 - 24:  600IU Menopur (2 injections), 0.25cc Omnitrope (1 injection), 0.25 Cetrotide (1 injection) and 1mg Dexamethasone

We also need to get the saliva kits shipped out for my mother and sister. They need to be over-nighted there which I'm sure will run us at least $50-$100, and means I need to get them collected and shipped on the same day. This has been a bit more difficult than you'd think since we need to coordinate three schedules and collect samples on the same morning. It's on my to do list for tomorrow so hopefully everything works out.

In the meantime, all my energy is directed at those 9 follicles maturing in my ovaries. Come on follies, grow, grow, grow! I need good, healthy, mature follicles at my appointment tomorrow.

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.

Another Win for IVFMeds.com

I woke up before my alarm this morning, worrying even in my sleep about my meds being delivered. I checked the tracking first thing but it hadn't been updated at all since the package landed in New York. Uh oh.

I got everything ready to start prepping my morning shot and got USPS customer service on the phone. The rep was very nice but had absolutely no new information - all she could see was the same tracking page I was already looking at. I told her the package contained time sensitive medication that I needed for the weekend and after a 2 second pause she told me the package wasn't going to make it and I should look into getting my meds locally. Double uh oh.

So here I am, trying to mix my Menopur via needle and figure out what to do. I called Kaiser first since they had a valid prescription on file for me - no answer. I forgot that they changed their pharmacy hours and they're no longer open over the weekend. My next call was to Rox San pharmacy, the pharmacy my clinic deals with most often, where I left the most scattered voicemail ever:

"Hi, my number is...I mean my name is S, I'm a patient over at SCRC and I ordered my medication online but it looks like my package has been delayed. I don't have enough meds to get through the weekend...I'm supposed to take 8, I mean a day...so I need to pick up a couple boxes of Menopur. I should probably get my Novarel too....My name, I mean my number, is blah blah, sorry I'm super scattered today kthanksbye"

It's not easy to use a cell phone and keep your field sterile and I kept accidentally sticking the mixing needle through the side of the rubber stopper. Oy. The next call was to SCRC where I left a message for the weekend nurse since no one was picking up. This one wasn't as scattered but you could probably tell I was freaking out a bit because both the pharmacist and the weekend nurse called back a few minutes later. The pharmacist was calm and kind and told me she could get in touch with the nurse for me and have my meds ready asap. It was about 9:30am now and they closed at 11:30am so we would need to move fairly quickly. A minute after that, the nurse called back and said she was sending over a script for 15 vials of Menopur and the Novarel. I was finally able to take my injection and ten minutes later the pharmacy called to say my order was ready.

Now here is where things got muddy again. I was all ready to go and pick up my Menopur when I get a tracking update that my package has landed in Los Angeles at the big sorting facility. Thus began the debate - do we go and buy the Rox San meds? Do we wait and hope the package makes it to our local post office and out for delivery before they close? The package was running several hours behind the first one which had made it to our local post office by 9ish. It was now almost 11am and it still wasn't there. Do we risk botching the entire cycle and have to cancel? No.

We decided it wasn't worth the risk. Rox San wasn't open on Sunday and this was my only chance to get my medication locally so we went ahead and bought more meds. Three boxes of Menopur,  one box of Novarel and needles/syringes ran us $1250 that I hadn't planned on spending this month. Ouch. But now we were prepared, I had enough meds to get through the weekend and if the package didn't come till Monday I would still be okay.

The pharmacist who packed my order at Rox San gave me this lovely hand carved jade pendent for luck. I'm sure they give them to all their infertility patients but it still made me feel all warm and fuzzy. I can't help but appreciate the little things like this and the way they can brighten up even a crazy stressful day. 

1pm rolls around and our local postman pulls up with no package. He double checked everything and said that he usually receives express packages in the morning. They never make deliveries in the afternoon. He definitely hadn't received anything for me, so I shouldn't expect the package till Monday. Again I felt okay about our decision, we had made the right move, the package didn't come so we'd covered our bases. I bet you can see where this is going.

2:30pm rolls around and there's a knock on my door. Oh hey, look at that.  It's another, different postman. He has my package. Safe and sound and delivered as expected, given that it was shipped out two days later than expected.  Oh man. So now I have the whole IVFMeds.com order, each package was shipped on Wednesday and delivered on Saturday and I just spent $1250 on local meds. Whoops.

I probably would have felt worse if the stakes weren't about 20k high. Cancelling this cycle would mean we were out what we'd already spent plus all the medication, so I'm glad we covered our behinds. I'm also looking into the offer the IVFMeds customer service rep made to reimburse me the difference in medication costs since they knew my package was shipping two days late. I'm not sure if they'll still honor it given the circumstances, but I'll give it a go. I had to bump my protocol two days anyway to accommodate the shipping time which I know not everyone can do and I had 15 vials of local Menopur to offset it. We'll see what they say on Monday.

Day 5 of injections is now complete and it looks like everything ended up working out. I will definitely be ordering from IVFMeds.com again, but with a little more wiggle room for shipping. Four days really does cut things a bit close. Their customer service has been amazing thus far but I'd like to have my meds in hand a couple weeks before my second cycle so I don't have to repeat this crazy stressful process.

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!

IVF Protocol a bit Clearer

Today I picked up my Omnitrope, needles, syringes and Dexamethasone. Kaiser is usually great about prescriptions but this time they were way off - they gave me Omnitrope cartridges in a weird dosage without the pen to inject them, they forgot my injecting needles and only included the mixing ones, and they only had half the needles and syringes I needed. I ended up spending 30 minutes at the counter while they tried to sort everything out and I still ended up without the pen for the Omnitrope. When I called my nurse to talk over it and find out more about my protocol, she had never worked with Omnitrope in this form before and had to sort out how it's going to work. It looks like I'll have to draw it up and inject it with the same needle, which is going to blunt the needle and make it hurt more -_- I'm not excited about that part.

Although I was hoping for only a couple days with tons of injections, it looks like I won't be that lucky:

CD 1: Nothing
CD 2 - 14: BCPs
CD 15 - 17: Nothing
CD 18 - 25:  2 injections of Menopur (4 and 4), 1 injection of Omnitrope and 1mg Dexamethasone

At some point I'll add in an injection of Cetrotide for 4 days, bringing my injection total to 4 injections per day. My little belly is going to be so, so sore! I have to go in tomorrow morning to get the small needles and syringes I'll need for the Omnitrope so I think I'll ask the nurse if I can inject the Omnitrope into a different place. If I'm already doing two injections into my belly each day, I'd really like to not have to add two more to the same place.

I was going to insert a photo of my new supplies in here, but I'm too lazy to take one right now. Just picture lots of needles and syringes, including big mixing needles, and I'll post one tomorrow when I'm less lazy.

Cleared To Stimmmmm!

It's official! I have been cleared to start my injections on Tuesday. They're going to start me off with the same 8 vials of Menopur per day, split into two doses. I think they might also want me to start taking the Dexamethasone soon as well, so I'm going to pick up the bottle, my needles/syringes, and the Omnitrope tomorrow.

Thus far, I think the protocol will look like:

• CD 1: Nada
• CD 2 - 14: Birth control pills
• CD 15 - 17: Nada
• CD 18 - 21 : 8 Vials Menopur + Dexamethasone?
• CD 22 - TBD

The Menopur makes two injections, the Omnitrope a third, and the Cetrotide a fourth. I think I only need to take the Cetrotide and Omnitrope for 3-4 days though, so there won't be too many days with four injections. I'll take any silver linings I can find lol.

The Omnitrope, a brand of Human Growth Hormone (HGH) is a bit of a gamble. For a group of women, usually those with poor egg quality or diminished ovarian reserve, adding HGH can really improve egg quality and fertilization rates. It can sometimes contribute to higher egg quantity as well so I've got everything crossed that I'm one of the women it helps. With 7 antral follies on the ultrasound, I would do anything to turn as many of those as I can into healthy embryos.

(Source)

Come on Yoda, I need the force to be with me!

First IVFMeds.com Package!

My first package from IVFMeds.com arrived! And it was, surprisingly, right on time. I know I've already admitted that I was really nervous ordering from overseas - if you google IVFMeds.com there are a couple reports of people complaining about problems with shipping speeds, packages getting stuck in customs and trouble getting refunded. They all made me pretty uncomfortable but since my nurse had never had a problem with them, I ordered anyway. 

.....And then called their customer service line about 10 times. Asking about their process, asking about their shipping methods, confirming the order, confirming the prescription for the order, asking about when the package might be here, asking about when the second package should ship - you get the point. I called a lot.

Each time I rang, a customer service rep answered quickly and courteously. I had no problems getting through, they were helpful and friendly, and more importantly they gave me correct information. The British gentleman who answered my last call about the estimated delivery date and the second package shipping was spot on - he told me the package would arrive Saturday (today) and that I needed to have someone home to sign for it. If there wasn't anyone home, he promised me the package wouldn't have any identifying information on it and suggested I leave a note for the postman and ask a neighbor to sign for it. Since they had to split my order into two shipments, the second would be going out Monday and should arrive Thursday.

Excellent packaging

 

The postman pulled up right on time Saturday afternoon. I almost missed him because he heard my dogs bark and decided to just drop the note in my mail slot and run without ringing the doorbell. I'm so glad I had the heads up from customer service or I wouldn't have been lurking around waiting for him. This one didn't exactly have nerves of steel.

On to the package! The order came in two envelopes - an outer poly bag with no identifying marks and an inner padded envelop. Each box of medicine was wrapped in bubble wrap, and since this order contained 32/72 Menopur, my two individual vials of Menopur were bubble wrapped and then placed inside a separate small box. I opened each package to inspect the vials and every one of them arrived safe and sound.

As I expected, the European Menopur comes with glass ampoules of Sodium Chloride instead of glass vials. You're supposed to snap the tops off at the marked weak point and draw up the liquid with a needle and syringe. The US Menopur comes with glass vials and Q-Caps - these little plastic caps that snap onto the glass vial and allow you to mix the Menopur without a needle and syringe. It doesn't look like these ampoules would be terribly hard to use, but since I have tons and tons of Sodium Chloride vials left over from my IUIs, I don't think I'll need to use these. I will probably just use the American Sodium Chloride vials with a Q-Cap and a European Menopur vial. The European Menopur also comes 10 vials to a box, while the US version comes 5 vials to a box.

The European Cetrotide is something I haven't used before, but it looks fairly easy to use as well. The packages came with a syringe pre-filled with a liquid, a vial of Cetrotide powder and two needles - a large one for mixing and a small one for injecting. It looks like much the same process as the Menopur and I assume it's similar to the American version of Cetrotide. Inject the liquid, mix it around, draw it up, swap the needle and inject.

Thus far I'm really pleased with IVFMeds.com - their service has been great and as long as my second package comes on time and the medicine works as it should, I will have no problem recommending them to anyone else going through IVF.

Ultrasounds and Shitty Labs

This morning was my first IVF appointment. It was a quick one, just a pop into the office for my pre-cycle ultrasound and labs.  I've done this routine a million time for my IUIs so I wasn't too nervous about going in.

The first stop was the lab for my estradiol draw. I asked the phlebotomist for a butterfly, warned him that I have difficult veins and pointed out the exact spot on the vein that would be easiest to draw from. He seemed really nice, confident and I thought he'd get it in one go.

Boooooooooy I was I wrong.

The first stick brought no luck, so he tried again. He wiggled the needle a bit here and there, tried to poke it in at a different angle, moved it a bit more and then tried again. I know I'm a difficult draw but at this point I couldn't help but compare him to the nice Kaiser tech in the infertility lab who always got my vein on the first go and used to chat with me about his weekend plans. Another wiggle, an under the skin angle adjustment, another poke, a particularly painful jab and the phlebotomist gave up. I was already bleeding, starting to bruise and he seemed no closer to reaching my vein than he had been before he put the needle in.  I was seriously unimpressed at this point and starting to sweat, which is my go to physiological response whenever I'm in pain and nervous. Ugh.

This one still hurts. That's all blood underneath the bottom tape.

After conceding defeat, he announced that he'd have to draw from my hand. Um, what? He promised it wouldn't hurt more than a bee sting (last I checked, bee stings aren't fun), had my flex my wrist and make a fix, and then stuck the needle into the top of my hand. He was right, it did in fact hurt like a bee sting, but since he'd finally struck blood I decided not to complain so I could get the hell out of there. Two cotton ball and tape band aids later I was free.

I've never had a hand draw before. I see many more in my future :(

The next stop was the ultrasound, which went off as it usually does. The tech was nice and efficient, sympathized with my many cotton ball bandages and didn't have to push hard in any direction to get a clear view. My ovaries are nice and suppressed from the birth control with seven little antral follicles snoozing away. The teensy simple cyst is still there on the left side but doesn't seem to be hurting anything. My estrogen eventually came back at 20, confirming the suppression.

The next decision is what to do about stims. I am clear to stop the birth control today, wait two days, and then start stims on Saturday. However, they only just shipped my Menopur from the UK. I'm supposed to have rush shipping but I have a hard time believing they will be here that quick. I have 15 vials of Menopur left over from my last IUI but that's one short of two days. If today is the last day for birth control and I bought one more vial of Menopur at Kaiser, I would have meds for Saturday and Sunday but my package would have to be here Monday morning for my morning injection. I don't see that happening.

The nurse said I'm clear to stay on the birth control pills a few more days if I want. She said I could easily take them through the weekend with no problem and not be over suppressed. I'm thinking maybe I'll split the difference, wait to take them until I hear more about my shipment. If it's coming right on time, I'll stop the pills on Friday or Saturday, and if it's running late I can get some Menopur from Kaiser or stay on the pills till Sunday.

Owie :( Nasty bruise is already forming

 

The Wheels of Infertility Turn Slowly

It feels like I've been playing phone tag all day long. Making calls, missing calls, no one is ever in the office when I need to speak with them and they only seem to return my calls when I have to pee. Still, I did manage to get a few things done today:

• Apply for Compassionate Care program and First Steps to get financial help.   
• We were approved for the minimum amount, 5% and 10%, but I'll take whatever we can get.
• Follow up with Reprogenetics. The billing manager needs a letter of agreement from Kaiser but the Kaiser lady has been on Jury Duty and then the billing manager went on vacation Friday to Monday. On Tuesday, both should be back in the office and I should get my letter. 
• Still no confirmation of the letter. I tried calling a couple times today but had no luck. 
• I need to order a very large amount of sperm. SCRC wants two vials, Reprogenetics wants two vials, and I'm thinking we should have another two on ice to ensure our donor remains available to us. That's 6 vials for roughly $5,000.
• Meet with the financial adviser at SCRC to officially sign the paperwork and pay the nonrefundable $18,230.00 fee for our two cycles. As the cycles progress, we will pay separately for medication, ICSI (which is required for PGD), PGD biopsy (which includes assisted hatching) and our FET. 
• I've got the forms mostly filled out, I just need to go over what is and isn't covered once more. They use really specific wording and I'm thinking they're going to make me pay separately for my two ultrasounds before stimms start, the mandatory ultrasounds that check if I'm suppressed and good to go.  
• Submit the paperwork to Reprogenetics. I've been waiting on the letter of approval so I know what my portion will be. I think we're going to pay for the additional chromosome testing.  
• I just sent off my paperwork. We decided to make up our minds about the additional chromosome testing once we know how many embryos we have. If we only get a couple, we'll skip it. If we get a bunch, like 10-14, we'll do it on the Fragile X negative embryos.
• Send DNA samples from myself, my mother and my sister to Reprogenetics for the creation of our probe.
• Hammer out a protocol with my doctor. Figure out what our plan of action is and decide how we're going to proceed. 
•  I spoke with the doctor today and we're going with a very unconventional cycle. Since I had such a nice response to my last IUI, we're going to try and repeat that success. We're going with an all Menopur cycle with some growth hormone and cetrotide thrown in for good measure.  
• Pay to have two vials of sperm shipped to Reprogenetics for the creation of our probe.
• Pick up and bring two vials to SCRC and pay the $500 storage fee to have them stored there. 
• Pick up and pay for my first round of medication.  
• I did some more research on this and it's going to be PRICEY. The Menopur alone will be $5k per cycle, plus the HGH, HGC, Anti-inflammatory and everything else. It's going to be at least $6k per cycle.   

There's still so much to do and a lot is hanging on that Kaiser approval. I can't send in any of my DNA samples or proceed with Reprogenetics until they have their letter. I also need to call my doctor back, get him a copy of a test that was left out of my file and find out what dosage of certain meds they want me to look for so I can get a better price quote.

TWW: Light Bulb

I started acupuncture at the same time as my first IUI, including the acupuncture diet. I've posted about it before, it's fairly restrictive, cuts out all white flour and sugars and emphasizes proteins and veggies. My breakfast on this diet was usually soup or eggs, or more specifically, egg whites with some whole eggs mixed in. Eggs were never my favorite food, especially after I burned out on them doing the Atkins diet in 2004, and I never ate just egg whites. Still, I figured it couldn't be too bad and started eating them on mornings where I didn't have soup, 50% whole egg and 50% egg white from a carton.

Scrambled Eggies

Some days, I ended up with a really awful tummy ache, complete with nausea and frequent trips to the bathroom. It would start about an hour after my breakfast and last 3-6 long, uncomfortable hours. I blamed it on the Menopur (it's so many hormones) on the herbs (I took them on an empty stomach) and on the prenatals and vitamins (lots of people get an upset stomach from prenatals). I tried to eat lots of acid absorbing foods like rice cakes and wheat toast just in case it was from not eating a lot of carbs, but nothing helped.  I'd just have to wait it out, feeling wretched and telling myself it was worth it if we got pregnant. I'd spend these days working from home, usually curled in a ball and miserable. Ugh.

This morning, it happened again. I made scrambled eggs and turkey bacon for breakfast at 10:30 and by 11:30 my stomach was starting to hurt. I assumed my curled-ball position and prepared for a miserable time when I realized something didn't add up. I hadn't taken any Menopur, acupuncture herbs or my vitamins today. In fact, the only thing I'd had was the eggs and turkey bacon. And then the light bulb went on. I only get this horrible stomach ache on days when I have eggs for breakfast. The worst stomach aches were from days when I had organic, cage free eggs mixed with egg whites for breakfast, on an empty stomach. It's not the hormones or the vitamins or anything else causing the horrible stomach aches. It's the eggs. An egg intolerance, or more likely and intolerance to egg whites. Ding Ding Ding.

Adding this photo was an entirely necessary edit.

Trying to be healthy and follow the diet, I've been making myself miserable and sick. I've never had a problem with eggs cooked in something, like egg noddles or baked goods, but on their own they now leave me a miserable, stomach clutching mess. Egg intolerance or sensitivity, unlike an egg allergy, is apparently developed later in life. They usually result in a mild IgG reaction, like my stomach ache, nausea and upset stomach. It all makes so much sense and means that I got really lucky and had very few actual symptoms from the Menopur.

No More Eggs for Breakfast

Next time I see my doctor, I'm going to ask for an egg sensitivity test to egg whites and egg yolks. If I'm lucky, maybe this is just a temporary sensitivity that will go away, eggs are such an easy source of protein, it would be a shame to cut them out even if I don't love them. In the meantime, I'm striking plain eggs from the menu. I'm hoping that at 2DPIUI, several little eggs are fertilized and starting cleavage or compaction, unaffected by my miserable stomach. Come on little ones, I promise things aren't always so upset in there!

Embryogenesis, hopefully my little ones are fertilized and dividing as above in day 2!

Cycle Acceleration!

While on my way to acupuncture this afternoon, I got a phone call from one of the nurses in the Kaiser infertility office. She had my marching orders for the next couple days and wanted to give me my instructions. I was driving so I had her on speaker and was listening for confirmation of Nurse C's instructions when this phone nurse said something completely different.

To Recap, Nurse C's Instructions:
During my appointment, Nurse C said I would require at least a couple more days of stimulation and had me order 10 more vials of Menopur. She guessed that we would be doing my IUI on Tuesday or Wednesday, and that I would be triggering on Sunday or Monday, with another appointment to check growth on Saturday. I would be continuing with my 6 vials of Menopur.

Phone Nurse's Instructions: 
Take the usual 6 vials of Menopur today and trigger on Saturday, with an IUI schedule for Monday. There would be no need to come in on Saturday.

This information did not at all jive with what Nurse C said. My E2 was good, yes, but with 7 follicles it was not the 200+ per 18mm follicle that we're looking for. It did not seem like a good idea to skip Saturday's ultrasound, this cycle and those follicles are too important to screw up. This also meant that we needed to have our donor vial on hand stat so I called the bank and placed our order over the phone. I'm so glad they store purchase history and credit card info, I never would have been able to place the order if the customer service rep didn't already have all my info in front of him.

When I got to acupuncture, I shared my concerns with my Acupuncturist S. Since she's a Certified Nurse Midwife at Kaiser, who has been there so long that she taught most of the OB/GYNs how to deliver babies (including my OB/GYN who is now the head of the department), she has an excellent relationship with most of the doctors, including Dr. K, and also happens to have her personal number. While I was on the table, having a treatment on my back this time, she gave Dr. K a call and talked over my procedure with her. I'm not sure if Dr. K had missed some notes or if she wasn't completely aware of the instructions given by Phone Nurse, but she agreed with me and S that I should be monitored on Saturday. At the very least, this would give us confirmation of the correct time to trigger so as not to leave viable eggs behind. I am incredibly grateful to have S on my team and feel much better about moving up the timeline as long as we check and make sure my eggs are mature first.

The new plan is to take 6 vials today, which I just did, and go in for another E2 draw and ultrasound at 7am tomorrow. I'm really not going to enjoy leaving the house before 6:30am but it's worth it to me to make sure these follicles are mature. If everything checks out, I have my trigger ready to go for Saturday and E has a rare day off on Monday. If they're still looking a little runty, I have more Menopur ready to go to give them a boost. Our vial will be picked up tomorrow and will be good and frosty for 5 days which gives us plenty of time. Whatever happens, we're prepared.

Slow and Steady

I just got out of my appointment and the follies are looking excellent. All seven are still plugging along, just at a slightly slower rate since the decrease in Menopur. I think the largest was 15 and the smallest was 13 so they're developing together, nice and even, but they're not quite ready for triggering.  I'm very pleased with their growth but but a little bummed that we'll need more Menopur like we originally thought. I thought we'd get off easy this cycle!

I just picked up two more boxes, another 10 vials, and got my Ovidrel trigger too just in case. If they need me to trigger on Sunday, the pharmacy is closed over the weekend so  I'd have no way of getting it. I will probably be back in for a rare Saturday appointment tomorrow morning depending on what Dr. K decides. If I don't trigger on Sunday (I don't think I will), they're thinking Monday might be the next contender.

My E2 levels came back this time at 926, an absolutely beautiful number, which if you average it out is about 132 per follicle. I'm sure they're not all in the 130s, probably more like 100-150 given the range of growth, but they're all on track and I have no reason to suspect that they won't all be ready to ovulate by the time I trigger. I love seeing those little follies on the screen, they show up as large, round, dark circles which is such a nice change from the empty, blurry grey ovarian tissue we saw last cycle. 

What a tiny order! This is the smallest one I've bought yet, it was only $730. What a bargain!

Although the appointment went well, the blood test this morning was a little hairy. I didn't have my usual phlebotomist and this new one didn't take my warning of difficult veins seriously. She tried first on the left, which is nearly impossible to find, before giving it up as a bad job and moving to the right. The right was already a little bruised from the draws on Monday and Wednesday and she only made it worse by repeatedly poking me and wiggling the needle around in my arm. It wasn't super painful, but was enough to raise my blood pressure up about 20 points as we saw when I went up to the nurse after. I usually have low pressure, especially in the morning, with a systolic reading around or below 100. My pressure today was 126/67 whereas Wednesdays reading was 103/60, already 4 points higher from a good blood draw than my usual haven't-been-stuck-with-needles pressure.

A nurse should be calling in the next couple hours to give me instructions on the Menopur and let me know if I'm going in Saturday. I'm predicting now that they're going to keep me on 6 vials, have me come in Saturday, but not trigger until Monday. I received a wonderful offer to hang out with my friend M, Roxie and Deano's mama, but my acupuncture appointment is smack in the middle of the day and doesn't allow for any other plans. Although I'd much rather hang out with M, it looks like I'll be spending the rest of the day driving to and from the acupuncturist in horrible Friday traffic. All this acupuncture had better be worth it in the end!

IUI #2 Is On!

I got a chance to speak with my RE today and she is recommending that we move forward with another IUI for this cycle! This means that if everything goes well and they continue growing, we'll be triggering with 7 mature little eggs in the next few days.

Seven follicles might seem like a lot for your average person and I can definitely see why. I have no intention of becoming the next octo(septo)mom and the potential for 7 little embryos to implant seems crazy. Most doctors suggest you trigger with one or two eggs, if you're okay with the possibility of twins, and might even cancel a cycle that showed 7 follicles. For us, this is not the case.

Back when we were first discussing IVF vs IUI, our RE Dr. K said she would be thrilled to see a 30% fertilization rate from my eggs. I'm only 27 but we don't know what shape my eggs are in because of the FXPOI, and from what I've researched, there's definitely a drop in quality in cycles where you produce tons of eggs. Someone without FXPOI might see 7 out of 15 eggs harvested fertilize and maybe 5 might make it to day 5 for freezing. I might be lucky to get 2 out of 7 and we're expecting those same odds, if not less, for IUI since the sperm won't be hand delivered to their eggs.

My hope is that with 7 potential targets for our sperm to hit, we might get super lucky and have 2 fertilize and implant. Three would give us better odds, but it's probably too much to ask for. Statistically, if our 50% odds held, one embryo would have Fragile X and the other would be healthy. Unfortunately, we all know that statistics don't hold up in small sample sizes. With two embryos we would really be just as likely to get two affected fetuses as two unaffected fetuses, and my fear is that we might end up having to terminate the whole (potential) pregnancy.

I have been mentally preparing myself for a TFMR (termination for medical reasons) since I got my Fragile X Premutation diagnosis, and although it's horrible and gut wrenching to even think about, I think it would be a lot easier to cope with if we get to take home a baby at the end. With a twin or triplet pregnancy, assuming we can get pregnant at all, I would be incredibly happy to end up with just one healthy baby. It would be horrible to have to terminate one or more affected fetuses, but we'd still get one child in the end so it would all be worth it. Getting pregnant with an affected singleton, or affected twins, having to terminate and come home with no baby, would be devastating.

For now, I'm trying to stay positive as usual, hang with my fuzzy babies, and send lots of good vibes to my follicles. I took 6 vials of Menopur today in a single injection, boy did that burn like hell, and I'll have my next appointment with my RE or nurse tomorrow morning to see how the follies are growing. They'll either be nice and mature and (just about) ready to trigger, or not quite grown and I'll need to continue stimming for a couple days.  I think I have 10 vials of Menopur left so I could do one more day of 6 or 8 vials before buying more, or two days of 5 vials if she wants me to reduce further. I'll also have acupuncture a couple hours after my appointment with Dr. K so I'll ask my acupuncturist S to do everything she can to increase blood flow to my ovaries and uterus. Fingers crossed for good results!

My waiting buddies. They're sleeping so sweetly because they jumped up on the counter while I was on a conference call and ate the four bowls of food I had laid out for dinner. Or more accurately, Fuckie(the white one) ate three bowls of dinner while Cillian ate his own. Now I get to defrost more food for the other two hungry kitties. Thanks Fuckie.  

SEVEN

I am in so much shock after my appointment this morning that I feel like I might cry. I can’t believe it, but we have SEVEN, SEVEN!!! follicles! At the beginning of this cycle, we were told not to get our hopes up for more than 1 or 2 and BAM! SEVEN beautiful, perfect follicles! I have 5 on the right, and 2 on the left and there might even have been another hiding on the left since it’s tough to get a good picture because your colon gets in the way. They looked like little bunches of dark grapes on the screen, I couldn't believe it when I saw them.


This is more than I ever thought my body would make. With FXPOI, 7 follicles might as well be a million and you’re lucky if you get even 1. After tons of Menopur injections yielding only 1 follicle last month, we figured this cycle would be, the nuclear option, would be a hail mary to see if I was even capable of making multiple eggs. I hoped that maybe 3, or secretly even 4 out of the original 5 small follicles would continue to grow, but I never dreamed it would work this well. I'm over the moon, completely overwhelmed and so, so hopeful.

They’re all growing at the same rate, between 10-14mm, and my E2 was 537 so all this Menopur is paying off! This is fabulous growth after only 2 more days of stimms and she didn't bother putting in another order for more Menopur, I might not need it! This makes the 2 daily injections, the bruises, the stomach pain,  the crazy bloat, the blood draws and early mornings all worth it. We could really have a shot this month to get a baby.


I am waiting on my call back now to see if I’m going in tomorrow or Friday morning and E and I need to discuss our options. He’s leaning towards doing IUI and hoping for multiples, with the hope that if we got pregnant with twins or triplets at least one might be healthy and unaffected.  I do agree it would be a pretty good shot, but I’m hesitant to lose the chance to potentially harvest 7 eggs. We could always follow the same protocol next month if we’re unsuccessful this month and harvest then, but it almost seems like too good an opportunity to pass up!

Either way, I’m so hopeful that this will be it!!