Testing... 1,2,3

Yesterday we went to the new OB/GYN with SIL.* Excited in our anticipation for another ultrasound, we weren't prepared for the possibility of NOT having one and were a little disappointed when it didn't occur. Not sure if it was because the appointment ran long, if the doctor felt it wasn't necessary, or she was holding off because she knew the perinatologist would want to do one. You know....because of all the testing coming up.

Testing? What testing?

Since I am of AMA, there are about a zillion tests that should be done to test for chromosomal abnormalities. Great another reminder that if something goes wrong, it's probably because we used my old-ass eggs. Thursdays doctor was not the first doctor to count me as 41, even though my birthday is not until the end of April. Seriously - I am waaaayyyyyyyyyyy over hearing the tut-tut regarding my age.

We elected not to do the chromosomal testing on our eggs/embryos. Not sure why, but it was one of the things I just didn't focus my laser (some say obsessive) research skills on during the IVF process. A part of me thought that a small biopsy could endanger our chances of implantation and thus we weren't really interested in lowering our chances (no matter how small) or spending extra money unnecessarily. Now, unlike congress, our proverbial bill is due and it is time to pony up (i.e. take all the tests).

Here is the nice handy-dandy chart for us to stress over for the next 6 or 8 weeks. Look a bit overwhelming? Yea, me too. Fortunately some of them overlap, so it's not like we have to do all. But we DO have to weigh the pros and cons of each and decide which we think is best.  Right now we are weighing more towards the amnio vs the CVS. Hubby says CVS is slightly riskier for miscarriage and the doctor mentioned something about loss of limbs(!!!). I haven't had the heart to look.

RISK ASSESSMENT CHART FOR DOWN SYNDROME AND TRISOMY 18 Screening parameters First Screen 11-14 weeks Integrated Screen Combines first screen & Quad Quad Screen 15-18 weeks Amniocentesis After 15 1/2 weeks CVS Chorionic Villi Sampling 10-12 weeks Down syndrome detection rate 83% 92% 81% 99.9% 99% False positive rate 5% 5% 5% 1% 1% Trisomy 18 detection rate 80% 90% 80% 99.9% 99% Biochemical Markers PAPP-A Free Beta hCG PAPP-A AFP hCG uE3 Inhibin-A AFP hCG uE3 Inhibin-A Diagnostic evaluation of hundreds of types of chromosomal anomalies Early Diagnostic evaluation of  chromosomal anomalies Nuchal Translucency NT NT NT *** *** Timing 1st Trimester 1st & 2nd Trimester 2nd Trimester 2nd Trimester 1st Trimester Open Neural tube defects Detection Rate *** 80% 80% 99.9% *** Fetal Nasal Bone presence Preliminary results/ significance *** *** *** ***

All this and we know we are at higher risk because of twins. I should be celebrating and instead I feel like a big bag of worry. At least the appointment went well.

*I never know whether to put SIL or surrogate. Some days it feels more appropriate to put surrogate for a number of reasons, but other days it seems so impersonal for such a great thing my SIL is doing. Bear with me. 

Still Here

And so are the twins. Yay!!!! Growth rate in both is great and heartbeats are great.

Our surrogate has been officially released to her obstetrician with special instructions to also see a perinatologist.  Her obstetrician will recommend a perinatologist that she [the doctor] is familiar with so they can work in tandem. Our clinic was very happy with our surrogates choice in obstetrician. Everyone is so excited for us. 

I'm excited too, but still very nervous. Twins increase everything, including risk. If I think about it too long, I will drive myself crazy.

More later - just wanted to drop a quick update. Crap it's late. Night all. (I can't believe it's after 1am - sheesh.) 

Cupid's Gift

Artwork by Setsiri Silapasuwanchai

Purchase here

Today could have been the best or worst Valentine's: this morning we had our ultrasound. Originally it was supposed to be on Saturday, but we realized that there was a miscommunication and that they don't do non-required-cycle ultrasounds on Saturday. That's a story in itself that at this point bores even me, so I will spare you the details.

I think I may have held my breath as the ultrasound began. My husband has never seen an ultrasound, which seems incredulous now that I think about it, so it was a completely new experience for him. (I've lost count on how many I've had in the last year alone!) After what seemed like forever (really just a few seconds), the big black circle came into focus. With a little white circle (yolk sack) inside. And a blinky heartbeat that measured at 129 beats per second. The doctor said it was perfect.

And then she showed us #2... Equally perfect.

Don't Bring It.

We received our 3rd beta test result today. For those of you keeping score:

January 27th: 130

January 29th: 365

February 2nd: 2268!

I have no idea what that means except that our nurse says our numbers are fantastic. On Tuesday we asked about singleton versus twins - the nurse I spoke with said right now they are considering it a singleton, but we won't know until the ultrasound. So what did we do? What any reasonable hopeful-parents-to-be would do: pestered our favorite nurse. 

"It is very, very difficult to know whether there could be more than one from bloodwork alone - and I have been wrong enough times to wait until the ultrasound rather than guess."

Fair enough. I guess I can stop obsessing with Dr. Google.

http://veterinarynewshub.com/wp-content/uploads/2012/09/Dr.Google.jpg

Oh who am I kidding? Just a few more peeks. Apparently we've reached a small milestone with our hCG of 2268. Between 1000-2000 you can see a gestational sac on an ultrasound. 

According to this IVF calculator, we are 4 weeks and 6 days pregnant with a due date of October 6th. 

If this was a normal milestone or challenge in my life, I'd be all 

"WOOOOOOOO HOOOOOO! We've made it this far - BRING IT <insert challenge here>!"

I think this time I will be all "woooo hooo. Don't bring it. Unless by "IT" you mean baby in 9 months. Or 10 months. Or whatever weird counting system they have going on these days that will result in a crying, pooping, bundle of joy". 

Wonder what my 14 year old self would have thought of that statement from my 40 year old self? Probably just happy I'm still all weird. 

60 Second Update

Embie we didn't transfer didn't make it. They left a message on my phone and I didn't feel the need to call back. It didn't upset me - not one bit - totally expected.

Tomorrow I go in for my check up appointment. I've been a little worried because I am still cramping, but I guess I shouldn't be surprised since I'm prone to infection AND I didn't take my doxycycline the night before my transfer like I was supposed to. Told the nurse on the day of transfer (when she asked about it). Completely slipped my mind to take it even though I told myself probably 20 times (and my husband at least 5)! Had to take it after dinner and dinner was after the reminder alarm went off. Damn you ADD. Oh well. I guess if I had to forget one medication -that was the one to forget.

G.C. says she is doing great except for a sore bum. LOL. I feel so bad for her. She told me that the night of the first shot that she kept procrastinating when her husband tried to give it to her. Made him keep practicing on the orange an hour past the time she was planning on taking it. Then when she finally got the shot she couldn't believe that she had been so worried over it that whole time. That it was nothing compared to what she had built up in her mind. Still, too many shots will give anyone sore spots. There wasn't an unbruised spot in my prime belly-shooting area by the time I was done. Hurt to wear pants. Sans pants (or skirt) probably isn't good for the office. Now that I think about it - why didn't I wear a dress???

That's it for now. Tomorrow is checkup for me and Sunday is prego test for G.C. Some moments I don't think of it at all and other times I wonder how wise it is troll craigslist for my dream crib. Well "troll" as in window shop, not as in act all douche-y. Why am I explaining myself? You all knew what I meant. I starting to ramble which means I need to hurry up and get to bed. Still a ton to do.

Night all!

6 Embies

We have 6 embryos. We will see how many continue. (4 of the eggs were immature). The embryologist said if they do well, then they might consider doing a 5 day transfer instead. We told her that we are not sure if we want to take that risk and to have the doctor call us tomorrow when we know more on how they are doing. 

Pros of going to 5 day: out of the embryos that survive, you can choose the very best ones to implant, resulting in a higher rate of pregnancy.

Cons of going to 5 day: embryos that could result in a pregnancy may not make it to 5 day outside of the womb. We could lose them all and have nothing to transfer. 

Trying to get less excited. It's hard. 

Failed again

The Beta hcg levels went down to 15: chemical pregnancy, ie. failed cycle.

I knew before I even read the email. I knew when my phone went off at 2:55am to let me know that my BFF's baby made its debut. I knew yesterday when I made my limbo post yesterday, I just didn't want to believe it.

This is the part where I feel like a failure.

My husband and I hugged each other for a long time this morning, but then barely spoke after he got out of bed. As hard as this is for me, I think it's harder for him. I have a son - he does not. He has wanted children from the very beginning and I had to disclose the problems we would encounter (my cryoablation) when we had only been dating 3 weeks. His only question then was if I still produced eggs...

He can't console me and I'm not sure how to console him. A selfish part inside wants me to yell out "you can still have a biological kid - it's ME that's the problem". I wonder if his family, or even he, thinks that marrying me was a bad idea. An illogical part of me whispers that he will leave. What do I bring to the table?

I feel broken.

I can't even do the basic function of a woman.

I haven't cried and just walk around pretending everything is fine. My mom says she is devastated and wondered if this is just what clinics do to get more money out of you. I have to be the strong one and explain the plain fact that clinics in India get more money on successes than failures. Not to mention attract more clients.

Last week I signed up for a seminar tonight at my clinic here in Atlanta. It's a seminar to discuss infertility options, get a free AMH blood test, and get free one-on-one with one off the doctors. I'm curious about my AMH since the one test in India came back so low, thus I will go. Talking with a doctor will help too. I'll probably avoid sitting next to the peppy people. Shouldn't be hard. I've noticed that everyone avoids people with recent failed cycles. I guess it's like the pregnant girl in high school - they don't want to "catch" it. 

Still in Limbo

We were suppose to get the update today. We didn't. Which is not surprising, because sometimes that's just how it is. 72 hours will give a better picture of where we are at anyway.

Woke up a 4:38am and started checking email. Realized around 11am it wasn't going to come. Hopefully I will wake at a normal time tomorrow morning.

Rather than write out a long post (and rather than reread what I wrote yesterday), I will just recap what I sent to my mom this morning.

yea, I know she is looking for the hcg value to double every 48-72 hours, so she may have not been able to do the test today, knowing that tomorrow is just as good (if not better.)

Just as an FYI,

At 14 days

any value over 25 is considered pregnant. 

any value under 5 is not preg

5-25 is indeterminate

Ours was 27.44

The average for 14 days is around 100. The value doubles every 48-72 hours (for many many weeks.) If you do not see the value doubling, then it is cause for concern that the growth may have stopped. This can be from ectopic pregnancy or that the embryo has just stopped growing and the body will usually miscarry it naturally. Happens all the time and of course at my age the chances of miscarriage is higher.

So I guess we are waiting to see if it is still growing properly. From what I understand, a low value could have been caused by the embryo implanting itself a little late, or it could be the embryo that fertilized late (1 out of the 3 did.) .  Healthy babies have been born with initial low hcg values, but it significantly lowers our chances. A statistic I saw said that <35% will be successful when the value is between 25-50 at the 16 day mark. Low hcg has no bearing on the baby's health after it is born.  If it is growing slowly, then there could still be chance and they will just monitor every 2-3 days until the 5-6 week mark when an ultrasound would show if there is a gestational sack and if it is empty. At least this is how it is done in the US. I haven't asked her yet. 

Literally in limbo and I guess it could go either way.

New Advances in Infertility

Each of these mouse pups was born from an egg scientists created using embryonic stem cells. 

On thursday, NPR had a fascinating story on a breakthrough discovery for infertility. Even more fascinating  they did it with induced pluripotent stem cells (as opposed to the controversial embryonic stem cells). If they can do it for women, then not only will it reduce/eliminate the biological clock worry, but also provide a solution for the dreaded "unexplained infertility" diagnosis that plagues so many women. This will be a game changer for future generations of infertile women. There are even great implications for men with sperm issues, as well  as the many hurdles faced by the LGBT community.

Alas, this will not apply to many of us currently in the throes of infertility. All is not lost. Many doctors are currently working on various cell technologies that apply to infertility. Autologous Endometrial Coculture is one example of a technology promising encouraging results. What does all that fancy wording mean? The short of is that they take cells from the lining of a woman's uterus and use them as a more natural environment for fertilized eggs than the previous methods. Studies have shown that in certain cases embryo development is improved, as are IVF success rates.

Dr. Patel's clinic in India is working with a similar concept: certain clients can qualify for the case study in which natural cells from the IVF patient are used to surround the egg pre-fertilization. They are seeing an increase in fertilized eggs and while it's too early to determine if this results in actual healthy babies born, I can say I was very impressed to learn that 3 out of 4 of my eggs were fertilized with this method. There is more to this method than I am [purposely] describing, but that is better left to the professionals or perhaps, when I can be less emotionally attached to the subject matter.

I have no idea if this will help the quality of my eggs/embryos in the long run, but it is still very exciting. My first cycle ended up with 2 eggs and only 1 of those fertilized. That 1 egg took over 24 hours to fertilize. On my second cycle (with the new protocol) I had 4 eggs extracted and out of those 3 fertilized. Like my first cycle, one of those was a late bloomer, but maybe it's the one implanted now and thus causing a lower hcg. Apparently my case is not an anomaly as the Akanksha Infertility Clinic is seeing really encouraging results with women that qualify for the case study. Even if it doesn't work for me, I will be really excited if this helps improve success rates for women in general.

Science is so cool. 

The results are in! Stage (I forget by now)

The number 3 is the first odd prime number, and the second smallest prime. It is both the first Fermat prime (22n + 1) and the first Mersenne prime (2n − 1), the only number that is both, as well as the first lucky prime.

It has significance in many world religions including Christianity (Trinity), Hinduism (Trimurti), Judaism (3 Patriarchs), Islam (3 holy cities for pilgrimage), Buddhism (3 Jewels), Taoism (3 Pure Ones), and Wicca (Triple Goddess).

According to Pythagoras and the Pythagorean school, the number 3, which they called triad, is the noblest of all digits, as it is the only number to equal the sum of all the terms below it, and the only number whose sum with those below equals the product of them and itself.

Personally, the number 3 is how I used to always hang pictures or decorations on my walls for what I believed to be the perfect balance and auspicious design.

And most importantly, 3 is the number of good embryos that were transferred to our surrogate yesterday.

Special Lady Cocktails

When I first was swept up by the internet infertility tornado, I remember reading forum posts from other hopeful women. Falling on a theme (as I often do), I obsessed over the ridiculousness of women taking all kinds of crazy pills - usually without having a doctor recommend them. OMG! DO YOU JUST TAKE ANYTHING YOU FIND ON THE INTERNET??? Some posts swore by the helpfulness while others confessed that they worried it may have hurt. Once discovered, some doctors gave full-on lectures how it was not appropriate for the poster's situation, only to find out that someone else (usually another doctor) in their clinic had told them to take it. Truthfully, I was personally affronted that such naivety and desperateness could drive women to arbitrarily take anything in an attempt to conceive.

The picture above is from MY house. That's right, Ms. Holier-than-thou is ...well, the same as everyone else.

At first it started small. My first pill was THE PILL, and I was told I would have to take it by my Indian doctor to make sure I was synced properly for my IVF treatment. Fair enough. I called my OB/GYN and promptly got a prescription. Let me mention here that I do not like taking birth control pills (bcp) as not only does it make me gain weight and experience occasional nauseousness, but sometimes I experience additional glum side effects (depending on the brand). Fine - whatever - I set my alarm on my phone to give me a daily reminder; particularly because my history of remembering to take medicine on a daily basis is pretty dismal. Especially BCP. Our local IVF doctor also advised to add a pre-natal vitamin (another item bound to make me nauseous) and I immediately relented as I ran to our local Publix.

Baby aspirin and acupuncture were added to the regime - the latter being something I normally would have scoffed at a year earlier. Doctor semi-recommend it and so I shelled out the cash. My husband gave me the big-eye, but I'm guessing he recognized my fervent look and said nothing. 100 bucks a pop for 6 weeks = not cheap. What can I say except I wanted no regrets.

IVF treatment #1 was dismal. 2 eggs retrieved, only 1 fertilized. Even that 1 took a damn long time to fertilize.

Now I am prepping for treatment #2. In typical fashion, I have been obsessively researching similar cases. Not just blog posts, but academic papers and any type of current research I can lay my grubby little eyes on. A clinic in India recommended 25mg of DHEA for 3 months. I rush to pull up the scientific documentation and realized all of the research is really based on a tiny Tel Aviv study. The study showed a significant difference in live birth rates with women who were poor responders and took 75mg of DHEA for 40 days vs women who did not. A follow-up study had additional encouraging results. Screw the 25mgs -I only had about 40 days till cycle, I was going to go full boat - 75mgs it is! [I would like to make a note here that I was not able to take the full 75mg initially because of side effects. I had to build up and even now I have minor side effects.]

Next I read how melatonin could also help woman with poor ovarian reserve and immediately I was hunting down more articles and recommended amounts. 3mgs seemed to be the magical number, but that amount knocked me on my butt. Still 1-2mg was doable and thus it was added. Combining it with the DHEA means I sleep really well, but I'm groggy as all get-out when I wake up. Heaven help me if I don't get a full 8-9 hours. Oddly enough, my friend says she takes 10mg all the time and it barely helps her sleep. What can I say? I'm a lightweight.

Did I stop there? Heck no! I was on a search that day and after reading some articles (which I can not find at the moment) regarding myo-inositol, my amazon shopping cart increased. Among other things, myo-inositol was suppose to help women with cyst issues and a giant cyst almost caused a no-go last cycle. My OB/GYN found a cyst last year and I began to wonder if some of the pain issues I had felt over the last year were cyst related. GIVE ME MYO-INOSITOL NOW!!!

There were a few other things on the list, but these 3 new items had good scientific data to back them up and they applied to women with similar (if not exact) conditions. The other pills I noticed my fellow women-at-arms were taking were either less scientifically regarded or didn't apply to me. Besides, as I mentioned before, I'm a light weight and I wanted to see how I was going to handle this new concoction.

Which brings me to last week. I'm not quite sure HOW I ended up at the Rainbow (read: hippie) Grocery store - but all of a sudden I found myself at the cashier's stand with CoQ10, some fancy fish oil supplements, and yes even some Royal Jelly that was well hidden in a jar of honey. And some awesome low-sugar dried mango. And a yummy nut mix. And Activated Charcoal that I told myself would be good to have on hand if my dogs ever get into something they shouldn't. Somehow I think my subconscious was trying for an easy excuse to get some for me. You know. Just in case.

"Just a spoon full of sugar..." (or honey) 

Things you should not read during 2WW (I mean it!)

From  http://www.fertilitynation.com

Ugh.

Supposed to get the news tomorrow, but I wouldn't be surprised if we don't hear from them till the 11th.

Looks like I need to pull out a yoga video and read my new "Mindfulness" book. 

Some news is good news

Yesterday I began to prepare myself for the worst. My husband was affected especially hard by our news of no fertilization (and by the evasiveness of the embryologist to my specific question) and I knew I had to be tough. There was no way he could take the news and deal with an emotional wreck of a wife. We barely spoke the rest of the day and only ate what was around our hotel room (i.e. snacks). I didn't even want to discuss next steps yet.

Today we were able to talk more on our walk to the clinic. Misc things revolving around IVF. Typical things that I think most couples go through including questioning some of the way things were handled. Think most couples go through that when faced with bad news; stages of loss and what-not.

Once we arrived in the clinic, rather then wait for Dr. Patel (which we knew would take awhile - yesterday's doctor strike caused double duty today), my husband asked if we could go straight up to the embryologist's office. The lady in the office told us to wait and after a few minutes went into the lab. She returned shortly and I assumed she informed the embryologist that we were here.

We waited. And waited. The seconds felt like minutes. After awhile, I knew the news would be bad. If she had good news, wouldn't she rush to tell us? I tell myself that maybe she is in the middle of an ICSI procedure and can't, but the other lady looked pretty forlorn. I suspect she already knows the bad news we are waiting for.

Finally the embryologist comes out. Her expression is not one of good news. She sits and starts speaking to my husband in Hindi.

All of a sudden I hear the Hindi word for "1" twice. I perk up. Then I hear "4-6 cells"! The conversation goes on and on and I don't want to interrupt for fear something might be missed, but I'm dying to know if I am right, and if so, the quality of the embryo. (It's amazing how much information you can get with only knowing a VERY limited amount of Hindi.)

Finally there is a pause in the conversation. I'm right! My husband asks if I want to see images. We are given surgical hair covers and face masks as we head into the lab. On the computer monitor I see the one egg unfertilized and next to it one booming with smooth edged cells. No fragmentation. It's 6-7 cells now; transfer is planned for this afternoon.

Holy crap.

I'm still not going to get overly excited, there are still many hurdles, but I will allow myself to be happy for today.

No news is probably not good news

2 mature eggs retrieved.
24 hours later neither have fertilized, but neither have degenerated.
ICSI was performed.
We are asked to check again tomorrow. Can take up to 48 hours. Embryologist will not answer the question of what is the longest she has seen take.
Husband can barely speak.

India is getting a egg-sperm-embryo bank!

Another great article from Times of India - Ahmedabad

Gujarat to have India's first egg-sperm-embryo bank

http://timesofindia.indiatimes.com/city/ahmedabad/Gujarat-to-have-Indias-first-egg-sperm-embryo-bank/articleshow/12643028.cms