Showing posts with label uterine lining. Show all posts
Showing posts with label uterine lining. Show all posts

Sunday, December 30, 2012

Cycle Limbo Part 2: Return of the Cycle


UPDATE

Nurse called. As long as my SIL can come in tomorrow and get an ultrasound - then we are proceeding as planned. Whoooooooooooooooooshhhhhhhhhh.

When the nurse initially called, she kind of presented it as my option with the knowledge that if my SIL's lining isn't thick enough upon transfer day, than the transfer won't take. Normally they want 11-14 days of the estrace to insure a thick lining, but they don't want to start the estrace until a untrasound and blood work on her confirms everything is a go (eg, no cysts, hormone levels good, etc..) My last cycle gave me only 12 days before transfer. She asked me if I wanted to go forth.

At first I asked questions about how would we avoid this next time if we waited. She said that normal protocol was to control the GC's cycle with BCP/Lupron overlap. Then I asked the follow up question that surprisingly, I think was a bit unexpected: why did we not do it this time? This was a little harder to answer, but the short of it was - they/she didn't want to start medications (including BCP) until all the initial testing had been completed. Of course my logical reply was: Does BCP effect the testing. Answer: No.

So getting past all that, I realized she expected an answer from me about whether I wanted to start or not. Here is where I lost it. Crying the cry only someone that is mildly dehydrated and still slightly sick can manage. My guess is that over the phone it sounded somewhat like a choking horse.

Normally when I get really upset, my sensibilities leave me, but they did not this time. I put the question back to her: "What you are telling me is that I have to choose between my chances lowering further from waiting a month, or take a chance that the lining won't be thick enough." She said she would speak to the doctor and call me back.

I laid the options out like that for a couple of reasons, but the main one was that I really didn't know which is riskier. One would think that a month wouldn't make a world of difference, but women in my age bracket know differently. My AMH dropped drastically in a very short period this year. Conversely, I don't recall our surrogates getting estrate (or similar) that long in India prior to the transfer, so I'm not sure if it is a booster/fail-safe thing or what.* From a medical perspective, since my GC and I started menses within 24 hours of each other, one would think at 29 years of age, her lining would be reasonably thick for ovulation at the proper time anyway.

After speaking with the doctor and both reviewing my records, the nurse called back. She stated that as long as my GC could come in for ultrasound tomorrow (she can), then we would continue the cycle as planned. We nailed down a few of the other details (like when I would start my big gun meds) and now I feel a crapload better than I was feeling. Earlier I was trying not to let panic surge, but I was having a hard time. I would have waited another month if I had to, but honestly, I am ready for this to be over and done with. The emotional and physical, even things you don't let anyone else see, is astronomically draining.

*Originally I thought the Indian surrogates did take meds from the beginning (from my own research of surrogacy), but I had my husband ask the Indian lady directly and she said that she only been told to start medication a few days prior to the transfer. My husband and I now debate if this was a protocol thing, problem with the surrogate, or other. 

Cycle Limbo

Picture from: http://www.examiner.com/review/limbo-a-post-mortem

Wednesday, when I was sick with a nasty cold (and had to work), I posted that I had questions for our nurse. I updated that post with her answers from her call to me. One thing she told me, was that if our GC's period did not started by Friday, to have our GC call her. I promptly wrote it in my notes (where the questions were), sent a copy of those notes to my husband, and started to put a reminder on my calendar to be sure to call our GC on Friday.

"Started" being the operative word. I was distracted by actual work stuff (people come by my desk all the time) and when I got back to a blank calendar entry - I had no recollection what it was for. Between being sick and mission critical work stuff, I hoped that I would remember. Thursday turned into me only leaving my bed to RUN for bathroom necessities due to an added bonus of stomach flu.

Friday rolled around and I was able to work from home. I also had the outstanding attorney papers (almost 60 pages) that I had to start going through ASAP. By Friday night, something tugged on my memory and I realized I hadn't received the insurance information from our GC yet.

<insert important announcement here> I'll go ahead here and announce that our GC is my sister-in-law. She is my little brother's wife who graciously wondrously volunteered to assist us. <end insert>

In my juggling of balls, I guess I thought that getting the insurance information from my SIL was what I needed to do on Friday that was so important. My period hadn't started, but our nurse had told us that my SIL wouldn't be starting injections for 2 more weeks. I was confused and misunderstood this as her "medications". As in ALL medications.

Friday night my period started and I promptly emailed and called our clinic as instructed. Equally prompt was the automated reply (and answering message) informing me that my nurse was out of the office till Jan 2nd. Great. That meant I was going to have to deal with other people trying to get in for my Day 2/3 ultrasound/blood work. Was able to get a hold of someone at the clinic the next morning and they scheduled me to come in for Sunday morning 8:45 AM to get an ultrasound.

You can probably guess what happened at that appointment. First I got my ultrasound and then I was asked, as almost a side note, if our GC had started her period. When I said I didn't know, the nurse on call asked if we were doing fresh or frozen cycle. As I began to explain that we have to do fresh, it sinks in what I forgot. A wave of panic passes over me, except I'm not even sure why because no one has ever told me what it means if the GC hasn't started her period yet. Then I ask the dreaded question. The very pregnant nurse answers - since she hasn't started her meds to insure her lining will be right, we may not be able to start this cycle.

WHAM.

I guess after seeing my face, she decides to call my nurse who I guess is on vacation. We desperately try to get my SIL and brother on the phone. We finally do. Her period started on Saturday. I have no idea if she was supposed to start some medication then. Preggo nurse (can you tell I'm irritated that I have to deal with a pregnant nurse at a fertility clinic in the midst of all this?) tells me that our personal nurse will call us in a few hours. I go home and listen to an recorded meeting we had with our nurse a month ago. Sounds like my SIL should have come in for an ultrasound and blood work as well today. And it sounded like from the other nurse, some estrogen medication as well. Great - just great.

Now I sit and wait. And try to hold myself together. And try not to beat myself up (which is utterly impossible). And know my husband is upset with my forgetfulness, but trying to hold it together and not say anything.

11 follicles were seen this morning and no cysts. 

Saturday, October 13, 2012

You have questions...We have answers

Actually I need your answers, so if any of this sounds familiar please post your experience/knowledge in the comment section.

On Tuesday night, I attended a seminar at my old clinic ACRM, here in Atlanta. I described some of it here and also pinky-swear promised to post the questions I posed to the new doctor during the Q&A session. (Ok, I didn't really pinky-swear, but I wrote I would, which is almost like the same thing.)

So here are the questions I asked.

1.) Can endometriosis affect the outcome of an IVF cycle if the woman is using a surrogate?
A.) Yes it is possible. [Sadly I have forgotten the reason behind it. I believe she did mention that there could be an effect on the eggs in a follicle and thus less eggs retrieved, but for the life of me I can't remember if she said certain things or if I am confusing it with stuff I have read.]

2.) Besides cost, what are some of the downsides of using ICSI?
A.) There have been studies done of the offspring conceived by ICSI and it was noted that the male children had a higher rate of sperm problems. Whether this is a cause of the ICSI or due to genetics (ie, the father having sperm issues thus ICSI was used) is unknown. 

[This one I already knew the answer to, but I wanted to make sure there wasn't anything else I didn't know about. Primarily because our clinic in India uses ICSI as a default with no extra charge (unlike here in the States).]


3.) How long after a laparoscopy, do you need to wait to start an IVF cycle?
A.) Generally the recovery time is short and we like to do the next cycle as soon as possible. Especially if the woman is older.
[I know they can't do it the same month as IVF, so I'm guessing that means you just have to wait until the next month.]

I'm getting conflicting statements about #1 and I'm a little concerned about it. Everything I read regarding endometriosis and IVF revolves around the woman carrying the baby, there is very little info for women using a surrogate.

My new OB/GYN did not seem to think that endometriosis would be a problem for me (with regards to lowering my IVF success rates) since we weren't using my uterus. In fact he thought there was a low likelihood that I had it since some of my symptoms were relieved with my cryoablation. He advised for me to find out if the cyst I had aspirated during my first IVF cycle was a chocolate cyst. He did mention at the end of our lengthy consultation that he did not specialize in reproductive endocrinology, so I'm guessing that was his out if he was wrong. The only surrogate cases he probably has is if someone walked into his office who IS a surrogate and already pregnant. Also this WAS before they locked me in the bathroom.

Conversely, Dr. GS on SIRM's forum indicated endometriosis could cause a problem in my case, but it was hard to tell if he understood that I would not be CARRYING the child. Even though I definitely mentioned it. (I am awaiting on a response for that clarification.) He mostly pointed me to articles that either talked about the problems in the woman's lining (and toxins activated in it) or in one case a long article he wrote with one tiny sentence that suggested a gestational surrogate would be a better option. That seemed to contradict his reply to me. Anyhow, I've awaiting clarification.  [UPDATE: Dr. GS did reply and state he missed the part about gestational surrogacy. He said that in the case of immunologic implantation dysfunction, it wouldn't apply to me, but an endometriotic cyst would affect egg quality.]

The REASON I'm even asking is because I don't know if I should be tested for it. We have decided to cycle again, but this may be my last one and I want to optimize my chances. If endometriosis can affect my eggs pre-aspiration, then it seems like a good idea to be tested and get any problems fixed. On the FLIP side, scheduling and doing a laparoscopy  plus recovery time could add a couple of months to the process - thus lowering our chances. PLUS some doctors advise against laparoscopic surgery for poor responders as it can further lower your ovarian reserve and raise FSH levels.

What to do, what to do. Time to go have a real one-on-one with our ACRM doctors again.

As I said at the beginning, feel free to chime in. 

Sunday, June 3, 2012

Stupid BCPs


It's official: my back really freaking hurts. Like worst-period-in-the-world hurts. For days now. I've come to the conclusion, based on other "girl problems", that this is the result of taking BCP*. Oh joy. My body wants my period to start and we are artificially postponing it. It's like a freaking war.

Let me back up a bit. Because my period decided to start early 2 months in a row, we had to change when I start my BCPs. Especially since plane and hotel reservations had already been booked for IVF treatment to start in India. What this means is that I had to start BCP a week later AND have to continue with active pills for 28 days instead of 21 days. Yep - I knew my body would LOVE this roller-coaster.

When I was 15 my OB/GYN put me in birth control to help with severe period problems. Unfortunately, most of the time it created more issues. Over the years we tried various kinds, and I think we finally found one that worked, but then I stopped taking BCP and by the time I went back on we couldn't remember which one was the one that caused the least amount of symptoms. Pile on top my ADD** and I would forget to take my pills all the time, causing my period to be everlasting. Wheeeeeeeee! Needless to say, it's been awhile since I have taken BCPs.

So for the last few days I've been dealing with ever-increasing back pain. Having had cryoblation uterine surgery several years ago, this is one of the symptoms that I have not had to deal with much until recently. (I say recently because as my uterine lining has begun to grow back, so has my symptoms have begun to return in increasing degrees.) Nothing like this back pain though; it's been a good 5 years since I've had to deal with this. Holy crap. Any time I take a deep breath it's even worse. Basically I'm walking around not wanting to breath: no fun.

Add on the lovely headache and nausea I now feel every night and I am a barrel full of monkeys good time.
Wine would probably help, but I'm really trying to not drink right now before my IVF treatment. Plus I've only been awake for an hour...Drinking all day probably isn't the best plan for me right now.

I've  tried yoga and back massages (thanks hubby!!!) to no avail. Maybe some Ibubrofen will help. That used to give me some relief. Unfortunately it will do nothing for my tiredness, headache, and nausea that will come later today. Blerg. Given my propensity of having side effects with medicines, I'll bet my IVF treatment is going to be a hootenanny.

*BCP stands for birth control pills
** I still use the older term ADD to differentiate from the hyperactivity symptom most commonly associated with ADHD. 

Saturday, March 31, 2012

Test results - Phase 1

When I first started investigating infertility, I noticed ALLLLL these tests that people were either posting about or asking about. In the interest of other OCD peeps that likes to compare everything under the sun, I've listed mine below.

Estradiol: 30.3
FSH: 12.4
LH: 4.7
Progesterone: 3.84
Prolactin: 1st test - 12.0; 2nd test - 14.8
X-Prolactine?: 6.9
TSH: 1st test - 3.77; 2nd test - 2.38
X-TSH:2.1
AMH: 1.7

The first prolactin and tsh actually has an E before it, but the X ones were on the same day. Not sure what that is about...

From what I understand, my FSH is troublesome. :-( We have to use surrogacy because I had surgery a few years ago that removed most of my uterine lining. It has grown back in many areas (causing me problems), but still tons of damage and the doctors do not believe I can carry a pregnancy. 

I really hope we can use my eggs, but only time will tell. Don't get me wrong, I would love any child equally, but I would really love to see a child that is a mesh between my husband's genetics and my own. My father died when I was young (accident), but both he and my mother come from an intelligent, attractive bloodline. 
Course some of us are a bit loopy, so if we can't use my eggs then I can focus on the fact that the child won't get that. 

Ahhhhhh - the ups and downs. 



Tuesday, March 27, 2012

Someone needs to write a paper

An idea appeared in my head that will probably be only interesting to a tiny, tiny subset of people in the entire world. Even in the tiny subset of women that do IVF, it will only be of interest to less than about 1% of those females. And some fertility doctors. And maybe some researchers. BUT THAT'S IT. And only if it isn't a medically ridiculous theory to begin with. (I only play a doctor in my brain.)

Screw it. Here it goes anyway. You can say you saw it here first. I'll be anonymously famous!

I'm wondering if cryoablation, or any uterine lining issue, would cause the pituitary gland to mistakenly produce slightly elevated levels of FSH. 

Feel free to chime in if you have any medical knowledge on the subject!

Trying to get research data on that would be a doozie. You'd need solid baseline before and then calculate proceeding ones with the norm for the age range. Oh yea, and you'd need to find enough women who were having it done.

I'd ask my doc, but I think that would officially put me in the "she asks weird questions" category.