I was reading the information for the research study that I mentioned on retrieval day. I just think that it’s fabulous that they are working on improving IVM. This procedure could help a lot of women like me. And I’m really happy to be able to help somehow, even if it’s just providing some immature eggs for them to look at.

Some of the paragraphs make me laugh, though. I especially love the line, “About 20% of all oocytes obtained at egg retrieval are discarded because they are immature.” Bwahahaha. 20%. That’s funny.

And that’s where the research and experimental protocols come in. I’m a numbers kind of girl, so let’s look at numbers.

IVF#1: 24 eggs, 2 mature = 8.3%
IVF#2: 13 eggs, 1 mature = 7.7%
IVF#3: 38 eggs, 3 mature = 7.9%
IVF#4: 25 eggs, 8 mature = 32.0%

Ummm, yeah. Wow. Seems I was pretty consistent on the old follistim protocol. This cycle pretty much blew them all out of the water! Guess I won’t be using follistim anymore. Menopur is my new one true love.

I doubt anyone really understands what’s really going on in there to cause this big jump. Maybe this cycle will shed some light on it for my doctor… but more likely his response will be, “Well, it worked! So we’ll keep doing it! But we have no idea why.” Obviously the FSH with a little bit of LH didn’t do much good… my ovaries need the LH, and lots of it. It’s certainly not normal.

I’m having a very hard time really believing that this has gone so well. I don’t feel as excited as I “should” – I was excited when we got the news, but now I’m bracing myself for tomorrow’s call and wondering if this is real. I said it pretty starkly before: I expected a positive pregnancy test far more than I ever expected a better maturation report like this. I mean, 6 embryos is practically.. normal!

::

My face is breaking out and my boobs hurt. Plus I’m really hungry, but every time I eat something I feel sick because I’m so bloated. Wheee, oh fun times. Gotta love IVF.

First of all I want to say just how amazing all of my friends are. When I found out the fertilization news the first thing I wanted to do was post it everywhere. And then at the end of the day I was incredibly antsy to be able to check my twitter, blog and forums for all the responses. Everyone is so! Very! Happy! and it’s just exciting to be able to celebrate with people who truly get it.

IVF is such a mystery to so many people – even (maybe especially) family – and as much as I try to explain how huge this news is, they can only sort of appreciate it. They know we’re excited, and that makes them excited, but… they don’t really get how aweful 2 mature eggs per cycle is. I can’t blame them – I mean, IVF is a big weird mystery to them. They don’t know if 12 is any more normal than 2. So when I tell them my numbers they always hesitate for a moment and say, “Is that good?” Don’t get me wrong, I’m very happy I’m including family in our journey and that we get to educate people on the ins and outs of IVF… but there really is something to be said for being able to send an email to my best friend that only says “Six embryos!!!” and for her to shriek out loud and say, “OMG OMG OMG!!!!” No explanation needed. (No words, either, really. I think, were we talking in person rather than email, the entire conversation may very well have been coposed of squeals of different pitches pictuated by hysterical laughter and a random shout of “Six!!!”)

After my initial excitement I think I kind of sunk into a state of disbelief. It was a weird, weird day for me… being at work around people who sort of know what we’re going through but don’t really understand fully, dealing with customers who have no clue at all what I’m going through… it was just a weird feeling. It was like I was split in two… the cycling me, and the working me.

Of course it didn’t help that I forgot to take my meds last night – since I didn’t have to take any cycle protocol shots or meds or anything yesterday I forgot to take my prenatal and antidepressant. What I have learned is that even on a day when you recieve some of the best news ever, without antidepressants I can still be in quite a grouchy mood. It didn’t really help with the feeling of being totally separated from my IVF life. How could I be so impatient with the small, insignificant things? But, alas. Life continues moving, even when I just want to stand still and tap out emails on my blackberry all day long.

::

I actually got some more exciting news today. When I got the call about fertilization she said to be at the clinic at 9:30am on Sunday for my transfer. I called and – after telling them how thrilled and over the moon we are about fertilization – asked if there was any chance we’d go to day 5. I’ve never been close to being allowed to go to day 5, so I really had no clue what their requirements and procedures are.

The nurse told me that for women under 35 (of which group I fall into) the lab’s requirement is 4 top-grade embryos on day 3. She said they have been monitoring the embryos at specific times today, and then on Sunday morning they will again evaluate them all. If we have enough that qualify as top-grade then they let them go to blast before transferring on Tuesday. We really have a shot at that!

We will be putting one embryo back regardless of which day it is, and all the remaining embryos will be cultured to blast before being frozen (or discarded, if they do not meet the criteria). So really the only thing a 5 day transfer will affect is the embryo they choose to transfer. Waiting gives them a better chance to evaluate them and choose the best one… it increases the pregancy rate. I am really really hoping to go to blast – but if we end up with a 3 day transfer I don’t think I’ll be too upset. I just hope we get a couple that culture well enough to freeze!

So we wait until Sunday morning, she said they will call either way – to let us know to come in Sunday, or wait until Tuesday. So that’s the next big piece of news I’m holding my breath for.

Last cycle our leftover didn’t make it to blast so I do worry about taking that step… but I was major overstimmed and it’s pretty obvious the quality of the embryos weren’t all that great. I keep reminding myself that this time my stimming was beautiful and controlled… they should be much better this time!

::

Physically… well. How is it that every cycle I forget how ick I felt after retrieval? Actually… IVF#2 I don’t remember feeling too ick. Bloated, yes… but not really sore. Probably because I only had 13 eggs that time. Which was really fantastic timing, since between retrieval and transfer we were on vacation in Boston, touring on foot.

But yeah, not feeling so great today. My midsection feels tender… simple things like pushing away from my desk makes me say “oomph.” No cramping or pain or anything today… just a little bit of twinging from the ovaries, which is normal. I did have some blood this morning though. Which was kind of funny in a not-funny way, because I was like, “OMFG, blood!!” and then realized that a) I have no embryos inside me yet and b) I just had surgery down there. So I quickly regained reality and chilled out. But not such a great moment.

The progesterone is gross, just to let you know. I forgot about that, too… maybe I just blocked it out. Suppositories all leak back out throughout the day… ick ick and ick.

And also, still having hot flashes. Or, maybe not hot “flashes,” but rather “a sustained period of feeling warm.” It is winter, people. Natalie does NOT feel warm in winter unless covered with a million blankets, a couple cats, and an overheating laptop – and even then my hands tend to be frozen. And here I am wearing 3/4 sleeves to work. This is… weird. It’s the hormones, obviously. When I wasn’t cycling my hands were all cold. Now they’re fine. And I’m having to take off my third layer at work. It’s just insane, I tell you.

::

Only two more days until sunday and the next piece of the news puzzle. Dare we still hope for continued fantastic news?

And the call says….. We have six embryos!!!!! They were able to ICSI 8 mature eggs (freaking amazing) and this morning we have 6 fertilized embryos! I feel like I have been dropped into someone else’s life. This is truly amazing. I thought my fertilization rate would be good – it always has been – but it just seemed like too much to possibly hope for.

I am still just… glowing. A reserved glow, to be sure – fertilization results are yet to come – but oh my gosh there are just not words to describe what elation I feel.

Our first cycle we anticipated “normal” and were blindsided.
Our second cycle we were promised ICSI would solve it. It didn’t. We were shocked and confused.
Our third cycle we changed trigger protocol and I carried some hope again, but I was disappointed.
So it’s not hard to imagine why I just laughed at this cycle. I had been down that road of hope before. You won’t fool me again – I had more or less come to terms with the expected result. I wasn’t angry or dissapointed at the thought of just a couple of mature eggs… just resigned. It is what it is. Yes, we’re trying something new again. But it won’t work.

So to get this news… to see my hopes finally materialize… it is shocking, amazing. I just can’t believe that after all this time that we’ve finally found something that works. I mean, that’s the truly amazing part. Not so much the numbers or the increased odds, but the fact that we took something that had no solution and found something that worked.

Of course we don’t really know what part of the protocol was the key part: was it the all-menopur stimming, or the IM trigger shot? As Den said, “Well we’ll never find out, because next time – if there is a next time – you’ll be doing both again!!” Indeed!

And then, yes, the bigger picture… what this could mean for our fertility future. This could mean several frozen embryos. Hell, if enough fertilize this could even mean a transfer with blasts on day 5, giving us an even better chance at selecting the best one to put back. My ideal hope has always been to get pregnant from a single embryo transfer, with several frozen “siblings” to transfer for the next child. Den says “don’t put the cart before the horse,” but at this point we actually stand a chance at achieving that.

Den is feeling encouraged, but he’s also very guarded right now, waiting for the fertilization report. We don’t take anything for granted, and while our fert rate should be good… having that many embryos really still seems far-fetched. He’s scared, and I totally get that. We won’t know until tomorrow when I get that phone call. (And then we hold our breath until transfer, and then until our freeze report, and then until a pregnancy test. Cycling always makes me feel like I can’t breathe. Everything after starting stims is just so nervewracking.)

I’m really trying not to think about it, because I don’t want to fret myself into a corner… I’d really like to just savor this small victory for today… and hope it turns into an even bigger one.

Last night I could barely sleep… I was hyped up on adrenaline. I opened my laptop for a couple hours, just to try to distract myself until I got somewhat sleepy. So I managed a few hours of sleep… and then slept in so that I didn’t have enough time to wash my hair. Oh well, that’s what hair nets are for in surgery, right?

We arrived right at 8pm, I got changed into the surgical gown and into bed. Then they started the incessant questions and paperwork. I feel bad for them, really – that is a lot of paperwork! And they have to arrange it all in a particular way so the doctors can just walk in, check through it, and walk off.

I mentioned working full-time and the nurse asked me what I do. I, without thinking, answered truthfully: part-time as a bank teller, part time as the assistant manager of a animal rescue organization. BAD IDEA, NATALIE. I do this every time, and every time Den and I want to kick my ass, because this always triggers a 20-minute discussion about cats – one that I don’t particularly feel like having while waiting for surgery. And why is it that the conversations always involve their cat who ran away, got eaten, hit by a car, they want to get rid of, etc etc. It inevitably leaves me biting my tongue. After the nurse left my little cubicle Den hissed at me, “I was trying to get your attention to say NOOOO don’t say it, but you said it anyways!” I am stupid. Next time, duct tape my mouth shut please.

The two nurses were talking a lot over the equipment for starting IV… something about the needles and tape and such. I was starting to shoot Den some panicked looks, like, this is not boding well. A little bit later they got to starting my IV. She looked at the vein in my left hand, tapping it and humming and hawing. A little novocaine, the needle went in… and that was IT. It was my best IV start yet!! I barely felt a thing, it started right away, and I had no problems the rest of the day. It was fantastic!!

A woman came by and introduced herself as being from research. She said that she knows my history of having a lot of immature eggs, and would I be willing to join a study? The study is about IVM – in vitro maturation, a technique which currently does not have a very good success rate (and thus is not covered by my insurance, in case you were wondering why we haven’t gone that route). They want to study immature eggs to figure out why they don’t have good success in the lab, to hopefully make it a viable solution for people like me. So Den and I said, “Yes, sir!” and gleefully signed the consents. Like Den said to me privately, it’s kind of neat to be on the leading edge of stuff… trying experimental things and helping pave the way for future women like me. Maybe in 10 years they will have some actual protocols for addressing this issue so they aren’t just shooting in the dark.

When the doctor arrived and got changed it was time to get into the OR. I left Den with my blackberry so he could peruse the news while bored and waiting, and I waddled off with the back of my gown clutched shut, IV bag held by the anesthesiologist. Same as always… lay down, arms on the wings, legs in the big stirrups. No stinging in the IV hand this time, just that things started to go a little blurry… and then a lot blurry… and then I was out.

When I woke up Den told me they got 25 eggs out of me. That was more than I was hoping for – I was aiming for about 20. I just worry because my very first cycle we had 24 retrieved, my successful cycle we had 13 retrieved. But 25 is a good number still. I twittered from my blackberry and then we were on our way.

Before we left I asked if the nurse could check on how many eggs were mature and let me know today. Since, you know, waiting is freaking torture.

We stopped for breakfast on the way home (I was still feeling a tad bit tipsy from the anesthesia, but not too bad). Tasted awesome. Ohhhh food after surgery is fantastic.

Den had to go to work, so he just dropped me off at home and left for his meetings. I went straight to bed! Whether from the anesthesia or my lack of sleep last night, or some combo of the two, I was exhausted! I carefully put my phone (making sure the ringer was ON) on the pillow beside me and fell asleep, expecting to be woken up by a call.

Instead I was woken up by the sound of a dog puking (maybe after this she’ll stop eating the plastic plant containers in the basement? Probably not). And no phone call. I looked at the clock, 3pm. Should I call them? They probably forgot. But then I thought, what if they haven’t called me because they can’t find any good ones and they’re desperately trying to find some before calling me? My mind can imagine a lot of bad news without much help. I called and left a message… could they please find out from the lab how it’s looking?

A few minutes later my phone rang. I answered it. It was one of the nurses. “I just called down to the lab. They’re still looking at some of the immature ones to see if they will be able to ICSI them later, (my heart starts pounding)… There were 5 eggs able to be ICSI’d right away, and then a little after that they were able to ICSI 2 more.”

All I could say was, “Holy crap!”

WE HAVE 7 MATURE EGGS AND THEY MAY HAVE SOME MORE LATER!!!!!

I thanked her profusely, hung up the phone, and burst into tears. 7. SEVEN. That’s 28%!!! Every one of my previous cycles has had an 8% maturity rate. This more than TRIPLED the number of mature eggs I normally have!! Oh my GOD.

I am still crying. I can’t wait until Den gets home so I can give him the news. I already called Kel to tell her. This is just unbelievable. I really really never expected that this was even POSSIBLE from my body.

Tomorrow I find out how many of them fertilized… I don’t expect it will be all of them, but it looks like we will have some good frostie candidates this time!!! WOW!!!

Just to say, my butt is quite sore today. I was limping a little bit just to try to not aggravate it further. There’s no visible bruise or anything, it’s just… sore. I cannot imagine doing IM shots every day.

::

To answer a few questions that I have gotten…

Shilpa asked, “if you have more than 1 embie, will you transfer more than 1?” (And I have gotten this question a lot, from many different people in different places.)

I do plan to transfer only one again. One GOOD one. My reasons span many different areas of concern, but it boils down to a couple of main things:
* I know I can get pregnant from a single embryo transfer. I personally don’t think putting back more than one increases our chance of success very much at all – from my data and experience I think the overall quality of that cycle batch is what decides whether or not I will get pregnant, whether there is one or three. Last cycle had we put back the second one I am absolutely positive it still would have resulted in a BFN. (But on the flip side, if it IS a good batch then I am pretty certain it would be twins.)
* Twins does significantly increase the risk of pregnancy loss. Having been through a horrific loss already the thought of increasing my risk scares me shitless.
* Also, I really wants a frosty or two for next time. And I think this, too, depends on the egg quality of the batch… I firmly believe that last cycle the spare embryo didn’t freeze because it wasn’t good all around. What I really really want is one sticky embryo growing inside me and several really good ones on ice for next time.

G asked, “How do you escape the IM PIOs?”

That is a stroke of luck, I tell you!! My clinic does progesterone suppositories for most of their patients, unless a patient has a specific need for more progesterone. And their numbers are comparable to other clinics, so obviously it works well! Thankfully my history has shown progesterone to not be an issue with me – the suppository easily supported my last pregnancy – so I get to keep doing that instead of PIO. I am very, very thankful.

::

Retrieval in the morning! I am excited. I’m always excited before retrieval. I get warm blankets and to be all fuzzy and knocked out (yes, I actually like that), and I get to find out what’s hiding inside of me. Okay, well that part is more nervewracking than exciting, but it kind of adds to the whole twitchy feeling of the night before retrieval.

And I am triggered! Retrieval is 9am Thursday.

I am feeling bloated. And looking horrendously bloated. I don’t feel that bad – unless I try eating an actual meal, at which point I feel like throwing it back up because everything is so squashed in there. (Which really makes me wonder – how on earth can I go through an entire pregnancy with a 5lb baby and huge uterus taking up my entire abdominal cavity and feel fine, but my ovaries bloat up and I feel ill? What is WITH that?) The belly is going to have fun when I get pregnant again…. it takes half a suggestion to get big and round and boy does it go for it. I guess it doesn’t look that noticeable when I’m wearing clothes, but I look down and it’s just so wrong. Dearest belly, I am NOT PREGNANT. Please deflate.

Yesterday’s E2 was 3300, so they wanted to drop down my dose to 2 vials instead of 3 of the menopur. I puttered about mixing my meds, thinking mainly about how I was going to do the trigger. Then this morning I woke up and thought to myself, Self, did you do 2 vials, or 3?? After mentally walking myself through my motions I ended up pretty sure that I had indeed given myself 3 just by rote. Well shit.

I did confess to the nurse that mistake, but she was pretty sure that wouldn’t affect anything. “We’re just supporting those follicles now,” she said. I felt better after that.

And after the ultrasound. My lining is at a lovely 12 triple. Right side has the same as yesterday (12 total), with the largest now measuring 17.5, 18, 19, 19.5, 20, 20.5. Left side also has the same as yesterday (14 total), with the largest measuring 13, 13, 13.5 16.5, 17, 17, 1, 18, 18.5, 19.5. My left ovary was very weird looking in that the top half had the big ones, and the bottom half had all the smaller ones. But she pointed out that we’ll still probably get eggs out of the smaller ones, since they’re all squished in there… they look small because there’s no room to grow, even though they’re ready.

My E2 from today came back at 4719… a good sight better than 6000+ like last time! (Even though I do realize that for “normal” people approaching 5000 is bad.) So trigger it is!

I was supposed to trigger at 9pm, which would put me at 36 hours before retrieval. The doctor apparently decided that triggering 2 hours early last time didn’t do anything, so he went back to normal protocol. But, I don’t know, it didn’t hurt anything. And maybe that’s why we got 3 mature eggs last time. So we triggered an hour early. Shhhh.

This was – drumroll, please – my very first IM shot. I was fine as long as I didn’t think too hard about it. I just kept telling myself that people do it, it’s fine. But then I started mixing the hcg with the big needle and stared at it thinking holy shit. It’s not even so much the thought of it hurting that bothered me, but I just had this irrational fear that the needle was huge and would hit bone or something. Yes, irrational, I know. But it wigged me right out.

Den reassured me – he had people at work show him how to do IM shots, and he even got to do a couple. I watched the video on how to do it – I did, not Den, the person who would be doing the shot. Later I realized how silly that was, but I needed the reassurance that it wasn’t a big deal. I iced my butt (which, shockingly enough, didn’t really feel numb like my belly gets). Bent my leg, leaned forward a little, and breathed. And did not look.
“Ready?” Den asked.
Poke. I felt a little pinch. I braced myself for the stinging.
“Okay, done!”
“Wait… you’re done already?!” I hadn’t even felt him pull the needle out. Maybe it was more numb than I thought back there. Or butts just aren’t all that sensitive. Could be a little of both, I’m thinking.

Onward to retrieval and the big reveal. How many embryos will we get this time? I still hold a little torch for some frosties. I am not naive enough to really believe that this change in protocol will give me a basketful, but getting 2 or 3 embies would be really really nice.

This cycle has gone quite well so far, I just don’t know what to expect at this retrieval.

Very very happy to report that my ultrasound showed everything growing just perfectly!! I still have 11 on the right, 13 or 14 on the left, and almost all of them are all grouped at about the same size (around 16mm). I walked out of there practically giddy.

They need another day before trigger – they’re pretty sure it will be tomorrow, but because of my egg maturity issue they want me to get scanned again just to be doubly sure that they aren’t jumping the gun. Fine with me.

So it’s looking like retrieval on Thursday, transfer on Saturday!

::

And also, Kel found The Ring!!

Two minor problems with it: the stone is huge for my finger (7mm!) and the ring itself doesn’t come small enough for my ring finger. So I’ll probably take this to the local jeweler to get something custom made with a smaller stone. But this is perfect… it has the graceful curves I wanted, it has a heart shaped stone, it’s simple and elegant without being too small and simple. J’adore.

Here’s my confession for the day: I’m nervous as heck about tomorrow’s ultrasound. I have been trying really hard not to think about it, because there’s absolutely nothing I can do… whatever is going on inside those ovaries is out of my control. But still, I worry. I don’t know what they’re going to find tomorrow. If I’ve overstimmed again I’m going to be PISSED. I think I may even cry.

Things are just different now. This whole cycle has been like walking on eggshells. I walked out of the last appointment feeling relieved and thinking to myself, “No bad news yet.” And that’s really how I feel all the way through this. There is no GOOD news… just news that isn’t bad… yet. I wait for the shoe to drop.

I was thinking about my IVF cycles and how each has been so different.

IVF#1 was the “textbook” cycle. The blissfully unaware of anything going wrong cycle. It was the kick in the teeth with the fertilization report… totally, utterly unprepared. It was the huge shock of disappointment.

IVF#2 was full of hope that we would “solve” the fertilization problem with ICSI… so we still weren’t prepared for the same result. Mostly I remember the anger… I was so furious. No one could give us answers. And then the shock of success when I least expected it. IVF#2 was Devin.

IVF#3 was so slow to get started. It was obstacle after obstacle… it was the cycle where everything went wrong. Insurance authorization problems, timing problems, major overstimming, and again poor fertilization despite trying something new. The whole cycle was a pain in my ass, exhausting and frustrating. And, unlike my first two cycles, I knew we’d be dealing with severe fertilization issues… so no happy fluffy rainbows for the first half of the cycle. I was slogging through mud, and I knew it was mud.

IVF#4 so far has been eerily quiet. I’m twitchy as hell after last cycle, waiting for something to go wrong. Well, there was the allergic reaction, but that doesn’t really impact the cycle itself so it doesn’t bother me. We will see how this one turns out… how I will finish IVF#4’s description.

Today I hung a painting (well, a print) on my wall.

I realize that I never actually wrote about the AFA conference I went to back in October. Suffice it to say nothing I heard was really new information and I didn’t have any big “ah-ha” moments. It was a little strange, really… I felt like an outsider for some reason… a lost, cynical veteran among bright-eyed, hopeful novices. There was so much more darkness in my heart, I was a shadow moving through.

There were plenty of booths there, promoting clinics and adoption agencies and selling little things. There was also an artist there – Ellen Spencer. Now I am not really a fan of most “art,” I normally just don’t get it. But every time I walked by her table this one painting drew me in. I kept stopping to stare at it. So I ended up buying a print, which of course was far more than I had intended to spend at the conference.

Today I finally dug it out of the bag it was carefully kept in, framed it, and hung it on my wall.

It’s obviously trees in an almost abstract, dreamlike mode. But to me they look like women holding up the upper branches… holding up the world. I guess that’s what spoke to me that day in October, shouldering my grief and infertility and loss. And yet the image is not dreary… the women-trees are stretching up, reaching towards the sky. It’s almost joyful. Serene. The image is empowering to me… reminding me to stand tall, telling me that I can keep holding it all up. It is hanging on the wall opposite our bed so I can continue to be reminded.

In a way I kind of feel like I went to that conference just to get that print. And it somehow feels worth it.

Go see what else is being shown for Show and Tell.