11 Prescriptions, 4 Pharmacies (I need an IVF assistant)

It's been a long two weeks!  Work is not letting up at all, even though I've talked to my managers and business partners about needing to reduce my stress.  Perhaps I'm not being clear?  I've been "coming out" to work and other friends about TTC and infertility, which another post I need to write...  in the meantime, today is my first day off in the last 2 weeks.  I worked all last weekend and have been simply exhausted this week.

WARNING - Confusing Post:
First, the drug names are likely misspelled, I know that but I've never taken a course on medical terminology so it is what it is.  


Second, if you are still TTC, dealing with IUI or IVF and don't want to read this very confusing post, skip down to the bottom and read the Moral of the Story.

I've been so busy and tired I'd forgotten to order my IVF meds.  Seriously, the "Insurance" pharmacy called my nurse, Nurse A, who called me because I've not responded to the pharmacy earlier this week.  But as far as I know, I only need one Rx starting sometime late next week, the Estrace.  So what's the rush, really?  

Currently I'm in my pre-IVF cycle (CD11) using OPK to test for ovulation (which I expect around CD14).  My RE will bring me in several days AFTER a positive OPK to test that ovulation occurred and then start me on the Estrace, then I can expect a period.  Once my new cycle starts, that's when Stims will start.

As I dug into the Rx ordering process, it got very complicated (call the pharmacy, they have a question, I have to call the nurse then call the pharmacy, or a different pharmacy, and this went on and on).

List of Pharmacy's (and how I'll reference them)

1. "Insurance" - a mail order pharmacy, the only one from which insurance will cover
2. "Local" - the local pharmacy down the street
3. "Random" - a random mail order pharmacy I've never heard of
4. "Specialty" - a local specialty pharmacy

Initially I was under the impression that ALL prescriptions were called into pharmacy #1 "Insurance".  When I called "Insurance" on Wednesday they had a list of 9 prescriptions.  

• They did not have the Estrace Rx, which is the Rx I need for next week.
• They advised that the Lupron Rx was on a manufacturer backorder and I'd have better luck if the Rx was called to a local specialty pharmacy (Pharmacy #3) and the insurance coverage could be labeled "request override" - so hopefully it would be covered coming from "Specialty".
• They had a Rx for PIO, which I wont use.  Instead I use the progesterone tablets inserted in my who-ha 3x's a day.
• There was no low-dose HCG Rx which I had written down that Dr. T wanted me to use on this protocol
• There was no Saizen Rx which I will also use, although I know it's not covered by insurance.

So I follow-up with Nurse A, by email.  The return email has comments to my questions and notes about where these prescriptions will now reside, hence I now have to work with 4 pharmacies to get all of my drugs.

So yesterday, Friday, the "Random" pharmacy called me stating I need to return their call ASAP because they were told I need their Rx starting Monday.  The Rx coming from Random is the Saizen, which is not something I need until I start Stims.  But I got that squared away because there is no shelf life concern on the Saizen (i.e. it lasts longer than 30 days so if I order it early, no concerns that it will go bad before I need it).

Then "Specialty" called me about my Lupron, stating they were told I'll need it right away.  Again, in my notes from my talk with the doctor I wouldn't start the Lupron until sometime during Stims because the Lupron suppresses ovulation.  Why would I need it right away?  It has a short shelf life (30 days) so I should only have it dispensed just before I need it.  I'm going to call the nurse back Monday and get this figured out, perhaps I start it with my Estrace and I just wrote it down wrong, but it wouldn't make sense to take a drug that suppresses ovulation, just after ovulation, would it?

So the prescription I know that I'll need as early as next week is the Estrace... who has that?  Oh, that's been called into Local, according to Nurse S.

In Summary (tracking for my own records):

1. Insurance
• Gonal-F (5-900IU)
• Vicoden (5 tablets)
• Methoprednozone (6 tablets)
• Doxycycline (26 tablets)
• Ovadrel (2 doses)
• Daisopam (1)
2. Local
• Estrace
3. Random
• Saizen
4. Specialty
• Lupron
• Low-dose HCG
• Progesterone tablets

I've been through IVF once before... even though it's a new protocol, this should be old school to me... but it's a cluster of confusion because no one gave me a list of the drugs I'll need, approximately when I'll need them and where they were called into. It really doesn't need to be this confusing if the RE's office would just document and end-to-end cycle plan to provide to patients.

Moral of the Story
If you get nothing else from this random, confusing blog post, take this away...

• TAKE GOOD NOTES ABOUT YOUR PROTOCOL when talking to your doctor.  
• Don't be afraid to question your nurse if your prescriptions don't match your notes.  

I'm not an expert, my notes could be backwards on one or two things...  but I do remember the detail of that conversation with Dr. T (and documented on my blog immediately afterward)...  I know I got 95% of it right.

Let's Do It, Again, Differently

I hadn't been to the RE office since December 22, my beta BFN.  It's been the longest time away from what often feels like my "home away from home"... the longest break in visits since I started back in April 2010.

As I was in the waiting room, a man came in and said his wife and triplets were downstairs.  They wanted to see if it was okay to bring the babies up to see the doctors & nurses (I'm sure because they made them).  All I could think is.... get me back in an exam room before those babies come through the door!  And my nurse called me back and just as I was walking by the door, in come the babies... I glanced for a microsecond and hauled it back to the safety zone behind the door.

My favorite nurse, S, greeted me and when she got me back into the room she hugged me.  Tears were hard to contain, on both of our parts.

As I waited for Dr. T I wrote down the most important question I knew I should ask:  "How much more aggressive can we get?"

Dr. T came and got me from the exam room to join her in my office.  She seemed affected when she was talking about how much she wishes the IVF worked for me.  They all know it's taking a toll on me and I can see that they truly want me to succeed!


My Fertility In General

• My FSH is consistently very good, especially for a "woman my age"
• While my AMH is on the low side plenty of women still get pregnant with lower AMH's than me (one of the doctors in the group studies AMH closely and my AMH shouldn't be a factor, especially given my good FSH)
• I absolutely should try again (they will tell women when it's not advised to try again)
• Regarding my 'aggressive approach' question, the most aggressive approach with the best odds for success is donor egg however she does not recommend this for me yet (and I'm not ready to go there at this time)

IVF#1 in Review (Ganirelix Antagonist Protocol)

• I responded well to the meds, 6 mature eggs (the 7th was almost mature)
• Everything went well except it took 13 days of Stimulation to get to retrieval, she'd like to reduce that (it's unknown that if it takes longer to get to retrieval if that compromises the eggs - or something like that)
• The embryos just didn't mature at the desired rate between day 3 and day 5
• My progesterone (using the suppositories instead of PIO) was excellent, at 45 on transfer day - see the BIG shot in the A$$ is NOT the only option for progesterone!  Note, I did take my suppositories 3x/daily religiously!

New Protocol (Luteal Estrace/Microflare Protocol)

• When my cycle starts this week, I'll call to report in
• I'll use OPK to test for ovulation at home
• 7 days after surge I'll go in to verify ovulation 
• Upon verified ovulation, start Estrace, in pill form 2x/day (to synch ovaries)
• On my next CD1 come in for bloodwork/ultrasound
• Start Stims (Gonal-F 400IU)
• Somewhere in here I also take a microdose Lupron (prevent premature ovulation)
• Dr. T recommends adding Saizen, a human growth hormone; this will not be covered by insurance (approx $600) but goes along with the more aggressive approach I requested
• She wants to do a Day 3 rather than Day 5 transfer this time, citing that my uterus would be the best environment to give the embies a chance
• She see's no problem with A, my acupuncturist, coming with me to Transfer to do treatment immediately following transfer
• Retrieval/Transfer will be sometime around late February/early March

I'm looking forward to getting started again!  

WTF Appointment Prep

I know, I know, I've been MIA.  It's the middle of January and I've not posted YET this year.  Well, here I go...

First, thank you for all of your encouragement and support from my dark day.  All of your comments were wonderful and well received; some of you were very perceptive as well.  I've been wanting to post since then to let everyone know that I've been better (it was a bad day) but I have not had the words after exposing myself so fully... and then my laptop crashed (fixed today).  Those who follow me on Twitter have the privy of knowing things are improving and that day was just my "crash" after my failed IVF on top of 6 failed IUI's, coming off of 8 months of hormones, the holidays and going into the new year where I will turn 40!

I did start seeing the IF shrink again and have started taking Xanax 3x's a day... WOW... it takes the edge off the terrible anxiety I was feeling AND I sleep well at night without any other drugs!

My WTF appointment with my RE is on Monday (yes my fertile friends who follow my blog, WTF means what you think it means).  I've not spent too much time prepping for it.  What do I ask?

• What have you learned about my ability to conceive after 6 IUI's and 1 IVF?

• What are the leading causes of my inability to conceive?  How do we address this?

• What could have been done to improve the number/quality of eggs/embryos from my IVF?  

• Will I be able to have a child with my own eggs?

• When can I do another IVF?  What will we do differently?  What are my chances for success?

What should I add to the list?  Will Dr. T have the answers?

It's not been a full month since my IVF BFN but this break has seemed to last an eternity.  I've actually enjoyed not counting my cycle days, no injections or suppositories (no alarm going off multiple times daily to remind me to medicate).  But I don't enjoy knowing it's a month where I've "wasted" an egg and I have no chance at pregnancy.

Sorry friends, for being a bad blogger.  I think the lack of blogging goes along with the TTC break.  I'm hoping my break will end next week (AF is due a few days after the WTF appointment).

What Direction is Forward?

Has anyone seen my Mojo?  My motivation?  My sense of being?  My purpose?

Normally I wouldn't share something so personal, something that exposes my weaknesses and vulnerabilities... but I'm having a bad day and I feel like I just need to get this out.

15 years ago I moved to Charlotte.  I started my career, experienced significant relationships, developed deep friendships, traveled, partied and created a very satisfied life... until recently.

I've been struggling...  for nearly two years I've been feeling lost.  Not constantly but consistently.

So much of my self, my confidence and purpose was wrapped up for so long in my career.  Since the layoff in early 2009 things changed.  Now that I am back at the same company that laid me off, I'm in a job I can't stand and that causes constant stress and anxiety.

While it hurts to admit it, many of my friends and I have grown apart, some have moved, I have changed.  While I see most of my friends regularly, it's not frequent.  A number of them are still into late nights of partying; many of them have husbands and children that keep them busy.  I find that I have far too many days that I spend alone... but I also know this is primarily self-imposed.  I'm not a ball of laughs to be around these days.

I'm also now about 50 lbs overweight, gained over the last 2 years.  I beat myself up over this constantly, every moment of every day.  As of yesterday I started working on this nutritionally but I am unmotivated to exercise.  Why?

I know what I need to do but I'm struggling with execution...  I need to find my sense of self, my motivation, my happiness.  I want to volunteer.  I need to get involved in church. I need to get into an exercise routine.  I need to proactively reach out to my friends.  I need to live my life purposefully, even while dealing with infertility (which only accentuates my problems).

And I worry about money.  I am tired of being 'house poor' (meaning having a mortgage too uncomfortably high for my comfort).  I want to sell my house but the economy will force a signifiant loss.  I do believe I could make up for it in my next, less expensive, house purchase.  I could actually buy a nice house and have NO MORTGAGE, rather than my current hefty mortgage.  The next question is WHERE would I buy my next house?

After nearly 20 years away from my hometown (I went to college in NC also) I have been thinking more and more about moving back.  This statement will absolutely SHOCK my family... I've not told them of these thoughts.

The reason why I seem to want to move back to my hometown is because of family.  My entire family is still in South Florida.  While I am not a fan of the HOT and HUMID Florida summers, in working to create my own little family, I'm realizing how important family is to me.  I want my child to be raised near family... I want to be near family... in order to do that I would need to move back to Florida.

My job, and many other opportunities at my company, allows me to work remotely.  With having little or no mortgage I can build up my savings again... and travel... and not be so uptight about money.  I could even request a role with less responsibility and, if that comes with less money, I could still live comfortably.

For the moment, I seem to be paralyzed with fear, anxiety and loneliness.  This too shall pass... but I need to move forward... and before I can do that I need to figure out what direction forward is?

*******
While I did pretty good over the holidays considering my IVF fail, I've been crying all day today.  My poor neighbor just came by and was subjected to my puffy, wet eyes.  I imagine much of this emotion I'm feeling is from coming off of 8 months of hormones.  This cycle is a forced break, which for the first time is fine with me.  It was expected that if my IVF failed I would have to take a couple of months off.  I have a meeting with my RE on January 17 to discuss next steps.

And in the meantime I'm going to figure out how to pick myself back up and start living again.

Oh Holy Night! Merry Christmas!

The family is at church, I stayed behind knowing I'm not emotionally strong enough to sit through Christmas Eve service without making a spectacle of myself.  Dad didn't understand, even when I broke down explaining it to him... but Mom understands and had him "leave it be".

I am enjoying my time with the family.  We went out to a Christmas Tree Farm and cut one down this morning.  The four dogs (my two, my sister's dog and my parents dog) are playing and having a ball.  We're expecting a white Christmas tomorrow.

I wish all of my blog friends a peaceful holiday season and a fertile New Year!  Thank you for your continued support.

I can't give you gifts but I can share this video of my BFF's daughter singing Oh Holy Night!  You will see her on Broadway in the coming years...

If you don't have 5 minutes.... forward to about 2:45 in the video... moved me to tears (which isn't difficult right now).

Merry Christmas!

I Don't Know What to Say

I'm still not pregnant.  Work has been absolute hell, I'm going to have to work during my holiday vacation (I've taken 4 days off all year back in May [of 20 days earned, and yes, I lose it at the end of a calendar year]) and my IVF failed.  But I need to keep work happy because I now have no lifetime maximum on IVF insurance coverage...  I can't lose it now.  I'm not pregnant... again... still.

Ways to Count the Days

Today is 8 days past my 5-day embryo transfer (8dp5dt), where my morula and two 8-cell embies were tranferred to my warm, waiting uterus.

This makes me 13 days past my retrieval (ovulation).

My beta is in 3 days, on Wednesday.  I have not POAS and I don't plan to do so until, at earliest, Tuesday evening or Wednesday morning.

I'm supposed to drive to the mountains (only a 3 hour drive) sometime Wednesday to meet my family for Christmas.  My iPhone does not get service in the mountain house, I actually have to drive 10 - 15 minutes into town to get reception... so I'll need to wait until my RN calls back on Wednesday before I leave for the mountains.

Of course, if it's positive I'll be ECSTATIC and, after making some calls & texts, I'll have no problem making the drive to see my family.  But if it's not positive... will I be in the state of mind to drive to the mountains that day?  What about the next day?

As for packing... do I need to get my progesterone supplements refilled so I can continue taking them through the holiday or will I not need progesterone?  Will I need to pack tampons?  Wine?

If it's negative how will I make it through the holiday with my family?  I'll be fragile and want to isolate but I'll still be expected to participate in the holiday activities... I'll be sharing a house with my parents and my sister's family and a total of 4 dogs (including my 2).  My bedroom is in the basement where the playroom is too...

I have so much hope I'll get my Christmas miracle... but with 3 days left in the 2ww I also have a lot of fear... what if I'm not pregnant?

While I hope I don't need to fall back on this, I did learn some amazing news the other day... in 2011 my company will have no lifetime maximum on infertility treatments.  Previously the maximum was $10k which I've pretty much used up with this one IVF (all 6 IUI's were out of pocket).  This news gives me peace of mind that I wont have to go broke trying to conceive my child... while I'll still have to cover the cost of sperm and many, many co-pay's, it will still be an AMAZING savings that does bring me a bit of peace.  My future decisions on TTC will not be weighted financially, but it will be more about how much I can take emotionally.

This time around I'm not acknowledging anything that could be construed as a symptom.  I've taken, injected and inserted far too many hormones to trust anything I feel could actually be a pregnancy symptom rather than a hormone side-effect.

I'm heading out now to meet-up with some local SMC's (Single Mom's by Choice) in various stages of the process.  While I love everyone I have met through this blog on my journey... and will continue to stay connected... I look forward to the day that my life (and blog) becomes about being a SMC, rather than infertile.  

1 Day Past 5-Day Transfer (1dp5dt)

I'm 1dp5dt and I'm having trouble feeling overly optimistic about success this cycle.  I just got the call from the embryologist that my remaining embie did not make it to freeze today... so I'm sad for my embie.

As I was in my gown, listening to my Circle & Bloom transfer meditation the doctor (not Dr. T) came in to report on my 4 embies.  All 4 were still growing, but at a slower rate than normal.  3 were still at 8-cell (typical of day 3) and 1 was classified a Morula (typical of day 4), so none had made it to a day 5 blastocyst, yet.

The doctor had hopes for the Morula, it was in pre-blastocyst stage.  He recommended that we use the Morula and two of the 8-cell embies for transfer.  I agreed.  I can't explain what it's like when you're minutes away from transfer and you get information about your embies - while doped up on Valium - and you have to make a decision about how many to transfer based on the new information. I was trying not to allow disappointment to set in just before transfer.

As far as the transfer went, I was taken back to the same operating room from my retrieval... with the "short bed" (it's like 1/2 a table because instead of foot stirrups, it uses knee stirrups).  For my retrieval, once I laid down on the short bed I was asleep within seconds.  For the transfer, I was awake.  So they raised the bed, then raised the bottom side of the bed (just imagine the blood rushing to your head) and I just started giggling.

The speculum used initially was too short so that was a little uncomfortable.  He got a longer speculum and that was much better.  He threaded the catheter through my cervix into my uterus (I could see this via ultrasound on a screen).  The embryologist brought in my embies in a tube that would be threaded through the catheter and they were released in my uterus.  The embryologist then goes back to confirm all embies were released from the tube and yells back "okay".  And that was that.

I was transferred back to the gurney and wheeled back to the prep area where I listened to my meditation again while I rested for 30 minutes.

G brought me home and stayed with me for a couple of hours.  It's funny because her kids were home with their dad, who was napping, so they kept calling her because they were bored.  It's all about Mom!  Shortly after she left I had my post-transfer acupuncture appointment, which was wonderful.

After acupuncture I began to consult Dr. Google to learn more about transferring a Morula at day-5.  Here's the scientific answer:

The morula stage is the final stage prior to formation of a fluid filled cavity called the blastocoel cavity. Once the cavitation has occurred, we can see the fluid in the cavity between the cells and we call the embryo an early blastocyst. Although morula stage embryos are usually seen on day 4 and blastocysts are usually seen on day 5, sometimes we have only morulas on day 5. In such a case, we do not know if the embryos are slower than average because they are weaker, or because they are strong and healthy but just going a little slower than average. Transferring morulas on day 5 results in a reasonable pregnancy rate, although it is not as high as the pregnancy rate with blastocyst transfer on day 5.


I did find a lot of message boards that reported success with Morula transfers and some said that sometimes the embies for Girls were slower growing (these were not statements backed up by science and the success stories I read were split about 50/50 for girl/boy's born from Morula transfer).

I have shed tears for my lost embie and now need to get back into a positive mindset that one of the little ones in my uterus is my future child.  Now to stay positively occupied for day 2 of bedrest...

A Marathon... literally

Before my retrieval on Monday I mentioned to my very sweet nurse anesthetist how I was concerned about ovulating before retrieval, not that I had any reason to believe it would happen.  She proceeded to tell me about a woman who once was coming in for her retrieval concerned about the same thing... and there was a road race going on directly past the clinic so the streets were blocked off.  The woman pleaded with the police officer that she had to get through because if she ovulated she would be out thousands of dollars!  And he let her through.  Funny story.

So I've just come to realize our city's annual marathon will be tomorrow morning (reminder, my transfer is tomorrow morning)... I pulled up the route map from the local newspaper website and yes, the marathon goes right between me and the RE's office, and directly by the RE's office.

I will not panic.  The paper reports that while traffic will be slow that very few areas will be blocked completely.  I called G and told her we need to leave earlier than we planned to get there.  So we will be leaving 30 minutes early to get to the clinic that is normally a 5 minute drive...  I will not panic.  I will stay relaxed and peaceful.  Crisis adverted.

Prepare... repeat

It's takes planning if you live alone and need to be on bedrest for two days.  It's especially tough because you don't know exactly when you'll start your bedrest until possibly the morning of that day.

My call was scheduled for this morning.

I went ahead and had an acupuncture treatment last night to prepare my body for transfer.

I spent the evening after acupuncture running to the Healthy Home Market for pre-made healthy meals and also the grocery to make my own ready-to-eat meals.  I made a list of everything I needed to do this morning if the call that came told me I'd have my transfer today:

• Bake breakfast casserole
• Bake chicken dish
• Restock dog food (elevated on the shelf)
• Take out garbage
• Take out recycling
• Unload/reload dishwasher
• Pick up prescription
• Clean kitchen counters
• Put laundry away

I showered and began to work (I work out of the house) and wait for the call.  I had a plan in my head on how I would quickly shift my responsibilities at work so I could be out for the next 2 days, along with my excuse I would use as to why I had to be out.

I got the call about 9:50am... transfer will be Saturday at 11am.  Great!  How are my embies (I had to ask, it wasn't offered)?  All FOUR are still growing.  WOOHOO!

So tomorrow night many of the items on my list will be redone in prep for my Saturday transfer.

I have also learned over the last few days to ask my nurse for what I want...

The IVF nurse on Monday pretty much told me that I can't do my own PIO injection due to the awkward angle and the thickness of the serum.  She said that women who gave themselves the injection in their thigh complained of pain walking.  While I'm sure I could have done PIO if I had no other choice... I asked my nurse if there was an alternative to PIO that would not compromise my success.  Now I am using progesterone 'tablets' three times a day.  These are powder filled capsules that are inserted directly up my va-jay-jay.  If it means not having a big A$$ needle in my A$$ every night... I'll take it!  I've set my alarm on my iPhone to remind me 3x's a day.

Also, when the nurse called to give me my transfer time she also told me my beta date would be 12/23.  Well besides that being just so uncomfortably close to Christmas... I was planning to go see my family the previous day.  I told the nurse I wanted to travel on 12/22 and she said, "okay, we'll do your Beta that day instead".

Ask... and you shall receive!

So for Saturday, my friend G has insisted on taking me, picking me up and sitting with me for a while.  G has 10 year old twin girls through IVF and insists I should get up only to pee... someone else should be getting me food, drink, etc.

I do plan on being horizontal the remainder of Saturday and all day Sunday... but I will go to the kitchen to get water, my pre-made food, etc.  Also, I will have an acupuncture treatment 4 hours after transfer.  The office is 2 blocks from my house... I'll be fine to drive there and back.

Can't wait until Saturday... so I can begin the next wait!

4 Fertilized Embies

Of the 7 eggs retrieved, 6 were mature and 4 fertilized normally.  My next report will be Thursday morning.

GROW embies GROW!!!

7 Eggs

My retrieval was this morning and it went very well.  7 eggs were retrieved.  I'm now anxiously awaiting the call tomorrow that will report on fertilization.

Recovery has been easy, no actual pain, just slight cramping.  I'm thankful for that because initial recovery from my Hysteroscopy in May was extremely painful.

The target is to do the transfer on Saturday (5 day transfer), if it's a 3 day transfer it will be Thursday.  And from what I gather... either way, I wont have much advance notice (a matter of hours)... which makes the planner in me frustrated.  A Saturday transfer is fine... but a Thursday transfer - at the last minute - will be a pain to deal with from a work perspective.  But I'll do whatever is necessary.

My friends ROCK!  J picked me up and and drove me to the clinic. L picked me up and brought me home, with my specially requested Gatoraide.  D was on stand-by should my rides fall through... not that they would.  Thanks J, L & D!!!

My heart remains heavy for Paige and everything she is going through.  There are no words.

IVF Instructions

While these instructions are specific to me, I thought sharing them might be helpful for anyone who will be going through IVF.  This is a glimpse into the instructions provided the day before retrieval, paraphrased.

Note, I'm removing references to "partner" since I'm using donor sperm and I have friends on point for drop off/pick up.

1. Nothing to eat or drink after midnight, not even water
2. Report in exactly 1 hour prior to procedure (DO NOT BE LATE).  Wear comfortable clothing and socks.  Do not wear jewelry or makeup. Do not wear cologne or perfumed products.  Wear glasses (not contacts). Bring picture ID.
3. You may experience some discomfort after retrieval.  Bring your Vicodin in case you have discomfort.
4. Activity: Anesthesia will gradually wear off.  Do not drive, rest quietly at home through the remainder of the day; do not work. Tomorrow, you may participate in light activities if you are feeling well.  Eat light meals as tolerated.  
5. You may experience cramping or vaginal bleeding.  You may use sanitary napkins and take Tylenol as needed.  Call if you experience continued or severe cramping or bleeding, or if you develop a fever.  Do not use tampons.
6. Do not stop taking medications until instructed by your IVF nurse.
• Begin Medrol the night of retrieval.  Take as directed for 6 nights
7. Day after retrieval, IVF nurse will call and report how many eggs fertilized to make embryos.  
• The transfer will be performed on day 3 or 5 and occasionally on day 6 following retrieval (retrieval is day 0)
• The embryologist & physician will determine the day of transfer based on the number of dividing embryos as well as your specific clinical situation.
• Actual time of transfer will be scheduled 1 or 2 days in advance
• If the clinical situation changes we may need to move your transfer (from day 3 to day 5 or 6)
8. Begin PIO shots 2 days after retrieval.  Continue once daily until pregnancy test.  You will be given further instructions after pregnancy test result.

Embryo Transfer Instructions

1. Arrive 30 minutes prior to your scheduled transfer time
2. Bring your Valium with you to take at arrival
3. Prior to your transfer start drinking water to fill your bladder
4. You will be awake during transfer.  You will stay at rest on the bed for 30 minutes after transfer.
5. Do not wear perfume, cologne, etc
6. Your first pregnancy test will be approximately 12 days afer transfer.  Remember you will have a series of 3 pregnancy tests and the first is a baseline.  Your IVF nurse will give further instructions based on test results.  Good luck!

According to my instruction sheet, my first beta will be 12/23... This is pushed up much closer to Christmas than I expected.  I'm going to ask if my first beta can be 12/22... as I plan to leave that day to be with my family for Christmas.  We'll be spending Christmas in a small town in the mountains, about 3 hours from where I live.  I'll have to see if I can find another location that will do the bloodwork, for beta #2 and #3 to confirm a BFP!  ...I'm thinking positive here.

Also, the PIO that was sent expires on 12/19...  I guess I'll have to order more to make it to the betas, and beyond.

It's On... Monday 9:30am ET

Trigger tonight at 9:30pm tonight.  I'll report in after retrieval.

I'm wishing myself great quality eggs turned great quality embryos turned a healthy pregnancy & baby!

Thanks for your positive thoughts & well wishes!

Hurry Up & Wait!

29 shots and counting as of 9pm ET this evening.

I was amazed how much my follies grew overnight.  Thursday the largest was 19... today (Friday) the largest was 23.  The majority are in their 'teens'.  Dr. T wants me to stim one more day (today) to ensure I have as many mature eggs as possible; I went back to the RE's office for another dose of free injectibles to get me through today (if you are counting, that's 4 trips to the RE in the last 2 days, good thing it's only 5 minutes away).  I'll go back in the morning for my third consecutive morning date with 'Wandy' and expect to get the green light to trigger tomorrow.  This would put my retrieval on Monday.

I'm quite certain my ER will be Monday so I went ahead and notified work that my 'outpatient surgery' is Monday so I'll be out.  I coordinated with teammates to cover my responsibilities, it will be fine.  I'll work some on Sunday to prepare to be out.

The good news is that if I have a 5 day transfer, as the doctor wants, that will be Saturday... so my 2 days of bedrest will not impact work!  And if it's a 3 day transfer... I guess I'll just say I had a post-op follow-up and the doctor ordered bedrest for a couple of days.  It's actually the truth.

I'm anxious to have the retrieval now.  I'm definitely regularly feeling the big follies on the left, it's not bad... just a constant reminder.  Until then, I'll simply hurry up and wait.

26 and counting

As of tonight I have given myself 26 shots over the last 11 days for this cycle.  I have only one bruise although I don't even know which injection caused the bruise.


The photo was taken yesterday, it's all of the empty boxes that held my injectibles to date...  I do have 3 non-boxed vials in the refrigerator too.  I'm planning to take a photo of all of it once I'm down to just shooting up the PIO.


Monitoring Report
As of this morning 7 follies were counted from 19 - 12 (and one at 7). Estrogen was 676 and progestrone 0.318.


My orders were to continue the same protocol today (300iu Gonal-F; 10units HCG lowdose; Ganirelix).  Of course I ran out of Gonal-F and Ganirelix... so I got samples from the RE.  I was even out of syringes for the HCG so I got a few more from the clinic.


I go for monitoring again in the morning and will probably trigger tomorrow night with a Sunday retrieval.


The biggest of the follies are on my left ovary... and I can certainly feel them now.  I definitely feel super-bloated too!


In other news... 
I had to say goodbye tonight to one of my dearest friends, E (add in the exaggerated hormones, for effect).  E, her husband and 2 year old daughter are relocating to TX tomorrow.   E was a sorority sister of mine in college but we were not tight back then.  We reconnected around 1999 when we were both dealing with difficult break-ups and trying to build up our network of single girlfriends locally.  We did just that and had some fun times over the years... a lot of partying.  And E and I trained for and ran two marathons together.  


E got married 5 years ago in Mexico - and all of us girls in our tight group of friends were there for a grand time!  E has been struggling to conceive a second child and so we talk about TTC and all that goes with it frequently.  


I'm so sad that I wont get to see E regularly (or her beautiful daughter) and E is sad to leave and anxious about going to a new city where she has no connections or network of friends.  I know she'll do great and meet people quickly/easily.  


It wont be the same here without E nearby.

My Follies are Growing... fa la la la la...

Follicle report: 17, 13, 12, 11, 11, 11, 10, 7, 6, 5. 

Estrogen 266
Progesterone 0.207

Started Ganirelix, actually Cetrotide, to prevent ovulation.  Continuing 10 units of low dose HCG and 300iu of Gonal-F every evening through Wednesday.  I had to order one more Gonal-F pen... I was one dose short.


Next monitoring appointment will be Thursday morning.  My retrieval will be this weekend, probably Saturday.  I cheered when I heard it would be over the weekend - I wont have to be out of work until the transfer.  If the embies will make it, a 5-day transfer will be Thursday.  I couldn't be more pleased about the timing (from a work impact perspective), it will make my lack of explanation for my time off easier to pull off!

And the Christmas Tree went up yesterday!

Passing the Cherry

I was just tapped for a Blogger Award, thanks to Gille at Endo and the Single Girl.

The rules of the award are these: 

1. Link back to the person who gave it to you
2. Pass it on to five (or more) other blogs
3. Leave them a comment telling them about the award 

I'm going to pass this on to some of the bloggers I've been following for a short time and a couple of Twitter friends.

• Mickey at One Good Egg 

• Jeri at Scrambled Eggs

• Mummy in Waiting at Maybe Baby (or maybe the looney bin)

• InBetween

• My So Called (TTC) Life

Thankful to be Single

Monday night was one of those moments that make me feel very alone, the kind of alone that makes me feel sad and resentful that I don't have someone special in my life, a husband.  I was frustrated from work and overwhelmed with starting my IVF injections - I really just wanted someone else to take over and figure it out for me.  But as soon as the pharmacist calmed my fears, I was fine again.  After five days of injections, it's old school for me now.

I'm actually thankful that I'm going to have this baby on my own.  I have too many friends, divorced, that have to deal with terrible custody issues with their ex's.

I have sat in court in support of a friend, G, who's ex was dragging not only G, but G's children into court to testify in a custody hearing.  He didn't have a job, didn't pay child support, had roommates and no room for his children to sleep in when they did visit; he didn't know their teacher's names or what activities they did after school.  G had a great job, a four bedroom house and is one of the most dedicated mom's I know.

Another friend, D, who is quite successful in her career is essentially broke because of how much she has to spend on lawyers because her ex keeps dragging her to court.  He pays no child support which D would be fine with if he would just stop taking her to court.  AND he keeps their kids from taking the medicines they need (something to do with the laws in that state and requiring both parents to consent).  D has to offer comfort when their dad drops out of their lives for a year at a time, misses birthdays or only wants one of the two kids to come visit for Christmas or Summer break.  Even her ex in-laws want their son to leave D alone to raise the kids.

Another friend's kids have called from their father's house requesting that she bring them clean towels and sheets because there were none at their dad's house (someone else uses their beds when they are not there and the sheets had not been changed).  

I am so thankful that I will not be faced with these types of situations that would break my heart as a mother.  I know I will provide a safe, warm, clean and loving home for my child and I will not have to compromise.  

Ideally, I would be with my Mr. Right (not perfect, just right) starting our family together.  However since I've dated MORE than my fair share of Mr. Not-So-Right's I understand how my friends ended up in these terrible custody situations.  I'm thankful I have not settled for having a child with a Mr. Not-So-Right!

I'm still dreading the PIO shots - when the time comes... but I do have my neighbor or friends willing to help me out.  I'll probably take them up on it until I get "comfortable" with stabbing that big-ass needle into muscle on a daily basis.

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Monitoring report
I went in Friday morning for monitoring...  the doctor on duty counted 4 follies on each ovary less than 10mm.  I'm continuing with the Gonal-F and HCG and will go back on Monday morning for monitoring again.

The Protocol

It's called the "BCP Ganirelix Gonadotrophins Protocol".  And I still really don't know what it means...

• 15 days of BCP - done
• 5 days of nothing  - done
• 300IU of Gonal-F started today for 4 days
• 10 units of Novarel Microdose (HCG) started today for the next four days
• Doxycycline (antibiotic) started today for 14 days

Friday morning I go in for more labs/ultrasound and will get further instructions from there.  I've got far more drugs in my kitchen than I know what to do with.

Starting Point

Wouldn't you know I started bleeding this morning... AF I guess.  She's early (only CD22) but I expect the starting of BCP and stopping it 15 days later messes with my cycle.  Dr. T wasn't phased that AF was arriving so I guess all is okay.  

I had 6 follicles on each ovary less than 8mm.  I think 12 follies is a good starting point (before BCP I only had 7 total).

The First of the IVF Shots

After a bad day in the office today I got home around 6:30 and realized I didn't know how to take my HCG.  It's not a prefilled syringe like every other self-injection I've done to date.  I didn't know which type of syringe to use (because I have two different types of empty syringes and an extra set of big-ass needles).  How do I get the medicine into the syringe?  Was it supposed to be a muscle or fat injection?

When I googled how to inject the Novarel there was nothing on the microdose I was taking... all instructions were related to mixing a concentrated vial with saline (or something).  I panicked.  

I called my neighbor for guidance (an ER doctor) but couldn't get her on the phone. Finally I called the pharmacy that sent me the drugs and at that point I was choking back tears explaining my dilemma... immediately I was put on with a pharmacist who had me laughing and relaxed within 30 seconds.  The microdose is already mixed, use the small insulin syringe, draw my dose, insert in fleshy abdomen.  It's as simple as that. Crisis averted.  

Telling the Boss

As for telling work about being out...  we've got all kinds of resource issues that have just hit the fan and so I'm taking on yet even more - when I'm already well over capacity.  I was IMing with my boss about the resource chaos late today and went ahead and slipped in "probably not the best time to bring this up... but I have to have outpatient surgery in early December - it will cost me 2 - 3 days".  She said "we'll deal"... and that was that.