Not-So-Oral Estrace

Last time I spoke to the doctor, he had mentioned that my lining (at the last FET) was about 8.6mm (they aim for over 8) but that he would consider adding in an Estrace suppository this time around. I asked the nurse about this, and the doctor agreed that I could add in the vaginal Estrace. I was expecting her to call in a new script, but (unlike Progesterone), there is no "official Estrace suppository" and you just take the exact same pill vaginally! That's right...you stick that little blue pill up there.

I started this last night and am hoping it will help to increase my lining this time. It is a bizarre thing to do, but I spoke to two nurses about it (and read a few online message boards). I highly recommend wearing a pantyliner!

All in all, even with the extra steps of taking 2 pills (orally and vaginally) 2 times a day, it is much better to take the pills than to do the injections. You only have to do the injection once every few days, but there's so much involved with the injection (time of night, numbing, drawing up medication, switching needles, injecting, heating pad, etc.)...not to mention that I can't give it to myself since it's very hard to reach back there. The pills allow me to be much more independent, but just require that I have 2 alarms set every day.

I was looking at my calendar and I can't believe the transfer is only about 2 weeks away. I am not looking forward to the actual transfer (with the full bladder) and I am certainly not looking forward to the 2-week wait! Hopefully, it won't be as dreadful this time around. I am telling myself now that I will not do any at-home pregnancy tests this time. I am hoping I can exercise enough self-control.

Not-So-Good Grief

Prior to starting our cycle I bought 4 different books on IVF and infertility. None of them cover the grief/loss period in detail. The majority of the books talk about the process of finding a doctor, different fertility treatment options, the STIMS process, transfers, etc. but then spend very little time on what happens if it doesn't work. Infertility for Dummies by Sharon Perkins and Jackie Meyers-Thompson talks about the grief process for 2 half pages (barely 1 full page). 

Injection sites after 4.5 weeks of del Estrogen and Progesterone

I think I've gone through the majority of the grief stages they discuss (borrowing from On Death and Dying by Elisabeth Kubler-Ross): Denial, Anger, Bargaining, Depression, and Acceptance. I'd say right now I'm still in the Depression stage, although every once in awhile I feel like I might be moving into the Acceptance stage...but then I go to sleep, wake up, and the depression hits me again. Someone told me it was "okay" for me to be "mad at God." The thing is, I'm not. I'm not mad at God. I'm not mad at my doctors. I'm not mad at myself nor my husband. I'm just sad. I'm grieving not only the fact that it didn't work, but also the time lost, the money lost, the hope lost, the babies lost.

The doctor retrieved 19 eggs on the day of ER. The next day, we found out that 17 of those 19 eggs were mature, and 11 had fertilized. That day we already went from 19 to 17 to 11. Then by Day 7, we were left with only 4 embryos that made it to blast. That day I grieved the loss of the 7 embryos that didn't make it. A couple weeks later, we got our PGS results back and I grieved the loss of 2 more that were abnormal. The day of the beta, I grieved the loss of the embryo that made it into my womb, but didn't hold on. I'm still grieving this loss.

The past month has been full of difficult things. Our lawnmower broke. My husband's car broke down. There was an issue with my credit when we tried to refinance our home. A water pipe broke. My dog had to go to the ER. I try to look on the bright side of each of these things, but it's pretty tough to do when it feels like everything is going wrong at once. 

I really need a vacation.

First IM Injection

I had my baseline appointment on 6.23.16. It was similar to the other monitoring appointments during Stims. First, I had my blood drawn and then I had an U/S--except the U/S was to check my uterine lining instead of my follicles. My uterine lining was at 3.4mm.

I had a nurse come to give me my first Del Estrogen injection so she could show my parents how to give an intramuscular (IM) shot (in my rear). I was incredibly nervous given the size of the needles and the location (going in a muscle), but when she looked at the needle gauge and sized me up, she thought because of my BMI, I would be better using a smaller gauge (and shorter!) needle. (Thank God!) I iced the area for approximately 5 minutes while she went over the protocol of drawing up the medication and then she showed my parents how and where to give the injection. The actual injection was pretty painless (I assume because of the icing). I am really glad we hired her to come show us. She was so nice and understanding, and it turns out that not only does she work at our clinic as well, but she had two IVF babies from them that are now 8 and 12 years old! She got pregnant on the first cycle with each of them. It felt good to finally meet someone who went through what I am going through and has two actual beautiful children to show for it. It was so encouraging.

Yesterday, the nurse called to discuss the FET with me. Due to my doctor's schedule, we will be doing the FET on Thursday, 6.14.16 (instead of 6.12.16). This means that I will have my next moderating appointment (to check uterine lining) on 7.9.16. They want to do three pregnancy tests on 7.26.16, 7.28.16, and 8.1.16. Then they want to do two ultrasounds on 8.8.16 and 8.21.16. It's so hard to think that far in advance, and if we will even get to that point. 

Right now I am stressing out about plane tickets to fly back home so I can actually spend some time at home this summer before flying back here to get ready for the FET...then I have to fly back after all the pregnancy tests and ultrasounds. This entire process will have taken the majority of the summer (~15 weeks/3 months)!

PGS Results

Last Friday (6/17/16) the nurse called me with the PGS results (a week sooner than expected). The news was not great. Out of the 4 blasts biopsied, only 1 was normal. Two were abnormal (1 missing chromosome 2, 1 missing chromosome 17), and the 4th was non-concurrent (inconclusive without further biopsy/testing). To make matters worse, my doctor wasn't able to discuss things until today (5 days later), so there was a lot of anxiety and replaying different scenarios in my mind all weekend long.

I finally spoke to the doctor today and we discussed moving forward with a FET of the normal blast, and the possibility of re-testing the non-concurrent one either now or later on. He said with where we are now (with PGS testing concluding a normal blast), there is a 65% chance of pregnancy, 10% chance of miscarriage, and 58% chance of live birth. Without the PGS, the birth rate would go down to 50%. He said that my attrition rates have been pretty average so far, (although 1 normal out of 3 would be slightly below average; 2 out of 4 would be average).

Part of me is excited to move forward. I am happy that we even get to move forward, but of course my mind starts thinking that if this doesn't work, and the 4th embryo is also abnormal, I'll have to start another cycle...and if I start another cycle, when could that possibly be because I don't have another long break from work until December. I also can't help but think that not having any extra (normal) embryos means there's no chance of a second baby...which is silly because at this point, I should only be focusing on having even one baby--which I would be thrilled, overjoyed, elated, and so blessed to have!

Today will be my last day of birth control, and I have a baseline BW and U/S appointment tomorrow morning at 7:45am. I'm scheduled to start Del Estrogen injections (intramuscularly!) tomorrow evening. We have decided to hire a nurse to come to the house to teach us how to do the first intramuscular (IM) injection. I am thinking my mom will be the one to give me those! Not looking forward to that...

Day 7 of Stims

Top: Gonal-f
Bottom: Cetrotide in its "Lunchables" pack

Update
I started stims on Friday (5/20/16), had a check up on Monday (5/23/16), and again yesterday (5/25/16). On Monday, during the u/s, the sonographer found 9 follicles in my right ovary and 10 in my left, and was able to measure a number of them that were 10+ mm. That afternoon, my nurse called and told me that they were surprised to see how quickly I was progressing (she assured me this was "a good problem to have") and that the doctor wanted to dial back on my Gonal-f (from 175 IU to 150 IU), to increase my Menopur (from 75 IU to 150 IU) and to add in a morning injection of Cetrotide (0.25 mg). My estrogen (estradiol) level was at 109 pg/ml. Yesterday, the u/s showed that more follicles were enlarging, and when my nurse called she said that my estrogen level was now at 781 pg/ml. My next appointment is tomorrow (Friday, 5/27/16).

Stims: Day 6 - 2nd morning of Cetrotide (25 mg),
5 nights of Gonal-f (175-150 IU) & Menopur (75-150 IU)

Starting Cetrotide
I was a little nervous to inject the Cetrotide, as I've heard it also burns and can cause an itchy rash at the injection site, but I found it to be pretty unremarkable. It is refrigerated, and comes in its own little "Lunchables" style pack, with syringe pre-filled with sterile water, powder vial, and alcohol swabs--I like how convenient this is. My only problem with it is getting all of the powdered medicine to dissolve completely. The injection itself didn't burn for me and only itched a tiny bit the first day, but nothing like a mosquito bite or anything. I did bruise at the first injection site. This morning when I did the injection, I accidentally stabbed my middle finger as the needle bent and went through the cap. I'm not sure if it was the throbbing pain in my finger or the medicine, but I got super nauseated and dizzy, and it was all I could do to rifle through my parents' bathroom drawers to find some Neosporin before I passed out. Luckily, I just barely made it to my bed before falling over. It was a rough morning.

The trigger
I got some good news from my nurse. I have been a little anxious about my upcoming trigger injection, as most of what I've read has stated that they need to be injected intramuscularly (i.e., in the butt muscle). We were prepared to hire a nurse who would be on call for 3 consecutive evenings (cost ~$125-$175) to come give me the injection, which could very well be in the middle of the night. My nurse told me that all my medications including the trigger injection will be given subcutaneously in my abdomen. She explained that there are 2 types of trigger injections: Lupron and HCG. "The reason why some physicians use one over the other is the mechanism of the trigger. For those patients who have a lot of follicles or are at risk for developing ovarian hyperstimulation syndrome (OHSS), you would use the Lupron, as this medication is in your system for a short amount of time. The HCG trigger is for the patient who will have an average response to the stimulation medication as the HCG medication is in the system longer." So I don't need to hire a nurse, and I can do the trigger injection myself!

Exercise
I was told I could continue my normal cardio and strength training during the early stages of injections (days 1-5), but by day 6, I would want to decrease the intensity and focus on non-impact exercises (yoga, light elliptical, swimming, etc.). Yesterday was day 6, so I took Noah for a 2 mile walk. Today I am going to do the same, but also hit the gym for a light elliptical workout (decreased intensity/time). I did an entire week's worth of cardio/strength from Saturday-Tuesday, so I was at least able to get that in...but it's going to kill me a little to not be able to do strength training as usual. Oh well...I'll live.

Mickey Collector's Series Band-Aids

Little treats
I've decided to reward myself after my nightly injections with a little treat: popsicles. I am loving these little Outshine Fruit Bars. They're only 35-45 calories a pop (ha!). I also got some Mickey Band-Aids, because who doesn't love Mickey? Little things like that, walking the dog, and working out, have helped keep me sane. I've been getting daily headaches which I am able to treat (for the most part) with Extra Strength Tylenol, lots of water, and naps...I've been taking lots and lots of naps!

1st and 2nd night of Stims

I did it. I gave myself 2 injections last night.

Last night I went to see my friend, Vince, play a show in WV, and then left early to get home before 10:00pm to give myself my first injections. My mom was by my side, but I insisted on doing everything myself.

Currently, I am taking 175 IU of Gonal-f and 75 IU of Menopur. Gonal-f is refrigerated, and can come in the Redi-ject pen, which is a disposable, pre-filled, and ready-to-use. You just dial your dosage, screw on the needle, and inject. Gonal-f (Gonadotropin FSH) is a follicle stimulating hormone that basically makes multiple follicles (cysts containing eggs), and causes multiple eggs to grow to a mature size. The Menopur needs to be reconstituted with sodium chloride solution (sterile water). Then you draw it up in a syringe from the vial and inject it. Menopur has 2 kinds of hormonal activity: FSH (which helps increase egg production, like Gonal-f) and LH activity (which assists with ovulation).

I did the Gonal-f first, because I knew the Menopur was going to sting. I will say that both needles were small and did not really hurt that much going in. The Gonal-f does not sting, but the pen trigger bothers me because I'm not able to watch as the medicine goes in, the way you can with a regular syringe. Mixing the Menopur is an art form, and I had to watch the instructional videos several times. It's really hard to get every drop of medicine out of those vials into the syringe. The Menopur does sting, and it seems to sting more toward the end. It's not unbearable, it's just uncomfortable. 

Left: Look how cute this little Sharps container is!
Right: The Menopur comes with vials of sodium chloride solution you use for reconstitution.

Last night, I felt good after my injections and I was really proud of myself. Today I am feeling a little depressed realizing I'll be doing this everyday (and eventually twice a day) for a couple weeks. I really cannot imagine doing multiple rounds of IVF. There is so much involved!

I think the hardest part, for me, is the isolation. This is a very lonely process, especially with my husband and friends nearly 2,200 miles away. Since we haven't told many people, I can't really post about anything on social media, which is hard. I am one of those people that really thrives on the support and encouragement received from others on social media...and since I can't really talk about my experience, I am relying on the support and encouragement of the few people that know about it...and of course, most everyone is super busy and preoccupied with their own lives, so I don't want to trouble them with my woes.

Right now I really just want to lie on my couch under my favorite blanket, snuggle my Golden Retriever, watch a cheesy Lifetime movie, and cry. Part of me wants to tell everyone, "Hey, this is what I'm doing. Look how brave I am giving myself injections every night. I'm doing this so that maybe we can have a baby. This. Really. Sucks." But I can't. 

So instead, I am trying my best to stay sane...I'm working out as much as I can within the restrictions I've been given. Under doctor's orders, I've eliminated alcohol and caffeine from my diet, and the only painkillers I can take are Extra Strength Tylenol (meaning my normal go-to for headaches, Advil, is out.) 

This is going to be a long couple of weeks...