Unsteady Ground

So to begin, I headed into the clinic this morning at 7:10 am to give myself more than 30 minutes to make it in to the lab for my appointment a 7:45 am. I found a better route from our area and it took only 20 minutes to get there. I was so excited that this could be an alternative to our freeway issue. Except that there was a big construction sign stating that on Monday July 6th the main road would be closed for construction. Drat! So plan A will remain in effect for egg retrieval where we will stay at my parents who live closer to the clinic.

The blood draw went well and then I walked over to the IF clinic for my ultrasound. I had a bad feeling that I would end up with "The Woman" RE today. And I did. She has no bedside manner. Seriously. She didn't even ask me to scoot down to the end of the table. Instead she put a condom on the u/s wand, lubed it up and stood there just waiting. Her technique is...painful and she didn't speak a single word to me as she checked out my girls. I had to ask, "Soooo do I have at least one follicle?" and her reply, "Yes, there's at least one." Ordinarily I would think it would be followed by an explanation from the RE about exactly how many she had found on each ovary, but not "The Woman." To catch you up on "The Woman" RE, when she did one of our IUI's her technique was so bad I nearly jumped off the table and then ended up bleeding for the next 5 days. Even if we had gotten pregnant that month I wouldn't have had a lining left for the embie to implant! My biggest fear is that she will be one of the RE's who does our retrieval or transfer and we have been praying against that from happening.

Back to the u/s, "The Woman" finished, grabbed my chart and was running out the door mumbling something about the ART nurses calling me. UNBELIEVABLE, she was just going to leave without telling me ANYTHING about my u/s??? It was like a bad one night stand* - wham-bam and running for the door without saying a word. I at least deserved something after our intimate encounter as she did just put a wand up my whoo-ha. So I stopped her by just firing away my questions at her and, let me tell you, it was like pulling teeth. Here is the summary after 5 days of stims:

6 follies total
4 follies on the right
2 follies on the left

Follie sizes
1-13mm
5- less than 10mm

Lining
6.5 mm (6-14 is ideal for implantation)

Six. I only have six. Don’t’ get me wrong, I’m glad its more than one but only six? I was surprised at this. I thought I would totally rock the stims and have an egg farm brewing in my belly. Right now, if I was an egg farmer I would have to file for chapter 11 bankruptcy. I walked out of there feeling deflated, disappointed and basically…blah.

I then had to go to work and spent the whole day with questions rolling around in my mind. What if this is because I messed up on my meds? What if I single handedly ruined our IVF cycle? What if I don’t’ make anymore follies? Will we have enough for a fresh cycle let alone a frozen? What if we don’t have any mature follies? What if our cycle gets cancelled? Could I just be over suppressed?

This last question is something that I’ve been thinking about since my first u/s on 6/24. I went back and listened to the message from the ART nurse again and confirmed that my E2 was below 7. They wanted me to be at least below 80 but I was below 7. Doesn't that sound extremely low? Aren’t I supposed to have SOME estrogen? Could I just be taking a while because I was basically starting from zero?

I didn’t have time to research this at work. I had to endure talking about pregnant ladies, babies, breastfeeding and hot flashes. Yes, hot flashes. I was in a meeting while three 45+ year old women that I work with were going on about how I just don’t understand what hot flashes are like but that someday I’d know. I said nothing but inside my head ran the following scenario where I just went off on them shouting,

“NEWS FLASH, I do know. I intentionally am giving myself hot flashes in a desperate attempt to try and get pregnant. And because of this I have to run off to appointments all the time which make you all speculate that I actually am pregnant and therefore you drop hints to me all the time to see if I’ll crack and break the “exciting news.” Well I’m cracking but not like you’d think because I’m infertile and all these appointments are so that we can do IVF, so there!”

*sigh* It was a long meeting and as you can probably tell it did nothing to help with my current mental state.

To make matters worse my cell phone battery died and I missed the call from the ART nurse regarding my blood work results and protocol changes. By the time I got to my car to plug in my phone it was past office hours. I did have a message from them regarding my E2 levels:

6/24 E2 = 7 pg/mL
7/2 E2 = 107 pg/mL

107???? Isn’t this too low for 5 days of stims? I instantly went into a spiral of sobbing. I thought I would be higher. I called Hammer who immediately left work to come home because I was inconsolable on the phone going on and on about how I was too old, my eggs were old, we were too late etc. It was pretty ugly. While I waited for him to arrive I called my mom who is a walking medical dictionary and knows just what to do to make things ‘all better.’ She was able to talk some sense into me. First that I was on too many drugs now to be rational and I needed to listen to Hammer and her, she was sooo right about that! And that I was jumping to conclusions since I couldn’t get in contact with my RE until tomorrow. I told her that they weren’t changing my protocol which I didn’t understand. Her, being the rational one, (I, not so much) thought was that it was likely because everything WAS fine and I was making assumptions.

I was basing my freak out on the following chart from the Advanced Fertility Clinic in Chicago, IL** (below) which shows that at day 5 I should be around 400-500 pg/mL.

“How is the monitoring of the IVF stimulation done?

We try to stimulate the woman to get at least 4 follicles with sizes of 14-20mm diameter. Ideally, there would be at least 8 follicles between 13-20 mm for IVF. The goal is to get a good number (about 8-15) of quality eggs. Blood hormone levels and developing follicle sizes are monitored. Ultrasound is used to measure the follicles. Estrogen hormone blood levels are important. Estrogen (actually estradiol) levels are usually under 60 pg/ml at cycle baseline and rise significantly as multiple follicles develop. Peak estradiol levels in IVF at the time of HCG are usually between 1000 and 4000 pg/ml. The stimulating process usually takes about 8-10 days.

Usually, it is not difficult to get enough follicles to develop. However, sometimes the response of the ovaries is poor and a low number of growing follicles are seen… The minimum number of follicles needed to proceed with IVF treatment depends on several factors, including follicle sizes, age of the woman, results of previous IVF stimulations and the willingness of the couple (and the doctor) to proceed with egg retrieval when there will be a low number of eggs obtained. In our experience, IVF success rates are very low with less than 3 mature follicles (18mm). Some IVF doctors will say that you should have at least 5 follicles of 14mm or greater while others might do the egg retrieval with only one follicle. Most IVF programs in the US want a minimum of about 3-4 mature (or close to mature) follicles. Women that are more likely to be low responders to ovarian stimulation would be those that have low antral follicle counts, those women who are older than about 37, women with elevated FSH levels, and women with other signs of reduced ovarian reserve.”

And this is why I became irrational. I was convinced I have reduced ovarian reserve and tail-spinned into a sob-fest. And while all these things I’ve worried about throughout day may come into being it is as my dad, who was listening on speaker phone, said, “None of this is in our control, it never was and it never will be. You just have to trust that God IS in control.” Aren’t dad’s great?

Now that I’ve calmed down a bit, eaten some chocolate and pizza (stress food), and spent some time praying I feel better. That and I’ve found some better information about where I should be at:

E2 Day 3 25-75 pg/mL
- my day 0 was less than 7 so I was probably still way below this at day 3

E2 Day 5 100 pg/mL or 2x day 3 levels
- so that means I’m actually right on track, I freaked out*** for nothing

E2 Surge day 200-600 pg/mL per 18mm (mature) follicle

My RE is giving the follies five more days to cook. So that means on the day I take my HCG trigger, if all my six eggs mature I should be at least 1,200 pg/mL. That’s a lot of ground to make up. But if your E2 levels are supposed to double every day after the day 5 check then I would be around 1,000 (107x2 = 214 x5 days = 1070 pg/ML so it’s possible.

And Hammer made a very good point that maybe we have only a small number of eggs because God was protecting us from having to make difficult decisions. We don’t want to be in the position where we have an ethical dilemma. When we talked and prayed about IVF we did feel that God had led us to go down this road. We also talked a lot about how many eggs we would fertilize. Since the first cycle has so many unknowns we agreed that we would not fertilize anymore eggs than we were willing to have children. We both felt extremely at peace with our decision to only fertilize seven eggs and freeze the rest. There was a lot of discussion about the probability game and that only doing seven could mean that we have few or no eggs in the end. But since the first cycle is a game of probability we would rather play it conservative until we know what we are dealing with as far as my egg making abilities and what his boys can do in the dish. We’ve had three years to save up for our baby and that has allowed us to have the means to do two full IVF cycles, drugs and all. We would rather pay more in the end than be in the position of having to decide which embryos we would use or not use. And since we both felt we couldn’t ‘get rid of’ or donate our embryos that could mean the purchase of a school bus in the future and my uterus just trembles at the thought of all those potential babies.

So our schedule will change a bit. Instead of Monday being our estimated egg retrieval day it will be another blood draw and ultrasound. So that means five more days of stims with the hope that we will trigger that night or the next day for a new estimated egg retrieval of Wednesday or Thursday.

Now all there is to do is pray and trust that God is still in control, always has been, and always will be.

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*I've never had a one night stand but I watch movies and therefore assume this is similar to a one night stand, 'cause movies are like real life, right?

**This is not my IF clinic but a great resource I've used in the past on IVF cycles

***For those of you who thought I was ridiculously calm, you now have proof that I can freak out with the best of them.

Current Meds: Lupron 5 units, Bravelle 1 vial AM + 2 vials PM
Side Effects: burning and redness at injection site (Lupron only), moderate agitation, hot flashes, FATIGUE, headache
Follie Report: Day 5 = 6 follies (4R, 3L), 1x13mm and 5x less than 10mm
Days Post Transfer: 0
# Eggs Transferred: 0
# Eggs Frozen: 0