Phone consultation with Dr. Sher at the Sher Institute for Reproductive Medicine (SIRM) in Vegas, baby!

I have long suspected that something other then 'unexplained' infertility was preventing us from getting pregnant and carrying to term. Luckily, I know a number of wonderful, knowledgeable women at Fertility Friend who have similar issues and who have undergone immunological testing and immune infertility specific treatments with success. These women helped to educate me on the possible immune issues we might have and led me to ask more questions. There are a few clinics in the United States that study immune system problems in infertility, but few, if any, in Canada. For that reason, Derek and I decided to schedule a phone consultation with Dr. Sher at SIRM in Las Vegas, which happened this afternoon.

This is a summary of what Dr. Sher had to say:

1) My IVF protocol through the Regional Fertility Clinic was incorrect. They started me on a low dose of Gonal-F and quickly increased it (because I wasn't responding well enough), which can cause poor egg quality. Considering we harvested 17 eggs, but only four made it past day three, there was likely something wrong with the eggs. Considering my youth (that was nice to hear!) and all my normal bloodwork, the poor egg quality was due to environmental factors, which Sher thinks relate to the protocol.

2) He is recommending immunological testing for Natural Killer cells as well as antithyroglobulin and antimicrosomal (both relate to anti-thyroid antibodies) for me and DQ Alpha and HLA genetic matching tests for Derek and I to check for genetic matching issues (which essentially means we share too much similar genetic material). These tests are not available in Canada, so we have to go through a lab in Calirfornia. Once I know what this entails, I'll update.

3) He does not recommend genetic testing of the embryos prior to transfer at this time (a relief, this is very expensive).

4) We qualify for the two IVF shared risk program. I will get the cost details from 'Sharon' tomorrow afternoon, but the jist of it is that the first IVF costs about 20% to 30% more then a typical IVF package. Should that IVF fail (or we miscarry), transfer of any frozen embryos for that cycle is free. Should that fail (or we miscarry), another IVF and FET is also free (likely not including med's, but still a huge savings).

I agree with everything he had to say and am glad our thoughts are in line. I have to say, he is a talker, and I couldn't get a half a sentence in edgewise, but all in all, I'm happy with the consultation. He also kindly assured me that this consultation, as well as the follow up after we do the immunological testing, is free of charge. We do not pay anything until we start a cycle with his clinic.

Hopefully the prices aren't too outrageous and this is something that might work for us! I will update when I know more.

Taking a Break (Cycle 50!)

Here I am, Cycle Day 1 of cycle 50 - I can't believe we've been actively trying for 50 cycles! This was my first full cycle post failed IVF and my period was about five days late, which is typical. Of course I tested. Stark white BFN's, as expected, and AF is on in full, painful force this morning.

Derek and I have been doing well since the IVF, and feel like we still have options. We're planning to do the FET (Frozen Embryo Transfer) in the fall, either in September, before I leave for University, or in November, after I return. We've talked about what we might do after that, should the FET fail, and we are of differing opinions. I was set to move on to adoption, but Derek is pretty sure he wants to do at least one more IVF, if not more. We're looking at switching clinics - either the Victoria Fertility Clinic or the Sher Institute in Las Vegas - if we decide to move forward with more cycles. We have time to decide, and a summer full of trying to focus on ourselves again.

We arrived home from a much needed vacation in Hawaii last week (we went with my parents, and my middle sister, Lara, was there for part of the trip too) and head to Penticton, B.C. for a ten day cycling camp on May 11. Vacations are fantastic at cheering a person up! Not to mention a loaded assignment schedule for University and our ongoing house renovations (which WILL happen this year!). I appreciate my busy life more at times like these - it's not as if I'm avoiding thinking about the failure, it's more like I'm able to process it in bits in pieces while looking forward to other things. I'm not letting infertility rule my life.

It might be premature, but I'm actually starting to think about the option of living child free, as is Derek. It is an option for me now, though it wasn't less then a year ago. It will be painful to make that sort of decision, and I hope it never comes to that, but at least I know in my heart that things will be ok, however they turn out.

IVF #1 - It worked...and then it didn't.

Previous to starting this whole IVF process, Derek and I discussed how and when we were going to do a pregnancy test following the transfer. I am a self admitted POAS addict, so had originally planned to test out my trigger and then (hopefully) watch the line get darker again to indicate a pregnancy. However, Derek pointed out, and rightfully so, that this whole process should involve the both of us, and we both needed to be involved in the testing. In an effort to take the pressure off, and to keep this as close to a shared process as possible, we agreed to test together on a day where we would be sure the trigger was gone, and any second line would mean a pregnancy.

There was some disagreement about the test date, but I recall that we decided to test 14 days post trigger (or 9DP3DT / 12DPO) while Derek remembers 14 days past the retrieval (11DP3DT / 14 DPO). Either way, we ended up testing on 10DP3DT / 13 DPO, this past Saturday. And we got this:

It's light, but it's a line, a line even Derek could see. It's a line that is reasonable for ten days past a three day transfer. It worked, and I cried. Derek asked why I was crying and I said I was just so happy!

But alas, it was not to be. I tested again the next day and the line didn't get any darker. Looking to calm my fears, I went in for a beta and tried my hardest to remain positive. I didn't get the results until the next day, Monday, and I knew what was coming. My beta was only 4, which is technically 'not pregnant' (below 5 is classified as not pregnant). My test that morning had been almost negative (damn those FRER's are sensitive!). By this time, I was 12DP3DT, or 15DPO.

Today is my official test day with the fertility clinic - yes, they make you wait until 18 days past retrieval - and I'm not even going to bother going in. I'll give them a call and let them know I've tested negative and schedule our WTF appointment. This is our third uterine loss (I also had an ectopic last summer) and I'm convinced there is something going on with implantation. Our plan going forward is to review the results of my repeat pregnancy loss panel and request additional immunology blood work for potential problems including increased NK cell activity and lupus.

We also need to take a few months off. Though I was happy, positive and emotionally stable through the whole IVF, I feel mentally drained at this point. In retrospect, this took a much bigger toll on us then we thought. In less then two weeks we will be in Hawaii with my parents and sister Lara for a couple of weeks, and then we head to Penticton, B.C. for ten days in mid-May, and we need it. We'll start the immunology testing in June and expect the results to take a few months. That puts us at August or September for our frozen embryo transfer (FET).

At this point in time, I don't feel like I could handle another IVF cycle. Adoption seems like a reasonable option for us at this point, and comes with a much better guarantee at close to the same price. That said, we'll see what the next year brings.

IVF #1 - 4dp3dt and we have Totsicles!

4dp3dt = four days past three day transfer, otherwise known as 7 DPO.

I'm not going crazy yet, but I can feel the crazy right around the corner. Time is slowly moving forward and I'm thankful for a very busy week at work (including travel from Wednesday to Friday) and a final assignment for University due next Sunday. My few symptoms, sore boobs and light cramping, can be attributed to the 600mg of progesterone and 4mg of estrogen I'm on each day, but that doesn't keep me from analyzing every little twinge and pushing on my boobs every once in a while to make sure they still hurt (they probably hurt because I keep pushing on them).

We got some amazing news yesterday! Left with little to no hope for frozen embryos after the transfer last Wednesday, we got a call from Chris the embryologist early yesterday afternoon to let us know that they had successfully frozen two day six hatching blasts yesterday morning! Last we heard, we had a few embryos that were a day or so behind that they were going to leave in culture to 'see what happens'. We didn't have a lot of hope, but figured there was no harm in letting them sit, right? Well, two of them caught up, and we have two more 'average' blasts on ice for when we need them.

Not only does this let me breathe a bit easier, but it will really help me to relax for the rest of this cycle, because we have a couple of totsicles in the fridge for a second go if we need it. Hopefully we use them for sibling(s), but it is a relief to know that we have a plan B.

IVF #1 - Embryo Transfer

One day post transfer and I'm already starting to obsess. Logically I know nothing has implanted yet, but every twinge and cramp draws my attention immediately to my abdomen and my thoughts to those two little embabies in there. How am I going to get through the next two weeks?

The transfer was right on schedule yesterday afternoon. Derek arrived shortly before the appointment and we were ushered into the same room the egg retrieval was performed in. I had a full to bursting bladder for the ultrasound guidance - too full, even, and they asked me to empty about half. Once I was up in the stirrups, the embryologist came into the room to talk to us about our embryos. We had two 'average' day three embryos, one a six cell and one an eight cell, which are exactly where they should be for how old they were. There are a few slow four and five cell embryos still in culture that they'll continued to monitor until day five (tomorrow) to see if we have any that catch up for freezing, but it didn't sound hopeful.

Dr. Scott and the nurse started to work on inserting the external catheter, which was painless - a nice change from the usual pain I experience because of my bent cervix. Apparently the pressure of my full bladder straightened it out. I was seriously shocked when she said she was in, my hand in Derek's ready to squeeze the living hell out of it! I think Derek was somewhat relieved that it went so well.

On the same monitor where I watched them harvest my eggs only a few days prior, they brought up a magnified image of our two little embryos. We watched on the monitor as he sucked them in to the needle, verify they were in there, and then come into the room with the catheter and hand it to the doctor. We were also able to watch on the ultrasound as she injected them - we could see exactly where they were injected. Of course, you can't see the embryos themselves, but there is an air bubble in the catheter between the two embabies that shows up as a white dot on the screen. In less then ten minutes, it was done.

She pulled all of her tools out and covered me up. I lay still for about 10 minutes while Derek and I reflected on the fact that we had two of our own inside me at that very moment. I was moved to a recliner and told to relax for 30 minutes before getting dressed to leave. We sat beside a couple who had gone in before us and wished each other luck as they left.

I spent last night lazing on the couch under direct orders from my husband, who cleaned, cooked and wouldn't let me get up unless it was just to go to the bathroom. We are both in a very positive place and feel like this is going to work for us. We're trying not to talk too much about what will happen if it doesn't, and I sincerely hope we never have to.

One of the best parts of the whole thing was when they handed us a picture of our embryos, which is now hanging up on our fridge with the other family pictures. Here's to hoping that this will be the first page in our baby book:




Six cell on the left, eight cell on the right.

 

IVF #1 - Fertilization Reports and Transfer Day

After a hugely successful retrieval, we were pumped to get a call from the embryologist on Monday morning telling us that 14 of the 17 eggs had fertilized naturally over night. This was much, much better then we expected, and I got to shock Derek in to silence when I called him to say he's a father of 14!

Unfortunately, we got some bad news on Tuesday (yesterday). Apparently most of the embryos had fragmented over night, and we only had between two and four that were of decent quality. Because of this, they recommended a three day transfer, which happens in about two and a half hours.

The website Advanced Fertility (a clinic in Chicago) has a pretty good explanation of what they look for in an embryo, including proper and timely division, and degree of fragmentation. You can read about it here. Fragmentation is when little bits of the cells break off from the main cells. There isn't a definitive explanation as to why this happens, it just does. Some theorize that it's due to poor egg quality, or possibly sperm issues, or even the type of protocol that's used for the IVF. That said, some fragmentation is ok, and even expected (up to 10% is normal). When we go in this afternoon, I expect them to tell me how fragmented the embryos were as well as at what stage they started to fragment.

Because of the fragmentation issues, they clinic recommended assisted hatching. After an egg is fertilized with the sperm, it develops a tough zona pellucida, in part to prevent other sperms from getting in a ruining the embryo (that does happen sometimes, and you can end up with too many chromosomes, or other issues). Assisted hatching uses a laser or needle to pierce the zona pellucida and allow the embryo to hatch. A summary of how and why it's done can be found here. Because our embryos have undergone assisted hatching, I started taking a steroid yesterday, and will continue for another five days, to prevent exposure of the embryo to inflammatory cells in my uterus.

What we are hoping for this afternoon is two good quality embryos to transfer over. We would be very happy if we had some to freeze, but that seems unlikely at this point.

So, with fingers and toes crossed, Derek and I head to the clinic for our 3:30 appointment to be PUPO. Pregnant Until Proven Otherwise!

IVF #1 - Egg Retrieval

Today was the big day! I was a bit stressed out because I stupidly spilled some of my HCG trigger shot on Friday night. I was supposed to be injecting 2 mL split between two syringes, but in the end, I had 1 mL in one, and just over 0.7 mL in the other. However, when I talked to the doctor doing my retrieval this morning, he said that the 10,000 units I was supposed to take (a total of 2 mL) was more of a safeguard, and half of the dose works just as well for most women.

We arrived at the clinic at 9:30 am and were ushered in to the back where the nurse sat me in a chair and put a heating pad over the arm that was going to get the IV. She explained the process to both of us and went over the post-ER instructions, including my doses for estrogen and progesterone to be started tomorrow morning. After about 20 minutes, the doctor came by and did my IV (he said I have nice veins - but really, it's just that he was great at inserting it). They walked me in to a darkened room with stars painted on the walls and roof and a TV screen on the far wall. He immediately gave me Fentanyl for the pain and Versed to relax me. I was awake and responsive for the whole procedure.

He inserted an ultrasound probe and I was able to watch what he was doing on the ultrasound screen. He gave me a heads up before he inserted the needle through the vaginal wall and in to my ovary. I felt a lot of pressure and some pain, so the nurse gave me some more pain meds. Afterwards, I felt very little until the very end of the procedure when he had to dig a bit to get at the last two follies on the left. It wasn't any worse then period cramps though, so tolerable.

I could see the needle go in to each follicle on the ultrasound, which looks like a dark, almost circular spot on the screen. I could actually see him sucking the fluid and egg out on the screen - pretty cool to watch! Every few minutes, the embryologist would come in to the room and pick up a bit of the fluid and take it in to the lab on the other side of the wall. I was able to see what he saw in his microscope on the TV screen at the end of the bed. Every few minutes he'd tell us how many eggs we were up to.

"...five eggs..."

"Up to seven now..."

"...eleven!"

I was out of the room and in recovery before he had counted them all, but he came by within about 15 minutes.

17 eggs!


If you recall, at my last ultrasound I have 11 follies on the right and five on the left (with only two looking promising), so we ended up with more follicles and eggs then we thought.

Now it's more of a waiting game. The clinic hasn't called today, which means they had enough sperm to attempt natural fertilization. The embryologist will call tomorrow morning with our fertilization report. According to the clinic's typical rates, we're looking at around 70% mature, so of those 17, around 12 will be mature. Of those 12, 70% will fertilize properly. We should end up with eight or nine embryos.

By Tuesday morning we should know if we're doing a three day transfer of two embryos, or a five day transfer of one blastocyst. It's really up to the embryologist to decide what will be best for us.

Either way, I'm very, very pleased with the retrieval and can't wait to get that call tomorrow. It's amazing to me that at this very moment, Derek and I have a bunch of our potential babies in a dish at the lab. Crazy.