Day 4 embryo report

We have:

9 morulas (morulae?)
1 "9+ cells"
2 8 cells
1 7 cells
1 3 cell
1 2 cell
1 eager-beaver early blastocyst (the nurse thought this was a good thing, so maybe I'm wrong? but my research says too fast, man)
1 no change for one day, on probation
1 no change for two days, discarded

So, the wee ones are still dividin' like champs. Now is the time I'm super grateful for being at Big Shiny Fertility Factory, with their Big Shiny Excellent Embryology Lab. Although I loved Dr. Stewart's Discount IVF Shack, I just can't be confident in their lab. And from here on in, it's all down to the lab (and the embryos, of course).

We'll see how this batch turns out, but I've thought a bit about the "ugly duckling" stage that my embryos went through last cycle, when they slowed down mightily between D3 and D5.  I've since learned that a lot of labs aren't particularly good at blastocyst culture. Blastocysts have different needs than embryos, and between days 3 and 5 the labs have to make a lot of adjustments, I dunno, give them different food, plump up their tiny pillows, something, stuff, do I look like an embryologist?  It's also an awkward and trying time chromosomally, so it could very well be that my embryos weren't/aren't good at making the transition... but a different lab may help.

So! 9 morulas, full speed ahead!

Day 3 embryo report

Our brood is still doing well. They like to see them between 6-8 cells on Day 3.

8 cell: 4
7 cell: 4
6 cell: 2
5 cell: 2
4 cell: 2
morula: 1
arrested: 3

All of them were rated "good"; not sure exactly what that means in terms of fragmentation, but I'm okay with that.

I was puzzled at the D3 morula; that's a whole day ahead in development. I'm guessing it's the eager little bugger who was 5 cells yesterday. Too-fast development is also a sign of a problem, so I've put it at the bottom. Because really, when you work that quickly, you're gonna make some mistakes.

 So 10 of the flock are in appropriate range, and a further 4 are not far out of range. Goooooooo little ones!

Day 2 embryo report

My little flock is doing well! They're supposed to be between 2 and 4 cells on the second day. Currently the breakdown is:

5 cell: 1
4 cell: 13
2 cell: 3
1 cell: 1

I feel protective of that poor little 1-cell. Can't help but think of the very-mediocre 2BB embryo that turned into our perfectly-splendid small son.

This practice calls every single day with an embryo update, which I really, really appreciate. I'm also trying to remember that, last time, my embryos were gorgeous through Day 3, went through an ugly duckling stage from days 4-5, and then bloomed out beautifully on Day 6 (including the one in my uterus).

It's nice to be sharing good news. <3

Holy moly!

My retrieval was yesterday. I haven't posted much because, well, I was kind of dejected.

By stim day 9, my E2 was up to 1400. By day 11, it was up to 2600. I was told that a dozen or so follicles were chugging along. I triggered the night of day 11, making for a ten-day stim period, precisely the same as my first and third IVFs.

By Thursday, Retrieval Day, I was feeling... tender. As in oh-god-I-never-noticed-that-speed-bump-was-quite-so-bumpy tender. I thought maybe this boded well, but I am nothing if not a rugged pessimist.

Retrieval went fine. Cab was eight minutes late, which reduced me to a rage-filled mess, but we got there fine, everything was fine, there was fineness.  As usual, I took the anesthesia flawlessly and woke up in a high good humor. I'm just super lucky in that whatever chemical pathways those drugs are supposed to tread are clearly wide open in my body; I go down like a sack of taters, and wake up like a sack of giggly taters.

I woke up, and eventually my doctor came by to say that he'd retrieved 27.

Whaaaa ---

My peak E2, the morning after trigger, was 3100. The most follicles I'd be told about was 13 or 14. My doctor had decided to switch from the Lupron trigger to the regular hCG trigger, airily saying "there aren't that many follicles, you'll be fine."

Where the hell were all of them hiding, is what I want to know?

It seems I may owe an apology to Dr. Stewart. For my third IVF, he counted 14 follicles and ended up retrieving 23 eggs. I attributed this mismatch to his rather ancient ultrasound equipment. But the ultrasound at Big Shiny Fertility Factor does everything but insert the wand itself. I'm going to have to form some theory that my ovaries are just coy little beasties, and sometimes they don't like to show their eggs until they absolutely have to.

When I heard "27 eggs" I immediately tamped down my expectations by reasoning that, with the E2 so low, most of them couldn't be mature.

Well.  Of the 27 eggs, 24 were mature, and 18 of them fertilized.

This is, in technical terms, awesome.

 So why was the E2 so low? Who knows. This cycle I took an antagonist, which various sources hint can lower estrogen levels and/or make estrogen tests less reliable. All I know is that a lousy cycle, my worst ever, suddenly turned into my best cycle in terms of mature eggs, and my second-best cycle in terms of fertilization (on IVF #1, I had one more).

I'm on OHSS watch, but I don't feel too bad -- tender and swollen, but taking it easy and sipping electrolyte drinks. Finally getting around to watching Legend of Korra (I was/am a huge A:TLA fan). Right now just being quiet, grateful, and wishing my best to the 18 little clumps of cells in a laboratory fifteen minutes down the road.

Day 7: when I'm up, I'm up

Okay, this is one thing that is true about me in general and really, really true of me-on-hormones: my mood is not whatyou'dcall stable. I'm a leaf on the wind. If the news is good, I'm up. If it's not, it's the end of the world. My emotional lability is less than my toddler's, but not a lot less.

But right now, I'm up. Because:

Doctor was downright cheerful about my progress. This morning, at follicle check:

Doc: Why so glum?

Me: I'm not happy about how things are going.

Doc: Why? Things are going well!

Me: My E2's so low.

Doc: It tripled between the first and second check, what more do you want?

Me: ...

Doc: *fishing around with ultrasound wand in my pelvic girdle* Follicles are looking good, very good. All is well.

Me: Patient is high-strung, okay?

He found 12-13 measurable follicles, which is a nice improvement from the last check. Full speed ahead, divert all power to my ovaries¹.

Also, I like my new fertility pharmacy. I'd been using The Apothecary Shoppe, mostly because they had the word Apothecary in their name. One of my ambitions in life is to own an antique oak apothecary chest, so yeah,  The Apothecary Shoppe. Made me think that my Follistim was being hand-crafted by a kindle old herbalist.

But they annoyed me mightily the last two cycles, by

1. Compounding a readily-available ready-made medicine (medrol) simply because they didn't have the ready-made version in stock. This cost me three times what it would have if they'd simply notified me so I could order it from another pharmacy. It was only an extra $26, but damn, it pissed me off. They tried to pull the same thing again next cycle, but I told them in no uncertain terms that no, thanks, I'd fill it locally.
2. Charging me for shipping when my order fell just below the minimum. Come on, boys. I have bought over twenty five thousand dollars' worth of medication from you. Make a goddamned exception.

Anyway, my new pharmacy is Mandell's, and I like them a lot. Everything's arrived perfectly, but mostly I'm charmed that the last two times I've placed orders with them, the person on the other end of the phone has said, warmly and sincerely, "Good luck!" It's almost like they know what kind of medication they're selling, and why, and want it to work. Anyway, it's sweet, and they also included a little bag of Hershey's Kisses in my top-up order of Menopur and Follistim ($7000 sans insurance, dear G-d, yes I'm very very grateful and I'm never quitting my job).

So... Mandell's, yeah. Recommended!

blah blah babble babble when I'm up I'm up when I'm down I'm down when I'm only halfway up I'm going to be either up or down in five minute, anyway

 ¹Two nerd references in one post, go me.

I love Google autocomplete.

It's such a fascinating window into humanity.

If you type "how to cope with g-" you get


How to cope with grief
How to cope with guilt
How to cope with gender disappointment
How to cope with growing up
How to cope with genital warts
How to cope with gad
How to cope with getting fired
How to cope with giving up a dog
How to cope with going bald
How to cope with getting dumped

I feel lucky in being able to say that almost none of these are concerns of mine.

If you just type "how to cope with" you get
How to cope with anxiety
How to cope with stress
How to cope with depression
How to cope with divorce
How to cope with death
How to cope with infertility
How to cope with colic
How to cope with loneliness
How to cope with death of a pet
How to cope with anger

I don't do quite as well off that list. I'm not getting a divorce, no one's dead, no one's got colic (hah!) and our dogs are hale and healthy (though one is doddering).

Oh, Google. You are my agony aunt.

Days 5 and 6 of stims

Yesterday, my E2 was a measly 194. I'm on track for my worst (least egg-ful) cycle ever.

My head is full of broken glass. I'm spending most of my time desperately trying not to think.

Day 3 of stims

After two days of 225 Follistim/75 Menopur, my E2 was a measly 64. My dosages were upped to 300/150, and we'll see what that knocks out of my ovaries.  Some people say that if your first E2 level is bad you should just pack up and go home; I don't know that I believe that, given that my low-initial-response cycle is also the one that ended up with the creature who is currently bellowing a rather atonal punk cover of "Old MacDonald" in my ear.

I'm just trying not to look at anything but the ground right underneath my feet.

Rallying, and making plans

Okay, I think I'm done with the wallowing-in-self-pity portion.


I have a plan. My plan is:

1. Go ahead with the scheduled IVF. We can put the pedal to the metal as far as stimulation goes, because hyperstimulation will not be an issue because
2. We'll be freezing everything.
3. Five days after my period arrives post-IVF, I am going to fly up to Boston for hysteroscopic surgery with Dr. Keith Isaacson, who is by all accounts one of the two best Asherman's surgeons in the US. I'm extraordinarily lucky in that he accepts my insurance, and that his hospital happens to be twenty minutes away from my sister's house. The surgery is apparently a quite minor one, although very dependent upon the skill of the doctor: no anesthesia, in-office, little to no recovery time.
4. If all goes well, several months later I should be cleared to transfer the frozen embryos.

My RE -- who is a good RE -- appears to be somewhat insulted that I don't want him to do the uterine surgery. I know this because he made a great show of telling me how much he's not insulted and how he has no professional jealousy and that surgeries like this aren't very profitable anyway. Furthermore, he feels my case is not very difficult, and he's never heard of this Dr. Isaacson I'm going to see instead.

I'm glad to hear that he feels my case is not difficult, but the fact that he's never heard of one of the very few experts who specialize in Asherman's tells me that I'm making the right decision by going to Boston.

Frankly, I don't care if he's vexed or pleased. I've only got one uterus, and I'm going to do everything I can to get it in tip-top shape.

@nutella, I'm pretty sure that my insurance will cover a freeze-all cycle just fine... it's just like a normal cycle except for the lack of transfer. I hope I'm not proven wrong about that, but I think it'll be okay. I don't see any exclusion in my policy. I am covered for three cycles, so in a way I'd be "wasting" a cycle by giving up the transfer, but under the circumstances I think the trade-off's worth it.

@lathany, thanks. I had never heard of it, either. Unfortunately this fits in perfectly with my anxiety disorder, which appears to believe that worrying about things actually prevents them from happening... because it's never the stuff you actually worry about, is it? Therefore, by worrying about everything, nothing bad will happen! Right?

@pajamamommas, it's one thing after another, isn't it? BTW, I keep going back to look at the pic of Tadpole asleep over the side of the bed. So. Damn. Cute.

@insertmetaphor, thanks -- I know you get it.

I didn't even know I was supposed to be worrying about that.

Turns out I have Asherman's Syndrome (a.k.a. intrauterine adhesions or scarring of the uterus.) Impossible to tell whether it was caused by the c-section and then went on to cause the miscarriage and subsequent D&C, or whether it was caused by the D&C.

There I was all worried about my estrogen and follicles, when I should have been worried about my uterus.

Well, fuck.

I'm not sure what comes next. The online Asherman's support group say that it's very important to be treated by an experienced surgeon. There's one a few states away, near where my sister lives. I could go up there, I guess. I don't know. Maybe I should do a freeze-all cycle first. I'm 38.5 and not getting any younger. I don't know. It's all so exhausting to think about.

I would just like one fucking thing to be easy, thanks.