The nurse practitioner wielding the transvaginal ultrasound wand said more than once as she tried and tried to locate either ovary to count follicles, "Well, not being able to locate an ovary is a good sign that you are suppressed!" And with the wand, she applied more pressure to my urethra. Geez.
Finally, ovaries were located and follicles counted. 6-7 on each ovary all under 6mm. We're already starting with more than we had for IVF #1. I have a feeling I will be making many comparisons in upcoming posts.
The nurse called with my E2 levels to confirm suppression. Yup, I start stims on Friday.
Now here is where I tell you E2 level. Let me know if it freaks you out as much as it does me. My E2 keeps getting lower and lower. My first baseline level ever was 38. Then at my first suppression check it was 26 or 28. Ok, those are good numbers. My most recent baseline level was 23. I thought that was low. Nope. Now it is 6. 6?! They assure me that 23 and 6 are not too low. But dang, I have almost no E2!
Tuesday, September 25, 2012
Monday, September 24, 2012
Genetic Screening
Shelley asked me to do a post on Genetic Screening, PGD, PGS, CCS, aCGH, so many iterations. While I am no expert, I have learned that Preimplantation Genetic Diagnosis or Screening (PGD, PGS) is the genetic testing of cells from embryos during IVF. But you already knew that.
PGS for infertility or recurrent miscarriage screens chromosomes for common aneuploidies (extra or missing chromosomes). The lab we are using can test chromosomes for abnormalities that are most common in early miscarriage.
I've been calling what F and I are planning for IVF #2, CCS, which stands for Comprehensive Chromosomal Screening. This process tests all chromosomes, including sex chromosomes. However, the lab where our biopsied cells will be sent calls what we are doing Microarray Comparative Genomic Hybridization, or aCGH. I'm going to assume these are the same thing. From what I understand, CCS or aCGH is the most comprehensive testing. I explained a bit about how the test results are given in this post.
There is also PGD for translocations and PGD for single gene defects. These are most often used by patients who are carriers of genetic disease.
So there are choices to be made about which test to use. And I guess not all labs have the same technology. But again, I don't really know much about the different labs who perform PGS and what types of testing they do. If you are interested in more information here is the link to the lab my clinic uses. Some clinics even perform PGD in house.
Our cost is around $5000. The PGD lab charges $2,500 for up to eight samples (if we were such rockstars as to get more than 8 embryos, we would pay $250 for each additional sample) and my clinic charges around $2,500 for the biopsy procedure. We have to make all payment arrangements before egg retrieval. In the event we don't get enough embryos to biopsy (we want more than four, that is our personal preference), or change our minds at the last minute, we will get a refund with no penalty (There are some tests that do have cancellation fees, I think the single gene defect and translocation PGD).
The embryos are grown to day 5 or 6, biopsied at my clinic's lab and then vitrified. The cells from the embryos are sent to the PGD lab for screening. I think they said it only takes 2 days to get the results back, but by then my uterus has already closed down for implantation. We'll have to do an FET. I wonder if people are more likely to choose single-embryo transfers after PGS?
---------
A small part of me hopes that we have 4 embryos so we can just go ahead and transfer 2. I don't know if it is a fear of what the tests might reveal, the complexity and severity of this additional treatment, the time and extra waiting, or even if it is that I still may not believe that this will help us. I feel a bit like we are part of a science experiment. But I also feel that this may be the extra step that will allow us to be parents.
I'll keep you posted. Tomorrow I go in for my suppression check. Fingers crossed all looks as it is supposed to.
PGS for infertility or recurrent miscarriage screens chromosomes for common aneuploidies (extra or missing chromosomes). The lab we are using can test chromosomes for abnormalities that are most common in early miscarriage.
I've been calling what F and I are planning for IVF #2, CCS, which stands for Comprehensive Chromosomal Screening. This process tests all chromosomes, including sex chromosomes. However, the lab where our biopsied cells will be sent calls what we are doing Microarray Comparative Genomic Hybridization, or aCGH. I'm going to assume these are the same thing. From what I understand, CCS or aCGH is the most comprehensive testing. I explained a bit about how the test results are given in this post.
There is also PGD for translocations and PGD for single gene defects. These are most often used by patients who are carriers of genetic disease.
So there are choices to be made about which test to use. And I guess not all labs have the same technology. But again, I don't really know much about the different labs who perform PGS and what types of testing they do. If you are interested in more information here is the link to the lab my clinic uses. Some clinics even perform PGD in house.
Our cost is around $5000. The PGD lab charges $2,500 for up to eight samples (if we were such rockstars as to get more than 8 embryos, we would pay $250 for each additional sample) and my clinic charges around $2,500 for the biopsy procedure. We have to make all payment arrangements before egg retrieval. In the event we don't get enough embryos to biopsy (we want more than four, that is our personal preference), or change our minds at the last minute, we will get a refund with no penalty (There are some tests that do have cancellation fees, I think the single gene defect and translocation PGD).
The embryos are grown to day 5 or 6, biopsied at my clinic's lab and then vitrified. The cells from the embryos are sent to the PGD lab for screening. I think they said it only takes 2 days to get the results back, but by then my uterus has already closed down for implantation. We'll have to do an FET. I wonder if people are more likely to choose single-embryo transfers after PGS?
---------
A small part of me hopes that we have 4 embryos so we can just go ahead and transfer 2. I don't know if it is a fear of what the tests might reveal, the complexity and severity of this additional treatment, the time and extra waiting, or even if it is that I still may not believe that this will help us. I feel a bit like we are part of a science experiment. But I also feel that this may be the extra step that will allow us to be parents.
I'll keep you posted. Tomorrow I go in for my suppression check. Fingers crossed all looks as it is supposed to.
Friday, September 21, 2012
September ICLW
I love participating in ICLW. Even though I usually fall behind in commenting, I always find new blogs to follow. Since my treatment has progressed, so has my reader. It has changed quite a bit since I first started blogging. Most of the blogs I followed when I started back in 2010 are now either parenting blogs or no longer updated because of parenting. Finding new blogs with those who are also still waiting for something to work is essential! On most days, part of my morning ritual involves checking in on the blogs. I don't know what I would do without that connection to other stories.
If you are a first time or not a regular reader of this blog, let me give you an ICLW welcome.
Who I am: J, a mid thirties, under-employed and geographically isolated infertile. I'm married to F.
Where I am in treatments: Since the last ICLW I have had an unexpected hysteroscopy to remove a piece of retained tissue from my third miscarriage that happened in June. This caused a slight delay for IVF #2. But I am almost there. Next week I have my suppression check that will hopefully give me the green light to begin injections on the 28th. That means my egg retrieval should happen somewhere between October 7-10. EEK! We will be doing Comprehensive Chromosome Screening on our embryos this round.
Recent posts on this blog that reflect where we are at this moment and what is on my mind: Our Number is Five and Infertility Resumes (still).
IF Blogs I am reading right now: Everyone Else But Me (because Fran is in early pregnancy hell after ultrasounds show a slowly progressing FET pregnancy), Fertility Lab Insider (because Carole is such an awesome advocate for patient education), Sometimes (because she could really use some extra support right now), Life and Love in the Petri Dish (because they are true IVF veterans and I am learning so much about CCS from their experiences)
Happy ICLW and thanks for visiting!
If you are a first time or not a regular reader of this blog, let me give you an ICLW welcome.
Who I am: J, a mid thirties, under-employed and geographically isolated infertile. I'm married to F.
Where I am in treatments: Since the last ICLW I have had an unexpected hysteroscopy to remove a piece of retained tissue from my third miscarriage that happened in June. This caused a slight delay for IVF #2. But I am almost there. Next week I have my suppression check that will hopefully give me the green light to begin injections on the 28th. That means my egg retrieval should happen somewhere between October 7-10. EEK! We will be doing Comprehensive Chromosome Screening on our embryos this round.
Recent posts on this blog that reflect where we are at this moment and what is on my mind: Our Number is Five and Infertility Resumes (still).
IF Blogs I am reading right now: Everyone Else But Me (because Fran is in early pregnancy hell after ultrasounds show a slowly progressing FET pregnancy), Fertility Lab Insider (because Carole is such an awesome advocate for patient education), Sometimes (because she could really use some extra support right now), Life and Love in the Petri Dish (because they are true IVF veterans and I am learning so much about CCS from their experiences)
Happy ICLW and thanks for visiting!
Tuesday, September 18, 2012
Cracked Eggs
I know people roll their eyes listening to others describe the weird dreams they had the previous night.
Me: "I had the WEIRDEST dream last night!"
You: "mmhmm.." Oh god, is she really going to tell us?
You have my blessings to skip this post. However, I just can't let a dream about cracked eggs go untold. This is an infertility blog after all.
I'll try to be as realist as possible, leaving out all the fuzzy details of space, place, and face switches. Really the only thing I want to tell you about this dream is that I was in charge of holding a number of (chicken) eggs in my hands. It just seemed easier to drop them on the floor under my chair. So I did.
I felt so guilty in this dream for dropping the eggs. It's hard not to pay attention to a dream that makes you feel an emotion so intensely. Guilt.
And of course, the fact that they were eggs of any kind made me wonder about the dream's meaning.
Am I anxious about the number of eggs I will produce this cycle? Yes.
Am I afraid that all my eggs are abnormal? Yes.
Do I feel responsible for the quality of my eggs? Yes.
On the other hand...
Could this dream have been just a random dream about chicken eggs? Yes.
Do I need to buy eggs today? Yes.
Me: "I had the WEIRDEST dream last night!"
You: "mmhmm.." Oh god, is she really going to tell us?
You have my blessings to skip this post. However, I just can't let a dream about cracked eggs go untold. This is an infertility blog after all.
I'll try to be as realist as possible, leaving out all the fuzzy details of space, place, and face switches. Really the only thing I want to tell you about this dream is that I was in charge of holding a number of (chicken) eggs in my hands. It just seemed easier to drop them on the floor under my chair. So I did.
I felt so guilty in this dream for dropping the eggs. It's hard not to pay attention to a dream that makes you feel an emotion so intensely. Guilt.
And of course, the fact that they were eggs of any kind made me wonder about the dream's meaning.
Am I anxious about the number of eggs I will produce this cycle? Yes.
Am I afraid that all my eggs are abnormal? Yes.
Do I feel responsible for the quality of my eggs? Yes.
On the other hand...
Could this dream have been just a random dream about chicken eggs? Yes.
Do I need to buy eggs today? Yes.
Friday, September 14, 2012
Leiomyomata
That is what I read on my bill statement: Hysteroscopy, surgical; with removal of leiomyomata.
If you google leiomyomata you will find fibroid or tumor. At my post-op with the RE yesterday, he described the tissue he sent to pathology as a "small bump" that "looked quite vascular" and was most likely attached at the spot where implantation occurred. I imagined a pulsing skin tag.
The pathology report confirmed that my leiomyomata was indeed leftover tissue from the pregnancy, or as we've been calling it, Hank.
Hank is easier to spell than leiomyomata. I'm just glad it is gone.
------------------
In other news, IVF #2 is now underway! Here is my Antagonist Protocol calendar:
9/14: start BCP and doxycycline for 10 days, aspirin and prenatal vitamin.
9/23: start dexamethasone
9/24: last BCP
9/25: suppression check!
9/28: Day one of Stims (300 IU of Follistim and 2 vials of Menopur)
10/4: possible start Ganirelix, if needed to prevent ovulation
10/7-10/10: possible egg retrieval dates
The plan remains to do CCS if we have 5 or more embryos on day 5, otherwise we will have a fresh transfer between 10/12 and 10/17.
If you google leiomyomata you will find fibroid or tumor. At my post-op with the RE yesterday, he described the tissue he sent to pathology as a "small bump" that "looked quite vascular" and was most likely attached at the spot where implantation occurred. I imagined a pulsing skin tag.
The pathology report confirmed that my leiomyomata was indeed leftover tissue from the pregnancy, or as we've been calling it, Hank.
Hank is easier to spell than leiomyomata. I'm just glad it is gone.
------------------
In other news, IVF #2 is now underway! Here is my Antagonist Protocol calendar:
9/14: start BCP and doxycycline for 10 days, aspirin and prenatal vitamin.
9/23: start dexamethasone
9/24: last BCP
9/25: suppression check!
9/28: Day one of Stims (300 IU of Follistim and 2 vials of Menopur)
10/4: possible start Ganirelix, if needed to prevent ovulation
10/7-10/10: possible egg retrieval dates
The plan remains to do CCS if we have 5 or more embryos on day 5, otherwise we will have a fresh transfer between 10/12 and 10/17.
Friday, September 7, 2012
Our Number is Five
You may remember that we are participating in a refund plan that
gives us 3 fresh cycles and 3 frozen cycles. Those are already paid
for. If we do CCS, we will still get two cycles per egg retrieval.
The difference will be that they will both be frozen transfers and we
will have to pay for CCS.
So we want a cut off number. A set number of embryos we need to have on day 5 before spending $5000 on CCS. The cost is $5000 whether you screen one embryo or eight.
If, on day 5, we only have one or two embryos, we obviously would not choose to screen them but would transfer them that day. If we have three embryos, we would also go ahead with a fresh transfer by putting back the best two and hopefully freezing the third.
Our dilemma emerges as we count to 4. We know from the genetic counselor, that for my age, half of our embryos could be abnormal. This is what we should expect.
If we have 4 embryos on day 5, wouldn't it be more economical to go ahead and transfer two and freeze two rather than screening the embryos? We won't know if a chromosomal issue is at play, but if any of the embryos are normal, the fresh transfer will hopefully work, if not, then hopefully we will get the good embryo with the FET. And we save $5000. Even if the 4 embryos are all abnormal and neither transfer works, we still save $5000 by not testing with only four embryos.
What scares me is that this strategy did not work for IVF #1 (the only difference is that we did an elective single embryo transfer for IVF #1). Will it work for IVF #2?
After talking about it with the genetic counselor and with each other (over and over), it seems that we will settle on five embryos as our cutoff number. With five embryos, a patient could theoretically have three transfers, or one left over from two transfers (what we currently have). Screening for the normals would definitely save time and money and hopefully prevent miscarriage in this case. So, that is what we want: we want at least five embryos on day 5 to proceed with Chromosome Screening.
We had five embryos with IVF #1. We also have one frozen embryo remaining to add to the mix. We are hoping the antagonist protocol can get us a few more and one of those will be the special embryo that becomes our child.
Having a cutoff number does make planning a bit tricky, however. We will have to prepare physically and logistically for a 5 day transfer, continue with meds, wait for the call on the morning of the fifth day. We should have some idea based on the egg retrieval and fertilization report but we won't know for sure until day 5 if we will biopsy or transfer.
What would you do if you were in our position? To screen or not to screen?
So we want a cut off number. A set number of embryos we need to have on day 5 before spending $5000 on CCS. The cost is $5000 whether you screen one embryo or eight.
If, on day 5, we only have one or two embryos, we obviously would not choose to screen them but would transfer them that day. If we have three embryos, we would also go ahead with a fresh transfer by putting back the best two and hopefully freezing the third.
Our dilemma emerges as we count to 4. We know from the genetic counselor, that for my age, half of our embryos could be abnormal. This is what we should expect.
If we have 4 embryos on day 5, wouldn't it be more economical to go ahead and transfer two and freeze two rather than screening the embryos? We won't know if a chromosomal issue is at play, but if any of the embryos are normal, the fresh transfer will hopefully work, if not, then hopefully we will get the good embryo with the FET. And we save $5000. Even if the 4 embryos are all abnormal and neither transfer works, we still save $5000 by not testing with only four embryos.
What scares me is that this strategy did not work for IVF #1 (the only difference is that we did an elective single embryo transfer for IVF #1). Will it work for IVF #2?
After talking about it with the genetic counselor and with each other (over and over), it seems that we will settle on five embryos as our cutoff number. With five embryos, a patient could theoretically have three transfers, or one left over from two transfers (what we currently have). Screening for the normals would definitely save time and money and hopefully prevent miscarriage in this case. So, that is what we want: we want at least five embryos on day 5 to proceed with Chromosome Screening.
We had five embryos with IVF #1. We also have one frozen embryo remaining to add to the mix. We are hoping the antagonist protocol can get us a few more and one of those will be the special embryo that becomes our child.
Having a cutoff number does make planning a bit tricky, however. We will have to prepare physically and logistically for a 5 day transfer, continue with meds, wait for the call on the morning of the fifth day. We should have some idea based on the egg retrieval and fertilization report but we won't know for sure until day 5 if we will biopsy or transfer.
What would you do if you were in our position? To screen or not to screen?
Tuesday, September 4, 2012
DNC
Am I the only infertile who can't seem to distinguish DNC from D&C in all the news headlines of late?
Gestalt Effect?
---------
Speaking of politics and reproductive health, Carole at Fertility Lab Insider recently wrote another fantastic post about reproductive rights and assisted reproduction. This one explains House Bill 212, or The Sanctity of Human Life bill, co-sponsored by Vice Presidential candidate Paul Ryan and currently in committee.
And it is a scary one.
Gestalt Effect?
---------
Speaking of politics and reproductive health, Carole at Fertility Lab Insider recently wrote another fantastic post about reproductive rights and assisted reproduction. This one explains House Bill 212, or The Sanctity of Human Life bill, co-sponsored by Vice Presidential candidate Paul Ryan and currently in committee.
And it is a scary one.
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