IVF Diary Vol III: 29 Apr 16 – Stage 1 complete

Medication(s) administered and dosage(s). 13DP5DT (13 days past 5 Day Transfer)  Prove time! PM Progesterone in Oil 1ml Intra-muscular injection, vivelle dot estrogen patches 0.1mg x2.

Medical procedures undertaken. Beta hCG blood test – AKA THE PREGNANCY TEST!

Any results?  We are pregnant! Last night I got back from DC, Chris was already at home, I asked him – “Are you ready to do this?”.  He nodded nervously.  So we went to the toilet together and I peed on the stick, turning it the wrong way round so I couldn’t see the window.  I left it on the counter top for a minute or so, and we turned it over together.  2 lines!  Woohoo!!! Except it was kind of a weird experience.  It wasn’t quite like last time when I was really excited.  It was like….OK, this is a good step forward….but now we have to wait and see what my levels come back tomorrow.

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the test line was darker than the control line!

Today the doctor called with my results (it wasn’t my doctor who called) – he is a straight talking kind of man.  There is absolutely no beating around the bush with him, he tells it like it is (he gave me the news that our first pregnancy was not viable and he was pretty blunt with us).  He said he had positive news!  OK I like positive news! He then mumbled something about my hCG levels, I asked him to repeat what he said because he wasn’t clear (he has a foreign accent), he said it was a nice high level that they like to see of 485!  My progesterone and estrogen levels were good too.  When I got of the phone I was a little disappointed, I was hoping for a little higher being 13DP5DT….but then after a while I reminded myself that this first number doesn’t matter so much (it’s higher than last time so that’s good!), it will be the next number that tells us the likelihood of this pregnancy having a chance!

What are my symptoms?  So I have pretty much been certain I am pregnant since the return of my OHSS symptoms earlier this week.  My belly sticks out ridiculously – I have put on 7″ round my belly.  The area beneath my ribs and belly button are painful if I bend over, or try to get in and out of bed.  I am feeling nauseous – not sure if that is pregnancy related or OHSS related. I couldn’t eat more than 5 spoonfuls of my porridge this morning.  I have had lots of sharp pains.  I’ve also had period type pains.  I have an unquenchable thirst.  I am peeing about 30 times a day.

How do I feel today? I am excited to be moving onto the next stage!  But having some reflections back to IVF cycle 1.  We lived in this ignorant bliss for 5 days last time.  This time is a whole lot different.  We are definitely in a better position than cycle 1 so I am trying to keep positive, it’s just hard not to think about what happened to my body last time we saw those two pink lines.

 What’s next? Wednesday is beta #2! Is it Wednesday yet?

The Final Countdown!!! 

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*Notes.  I take First Response Reproductive Health multi vitamin gummies (pre-natal), 5mg Melatonin at bed time and CoQ10 200mg gummies, and  Pur-absorb iron supplements daily.  NSTR = Nothing Significant To Report.

IVF Diary Vol III: 20-24 Apr 16

Medication(s) administered and dosage(s). 8DP5DT (8 days past 5 Day Transfer)  PM Progesterone in Oil 1ml Intra-muscular injection, vivelle dot estrogen patches 0.1mg x2.

These injections do not get any easier!! Fortunately (for me) the past two evenings Chris has been doing the injecting part.  Kudos to him.  It doesn’t get any easier for him.  He had a nervous laughing fit the other night after he pierced my skin and was starting to inject, and I was trying hard not to laugh at him (I didn’t want my muscles to tense up or to shake the needle around as it was inside me!!!). Nope, it doesn’t get easier.

Medical procedures undertaken. Nil!

Any results?  Apart from finding out I needed to be taking iron supplements, I wrote a post about that and had a brief ‘freak out’ moment of feeling like maybe I had a chance to improve my egg quality.  But that was silly, and I realise that now.  I did go out and buy some iron supplements.  I bought it in liquid form because I find the majority of pills hard to stomach (there is something about the pill lining they use that makes me puke them back up).  Basically the supplement tastes like I am swallowing a tablespoon of blood. BLEUGHHHHHHH.

What are my symptoms?  Yesterday I struggled with my OHSS symptoms.  We had a nice day out watching a parade and going to a festival that celebrates NATO.  But it’s really the first time I have been out and about for a significant amount of time not sitting down.  We then went to the shops and after about an hour my stomach was in pain.  I just needed to sit!  I was also incredibly thirsty all day, nothing could quench my thirst!!!  Last night I got up to pee FIVE times!!!! I also found it hard to get in and out of bed each time because of my hugely bloated painful tummy.  I am a little worried that my OHSS has done a U turn and rather than getting better is now getting worse.  This could mean I am pregnant though because OHSS can get worse as my body starts to produce hCG after the embryo implants.  It’s something I’ve been told to watch out for….If things don’t subside today then tomorrow is my last chance to go in for an ultrasound before I am supposed to be back in DC – I don’t want to be getting worse whilst I am away from home!  I am going to take it easy today though, maybe I just over did it yesterday.

How do I feel today? It has been really hard not to pee on a stick the past few days.  Especially yesterday with my symptoms developing as they were I just felt like I might see a positive!  And so now I have my expectations set high, I’m terrified to be wrong and see a blank white space on that pregnancy test.  So I haven’t done it.  I looked back and compared my symptoms from cycle 1 (BFP – positive) to cycle 2 (BFN – negative) and actually I seemed to have experienced similar symptoms in both cycles.  I guess it is that damn progesterone and estrogen making me feel like this!

Chris told me that if this cycle fails he wants to wait several months before transferring our final frozen embryo.  Which I understand why he feels like that.  But I feel differently about it.  I said we should have this conversation later and not now.  I need to be positive, I need to be hopeful right now, I want this to work so so much I can’t even think beyond this.  Last cycle I was OK with thinking about the future and what’s next because I knew we could always give IVF another try.  This time for me is different.  I know there isn’t a next IVF.  I know this to me is all or nothing.

 What’s next? Friday is test time – in between all that I have a work trip to DC to occupy me and keep me busy!  This does mean I will be doing more injections on my own 😦 and Chris will be on his own in the house alone this week when perhaps we really need each other right now.

The Final Countdown!!! 

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*Notes.  I take First Response Reproductive Health multi vitamin gummies (pre-natal), 5mg Melatonin at bed time and CoQ10 200mg gummies, and  Pur-absorb iron supplements daily.  NSTR = Nothing Significant To Report.

IVF Diary Vol II: Our Failed Cycle

I had been eagerly waiting for Chris to finish work on Thursday, I had been off work ill with this cold so was getting impatient.  As soon as we were  both ready, I went to pee on that stick.  I watched as the wet line slowly crept up the test window…it went straight past the result line to the control line without even a vague faint line.  It was so white and empty.  At 12DP5DT I should be seeing that line.  It was all over.  I cried.  I came out of the toilet and just hugged Chris and told him “It didn’t work, I’m so sorry”.

So many things were running through my head.  Bitter sadness at our situation.  No halloween baby this year for us.  No frozen embryos from this cycle despite our great fertilisation success rate.  These embies were not meant to be.  Anger.  The anger at our failure and hopelessness.  The anger at not knowing why.

Of course, there is always a chance the pregnancy test could be wrong, but the odds at this stage were not in my favour, I’m not that naive.

Thursday night I woke up every hour with our negative result on my mind, and finally at 5AM I woke after a dream about being stuck on a sinking nuclear weapon ship that I helped to destroy by providing intelligence about it (I was a spy in my dream!).  And as the ship started to sink, one small rescue boat was filling up quickly with other people, there was no room for me on it, I shouted out, “please save my frozen embryos. Please, all I want is for you to make sure they are born and grow up knowing that I was their mother, and I loved them.”  I woke up in a cold sweat with tears streaming down my face.

For all our failed IUIs, the clinic never made me go in to have a beta blood test if I got a negative.  For IVF, everyone has to have a blood test.  I now know what it feels like to go to that blood test with a heavy heart, knowing it is pointless.  The idea of not testing and waiting to get the results by phone whilst at work horrifies me, so I am glad I tested the night before to prepare me for the worst, and be with Chris at the same time.  I am not brave enough for that.

Today when I went in for my blood test I got the new nurse.  I knew she was new because she was literally shaking as she took the blood from me, and then afterwards proceeded to spill my blood from the end of needle all over the table.  She also asked me some very awkward questions, in a sweet naive way, so I could tell she was a newbie around here!   But I wasn’t in the mood for being polite and quaint, so I cursed myself as I left, telling myself it was typical for that to happen to me of all days!!!

I got THE phone call from my doctor not long after lunch when she confirmed what I already suspected.  A negative result.  She basically ran through what happened during my cycle – 14 eggs collected 11 mature, 11 made it to Day 5, 2 reasonable blastocysts transferred on Day 5, and then none made it to the freezer.  She said that my egg quality was not looking good and we can talk about it some more at a later date when I am ready.  I thanked her, put the phone down and immediately picked up the phone again and called the clinic to schedule a consult with her for next week.

What next?  Chris and I talked about possible next steps, but it was foggy.  I looked at my calendar and figured out if we did another IVF cycle when it might be.  The thought of going through all of this again to end up with nothing seems terrifying.  They say you should try at least three complete rounds of IVF before considering to changing tactics.  In the UK, depending on where you live, you may only get 2 rounds of IVF with the NHS, but there is lots of research that suggests 3 rounds is the magic number.  My bets are on. We don’t seem to be able get enough embryos to freeze so there will be no point in trying for genetic testing, I am betting my doctor will suggest donor eggs.  This is a path we are unlikely to go down (which I will expand upon for another time).  Or donor embryos, which we know little about.  But before we even consider any of that we still have one frozen blastocyst from our first cycle, so we also need to think about that too.

It’s devastating to get this far to have nothing to show for it.  I hope that at the least we will learn something more about our infertility.

I always say it’s never over ’til the fat lady sings….predicting a successful pregnancy outcome

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I always say it’s never over ’til the fat lady sings.  But that doesn’t mean I can’t see that fat lady getting ready to get on stage…I can also hear her warming up, running through a few scales too.

So, my suspicions were pretty much confirmed about why I didn’t get my results yesterday.  My results were not good.  And let me point out here that these are not my words, but the words of my nurse.

My hCG levels last Weds were 49 –  just a bit lower about where they should be, but were not overly worrisome…

My results from Tues this week, however, were 126.  They went up!!!! But those of you who are familiar with hCG levels and where they should be by now will know this is not a great number.  hCG levels should double every 2 to 3 days.  What does this mean?  Well my doctor wants me to keep taking my progesterone and estrogen, just in case – there is always a small chance this pregnancy is still viable!! But I have to go in for another beta test on Friday to double check that this pregnancy is, in fact, over.

I can safely say I am no longer feeling cautiously optimistic….I am feeling pessimistic as hell and sad.  If you would like to hold onto hope for us, I gratefully take your strength and thank you for helping to hold us up, but quite frankly when the nurse tells you it is not good, it’s not good.  I understand she is preparing us for the worst.

BUT!!!!! I decided to do a bit of research on what all this really means, what are MY chances?  You know I had to do it, as one of my colleagues told me today – GTS!  (Google That S#*% !!!).  OK, I’m going to get a bit technical here….hang in there if you have in interest in hCG levels (the beautiful pregnancy hormone!!)….


I found a very useful study* that looked at the predictive values of hCG levels for a viable pregnancy 13 days after a 3 day Embryo Transfer (I took my first beta test 14 days after my 3 day Embryo transfer).  My result of 49, according to their model, gives me the following chances of outcome: 45% successful singleton pregnancy, 31% miscarriage, 13% bio-chemical pregnancy, 9% ectopic pregnancy, 3% successful multiples pregnancy.  Well I am glad they didn’t tell me what my hCG levels were last week!

According to these researchers’ analysis, they decided that the cut-off level for predicting a viable pregnancy was an hCG level is 76 IU/I (80% sensitivity)….although this is considerably higher than some other researchers have reported (for example other studies have found the cut off at a similar sensitivity to be: 42 mIU/ml (Qasim et al., 1996); 55 IU/l (Bjercke et al., 1999); and 50 IU/l (Sugantha et al., 2000)).

Wow guys, 76 seems to be a whole lot higher than the others….so do they have credibility in their research?  Well from what I can ‘statistically understand’ and in understanding their research design, it looks solid; their sample size is excellent, some of the best I have seen in articles about artificial reproductive technologies….but I am not a medical professional, so I am totally relying on my knowledge of stats and may be there is something ‘medically awry’ that I cannot see.

If I use any of these models, and consider my hCG level of 49 from last week, these researchers would have told me my chances of a viable pregnancy were always going to be low.

However, there was one interesting point that came out from this study that caught my eye:

In subjects with unexplained infertility, ICSI may result in lower than expected HCG levels (Gold et al., 2000)….The explanation for this was not clear.  Although the early embryo cleavage is delayed in ICSI-derived embryos and the fragmentation of embryos is increased the implantation potential is comparable with IVF-derived embryos.

Even though my numbers have not multiplied nicely….in the back of my mind I am holding onto this slither of hope….holding on that we are the ones in that 5% extreme quantile who defy the norm, and it is because we are unexplained and our embryo was ‘ICSI-ed‘ that my hCG numbers are much lower.

Until Friday…………. :-s

*Pokkeus, P., Hiilesmaa, V. & Tiitinen, A. (2002) Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Human Reproduction 17(7):1901-1905. Available at: http://humrep.oxfordjournals.org/content/17/7/1901.full