The Game Plan

     My last Depot Lupron injection was May 1st - the last in a series of 3. You can read more about my premature foray into menopause here. While I have been on Lupron injections, I have been working with Dr. Kwak-Kim, a Reproductive Immunologist based out of Chicago, to formulate an immune protocol for my FET. My RE has been out of the country visiting family, and he is now back in action, and together we also came up with a plan. The marriage of this entire preparation is overwhelming.

Here's what we got so far:

5/1 last Depot Lupron injection

5/3 begin Prednisone as part of immune protocol to decrease cytokine level

5/17 blood work for Dr. KK - CBC, metabolic panel, TSH, NK cells and Cytokines (NK and cytokines have to be drawn and then mailed to Dr. KKs lab - a local hospital is willing to do this "courtesy draw" so long as I supply the orders, test tubes, etc - which Dr KKs office supplies me with)

5/23 Baseline u/s for FET...if all goes well I start estrace and Augmentin ( a broad-spectrum antibiotic to r/o endometrial infection)

5/28 Begin Lovenox as part of my immune protocol

5/31 Repeat the blood work panel from 5/17

6/3 Fly to Chicago to have my uterine blood flow checked. I am also due for a lining check for my RE so I plan to have them do it there...if all goes well, I'll start progesterone

6/8-6/10 ****crossing my fingers SO DAMN HARD**** that this will be a transfer of 2 blastocysts.


So many thing are different about this cycle, and these differences bring hope. Hope is a scary thing.

Our prior cycles were antagonist with equal parts Menopur and Gonal F. The only difference between them was the fact that we used estrogen priming for IVF #2. Both yielded 7 usable eggs, of which 4 and 3, respectively, fertilized. Both cycles were 3dts - our first IVF we did an eSET, and our second we transferred two.

This cycle has been a total 180...we did MDLF with estrogen priming, we used a lower total dose of stims, we used a small amount of Menopur instead of equal amounts, we added HGH, we found out that I was heterozygous for MTHFR and began treating that with Methylfolate, we visited the RI who put me on levothyroxine for my thyroid, I took prednisone during stims for my cytokines, I began self-treating cytokines with fish oil and chia seeds, we primed my uterine lining with Depot Lupron for 3 monthly injections, we are doing a FET for the first time, and we have blasts!! Something we have never had before...and, finally, I'll be on lovenox for poor uterine bloodflow and prednisone for my cytokines. If that doesn't work, we will use IVIG, which was somehow, some way, approved by my insurance (but will still be $520/infusion until we hit our OOP max).

Whew...did you keep up with all of that?

These changes excite me, but they also scare the shit out of me because nothing will guarantee that it works. I'm at a point where I feel it is impossible to be pregnant, and I am trying so.damn.hard to keep my chin up, pretend the glass is half-full, keep my eyes on the prize, see the silver lining, and all sorts of other cliché things that people say when you want to crawl in a hole and die over how shitty your life is going.

Time will tell, and for once in this whole shitty journey, I'm really hoping that it is finally MY time.



IVF #3: Roundup

     To recap, this cycle started with a baseline of 3 follicles and an estrogen of 195. Then I had a mental breakdown. A few days later, I had 5 follicles and my estrogen of 196. So, not a great start.

     We did everything completely different for this cycle. I was on a MDLF protocol with prednisone (for high normal Th1/Th2 Cytokine Ratio). I took 10 units of micro-dose lupron AM & PM beginning 2/8 and added300 units of Gonal-F in the AM starting 2/10. We added in a vial of Menopur in the PM on 2/12 and continued with that. I then added 20 units of HGH (Omnitrope) for four nights beginning Thursday 2/18. So, by the end, I was up to 5 injections a day!

     My follicle count grew to 11, which is the most I have ever had during a cycle, and my estrogen on the day of trigger was 3116! I was so blown away by this because I had never had an estrogen at trigger higher than 1979! However, I know how this IVF shit works...nothing good happens without anything bad...and I said to my husband "watch, we'll get 5 eggs."

Guess what?

   We got 5 fucking eggs. Ok, that isn't the whole story. We actually retrieved 12 eggs. I was pretty uncomfortable towards the end so props to you PCOS girls who have 1023232 follicles. Although I still hate you bitches because you make it rain embryos. #sorrynotsorry. #Iamkidding. #kindof.

     Annnyyywwwaaayyy, of the 12 retrieved, 5 were mature and 5 looked like they could possibly mature in the lab. 2 did. So, that brought our total haul to 7. This is hilarious because we have wound up with 7 eggs every cycle! My ovaries are pre-set on a very specific number apparently.  This is also the first cycle we have done ICSI and 6 of our eggs fertilized normally!! This is the highest number of embryos we've ever had!!!

     If I'm being honest, I'm slightly disappointed. I was really hoping more would mature and fertilize. However, 6 embryos is a totally normal number to have for anyone, let alone someone with DOR. I just feel so much pressure to freeze several embryos because I'm about to go on 3 months of depot lupron, after which, the lupron will hang out in my system and keep my ovaries suppressed for several months so stimming again too soon will yield a shit cycle.

     We are culturing out the embryos to day 5, which is nothing short of terrifying. We've never done this before. I'm praying that this protocol shift, my supplements and HGH really kicked the quality of my eggs into high gear, and that ICSI helped us get the best sperm possible.

     Mostly though, I'm just hoping that somehow, someway, my future child is in there.
    

 

Cycle Update: IVF #3

Source

     I started injections for IVF #3 last week so today is day 8. I'm doing a Microdose Lupron Flare (MDLF) protocol and primed with estrogen. Things are off to a bit of a rocky start.

    IVF #1 was new and exciting. I knew I had DOR and would likely not bring in a haul of eggs like many others, but overall, I knew it was a "practice round." This still didn't stop me from leaving most monitoring appointments in tears. IVF #2 was s completely different story. Estrogen priming with patches was so quick and I began stimming during a weekend away in NH. I learned to let the techs know that I didn't want to know my u/s results and I didn't read into the results. Because that cycle did result in a pregnancy, even if only for a moment, I feel pretty good about it.

     Enter IVF #3. I began injections after finding out about my Dr. KK results and that SIRM CT was closing. To top that off, at my baseline monitoring appointment, I only had 3 follicles. THREE.FUCKING.FOLLICLES. As of my next monitoring appointment, I was up to 5 follicles and I'm wondering if almost 4 weeks on estrogen priming (to accomodate batching at SIRM - something I never had to do before) I go in again for monitoring tomorrow. I'm the crazy girl who rolls up into the ultrasound room with my ipod, and tells the doctor that I can't know any information or else I'll lose my shit all day, so please don't mind me laying there, music blaring and eyes closed.

    I started the cycle with 10 units of lupron AM and PM. Then a couple of days later I added in 300 units of Gonal-F in the morning along with the lupron. After my last monitoring appointment last week we added in a vial of menopur at night. I was on Estradiol until yesterday.

     I'm not feeling great about this cycle. It's not starting great and it's looking like it could yield the fewest eggs yet. I know the egg count doesn't necessarily mean much, but I had the highest hopes for this cycle. Stupid me. Worse, if this cycle doesn't get us some embryos, we run the risk of having nothing to transfer at the conclusion of the depot lupron treatment, if needed. That shit stays in your system for months  after the last injection and would effectively kill any stim cycle before it could even start for months to come.

    More uncertainty. More waiting. Less hope. That's where I stand today.