The protocol that worked...

A number of you have asked me about what happened prior to my BFP. I've offered to give a play-by-play and decided that it was easier to do it here since I'm sure it will come up again.

First things first. Disclaimer: I am not a medical doctor. I am not offering medical advice. My results may or may not work for you. I am only offering up the protocol that worked for me. Please view it accordingly.

Appointment 1: Preliminary FSH reading (Dec. 17, 2012)

Blood test result today:

Estradiol (E2): 41

Follicle stimulating hormone (FSH): 35

As per MD, your FSH is elevated. MD recommends birth control pill to lower FSH in order for the follicles to grow.

Medication instructions:

Start/Continue with prenatal vitamins – one tablet everyday

Start birth control pill today, 12/17/12 – 2(two) tablets taken together from 12/17 to 12/23.

Next monitoring on 12/24/12 for blood only at 8am Columbus Circle.

Please email me back if you need me to call in script for birth control pills. Email me name of the pharmacy and telephone number.

Please let me know if you have any questions.

Note: between Dec. 24th and Jan 11th, I did not return, due to a family emergency. I was taking 1 tablet every other day during that time.

Appointment 2: Monitoring and Bloodwork (Jan 11, 2013)

Estrogen <Low
FSH 35

Instructions:
Please take birth control pills to help suppress the FSH level for a
dominant follicle to grow.

Increase birth control pills to 1 tablet every day from today to 1/21/13

Your next appointment is scheduled for 1/22/13 for blood work only.

Have a good day!

Note: I did not return on 1/22 because I had the flu. I continued to take the tablets and returned on 1/27.

Appointment 3: Monitoring and Bloodwork (Jan 27, 2013)- FSH is lower now, time to wean off of OCP

below are your blood results.

E2  31
FSH  4
LH  3
P4  0.2

Please reduce birth control pills 1 tablet every other day ( skip today,
take 1 tomorrow, every other day until 2/3) and return to the office on 2/4
only for blood work . If you have any questions, please feel free to
contact us.

 Appointment 4: Monitoring and Bloodwork (Feb 4, 2013) - FSH is elevated again on 1 tablet every other day
Your lab results from today are as follows:

Estrogen 42
FSH 25
LH 10
Progesterone <low

Please continue with the birth control pill 1 tab every other day until
2/7/13 and return to the clinic on 2/8/13 for blood work only.

Appointment 5: Monitoring and Bloodwork (Feb 8, 2013) - Snowstorm hits NYC, nurses say to stay on one every other day and come on the 11th

Please continue the pill every other day and return on Monday for blood
work, 2/11/13.

Appointment 6: Monitoring and Bloodwork (Feb 11, 2013) - FSH is still a bit elevated, but E2 levels indicate a follie may be growing

 I am writing with the results of your blood work today:

E2      62

FSH    21

LH      11

P4     0.1

The doctor has reviewed your chart and would like you to return for blood
work and sonogram on Thursday, February 14, 2013, any time between 7:00 am
and 1:30 pm. No medications at this time.

Appointment 7: Bloodwork and Sonogram ( (Feb 14, 2013) - Sonogram indicates there are two follies growing on the left ovary - 7mm and 4mm; no meds

FSH    21

Your FSH level is stable. You don't have to take any medications, simply
return to the office on Tuesday 2/19 for blood work and sonogram. If you
have any questions, please feel free to contact us.

Appointment 8: Sonogram (Feb 19, 2013) - Sonogram now shows one follie at 15.5mm

Appointment 9: Bloodwork and Sonogram (Feb 20, 2013) - Sonogram now shows one follie at 18mm 

Blood test result:

Estradiol (E2):277

Luteinizing hormone (LH):41

Progesterone (P4): 0.6

As per MD, your Egg Retrieval is confirmed for 2/22/13, Friday, at 8am/

Please return to office with your husband at 7:30am.
Anika, continue with Ibuprofen/Advil 600mg every 12 hours until tomorrow's
procedure.


And there you have it, folks! My doctor followed a natural IVF cycle protocol, using OCP to suppress my FSH levels and encourage a follicle to grow. Until egg retrieval, OCP were the only meds I took. 36 hours before my retrieval, I took a nasal spray. That was it. When I first embarked on my IVF journey, I thought I would have to give myself shots, but I didn't. This was minimally invasive!

Retrieved an egg today...

This morning, I woke up at 4am! Nerves? I'm not sure. We had an egg retrieval appointment at 8:00. Dh and I got there early and I tried to busy myself in the waiting area.

I went in for the sonogram, first, to make sure the follicle was still there. And it was - measuring a nice, plump 21mm! The doctor (a new woman I've never seen before) said my lining was good, which was comforting. I told her that if the egg fertilized, I want a fresh transfer for this cycle - not frozen.

Next was the procedure room. My instructions for retrieval day were to not wear anything with perfume - no lotion, deodorant, etc. I can survive a morning without deodorant, but I cannot survive a morning without lotion. When I changed into my hospital gown, it looked like I had fallen into a vat of flour. All for a good cause!

I felt more pain at this retrieval than I felt at the one almost exactly a year ago (2/28, I think??) But, they got the egg and Dh made his contribution, so we are just waiting. We should hear by tomorrow at 3pm whether it's viable or not. If it is viable, they will do the embryo transfer on Sunday morning at 11:45.

In the interim, I am taking progesterone suppositories 2x daily and estradiol (2mg per day).

I felt on top of the world after the procedure. I went to the mall and bought a ton of girly clothing. Since my hormones have been regulated, I've felt more like "dressing up" and accessorizing.

I'll follow up tomorrow to let you know the news from the doc!

Keep crossing those fingers!!!

Appointment results from yesterday

So, at my sonogram yesterday, there was a 15.5mm follie. I couldn't believe it! Last Friday, there were two - 4mm and 7mm, natch both on the left ovary. However, I didn't expect 15.5mm. The follie from last year did NOT grow that quickly. This is a good sign.

After my appointment, I got the following mail (truncated):

-----------------------------

Please confirm receipt of email

Hope this email finds you well. Dr. Yang reviewed your test result today and below is your medication instructions.

Blood test result:

Estradiol (E2):245

FSH:8

Luteinizing hormone (LH):11

Progesterone (P4): 0.3

As per MD, your hormone level shows that your LH is elevated. Elevated LH means that you are starting to surge on your own. Possible egg retrieval tomorrow IF the follicle is still there._ Please try to be here at 7am tomorrow for STAT blood and ultrasound.

No Nasal Spray tonight. 

-------------------------------

What a way to scare me!!! I leave the clinic talking about possibly triggering that night and get an email about coming in the very next day (today) for an egg retrieval. This train was moving at 200mph. 

So, DH and I went this morning, but the egg retrieval wasn't necessary. My LH was only 8 today - so no spike. However, my E2 levels were slightly lower - 240. Of course the crazy-lady in me hit the internet right away to see if that was a harbinger, but the sites I read seemed to think it was okay.

I am really hoping that it doesn't signify a decrease in egg quality. I asked the nurse what the E2 drop meant and she said it could mean that the egg is done maturing. 

So, I have to trigger with the nasal spray tonight. $80 nasal spray! $80 nasal spray that I had at home and DH threw away... I digress...

I have another appointment tomorrow morning and they will most likely schedule egg retrieval for Friday morning.

I haven't been to work all week because of school work, but it all works out for my appointments. It also helps that school is right around the corner from the clinic.

Please send vibes for a healthy egg retrieval, if you've got any vibes to spare!!!

If you surrender to the wind...

There is a quote by Toni Morrison that I have just been loving...

"If you surrender to the wind you can ride it" - Toni Morrison

sur·ren·der (s -r n d r). v. sur·ren·dered, sur·ren·der·ing, sur·ren·ders. v.tr. 1. To relinquish possession or control of to another because of demand or compulsion.

In my foolish youth, I saw surrender as such a dirty word! Nik doesn't surrender... she prevails... against the obstacles, against the odds.

However, I am a firm believer that you have everything within you, RIGHT NOW, to be everything you will ever need to be. 

It wasn't until I met DH that I realized there is some strength in surrender. There is some strength in having a bit of vulnerability. 

Life and love are a beautifully-orchestrated dance where sometimes it's just not your turn to lead...

If you surrender, the strength of something else can propel you. If you fight, you are not propelled as far AND you'll be worn out. 

Today I am surrendering. I am surrendering to the legal brief that desires completion. I am surrendering to the clinic making a last-minute decision to not retrieve my egg today, but wait until Friday. I am surrendering to the  desire to just take a minute for myself and to steal a couple of deep breaths and quiet time without feeling guilty.

I will ride it...

LAW

I've never met a wagon I didn't love...

And, just that quickly, I am back on the "TTC" wagon.

So, let me take a step back... and by back, I mean late December. With the year drawing to a close, I realized I still had roughly $1k in my medical spending account. My account, like many, is one of those "use it or lose it accounts". I could have let the money go to waste, but I decided to book whatever doctor appointments we would routinely have in the spring. I booked the dentist for the three of us, the optometrist and... there was still money left over... even after I bought a pair of glasses.

Well, if you'd ever paid attention to my other posts where I lamented about the cost of infertility treatments, you know that going back to the clinic was a quick way to spend some cash.

I went back, initially, to get more HRT/BCP... and, who am I kidding? I wanted to know what my FSH levels were since the night sweats were back in full force.

Naturally, they put me on the BCP right away. They wanted me to take two pills a day. I did and went for my weekly visits and at some point my FSH went down to 6 and they told me to stop. However, when I stopped, my FSH went back up to 25. So, they told me to go on, again... and something happened. I got the flu and couldn't make it in. However, I kept taking the BCP thinking that once I was over my bug, I would go in. Well, that stabilized my FSH. Once they took me off again, it didn't go back up.

Now, at that point, they were only doing bloodwork. There weren't any numbers to indicate that a follicle was growing, so they didn't give me a sonogram. FSH was stable enough (at a high 21, but stable nonetheless) but I wasn't growing a follie.

Then I got the dreaded mail. It went something like "if something doesn't happen soon, we're going to bring you in to discuss further treatment with the doctor". I was crushed! PLEASE... don't give up. Just wait a little bit and give a follie a chance to grow.

So, I went in on Valentine's day. How un-romantic. They normally draw my blood and tell me they'll email me later, but they told me to stay for a sonogram. A sonogram! And I saw it... right on the screen... two little follies. One measuring 7mm and one measuring 4mm. I'll take it!

I shared the news right away with DH and my sister. I spent the weekend trying not to do anything wrong... no coffee (although I did have wine) and just generally stayed under the radar.

Today I went back. There's a 15.5mm follie! The doctor said "this is like waiting for a bus... we have to make sure we catch it on time." I have also been instructed to carry my nasal spray with me because "you may have to trigger at any time".

If you are in the finger crossing business, please cross them... if meditation is your thing, please spare a thought... if you love candles, please light one... Whatever you do, please stand with us in solidarity to get this little follie to his/her rightful home...

Thanks for reading... and remember, LAW - love always wins...

5 stages of infertility grief

A friend asked me how I was doing and it forced me to think for a little bit. How AM I doing? The answer is not always clear-cut. Some days are better than others. For instance, last  week Wednesday was d-day for a few people I know who have fertility issues. We all had appointments and I thought we would all get exceptional news about the day, but it was the exact opposite. NO ONE got good news. You'd have to imagine that with enough days like that, one wouldn't be doing so well.

My news last week was that no follie is growing. I am being weaned off OCP once again, which I'm not too optimistic about. Add to that, the fact that infertility treatments are extremely expensive and you've got one unhappy lady this way.

If I looked at the five stages of grief as:
Denial
Anger
Bargaining
Depression
Acceptance
I'd have to say I am toggling between anger and bargaining on any given day. It makes sense, right, I am grieving the loss of my fertility. And, not only the loss, but the unexpected loss because had this happened at 47, I don't think I'd blink nary an eye. But for it to happen 4 months after my wedding day dead smack in the middle of me saying "I think I am ready for another baby", well, that's just cruel.

I am not ready to be infertile, so every.single.time I see a snot nosed teenager on FB showing her belly pics or talking about how her "hubby", who is usually some equally underaged snot, looks so cute sleeping with their other baby, I just want to throw a chair - ANGER

Whenever I hear about people who don't invest in their children, curse out their children, don't properly nourish their children, etc..., but still manage to have FIVE, yeah... makes me want to punch a hole in a wall - ANGER

But, then, I think... maybe I will do yoga every day - BARGAINING

And juice all of my meals and take shots of wheat grass and go to bed at 7 and do EVERY.SINGLE.THING that other women don't have to do in order to get knocked up - ANGRY BARGAINING

and then... maybe, just maybe, I will get tender boobs, or nauseous after I eat my favorite meal or tired as soon as I wake up and take a test just for the heck of it to find out that we are indeed, against the odds, expecting - DENIAL

So, yeah, as you can see, we've got a long way to go. I have things keeping me busy - but not busy enough. I can only take it day by day. That's all I can do. And one day, I hope to write about my acceptance... in whichever form it takes.

FSH is back up...

I read something once that said you are only as good as your highest FSH level. Gosh, I was hoping it was LOWEST... but no. So, I'm only as good as my FSH level of 100? That level screams... "ovaries? what ovaries?" My ovaries are shriveled up lump of all things unholy. However, I need to find the positive in this. I will say that my left ovary consistently attempts to give me a follie! The right one is the turn-coat. I'm not sure whose team she's on. So, at my appointment on Wednesday, the 8mm follie from last week was long gone, but there was a new 5mm follie on the left side. The right - nada!
I am doubling up OCP for a couple of days, then taking one per day until my next appointment on the 9th. The 9th must be a good day for fertility, because another friend with POF has an appointment that day and my sister has a SONOGRAM... oh yes, she's with child :) It's not public, yet. Neither is this blog, so I can say it here! Ok. So, fingers crossed for everyone on the 9th. Let's bring back some good stories.


My FSH is 33 now. Here's the mail from the clinic after my visit on Wednesday:

Please confirm receipt of this email.Below are your blood results for today:
Estrogen: <L
FSH: 33
LH:14
 p4: 0.5


At this time, the MD has reviewed your results and your instructions are as follows:

Please be aware that since your FSH was unable to stabilize at the lower level once the MD weaned your body off the birth control pill, the MD would like you to begin taking the birth control pills again to bring the levels back down.  Your FSH was at 17 when you last monitored, however today it went back up to 33.  The MD would like to try the birth control suppression again to see if your body will be able to have the levels remain low enough to begin IVF treatment.

Please begin taking two birth control pills daily from today 5/2 until 5/5

Please decrease to ONE birth control pill daily from 5/6 until 5/8


Your next appointment is scheduled for: Wednesday May 9th, 2012 at Columbus Circle.

Please let me know if you have any questions or concerns.
Have a great day!

Felt like giving up...

I'm not proud of that fact, but the past couple of days have been a little bit of a low point for me. I guess it all started on Wednesday when I had my appointment at the clinic. I used my time there to also square away my mounting bill. I paid it in full to the tune of $912!!! Yes, $912 USD! Do you know what I could do with $912? That was the primary thought running through my head. $555 of that $912 was for the cracked egg retrieval. I had to pay half a grand for them to retrieve a scrambled egg. So, of course, I took to the internet to see what the odds were of them ever retrieving an egg that was worth $5, much less $555 and the stats weren't encouraging.
The other thing that made the $912 news seem so insurmountable was the follie check. Do you remember the two follies measuring around 8mm just a week before? Well, I guess they were on vacation. Now there's only a 9mm follie. And, I'm not saying "ONLY" to sound like an ingrate, but that means that I'm embarking on another natural IVF cycle. So, I have my next appointment on Tuesday, 2-May to see how that follie is developing and I'm taking OCP every other day until 30-April.
So, here's the mail from the clinic until Tuesday. I will update as soon as I know something more:

This email to inform you about your bloodwork results and your instructions for today, April 25th, 2012:

E2 133

FSH 17

LH 10

Progesterone 0.6

Dr.Wong reviewed your results, please see your instructions below :

• Please continue with birth control pills, 1 tablet, every other day. Last pill on 4/30/12.

• Please return to office on 5/2/12 at 9am, to Columbus Circle location, for bloodwork and ultrasound.

Please let me know if you have any questions regarding this email.

Thank you and have a great day.

It's been a while...

I took the girl to Jamaica to celebrate her birthday. We were there for only 5 short days, but the lead-up and wind-down have taken more out of me than I realized. We got back on Wednesday night - 18-April. I had an appointment on Thursday morning. I had been taking birth control pills every other day and having crazy twinges every single day - which I attributed to the shock therapy I got at acupuncture.
Well, not sure if it was the shock therapy or the fact that I was forced to relax, even if for only 5 days, but I have two follicles growing. There was the obligatory one on the left side - which always seems to be there. HOWEVER, there was one on the right side as well. I have never seen anything but dust on that side, so I was happy for the news. On Thursday, they were measuring 7.5mm on the right and 8mm on the left.
Grow follies, grow! I have an appointment on Wednesday to check on them. Until them, I'm taking prenatals every day and OCP every other day. Fingers crossed. I'm feeling hopeful!

Destination Maternity!

I took the day off today. I just needed a breather from work - I usually do. Thanks to the 17mm follie-cyst yesterday, I had to go in for another blood draw and sonogram - just my luck to have an appointment on our day off. I did manage to sleep in (is 8:30 considered sleeping in?) 

I got to the office at about ten after ten and had my blood draw. Then it was the waiting game to be called in for my sonogram. The nurse called me in and instructed me to get changed. The two minutes it took her to come back in felt like an eternity. She performed the sonogram and nothing came up on the screen. No more follie-cyst! Whatever that means, it's not as bad as the idea of having a huge cyst. So, I'm a bit relieved.

The optimist in me hopes it was a follie and that I've ovulated. The realist in me is just glad it's not a cyst. I was instructed to wait for my mail today with further instructions on where to go from there. I walked out into the the jungle that is NYC and I felt directionless.... not because I expected anything to happen, but because I really didn't know what to do next. Should I go to the store for my mom, should I go and get my hair washed, should I get my nails done? I couldn't decide. I went into the GAP to find a pair of jeans and left after 5 minutes of useless browsing. I decided to head west on 57th street towards my bus. I walked for about 3 avenues and decided to look up to see where I should go next. There was a HUGE sign that said "DESTINATION MATERNITY"... It was a mini-mall with maternity shops and a maternity spa. I made a mental note - must come here once we conceive. The sign put a little smile on my face... gave me some direction. Whether or not my appointment went the way I wanted it to go today, I am not directionless, nor purposeless. It may take a while to get to that BFP, but gosh darnit, I'm going to get there.

Destination maternity or BUST :)

Follicle or Cyst?

A mail from my clinic after my visit this morning:

 

This email is to inform you of your instructions.

 

Estrogen 54

FSH 9

LH 6

Progesterone 1

 

Please be advised that the sonogram confirmed a 17mm follicle, however the estrogen does not correspond with the size. Dr.  requests that you return tomorrow for bloodwork and sonogram to confirm if the follicle is true follicle or a cyst. Please let me know if you have any questions or concerns.

So, what do you think? Is it a follicle or a cyst? I'm HOPING it's not a cyst, but an estrogen level that low is an indication that if it's not a cyst, it's a very poor quality egg. At least they are growing, right? Something good has to come along.

I'll keep you posted on the results.

As a bright spot, how awesome is that FSH level? Just beautiful!