And then there was one

One.

One normal blastocyst.

BUT, one is so many hundreds and thousands, of times better than none!  One is the difference between being parents and NOT being parents.  So we are happy.  And this one normal blastocyst is of good quality with a 75% chance of pregnancy.  Dr. A is very positive and confident that we'll get a pregnancy out of it.  But it also means if we want more than 1 child, we're sticking needles in my tummy again within just a few days here.

Sorry it's taken me so long to pick up where I left off.  I wasn't under a rock mourning our losses or anything since we've been very mentally prepared for whatever comes our way along this journey.  However there is a little something that got in the way of my posting prior to today: THE HOLIDAYS!  Sheesh...such a busy time.  But with our second round of stimulation and retrieval just a few days away, I'm somewhat astonished at how my body has been totally and perfectly navigating around all the important holiday milestones - our Thanksgiving travel, expensive tickets to a Broadway show we purchased MONTHS ago, multiple holiday parties and events, Christmas day AND New Years!  Essentially we got the month of December off while still avoiding Thanksgiving (retrieval was 2 days prior to it) and New Years (stimulation should begin a few days after it).  Thank you for that, Body.

Now let me get back to the info on our 2 embryos and how/why we went from 2 highly graded embryos - to only 1:

We met with Dr. A a few weeks ago and she gave us the news that our best looking embryo (the 4AA) was chromosomally abnormal.  It had a Trisomy 22 abnormality which meant there were 3 copies of chromosome 22 rather than a pair, as there should be.  Embryos with this abnormality would usually not even result in a pregnancy, however because ours was such a high graded embryo (AA is THE BEST) it likely would have for us and ultimately resulted in a miscarriage.  (On the odd chance that a person should be born with a genetic disorder associated with Trisomy 22, they would be greatly disabled mentally, physically or both.)  So while that was not what we wanted to hear, we were glad to be able to rule that embryo out and not waste time, money, physical energy and emotional turmoil going into a situation where I could become pregnant with a chomosomally abnormal fetus.

On the other hand - our 2nd best looking embryo, which was our only other embryo, (the 5BB) was chromosomally normal!!  This was wonderful news of course.  I can't imagine how devastating it'd be to go through this whole IVF process only to end up with nothing at the end.  So we celebrate our successes along the way - and this is certainly a success to celebrate!

oh, and Happy New Year too!

Dr. A also sent us out of her office with a paper which told us the genders of both embryos (the normal and the abnormal).  She gave us the info since it's ours to have, but suggested we not look at it, and I think I understand why.  I would guess it's less of an issue about knowing the gender of the normal embryo and more about knowing the gender of the abnormal one.  I think it feels like more of a loss when you know the gender.  But I repeat - it's not an embryo we want, so it never really felt like a loss to us.  As I've mentioned before, Hubby and I are planners and very practical people and knowing the gender of our embryos makes logical sense to us, so we did open the paper once we got home.  I won't be sharing the genders here, nor do we plan to share the genders with our family and friends (the few who know we're doing IVF).  It's something we want to keep to ourselves as we continue to plan our family.  But I will tell you that the gender of our normal embryo is a gender one of us has very much been hoping for.  You're right, that basically gives nothing away!  *evil laugh*

"muahahahahahahaha!!!!....."

Dr. A suggested we take a cycle off in between IVF stimulations which is why December was our month to relax and enjoy before January starts us over again.  But we're starting again with a lot of great information under our belt - and with a hearty, frozen embryo just a few miles from our house.  That's right - have I mentioned how close the infertility facility that houses our frozen embryo(s) is?  We drive by it all the time and sometimes we wave at our "kid".  :)  It IS truly incredible though, to think that someday that little embryo which is frozen and stored inside this medical building, could be walking around in the world and calling us Mom & Dad.

How are you kicking off 2014?  We're kicking it off with IVF Round #2...  In T-minus about 5 days.  2014 is going to be a great year for us, I can feel it.  If you'd like to keep following along with me - stay tuned!

Getting good grades

They're not even fetuses and we're worrying about the grades our kids are getting... it starts younger and younger each generation, doesn't it?

On Day 5 we started getting a different kind of report.  No more information on the cells and the grade, but instead since the embryos were becoming blastocysts, we were getting information on where they were in their overall development and expansion:

• 1 - Blastocoel cavity less than half the volume of the embryo
• 2 - Blastocoel cavity more than half the volume of the embryo
• 3 - Full blastocyst, cavity completely filling the embryo
• 4 - Expanded blastocyst, cavity larger than the embryo, with thinning of the shell
• 5 - Hatching out of the shell
• 6 - Hatched out of the shell

and then scores on the Inner Cell Mass which is the part of the blast that becomes the fetus:

• A - Many cells, tightly packed
• B - Several cells, loosely grouped
• C - Very few cells

and finally, scores on the Trophectoderm which is the part of the blast that becomes the placenta:

• A - Many cells, forming a cohesive layer
• B - Few cells, forming a loose epithelium
• C - Very few large cells

This is called the Gardner blastocyst grading system.  Here's a great page to help explain better.  So at this stage we started seeing embryos/blastocysts being labeled things like 2BC and 4AB and 5AA, following the grading you see above.

You'll hopefully remember where we left off with our little embryos at Day 4.  We had 4 morulas (stage between cleavage and blastocyst) that we were watching and hoping would grow into hearty blastocysts with excellent grades!

Day 5 (12/1)
Tracking 3 embryos!

Embryo Count	Blast Expansion Grade	Inner Cell Mass Score	Trophectoderm Score
1	4	A	A
1	early blast
1	morula

Day 5 brought us the above report card.  To decipher, this means we have a 4AA blastocyst, an early blastocyst (not yet graded) and a morula still in the running.  The last embryo (of the 4 morulas we had in my last post) did not continue to grow and divide so we'll stop watching it and continue to concentrate on the 3 good ones.

Our 4AA blastocyst was, as Dr. A put it - the best of the best!  It doesn't get better than this at this stage and as long as it's chromosomally normal it has a 90% chance of pregnancy.  The 4AA was frozen today and we'll wait for its 2 buddies to hopefully catch up.  Wonderful news on this 5th day!

Day 6 (12/2)

Tracking 2 embryos!

Embryo Count	Blast Expansion Grade	Inner Cell Mass Score	Trophectoderm Score	Freeze/ Biopsy Day
1	4	A	A	5
1	5	B	B	6
1	1	C	C	NA

Day 6 was the last day of watching our little embryos grow and the last day of the nerve-wracking yet simultaneously exciting emails.  It's hard to watch the numbers drop a little each day, but it's also interesting how our numbers dropped so subtly each day.  We never lost more than 1 per day, which made it a lot easier to go from 6 to 2.  Mother Nature may have been rough on us to put us in this IVF boat to begin with, but at least she was making seas a bit easier to navigate.

Today a 5BB joined our frozen 4AA from yesterday.  The 1CC didn't have pregnancy potential so we will stop watching that one and it was not frozen with its siblings.

It was around this day that I noticed almost all my bloating was gone.  It came on so subtly but also dissipated the same way.  And when I finally was home (from Thanksgiving travel) and able to weigh myself, I'd lost the 2-3 pounds I put on during stimulation, so THAT was a huge relief.  Even though I knew I was going to gain water weight - it doesn't make seeing those pounds on the scale any easier!

So our last and final stage before we truly know how we came out from this round is the genetic testing.  Specifically PGS with aCGH (Preimplantation Genetic Screening with array-Comparative Genomic Hybridization).  This is the newest step in the IVF process, and something most couples didn't even go through until just the last few years.  Knowing if an embryo is chromosomally normal or not is huge.  I mean HUUUUUUUUUUGE.  Typically it's the chromosomally abnormal embryos which do not implant, or if they do implant, will likely miscarry.  Plus, it also gives couples who do get pregnant, more peace of mind knowing the likelihood of those 2nd trimester chromosome and genetic screenings coming back with bad news is far less likely.  Sign me up!

Well, we did sign me up and we've sent a small collection of cells from each of our 2 embryos to IVIGEN to be biospied.  We'll get the results tomorrow when we go in for a consult with Dr. A.  She had the results late last week (only 4 days after our oldest embryo was frozen!) but wanted to review them with us in person tomorrow.  I'm a little nervous for the news - but she did give us a cryptic "It's good" in her email.  Good isn't great, but good isn't bad either.  My fingers are about to fall off from crossing them so much lately, but they're crossed again.  I'll be back soon with an update!

Another day, another number

Immediately following the egg retrieval day comes a daily update/status report from my doctor on how our little eggs/embryos are doing.  I found that each morning I was nervous/excited to see an email waiting from Dr. A.  Would it be bad news?  Good news?  Great news?  Thank God we were traveling for the holidays and highly distracted most of the time.  I can only imagine how that notorious "2WW" (two week window) waiting to take a pregnancy test after embryo transfer must feel, when I was anxious each day just for our embryo report!

For an explanation on embryo grading I like this page.  This is also a good page, but I noticed that their grading is backwards from the grading that was done for our embryos.  (For us, the lower the number, the better.)  As these fertilized eggs, aka. embryos age, they will have a grade and a cell count and that's the report we would get each day.  The grading refers to the even-ness of the cells size and lack of fragmentation (the more even-ness and less fragmentation, the better, and the lower the grade #).  We also want to see the number of cells increase each day from ~2 cells in the first day to ~10 by the 3rd day.  We would get these daily reports along this grading scale for the first 3 days.  Day 4 there is no report because they are morulas and Day 5 the report/rating changes since they are (hopefully) blastocysts by then.

Our Daily Reports

Day 1 (Day after retrieval):
Tracking 5 embryos!

Embryo Count	Cells Count	Grading
5	NA	NA

We got an email and a voicemail from Dr. A telling us that 5 of our 6 mature eggs fertilized which was GREAT.  At this point we got no information on quality since it was too early.  Quality and grading begin on Day 2.  I asked Dr. A what to expect from these little embryos.  What kind of success rate does she typically see?  Might we end up with 5 great embryos to send for genetic testing?  She said it's typically about 50% that make it to high quality blastocyst.  So we're keeping our fingers crossed for those 2-3!

I was still feelling bloated and very gassy, like that painful gas you get in your pelvic area, but can’t manage to release.  I thought about taking a Gas-X, but never got around to it (so that tells you how much it was truly bothering me).  Dr. A said it’s partly cuz of the anesthesia but mostly cuz my ovaries are recovering from the procedure.  It didn’t keep me from cooking all day for Thanksgiving the next day, though!

Day 2 (11/28):
Tracking 5 embryos!

Embryo Count	Cells Count	Grading
1	5	1
3	4	1
1	3	1

We got the morning report that all 5 embryos were Grade 1 which is the best quality!  Very excited to hear this.  6 eggs (from my retrieval) didn't seem like a big number to me, but we felt more positive when our first news about the embryos was that they were Top of Their Class (Go little embryos!  Go!)  Hubby and I commented on our drive to Thanksgiving how it's really crazy to think there are embryos that exist out there which are a combination of our DNA.  Like these little things could become our kids!  It was a very surreal, exciting and scary thought.

Physically I was feeling fine for the most part.  Still a little gassy and still couldn't release any of it (but still didn't take anything for it).  It wasn't as bas as the previous day though.

Day 3 (11/29):
Tracking 4 embryos!

Embryo Count	Cells Count	Grading
2	8	1
2	8	2
1	4	3

By Day 3 (which, I couldn't help but think to myself - is a day some IVF clinics do transfers, which means the embryos start to have enough information to speculate potential success) our number had dropped again.  But just by 1.  I'm so thankful that we never had a significant drop in numbers or some other heartbreaking shock.  4 embryos were continuing to divide well with little fragmentation, but the 5th wasn't looking so hot and so, while it would remain in culture - it would likely not come through for us.  We continued to stay positive - 4 is 4 more than a lot of people end up with.  We were thankful...

Today is probably the first day I felt just about fine.  The bloating was slowly starting to reduce and the gas pains were gone.  These side effects are almost not worth mentioning, they were so minor.  We flew to visit Hubby's relatives today which wasn't a problem for me at all.

Day 4 (11/30):
Tracking 4 embryos!

No change/no report

On Day 4, the embryos are "morulas".   (Kinda sounds like a character from The Addams Family, huh?)  Dr. A said that there is no new report today, so at least we got a day off from being anxious!  I found myself very hopeful that maybe these 4 embryos will be all we need to get our 2-3 kids.  Maybe I *won't* have to go through another round of stimulation/retrieval?!  But I know the hope is faint.  And to be honest, the stimulation/retrieval were really not that bad for me.  I'm just starting to get impatient about trying to get pregnant!

A Happy Little Blastocyst

The next news will be coming in for Day 5 and Day 6.  The hope is that the embryos will be at blastocyst stage and we should get (a new type of) grading report on them as well.

So far so good!

6 Eggs!

We got 6 eggs!  And they were all mature!  I’ll take it.  I’ve read that average for a retrieval is 5-15 and realize our 6 is down there at the bottom, but I’ll still take it!  There’s that saying all over the IVF chat boards “all it takes is 1”, but unfortunately for us I think our saying is “all it takes is 3 excellently graded embryos (or maybe 4?)” depending on how many kids we want to have.  You’ll recall, we’re not doing this SO much to get pregnant now as to make sure we can have more than 1 child and hoping to bank embryos for later.  I'm pretty sure this wasn't the only week I'll have to take some shots in the belly... *sigh*

Le Sigh

My retrieval appt was for 8am yesterday, but they ask you to show up 45 mins early.  It’s a small infertility facility as opposed to a hospital.  But I liked the smaller feel of it – more intimate and “cozy” (I know, a weird word to describe an infertility clinic).  We arrived at 7:15am, and were taken to the pre-op area, which I guess is also the post-op area. I got settled in.  Put on my gown (the nicest/thickest hospital gown ever!) and booties and got my IV put in.  If I might take a moment to share – SO glad they put the IV on the inside of my arm as opposed to my wrist (where it was for my polyp removal).  It’s a lot more comfortable in the days after – esp if you wear a watch!   Hubby was with me the whole time while the nurse was prepping me.  I met the anesthesiologist who was awesome and funny yet patient and informing - just the kind of doctor you want.  Dr. A came in to say hello shortly before the procedure and then we WALKED to the retrieval/operating room.  Yes, I followed a nurse who was carrying my IV bag (staying right on her heels so that I didn’t accidentally pull my IV out!)  Hubby departed at that point to go do his all-important task.  Ah, the fairness of this picture, where we women are poked and prodded and injected and drugged and all the guy has to do is something he’s trained for since he was 13 years old… but I digress.

The small operating room was literally a few short steps from the pre/post-op area and I climbed up on the table myself.  I saw the giant stirrups in front of me, but wasn’t required to commit the very unladylike task of having to position myself into them.  Thanks to the doctors and nurses for saving my dignity for when I’m sedated.  I think.  (Now I’m picturing them wrangling me into them while I’m totally passed out…)

Very ladylike...

When I put on my gown I was wondering what these vent things were on the top and bottom and speculated if it wasn't for (eeks) drainage during some other kind of procedure.  But after I was lying on the table, a nurse attached a nozzle to the opening in my gown and it was blowing warm air in.  NICE!  Can I get one of these for at home?!  The last thing I remember (I truly hope I’d already been given some loopy-drugs in my IV at this point and I wasn’t just being weird) was rambling to the anesthesiologist that he could take my glasses off and then telling him that my glasses-case was in my purse (which Hubby had).  I’m sure the doctor got right on that.  And I’m pretty glad that he didn’t.

Suddenly I was waking up back in that post-op area with a nurse and Hubby there to greet me.  I felt pretty good all things considered.  And then I sandwiched my procedure with two silly comments (which I blame on drugs): when the nurse asked me if I’d like some apple juice, I exclaimed “sure.” And then feeling like I was all alert, in control of my speech and therefore was going to speak all the words in my head, promptly asked her if Hubby could have some too since “he loves apple juice!”  I wonder if a look didn’t pass between the two of them, but shortly thereafter we were both sipping apple juice!

The procedure only lasted about 20-30 minutes so all in all we were there for a pretty short amount of time.  The nurse helped me up to use the restroom.  I got back into my clothes and put on this gigantic pad they gave me (the kind I haven’t seen since I was about 12 years old).  I didn’t need said gigantic pad – the spotting was very minimal.  But I suppose it’s necessary and better than nothing!  (Can’t they get some liners up in this place?)

We stopped by the grocery store on the way home and I gave Hubby a (very short) verbal list of items to pick up while I slept in the car.  He’s not the cook in our home and rarely does the shopping and I suppose just wanted to be thorough and make sure I had everything I could (POSSIBLY) need, but he essentially multiplied each item on my list by 5 and added a few other things too.  Just before we're about to leave town for Thanksgiving – thanks Hubby.  I do love you.

One of these, and one of these, and one of these and one of...

I climbed into bed as soon as we got home (but not before stopping to quickly text a sweet friend who was checking in with me) and slept for about 4 hours.  Woke up feeling GREAT but hungry.  I went looking for Hubby and found him ASSED OUT on the couch.  Poor guy has been working so much lately – I think an afternoon full of sleep was just what we BOTH needed.  I felt so great that I cooked lunch for us – soup from scratch!  But then we both fell asleep for the rest of the afternoon, getting up just in time for dinner.

I realize I’ve just given you a total play-by-play of my day (much of which was NOT part of the egg retrieval) but I suppose I included the latter part to illustrate how minor a procedure it really was.  I felt great overall!  Very light spotting, kind of like the last, last, day after your period ends.  Still felt a little bloated but that should fade hopefully by the end of the week (and be replaced with bloating from Thanksgiving).

Over the next few days we’ll get a daily call/email from Dr. A on how our eggs/embryos are progressing.  It’s hard to think what we might end up with, if anything at all.  They still have to divide and develop and grow and look normal and hopefully get to Day 5 and THEN we still have to do the PGS which could dwindle the number even more.  Ugh... it's hard waiting to find out.  I'm assuming second only to the waiting after an embryo transfer!

But we're keeping our heads up.  And staying positive!  After all, we have the holidays to look forward to.  And much to be thankful for overall.  Happy Thanksgiving to any and all of you who read this!

Trigger Happy

Last night of shots!!!

Last night was the final night of shots (and we decided to finish strong by doing 3 of them :-|  …)  The trigger shot (Novarel) was precisely at 8:30pm since my retrieval is exactly 36 hours from then (tomorrow morning).  The Novarel powder was mixed with a dose of Ganirelix (and a little additional water) and then we also had to do the rest of my Omnitrope.  However, the two meds couldn’t be mixed together so it was supposed to be 2 shots.  EXCEPT that Hubby didn’t realize the Novarel/Ganirelix bottle wasn’t totally empty until after giving me the shot…  So we had to add a little more water to make it easier to empty the bottle and that meant a THIRD shot.  Well, by now we were pros – so it’s not a really big deal.   All the other 8 nights were single shots I could barely detect.

Thinking happy thoughts!!

So I thought the trigger was going to have to be in a muscle (butt/thigh) but it just went into my belly too, exactly like the others.  Whew – awesome!  These shots have all been relatively insignificant, but I’m still glad they’re over.

The only difference I noticed with the Novarel is that I had a little of the red splotchiness show up near where we injected it, but it was gone this morning.  My skin felt a tad sensitive near the injection site also, but it was faint.  It’s interesting to see how the different drugs effect me though, since I had Omnitrope on one side of my belly and Ganirelix/Novarel on the other – I could tell the ever-so-slight differences in reaction.

Supposed to kinda take it easy today (sure thing!)  Hubby had some Levaquin to take last night and tonight – it’s an antibiotic which should reduce bacteria in his swimmers.  And to reduce risk of infection after retrieval for me, I’m taking a Doxycycline tonight as well.  But no shots tonight!!

My retrieval is first thing tomorrow morning so it’s an early-ish night for us.  I've been feeling great overall.  Just tonight I started to feel a faint bit of cramping (similar to Aunt Flo cramps) but nothing major.  Wishing for lots of mature eggs tomorrow (well THAT’S something I’ve never found myself wishing for before…)  See you all on the other side.  I'm hoping to lose this 2-3 pounds of (hopefully water) weight I seem to have put on over the past week!!  Please tell me that goes away quickly?!

Awesome progress!

Thought I'd just drop in here again with an update on how the nightly shots, ultrasounds and blood-work are all going.  Overall - these injections are nowhere near as bad as I was imagining they'd be, which is great.  But they are starting to become a little tedious and I'm looking forward to when they'll be over (soon! soon!)  Hubby and I were a little disheartened when we'd gotten to Friday night, last night and wanted to go out to a nice dinner.  But then realized that we wouldn't have enough time because with Hubby's work schedule it'd only have left us about 45 minutes before we wanted to get home to do my nightly shot.  Oh well, it's a small sacrifice to pay!

Maybe I should try taking these kinds of shots with my other kind of shots -

it could make the night way more fun!

Pull up a chair and some popcorn, here's my injections Play-by-Play!
You'll recall that my nights 1-4 are here with night 5 kinda summarized along with my ultrasound appointment here.

Night 6: Tonight we added the Ganirelix to help hold off ovulating (Follistim + Menopur + Ganirelix.)  The shot was a little sting-y, but I kinda think I didn't ice very well beforehand.  It was also a BIG shot (2.5mL) because of all the water my instructions told us to include with the Menopur and Ganirelix.  I found out later from Dr. A that we didn't need as much water as we thought.  Whew, for tomorrow when we add the Omnitrope too!  Everything's going really well though – still no major side effects.  Although by this evening I was feeling like the shots were getting kinda old.  Like HOW many more days do we need to do this?  Argh!!  Stay the course, girlfriend, stay the course!

Night 7: Shot felt great tonight (meaning - I couldn't feel it.)  I think overall the Ganirelix is a bit more “sting-y” than the other meds, but with the ice – it’s still not significant.  The needle for the blood-work I have to have done every(other) day is WAY worse anyway.  I’ve come to the conclusion that even though the bloating came on very slowly and subtly, I’m definitely bloated by this point.  Not noticeably or really visually but I wonder if this isn’t how pregnant women feel.  I couldn’t suck my stomach in if I tried.  Never felt like that before.  I think my pants are fitting okay, though to stay comfy I've been wearing mostly leggings and tunics (or dresses).  Oh well, Thanksgiving is next week – bring it!

Night 8: Injections caused our first "life interruption" tonight since we had to leave a get together with friends a little early to get home for my shot (while the guys at the party were doing a different kind!)  But since so many friends have kids these days we certainly weren't the first to leave.  Injection stung just a little today, not sure why.  It could totally be my imagination or some big coincidence, but I swear the nights we have to add the Omnitrope (odd numbered nights) the shot doesn't sting at all.  Still, the faint sting is nothing like what I’d been anticipating before this all started.  I've been feeling a little bit tired, but also nowhere near as tired as a friend told me I'd be during injections.  And it didn't stop me from cooking up a storm for our get together either!

So we've had some really great news on how I'm progressing.  I went in for my 7 Day Ultrasound yesterday and Dr. A said it was looking really good with the specs you'll see below.  She was 95% sure of a Wednesday retrieval which (whew!!!) would certainly NOT be Thanksgiving.  She gave Tuesday a 5% chance and 0% for Mon/Thur.  Cool - as long as no Turkey Day, I'm happy!

Well when she got my blood-work back (late last night) from yesterday's appointment, my Estradiol (estrogen) levels were climbing so nicely (1009 pg/mL), she wanted to see me again this morning and do another ultrasound/blood-panel.

So Hubby and I rushed over this morning.  Ultrasound showed great follicle growth (in just 1 day) and my Estradiol levels today were all the way up at 1300 pg/mL.  Dr. A seemed very pleased with this overall.  I even got a "WOW :)!!" email from her.  She told me that women who reach over 1000 pg/mL near the end of Stimulation have a great prognosis for IVF and retrieving mature eggs!  She went on to say that a mature egg secretes ~100 pg/mL of Estradiol so if we're tracking about 16 follicles on Day 8 and my Estradiol is 1300 pg/mL, that's really great!  (I'll let you do the math...)

But of course, before I start organizing a celebration parade it's important to remember that really, there are no guarantees.  Each step of IVF is a process and each step deserves it's own celebration or mourning along the way.  First you hope you get the ok to proceed, then you hope you respond to the meds, then you hope the eggs mature, then you hope you retrieve a great number of eggs, then you hope they fertilize, then you hope they divide and mature correctly, then you hope they come back chromosomaly normal!  And that's all *just* the part that "healthy, fertile" women can do in their sleep (no, seriously).  You still have to, you know, GET PREGNANT!  But I'm getting off track...

So with my follicles and Estradiol levels tracking where they are today - the 5% chance of retrieval day being Tuesday just kicked in.  Maybe I should buy a lottery ticket?

My Specs

Baseline (taken 1-2 days before Stimulation):
Right Ovary: 4 (antral follicle count)
Left Ovary: 5 (antral follicle count)
Estrogen (Estradiol) Level: 33 pg/mL

Day 5 Stimulation:
Right Ovary: 6 follicles (4 worth tracking:) 12.5mm, 13.5mm, 12mm, 9mm
Left Ovary:  7 follicles (6 worth tracking:) 7mm, 8mm, 6mm, 5mm, 12.5mm, 12mm
Estrogen (Estradiol) Level: 330 pg/mL
Endometrium (uterine lining): 6.4mm trilaminar

Day 7 Stimulation:
Right Ovary: 7 follicles (6 worth tracking) 16mm, 19mm, 15mm, 10mm, 12.5mm, 12mm
Left Ovary: 7 follicles (5 worth tracking): 12.5mm, 9mm, 10mm, 6mm, 8mm
Estrogen (Estradiol) Level: 1009 pg/mL
Endometrium (uterine lining): 8.7mm trilaminar

Day 8 Stimulation (today!):
Right Ovary: 9 follicles: 9mm, 7mm, 19.5mm, 15mm, 18mm, 9mm, 11mm, 17mm, 8mm, 8mm
Left Ovary: 7 follilces: 14.5mm, 11mm, 6mm, 11.5mm, 17mm, 6mm, 4mm
Estrogen (Estradiol) Level: 1300 pg/mL
Endometrium (uterine lining): 10mm trilaminar

Remember what I said after my Day 5 Ultrasound:  baseline is taken before meds are started.  At that point, they do an antral follicle count to see how many follicles there are.  I had 9 total, but you'll notice today there were far more than that first day.  It's not because more follicles develop, but that with everything starting to mature and grow, you can see more than before.  Some of them were hiding at the baseline.  We're waiting for as many follicles as we can, to grow to larger than 18mm which would indicate a more mature egg.  We're hopeful for 8 mature eggs from this Stimulation!!  Fingers crossed!

Trigger shot is slated for tomorrow night.  I won't miss this Stimulation phase - but I'm definitely a little anxious for what's next!

A few of my favorite things

Don't lie - the moment something new goes on with you or you hear about some awesome new face cream or some celebrity died or a doctor tells you you have xyz-itis, you Google it.  Even though you know you could get a lot more crap coming back in those search results than is worth digging through.

Well, I do the same thing.

So as soon as we started thinking about heading down this IVF road, I was Googling for info and yet also trying to absorb everything I was reading with a grain of salt.  But not everything out there is junk.  Along the way I've found some blogs, videos or articles that seem pretty legit or make a lot of sense or have been very helpful to me.

Maybe you'd like to see them too?  (I'll come back and add to this list periodically):

Blogs:

• Best Friend's Guide to IVF - I like this list she came up with, tho from my experience, the side effects and "pains" she's listed are far from reality.  But could likely be due to a difference in our medications.
• 12 Tips for IVF - This is another cute and somewhat helpful list.  I haven't found that I need to work from home or am even too tired to cook dinner, but everyone will react differently.  (I'm also not on progesterone yet since we're just banking embryos now and will do the transfer later on.)
• Fun with IVF - I actually found myself laughing out loud at some of her entries.  She has a lot of humor in her writing (which is what I think we all need to keep us a little grounded through this fun time).  Plus - she has a happy ending!

Videos:

• Today Show Couple - this segment was SO timely.  I saw it live as I was getting ready for work one morning, literally the same week Dr. A suggested we think about doing IVF.  It's a great (albeit slightly dumbed-down) summary of the IVF process. Note both videos in this article are worth watching!
• Mixing Follistim and Menopur - Dr. A sent this to me, but it's really the best video out there showing how to mix those specific meds that I happen to be taking.  It's really not rocket science and for the most part, as long as you get everything mixed together into 1 syringe and then injected into your belly - you're golden.
• Injections - I really like this nurse-lady from the Sher Fertility Institute.  I have a feeling she'd call me "Hon" if I was spending time with her in person.  She's in a lot of their videos and they're all very helpful.
• Various Videos from Sher Fertility Institute - the same nurse-lady does lots of helpful instructional videos depending on what you're looking for.  Mixing specific medicines, giving different types of injections, even a discussion on genetic testing.

Informative Pages:

• Day 3 FSH and Ovarian Reserve - Our specific infertility issues stem from my elevated FSH levels (we've seen anywhere from ~8.9-12.2 mIU/ml) so finding this page (and LOTS of other pages at Advanced Fertility Center of Chicago) has been helpful reading.
• Female Hormone Levels - I'm a numbers person, so it was nice to read through the information on where I should expect to see certain hormone levels (estrogen and progesterone) on specific days during and even before my IVF cycle.  Maybe we shouldn't do this but we all want to check if we're "normal", right?
• The Significance of Monitoring Infertility Treatments - Came across this page when I was looking for information on what tells the doctor to stop Stimulation and trigger for retrieval, but it has great information about what doctors are looking for all along the way.
• Intracytoplasmic Sperm Injection (ICSI) Fertilization - Pronounced "ick-see".  This is the process of injecting a single sperm into an egg in order to fertilize it.  As opposed to placing sperm and egg into the same dish and hoping to see fertilization that way.  It's typically been used in situations with severe male infertility, but can also be helpful in cases with high FSH (me!) where the eggs might be "harder".  Additionally, ICSI is recommended when doing PGS.  Sometimes additional sperm remain stuck to the embryo, so if the biopsy gets part of the sperm in addition to the embryo cells, it could generate false results.
• Understanding Cleavage Stage Embryo Grading (up to ~Day 3) - After your retrieval you'll start getting information about your embryos and this page will help to understand what is being evaluated.  However, note that by ~Day 5 the grading (for us) changed to the Gardner blastocyst grading system, below.
• Assisted Hatching - The embryologist thins the thick protein shell around the embryo to help it hatch.  This has been found to help in implantation but can also increase the chance of identical twins.  For us, it's automatically done as part of the PGS process since they have to get at 1-2 cells from the blastocyst in order to biopsy it.
• Gardner Blastocyst Grading System (~Day 5-6) - Embryos become blastocysts around Day 5-6 and our grading changed to the Gardner system (a number + 2 letters, ie: "5BB") at this point.
• Preimplantation Genetic Screening (PGS) - The process by which cells are taken from a blastocyst and evaluated to test for chromosomal defects and abnormalities.  Frequently abbreviated to PGS and what I refer to in this blog, as genetic testing.  (PGD is slightly different - D stands for Diagnosis.  This is the same idea but only looking for a specific genetic disorder carried by the parents and not an overall chromosomal screening).  PGS will help us to ensure any embryos we select for transfer are chromosomally normal.  This new capability has increased IVF success from ~30% to ~70% in recent years and in some cases reduced the "risk" of multiples.
• Causes of IVF Failures - a sad part of the IVF process is that it does have failures and it's important to be aware of what could cause a failure.  IVF isn't a sure-fire solution and everyone should definitely be aware of that.

5 Day ultrasound

Yay, it's working!

The first big checkpoint during IVF Stimulation is the midpoint ultrasound, around day 4-5.  It's the first time seeing the doctor after starting Stimulation.  For me, it was yesterday morning.  And thankfully - everything looked great.  Like I've mentioned before - Dr. A is a very optimistic and positive thinking doctor.  She delivers all news with a smile and an attitude that's like "everything is awesome!"  So it's sometimes hard for me to gauge if things are just okay or actually better than expected.  Her reaction to my ultrasound seemed to be somewhere around ever-so-slightly better than we were expecting (??) so I'm feeling pretty positive about that!

My Specs

Baseline (taken 1-2 days before Stimulation):

• Right Ovary: 4 (antral follicle count)
• Left Ovary: 5 (antral follicle count)
• Estrogen (Estradiol) Level: 33 pg/ml

Day 5 Stimulation:

• Right Ovary: 6 follicles (4 worth tracking:) 12.5mm, 13.5mm, 12mm, 9mm
• Left Ovary:  7 follicles (6 worth tracking:) 7mm, 8mm, 6mm, 5mm, 12.5mm, 12mm
• Estrogen (Estradiol) Level: 330 pg/ml
• Endometrium (uterine lining): 6.4mm trilaminar

To decipher this a bit - a baseline is taken before meds are started.  At that point, they do an antral follicle count to see how many follicles there are.  I had 9 total, but you'll notice yesterday there were more than that first day.  It's not because more follicles develop, but that with everything starting to mature and grow, you can see more than before.  Some of them were hiding at the baseline.  We're waiting for the follicles to grow to larger than 18mm which would indicate a more mature egg.  Dr. A is hoping to get 6-8 mature eggs from these 10 we're tracking.  She said this is all excellent and exactly what we want to see.  Sweet!

She went on to call my estrogen levels "awesome" stating that a level of 150 pg/ml would be considered appropriate for yesterday and anything higher is great.  Well great!  This is all... GREAT!!  

We're supposed to stay the course tonight (injections-wise) and add Ganirelix tomorrow, which will help to hold off my ovulating too early.

Overall I'm still feeling very good.  I think I'm feeling more bloated, but I'm not sure if it’s really bloating or the few pounds I've gained from backing off on the running the last few months (man, the sacrifices we make for our kids – before we even HAVE them!)

About halfway through and so far so good!

Shots, shots, shots, shots, shots!

There is still a little kid in me that HATES getting shots.  Why is that?  It's a teensy little prick that you feel for about half a second.  It's far less painful than say, running a half marathon - and yet I've opted to do the latter voluntarily!  Yet so many of us HATE shots.  HATE needles.  Dread it!

It's kind of a good thing that the injections snuck up on us a week earlier than we'd been anticipating - cuz we skipped over all the anticipation of getting/giving the shots and just HAD to suddenly face doing them the next day!

Well one thing any IVF patient learns very quickly is that, those shots?... they are so totally not as bad as you're expecting them to be.  I thought my heart was going to pound right out of my chest with anticipation as I was waiting for Hubby to stab that needle into my belly and get it all over with already.  And then I kept waiting, and waiting and was about to yell at him to hurry it up, cuz the suspense was killing me - when I realized he'd already given me the shot!  Let me tell you: ICE IS YOUR FRIEND.

I read online somewhere that icing before (and after) the shots is good for 2 reasons - numbing the injection site and reducing bruising.  Now, as I lie on the couch each night with my icepack resting on my bare stomach for 3-4 minutes, I do find myself thinking - "isn't this actually more painful than a half-second-long prick?"  But I digress!  Definitely use ice, my friends.

Now, a play-by-play of the first 4 nights of shots.  Cuz everyone totally wants to read about shots, right?

You'll recall from this post, all the meds we have to get from inside vials and cartridges INTO my belly fat...

Night 1:  It took us almost half an hour to prepare the injection.  It's very intimidating looking at all these vials and needles and bottles and containers.  We laid everything out, read the instructions about 10 times each, double-triple checked each measurement and medicine and of course all the while we were both a little anxious about that first shot.  We made the decision that Hubby would administer the shot each night, even though I know plenty of women do self-administer.  But I like the idea of him having a role in all of this and I also liked that I could pawn that responsibility off on him!  Fortunately we were able to mix 3 different medicines into 1 shot.  Thank you Dr. A!  This is the night I was waiting and waiting and waiting for that shot and realized he'd given it and I didn't feel it at all.  Awesome!  Zero side effects other than a tiny red dot on my belly which I noticed was still there by the next night.

Night 2:  Already way easier all around.  The injection took half the time to prepare and Hubby was able to give the shot faster too.  Tonight I felt just a tiny sting as the medicine went in - I'm wondering if I took it out of the fridge too late and the meds were still cold.  Note to self: take the meds out of the fridge about half an hour before injection time.  I noticed some slight red splotchiness on my belly shortly afterwards, but not exactly where injection was.  Dr. A told me later that it's normal.  I've maybe noticed some tummy gurgling going on – or maybe that’s just the chili I had for dinner?

Night 3: Totally becoming not a big deal and totally didn't feel the shot again tonight.  The faint splotchiness from last night stuck around today but was gone by late afternoon. Not feeling any bloating yet.  So far everything is great!  No side effects!

Night 4: No biggie.  Piece of cake.  I did notice that I had a headache after the shot tonight that didn't go away until late the next morning.   Perhaps my first side-effect?  (not a bad record!)  Dr. A told me that it's probably due to the increase in estrogen my body is producing.  I didn't take anything for it and it went away on its own.  I also noticed a tiny bruise – almost unnoticeable though.  I keep examining my belly to see if I see signs of anything!  With so few side effects I'm wondering if anything's going on in there?!  Hello, is this stuff working??

"I'm gonna go to med school after this"...

Hubby has joked around saying this each time he's administered a shot.  I'll wait until my next post to go into details about the actual injections, but wanted to first share all these medicines we're dealing with.  Hubby and I feel like we're reading a cookbook as we measure and mix and stir and combine.  It can be a bit tedious and especially that first night: intimidating, but it quickly becomes routine.

I kinda feel like a pharmacist or something handling all this stuff...

My Drugs:

(may totally differ from someone else's either in types or dosages)

Nightly: 150 IUs Follistim
(used to help mature eggs/follicles)

Nightly: 2 vials Menopur
(used to help mature eggs/follicles)

Every other night: 50 IUs Omnitrope
(this is not specifically an infertility drug, but has been
shown to help the maturation of eggs in IVF cycles)

Nightly starting Day 5: .5mL Ganirelix
(used later in the Stimulation to hold off ovulation)

~36 hours before retrieval: Novarel
(trigger shot to help ovulation along)

It's an intimidating group, but you quickly become very familiar with each of them.  And by the end of the cycle you're all great friends.  Sorta like summer camp... ;)

Here's what I need each night to get all these drugs into mah belleh:

Start with the above on Day 1, and continue every other night

Start with the above on Day 2 (Day 1 minus Omnitrope)
and continue every other night

It's almost exactly like mixing a cocktail. ;)  Who doesn't love mixing a cocktail?! (I guess I'd really just prefer drinking one.)

Here's a video Dr. A forwarded showing how to mix the injections of Follistim and Menopur.  We weren't shown how to use the Q-Cap, but no biggie - we just use the syringe to mix everything.

On days requiring Omnitrope or Ganirelix (or both), we add it/them
into one of the Menopur vials and continue as indicated

It's fun - it's totally fun.  OK not really.  But if all of this gets us a couple healthy babies it's all worth it.

xoxo, the Mixologist

The roller coaster starts

I definitely have a love/hate relationship with this Mother Nature character.  After 2 full days of examining calendars, discussing our holiday options and weighing work stress – Hubby and I decided to move forward with starting injections this month, on day 2 of my period.  This would mean canceling our trip to visit his family the day after Thanksgiving – something we would offset by visiting them during Christmas instead.  Our other options were pushing the stimulation start out 2 weeks (big projects at work near retrieval day) or pushing it out a month with my natural cycle (retrieval would fall like, ON Christmas day).  We also could have waited until January but we just didn't want to keep pushing this out – the whole idea is to "get sh*t done", remember?!

So – we were feeling comfortable with our decision.  Talking about what we'd tell his family and when we should tell them.  Trying to psych ourselves up for the idea that we'd be starting injections in just over a week!  Eeeks!!

And then….

AND THEN…..!

My period arrived…ONE week early (I'm usually like clock-work.  WHAA?!!)  

This was – mostly good.  It meant stimulation would no longer fall right DURING the Thanksgiving holiday and weekend afterward, and would therefore not disrupt our travel plans (good thing we hadn't told anyone they were changing yet!)  But it did obviously move everything up about a week.  That meant there was a chance (tho teeny-tiny) that the retrieval would fall on Thanksgiving Day.  It also meant that the scary injections that I was trying to psych myself up to happen in a week – would be happening TOMORROW!  Good thing we didn't have plans to be out drinking, clubbing and dancing like we usually did on weekends(…8 years ago).

The week ahead looked light - that was good.  Nothing needed to be cancelled - no excuses made.  I really had no idea what to expect in way of side effects from the injections over the next 10 days.  I'd heard exhaustion and a lot of bloating/bruising which would get worse the farther into Stimulation one was.  But obviously I had no idea how I, personally would react.  But better to have a clear week and fridge full of leftovers, just to be safe.

Since I haven't mentioned it before - allow me to share the overall IVF schedule we will be following as per Dr. A's program.  We are opting to do PGS (Pre-implantation Genetic Screening, also known as Pre-implantation Genetic Diagnosis) which is the genetic testing you've heard me mention.  This is an additional cost and something very new to mainstream IVF, but a game-changer.  This also changes the schedule we follow where there is a large break between retrieval and transfer - different than most traditional IVF schedules people are used to.

Our IVF Schedule:

• Stimulation - starts the 2nd day of your period.  Consists of injections each night to stimulate your ovaries to mature all the eggs.  Stimulation typically lasts about 10 days where you're taking injections to mature the eggs while holding off ovulation.  Numerous ultrasounds and bloodwork are scheduled throughout in order to see how the follicles are growing and check your estrogen levels in order to know the best time to go in and retrieve.
• Trigger - around Day 10 of Stim the doctor will prescribe a "trigger" shot which should provide final maturation for the eggs and help ovulation along.  Retrieval should happen within 36 hours of this trigger shot.
• Retrieval - roughly Day 11 or 12 of Stimulation.  An outpatient procedure with either general anesthesia or heavy sedation.  The Hubby will need to provide the swimmers (and be there for moral support, help you home, clean the house, cook you dinner, give you a massage, buy you a new handbag etc.) so it's an all day commitment for both of you.  The doctor will go in and suction out the matured follicles in the hopes that they contain mature eggs.  They are immediately whisked away to the embryologists who will fertilize them.
• PARTY!!! - at this point you can kick back and relax.  Take a vacation, go out and party, run a marathon etc.  You get a break for about 5 weeks.  Essentially you have to wait until your body is ready for implantation and your body essentially just ovulated.  Typically a body is ready for implantation about 1-2 weeks after ovulating.  But we also have to wait for the genetic testing which takes about 2 weeks AFTER the embryos have aged 5 days.  At this point, your body isn't in the right phase of the cycle to do a transfer so it takes another 2 weeks after that before transfer can happen.  Hence ~5 weeks after retrieval.
• Embryo maturation - "meanwhile, back at the lab..." your fertilized eggs are (hopefully) growing and splitting and doing so beautifully.  The best eggs were chosen to be fertilized by the best sperm and now they're being monitored by embryologists.  If they don't look promising, they're discarded.  The hope is that there are great looking blastocysts by Day 5.  If so, a micro-section of cells is removed in order to be biopsied as part of the genetic testing.  A couple weeks later we'll get a "report card" back for each of the embryos.  And thus the whole parent-judging-their-children begins!  "Why did you only get a B+ instead of an A?!?"  We'll hang the report card on our fridge if our "kids" have performed well enough...
• Transfer - ~5 weeks after retrieval (if doing PGS) the chosen embryo(s) will be transferred during another out-patient procedure.  This one is without any sedation or general anesthesia and is a very fast and painless procedure in the big scheme of things.  Go home, lie around for a couple days, and keep your fingers (and legs?) crossed that the kid with the great report card is continuing to excel in there.

It can be a long and complicated process with many possibilities for disappointment along the way.  But here we were, about to get in, sit down, shut up and hold on - the IVF journey was about to start!

Baseline ultrasound and the holidays

Yesterday was about a week before my period would begin, so we went in for a baseline ultrasound appointment.  We needed to check if the ovarian cyst I had last month (most likely due to the birth control pills Dr. A put me on to get me ready for October stimulation…which didn’t happen because of the cyst - whatthewhat?!) was gone.  And then if it was gone and we were cleared for starting stimulation this month, they needed to check my lining and get an antral follicle count, etc.

I knew in the back of my head that I mostly wanted to get the green light to finally move forward with stimulation (and thus, with IVF) but I also knew that I kinda DIDN’T want the green light cuz it would likely mean canceling our trip out of state to see Hubby’s family during the Thanksgiving holiday.

Well we got the green light!  Cyst was gone.  Antral follicle count was 4 on the right side and 5 on the left, which got us a “great” from Dr. A.  And my uterine lining looked “fantastic “!  We can start the stimulation injections on Day 2 of my cycle/period, should we make that decision.

Thus started a couple days of complicated decision-making/compromise/studying of the calendar.  How fair is it that the actual definition of marriage (compromising) was tested immediately upon venturing into this world of IVF?  As if we didn’t have enough on our minds – now we needed to discuss the best timing for injections/retrieval while balancing holiday travel and work (whose family do we see?  whose family don’t we see?  or might we need to just split up for the holidays?  whose work schedule gets the most stressed rushing around to time shots and ultrasounds?)  And you can’t just say – “oh hey, I think I want to start my IVF stimulation… next Thursday!”  Nope.  Mother Nature just does what she wants and if it means you eat turkey takeout at home by yourselves with a syringe of Menopur for dessert, that’s what you do.

Here are the stimulation milestones we needed to weigh in order to decide when to start:

• Cycle Day 1: the day your period arrives.  Really this means it's go-time and the schedule can't be altered unless it's pushed out at least a couple weeks.
• Cycle Day 2/Stim Day 1: baseline blood-work to check estradiol (estrogen) levels.  You want the levels to be between 25-75 (the lower end, the better).  Start injections in the evening.  They need to be at the same time every night, a couple of them have to be refrigerated and there is a good 5-15 minutes of prep/mixing involved before the syringe is ready to go.  So this makes traveling during stimulation quite challenging. 
• Stim Day 5: Dr. A would want to see me for my first ultrasound/bloodwork. This would also make traveling a little difficult :-|.  Additional ultrasounds/bloodwork are slated for Stim Days 7 and 10
• Stim Day 10+/-: somewhere around here, depending on how the follicles are maturing, the trigger shot is prescribed.  
• 36 Hours After Trigger Shot: The 1-day outpatient retrieval procedure (under general anesthesia) happens, followed immediately by fertilization.  Both Hubby and I would need to be VERY present.

The box of medications that arrived on our front porch last month was large enough to have held a case of wine (I wish it had?)  One does not travel lightly while on IVF stimulation drugs.  Let’s also not forget that the stimulation can cause more and more bloating and discomfort the further into it one gets.  It’s really not something you can casually do and continue to very easily partake in daily activities.  It’s really meant to be a time to try and rest up and take it easy.  So really the choice was: IVF or travel.  We could not have done both...

Another option I had (instead of missing holiday travel) was to go on birth control pills again to delay stimulation by 2 weeks - but not have to wait a full month for my next natural cycle.  I could wait until my period started, then start the BCPs and remain on them for a minimum of 10 days.  After stopping, stimulation injections can begin 5 days later (as long as the BCPs don't cause another cyst.)  That seemed like a great compromise since it would allow us to enjoy Thanksgiving with our families and still get the stimulation and retrieval in before Christmas got too close.  Oh, but until we realized that would put our retrieval on the same day as a HUGE annual deliverable Hubby has at work.  **GAAAAAAHHHHHH!!!!!!!**

OK, what if we wait until my natural cycle in December?  Oh that puts retrieval day on December 25th...  "All I want for Christmas is tons of healthy blastocysts!"

So this is why Dr. A doesn’t really recommend you invite IVF over for the holidays…

And here we are...

It's sort of a little joke Mother Nature decided to play on me, I suppose.  My mother had me when she was 40 years old and my sister when she was 42 (Sissy's lucky she had her kids young!  Sheesh!)  When Mom was in the hospital birthing me, a nurse actually thought she was joking around when she responded "40" to the question "what is your age?"  I lived my whole life thinking I had the best genes a girl could be given: time and no (physical) pressures causing the clock to tick too loudly.  So I wasn't all that concerned when my most serious relationship ('til that point) ended when I was 30, even though I'd been living my whole life to become a mom.

Let's fast-forward a little: I met Hubby at 32, married at 35 and went off The Pill the same month.  "Oh this should be easy," I thought.  "I'm still 4 years younger than Mom was when she started trying."

But it wasn't easy...and it wasn't easy for a vast majority of my friends who'd been trying quite a bit longer than we had.  In a way - that 6 months of Trying-Before-You-Can-See-A-Fertility-Specialist couldn't come fast enough because Hubby and I are very analytical and results-oriented people and wanted to start diving into whether there might be issues or not.

Meanwhile I asked my mom if there were such things as ovulation predictor kits when she was trying to get pregnant and she didn't even know what I was talking about.  That means that back in 1976, this 39-year-old woman, who got married in August and was pregnant in January didn't even know when she was ovulating.  Totally not fair, Mom.  Totally not fair.

So the results came back: Hubby is perfectly fine and hearty and manly and robust and his sperm could collectively lift a car off a human should they come across such an accident.  All kidding aside, this was actually of course, great news.  Now I could get ALL the attention.  :)

First things first - Dr. A, my reproductive endocrinologist, found a uterine polyp.  Little goober... don't know how long it was hiding out in there, but she suggested that it could have been part of the problem.  Uterine polyps aren't dangerous, but they can certainly get in the way of a fertilized egg implanting into one's uterus!

However, the slightly bigger deal was that she also found my FSH (follicle stimulating hormone) levels to be slightly elevated.  These can fluctuate each month: one month I was 8.9 and another 12.2.  Neither is low (which one would prefer them to be) and the 12.2 is kinda getting into that "higher" range.  Dr. A is a very optimistic and positive thinking doctor who basically delivers all news with a smile, so I'm not always sure how serious a situation is.  Her email tone when delivering the 12.2 number was far from "run for your life!!!!" nor was it in all CAPS, and her attitude has been very "yah, you could keep trying naturally..."  But - Hubby and I have joked throughout our entire relationship that we work so well together because we both just like to "GET SH*T DONE", so continuing to try naturally was not what we had in mind.  Dr. A's recommendation for the fastest route to being pregnant, was to do IVF.  We went to her to get pregnant and she felt the best and fastest way for us to get pregnant was to do IVF.  Not only could we hopefully isolate the very healthiest of eggs to have a baby now, but once we did, we could freeze embryos for the future.  So no matter how high my FSH levels get down the road, we don't need to be as worried about how we'll obtain the family we want (a dog, the picket fence and those 2.5 kids - maybe only .5 of a kid will be easier to conceive?...)

We'd only really officially been trying for 8 months at this point and had tried nothing else.  It seemed a bit like leap-frog to suddenly be discussing IVF before we'd even celebrated our 1st wedding anniversary.  Should we talk about fertility drugs?  How about IUI (intrauterine insemination)?  But that's the whole reason I was going to Dr. A.  She likes to get sh*t done too:  she doesn't require all her patients to ride the exact same merry-go-round of treatments if those treatments don't seem to make sense for that particular case of infertility (go figure, right?)  I know at least 2 other friends being put through the FIFO pipeline of infertility treatments just because it's their medical facility's process.  So while I'm used to hearing of people having tried "EVERYTHING" before getting to IVF and it therefore felt speedy for us to arrive there so suddenly, it's really not the best way to get there.

Here's what made IVF an easy decision for us:

1. Since my employer has fantastic insurance, it was not cost-prohibitive for us (sadly, I know this is an issue for many people and that is truly heartbreaking)
2. The genetic testing that is done has a very high probability of ruling out Down Syndrome and other genetic disorders - this is huge.  HUGE.  This is 1 item that *would* give me a leg up on my mom who, because of her age, had to have amniocentesis tests around week 20 with her pregnancies.  We would do as much as we could to avoid facing a horribly difficult decision, halfway through a physically healthy pregnancy.
3. We can take a "snapshot" of my eggs with Hubby's sperm at the ages we are today: 36 & 37, respectively, and freeze embryos to feel more confident about future babies.
4. We can better control the whole twins situation since the confidence of each embryo (having done the genetic testing to rule out abnormality/aneuploidy) is much higher than in IVF without genetic testing.  Without knowing if an embryo is "normal", 2 embryos were frequently transferred to a mother in the hopes that 1, or both, would implant, since it was usually the aneuploid embryos who would not succeed in pregnancy.  With genetic testing, we'll know before transfer whether an embryo is normal and even just how robust it is - hence: feeling more confident about only transferring 1 single embryo!
5. Also due to the genetic testing, we will know the gender of any embryos and (assuming we have both embryos to choose from) can decide what gender/order to build our family.  A new definition for the term "Family Planning"!
6. We've found no compelling studies of harm either to the mother or to the babies who have gone through/come from IVF over the past 30+ years.

Um, it kind of all makes sense.

And now the odd reality which resulted from all of this information?:  If I could get pregnant right now with only Mother Nature's assistance (oh and I guess Hubby's too), vs. getting pregnant via IVF, I would opt for IVF.  It is mind-blowing where we are with science today.  The miracle of life has always been a true miracle, but lately it almost kinda has nothing on the miracle of IVF!

And so... here we are!
I have no idea how long or short this journey may be, but you're welcome to accompany me.  (Hey - I'm a poet in addition to being long-winded!)