WTF Appointment Followup

c3db6596bdbdf58f0024f5de396179f7Also known as, not fucking pregnant yet. Or, let’s try this next time.

As most of you know, last Friday I had the followup appointment to my failed fresh and frozen transfer. After some drama getting the Dr on the phone (middle of the day phone appointments are a bad idea mmkay?) I have a game plan.

As expected, right now, there is no for sure reason why it didn’t work, it was either bum embryo’s or implantation failure. Egg quality is good. Sperm is good. Lining was textbook. Bloodwork is good. All in all Bill shouldn’t be able to look at me without me getting knocked up. But as we all know, that isn’t happening. So the Dr will be treating it as implantation failure and we will operate on the assumption that my body is an asshole and views our embryo’s as a foreign body.

As per my questions list, here are the answers to those questions:

  • Why did I have so many immature eggs? (7 out of 17)
    • Dose was started low due to high antral follicle count. Small follicles did not catch up in time.
  • Of the immature, how immature were they?
    • Not overly immature. Starting at a higher dose will resolve this issue.
  • Were any over mature or were those not retrieved?
    • The overmature eggs were not retrieved.
  • Is my overall egg quality okay for my age?
    • Egg quality is great.
  • Did we have any sperm issues of any sort?
    • Sperm quality is great.
  • Out of 10 fertilized eggs, only having 2 to transfer and 2 to freeze, is that an okay amount?
    • Fertilization and the amount that made it to transfer and freeze was as expected.
  • My ovaries have repeatedly been referred to as PCO, is PCOS still ruled out for me despite other symptoms?
    • PCOS still ruled out based on bloodwork comparison.
  • Should I try adding Metformin? Specifically 1500mg extended release to try and help egg quality before next retrieval.
    • No metformin needed.
  • I currently take folgard and baby aspirin, which I have been told is fine for my type of MTHFR. But should I switch to l methyl folate and/or a different prenatal?
    • Folgard is okay for the type of MTHFR I have. Prenatal is also fine.
  • I have read that starting lovenox with stims can help bloodflow to the ovaries. Should I try starting with stims rather then right before transfer?
    • Will start lovenox with stims to help bloodflow to ovaries.
  • Should I also possibly be taking lovenox twice daily, given A1298C is linked to shallow implantation?
    • Will start with higher dose once daily, going to twice daily with positive beta.
  • Should I have excision surgery before I do another cycle? I have a consult appointment with an endo/excision specialist for February.
    • Absolutely yes.
  • Should I have any immune testing done? Endo is possibly creating an immune response, but maybe something else as well?
    • Testing could be done, will be treated as immune failure anyway.
  • Is dexamethasone enough, or should I consider prednisone?
    • Will be on prednisone.
  • What about intralipids?
    • Will take intralipids every other week.
  • Any other supplements or diet changes you recommend before cycling again?
    • Previous supplements are fine.
  • What protocol changes will you make for another cycle?
    • Will switch to antagonist protocol with a lupron trigger. Possibility of having to do freeze all. Start at 225 Gonal-F and 150 Menopur, lowering the gonal based on response. No lupron to suppress.
  • NK cell and/or dq alpha testing?
    • Forgot to ask about dq alpha, but will be treated as though I have high NK cell activity.

So to sum it up, this is what will happen over the next couple months:

  • Consult with Dr Falcone
  • Excision surgery for endometriosis, possible ovarian drilling, and recovery time (4 weeks recovery).
  • Low carb, no sugar diet (helps with endo related immune response).
  • Start BACK on cycling supplements since it takes 90+ days to affect egg quality.
  • Endometrial biopsy.

Hopefully mid to late summer I can cycle again:

  • Start with birth control for 2 weeks
  • Get period
  • Start stims
    • 40mg Lovenox once daily
    • 225 IU Gonal-F, tapered down to 125IU after 2-3 days
    • 150IU Menopur the duration
  • Immune treatment:
    • Intralipids every other week
    • Neupogen wash pre-transfer
    • Intrauterine HCG at transfer
    • Prednisone

From there it is hope for the best and pray for no implantation failure again.

WTF Appointment Questions

This coming Friday I have what is lovingly referred to in the infertility community as a WTF appointment. At this appointment I basically ask any questions about why the Dr thinks my transfers failed, and what changes we will make for another try. So far I have a fairly extensive list and thought I might share it with everyone, and see if anyone has any other additions for me. Anyhow, on to the questions:

  • Why did I have so many immature eggs? (7 out of 17)
  • Of the immature, how immature were they?
  • Were any over mature or were those not retrieved?
  • Is my overall egg quality okay for my age?
  • Did we have any sperm issues of any sort?
  • Out of 10 fertilized eggs, only having 2 to transfer and 2 to freeze, is that an okay amount?
  • My ovaries have repeatedly been referred to as PCO, is PCOS still ruled out for me despite other symptoms?
    • High antral follicle count
    • Abdominal weight
    • Male pattern hair growth.
    • Issues losing weight.
  • Should I try adding Metformin? Specifically 1500mg extended release to try and help egg quality before next retrieval.
  • I currently take folgard and baby aspirin, which I have been told is fine for my type of MTHFR. But should I switch to l methyl folate and/or a different prenatal?
  • I have read that starting lovenox with stims can help bloodflow to the ovaries. Should I try starting with stims rather then right before transfer?
  • Should I also possibly be taking lovenox twice daily, given A1298C is linked to shallow implantation?
  • Should I have excision surgery before I do another cycle? I have a consult appointment with an endo/excision specialist for February.
  • Should I have any immune testing done? Endo is possibly creating an immune response, but maybe something else as well?
  • Is dexamethasone enough, or should I consider prednisone?
  • What about intralipids?
  • Any other supplements or diet changes you recommend before cycling again?
  • What protocol changes will you make for another cycle?
  • NK cell and/or dq alpha testing?

Anything I seem to be missing?

2014 Was Shit

I would do a year in review. But who needs more depressing shit to read? I certainly don’t need a checklist to stare at to remind me how shit this year has been. Instead, I’ll just say it’s been shit. I’d love to say 2015 will be better. But in all honesty, unless I hit the lotto I don’t play, nothing will change. I’m just sitting here, waiting for my life to continue on. Because that’s what infertility does to you, and I have no hopes of spending next Christmas with a baby in my arms. Until then, I get to just sit here, and watch everyone else move on. Put up with being asked why I’m not moving with them, when will I, and why don’t I just go do ________________.

I really hate resolutions, as you never follow through on them, but I have some for this year. They are:

  1. thDo the handwritten planner thing
  2. Weekly meal plans
  3. Change diet
  4. Track what I eat
  5. Go back to the gym
  6. Get a cheaper house on land contract
  7. File bankruptcy
  8. Go back to counseling
  9. See endo specialist
  10. Do IVF again

So yeah. There’s my list. Let’s see how quickly I can fail on those!

Egg Maturity at Retrieval

I also posted this at the RESOLVE forums, but figured I would ask the community at large here for help (feel free to respond over there if that is more comfortable for you!):

I am starting a list of questions for my WTF meeting, and one of my biggest questions is about the maturity of eggs retrieved for my first IVF. In total I had 17 eggs retrieved, 7 of which were immature. That just seems like alot to me. There has been no mention of poor egg quality, so I am wondering if anyone else has had so many immature eggs at retrieval and if so, what was the reason you were given? If you cycled again, what did you change and did it bring about more mature eggs?

Right now, my guess is that my dose of meds was bumped up too late. I was at risk of OHSS due to an extremely high antral follicle count, so started out at 75IU Gonal-F and 75IU Menopur for 6 days. I was then bumped up to 150IU Gonal-F and 75IU Menopur for the following 5 days. In all I stimmed for 11 days. Although the day of trigger I was ordered to give myself one final bump of Gonal-F that morning, which was another 150IU. But of course, this is just a guess, so any comments or suggestions would be greatly appreciated. Thanks ladies!

So What’s Going On?

I’ve had some questions recently as far as where I am and what is going on now. What’s my next move? How do I feel?

Emotionally? I’m a complete trainwreck. I think that’s to be expected. The 2ww post transfer was five times worse then any other 2ww I have ever been through. Why? I think it’s because I knew there were fertilized embryo’s in there. I didn’t have to wonder if egg and sperm met. I knew they did. So at this point it means either something was wrong with both of those embryo’s, or my body just sucks. Reality is, it’s 50/50 which of those is the issue. Being how long it took just to get to that point, and being only human, I want to blame myself. Well, I should say my body, given it wasn’t willful. But, you know, that isn’t how that works. I may not have control over it, but I want to place blame on myself as opposed to it being poor luck or poor biology.

Physically? My bruises from the lovenox have finally faded. It’s a good thing I’m a fat girl and no one would ever see my stomach except Bill, because it looked like I had been beaten across the abdomen. Really hot look, lemme tell ya.

b0b5c673c756d109547635b59b59481bThe next step is already under way. I got my period 2 days after I stopped all medication and I went in for yet another baseline the very next week. Started birth control on the 12th and started lupron this past Friday night. I take my last BCP tomorrow and then wait to get a withdrawl bleed so I can go for another scan. Then I start estrogen multiple times a day in the hopes of artificially preparing my lining to transfer my 2 frozen embryo’s a couple days before Christmas.