June/July Trouble TTCAL check-in

BrightenMySky

@chloe97 I really like my RE and he is not condescending at all.  I am debating whether to ask for a different nurse, as I get the impression she will be my go-to if we go forward with IVF.  I don't want to seem high maintenance, but at the same time, taking notes is a major way I manage anxiety and it helps me focus, and if she can't see that, I don't know in what other ways she is going to exacerbate anxiety for me.  

I'm eating my feelings (pineapple pizza) right now, but have been cutting down on caffeine and trying to get back into healthier food.  Whole 30 sounds interesting.  It took a long time for me to get AF post d&c, and I had some spotting/cramping in that time.  The first AF was not bad, and then the second was super heavy, and my RE said that there was some retained material that cleared itself out that time.  Not sure if that anecdata helps you or not, but fx in any case that it's not Ashermans.  

chloe97

@BrightenMySky Anecdotal data is extremely helpful right now! Do you remember how long it took for your first heavy AF? I'm on CD 58. Thank god I took OPKs and started temping again last week to confirm ovulation or I'd be going crazy right now!

Im not a huge Whole 30 person, I just use that term bc most people know it. It's basically just eating all no processed foods. It's so hard to do in our society where 3/4 of the grocery store is processed! 

BrightenMySky

@chloe97 I have read that you should try to do most of your grocery shopping from the perimeter of the store, which makes sense in most of the stores I've shopped at--gets you out of the processed stuff.  So, my d&c was 2/1, AF#1 was mid-April, and then AF#2 (which was super plus tampon/hr heavy for a while) was the next cycle, which ended up being a little shorter than my usual. 

ETA: I was concerned about Ashermans as well.  I didn't have 2 d&cs, but I had retained material for quite some time, even after 1 d&c and a course of cytotec that seemed to work (at least when it was happening).  I haven't had a successful pregnancy yet, but my RE said my uterus now looks good.

chloe97

@BrightenMySky This is so helpful. I'm so you had to wait so long for an AF, but it's helpful to hear from someone who has had a similar scare to what I am dealing with currently. My doctor swears up and down that Ashermans after D&C is super rare, but I know that the risk increases after 2. My first AF with my MMC D&C was in 31 days and it got stuck, but it was really weird. The 2nd was heavy and normal- seeming.

roxgibbons

@BrightenMySky I'm sorry your IVF consult left you felling disheartened and the nurse was condescending. What's it to her if you want to take notes? I can imagine you get a lot of information and it just makes sense to take notes. I would.  I actually just scheduled our IVF consult as well with one of the IVF doctors at our clinic. IUI #4 did not work out and we both took it really hard. We decided to go for the consult to get all the information and costs so we have all the facts in front of us. It felt very strange not jumping into another cycle but I think this is what's best for now. The consult is in August 9th so we have a bit of time to prepare for that and decompress. If you went ahead with IVF when would you start?

@BornReady I am so happy for you. Your story brings me hope and one of the reasons I'm starting to consider IVF and PGS testing. You're almost there! Please keep us updated on your FET date. Oh and I totally feel you on the BC. I had to be on them for a 5-6 weeks in preparation for my tubal cannulation and hysteroscopy and I hated it! I felt so out of sorts.

@chloe97 I'm usually pretty good about clean eating and I usually will eat Whole 30 style, but the last couple months I haven't been as consistent and have definitely fallen off the wagon. Emotions/hormones can make a girl eat some crazy stuff. Now that my birthday is over, I am back on track or at least I need to get back on track so I prepped a bunch of food, especially if we are considering IVF and/or future medicated cycles, I need to get consistent  for my egg quality and lose the last few pounds I've been holding on to. I'm going to look into the egg quality nutrition counselor in my area. I've never heard of such a thing but I'm interested. I started DHEA per my RE's advise for now. Good luck with your ultrasound on Friday. To add to your data- I got 4 weeks past D&C but it was not heavy at all. My body was also doing some crazy stuff right before AF and I had some pretty intense cramps.  My AFs since then have been a lot heavier and more normal I guess. But the first one was definitely odd.

BrightenMySky

@roxgibbons I am really sorry this IUI was not it for you.  We are taking a cycle off from meds (in part because of an upcoming vacation), but will try naturally--I did not want to do the BCP so will just end up taking estrogen post-O if we want to move forward, and then would hope to start IVF in a few weeks assuming not pregnant at that point.  After having all the med demos this morning, DH turned to me and said maybe we should just keep going with IUIs.  Sigh.  

chloe97

@roxgibbons Thank you for the anecdotal data! I don't remember where you are, but I'm going to a holistic reproductive center. They actually do Skype egg quality nutritional counseling if you're interested.They work very closely with one of the bigger fertility clinics in here, so I trust them! My appointment is on Saturday so I will fill you all in on my appointment and let you know if it's worth it and can PM you the info. My insurance pays for services from nutritionists so I think I can get reimbursed for it, which would be amazing. It's $125 out of pocket otherwise.

My biggest issue with the diet and exercise thing is the alcohol issue. This is so weird because I was happy to give up drinking while pregnant, but it annoys me to have to do so when TTC. I think it's because so much of my social life revolves around drinking. It's so much easier for me to be around my single/or married non-pregnant friends right now and they all want to do brewery tours all the time.

fivetimesnoluck

So happy for this thread within TTCAL. Familiar with all of you - so I will skip the long intro.

TL;DR version: After a DH submitted for a second SA, RE said if he didn't know my history of five conceptions, that just looking at DH's numbers and my chart would lead him to believe we are likely infertile. (RE said that IF and RPL are first cousins and he has seen people affected by both issues, sometimes switching. Isn't that just awesome? The good news just keeps coming. /sarc)

I got the call from our office today with my protocol... I will take a small dose of Dexamethasone (steroid) for CD1-18 (actually starting today, so CD2-18). Will take a small dose of Clomid CD6-8, Menopur on CD9 and 10 and then have U/S on CD11 to determine dating of next steps.

I have DOR, but otherwise have a regular cycle and ovulate on my own, so much of my protocol (Prozac, Clomid, steroid, Trental, Menopur, etc) is mostly serving to try and produce a Good Egg.

Question: For those who have done this before, when you have your ultrasound, does that determine your trigger and IUI date? What is the typical time frame between trigger and actual procedure?

I have all the things crossed for you for your transfers, @BornReady and @AandDM2014 - hoping for the best!

I remain grateful for all of you and this community. xo

BrightenMySky

@fivetimesnoluck hugs.  All but 1 of my IUIs have been Clomid CD3-7 (give or take a day or two, depending on scheduling), u/s and bw ~ CD11, trigger that night, IUI 2 mornings later (so ~36 hrs between trigger and IUI).  The only cycle that was not like that, I wasn't ready to trigger when I went in for monitoring, but they had be come in earlier than usual for the monitoring that time, so I was always just a little confused about that one.  My RE seemed to be more concerned about bw at that point to determine when to trigger.  

roxgibbons

@BrightenMySky  we are kind of on the same break plan as you guys this month.  No meds or IUI and just giving it a try naturally. We are leaving in a little over two weeks so we decided the best thing to do would be to relax and regroup and have the IVF consult when we get back.  I can understand your DH feeling overwhelmed- it does seem like a lot of meds and protocols. I have no clue which direction we are going to go in but I'm generally feeling overwhelmed right now so I think the break will help.

@chloe97 Thanks! Yes let us know how it goes. I live in CA in the Bay Area, so I will definitely look into it. I can understand the struggle of giving up drinking during TWW. I was in the drink till it's pink camp for a while since socially we would go out to dinners or go wine tasting with friends, but ever since we started medicated cycles I've cut way down in general on alcohol and caffeine as well.  I usually don't drink during TWW now but I may have a glass of wine if it's an occasion and sometimes a glass of wine definitely helps take the edge off. 

@fivetimesnoluck This thread is great. Glad you are joining us. My IUI cycles have been Letrozole CD 3-7 and the last two follicle scans I went on CD 10. Based on the measurements of the follicles they plan the trigger timing. My last IUI they had me trigger the evening of my follicle scan around 10pm and my IUI was scheduled about 36 hours later. Generally my IUIs are scheduled 24-36 hours post trigger. One IUI I had a really large dominant follicle that was 24mm and that one my nurse sped up the trigger and IUI timing since she was afraid we would lose our window. If I do IUIs again I will do injectable meds to give me more of a boost and my understanding is they monitor every couple of days with that protocol. GL to you!!

AandDM2014

Wow, it's been a long time since a check in here! I started estrogen yesterday and will go in next Tuesday for a lining/hormone check, where they will probably increase my dose of estrace to 8mg orally and 4mg vaginally daily (that's what happened last time).

@BornReady good thing you tested! If we have to do another stim cycle we will have the embies tested as well. I super wish we had last time, but my doc didn't recommend it because I was 26 and DH was 29. No reason to suspect they would all suck.

@BrightenMySky I'm sorry your DH wasn't totally on board with IVF. It can be a bit scary for them. When we first started with our RE my DH refused to give me any shots (I had to do one trigger shot, one time). After we moved to IVF he sort of got over it when he realized what I was actually going to be going though and offered to do all my shots. I didn't do any of my stim shots; he did them all. It'll be interesting to see how your DH helps you if you do IVF!

@chloe97 I hope you appointment with your RE goes well and that the egg quality nutritionist can help you out!

@fivetimesnoluck Thank you! I'm still hoping this cycle will finally give us a take home baby!

BrightenMySky

@AandDM2014 he will definitely do whatever shots I want. For my last IUI, I had him on standby but ended up doing the trigger myself. It seems like with IVF he'll definitely need to do at least the trigger since it will be in the hip, and then we'll see about the rest. I think it was just overwhelming for both of us, and he does not want me to feel pressured to go forward or to do so right now, since it's so much on me. Which I appreciate. 

AandDM2014

@BrightenMySky That is great that he isn't pressuring you to move to IVF. I'm glad my DH didn't, as I was super opposed to it when we first started with our RE. I would definitely recommend he help you with all the shots, if you do IVF. It's just so much easier to not have to worry about it, and let him deal with remembering what dosages and how to correctly inject and everything! You'll have so much on your plate already with the darn emotions that come with the shots, plus it's the only way he can be involved (other than sample giving, which is easy and a one time thing). I know it made my DH feel included that it was his job to make sure I got the right meds to grow the eggs. I also suggest, if you have to do PIO, to have DH do them. It's so much easier!

BornReady

@BrightenMySky Sorry your IVF consult/nurse coordinator left you feeling not great about the process. When I first met with our nurse coordinator I found her to be very cold and distant. Totally not my style... I'm a therapist and thus spend a lot of my time with other therapists who are all about feelings and making one feel welcome, not this lady. She has definitely grown on me over time and is super responsive and a good advocate for me during this crazy process. Still not exactly warm and fuzzy, but I know she can take care of business so I'm cool with her now. You could always ask what your options are in terms of switching. At my clinic, which is HUGE, each physician has their own coordinator who handles case loads at each site. For me there is my main coordinator and another nurse who works out of the main office and will also follow up with me. 

@fivetimesnoluck I only did 1 IUI. Trigger was based on my estrogen level (bloodwork) and ultrasound done around day 11 of my cycle (I'm an early ovulator). I triggered at night after BW and ultrasound showed 2 mature follicles and had an IUI 36 hours after. I hear you on the "good news just keeps coming", like I've mentioned before it feels like I'm never getting clear cut good news at the RE, more like the more you know, the more f*cked up everything really is. Today my RE was talking about my fertilization and was like "Maybe your husband isn't the whole problem like we thought and your egg reserve is not as good as we thought". Thanks lady. What's this about prozac and egg quality? I've never heard that before.

@chloe97 Your egg counselor sounds fascinating. Who knew these things existed?!? This whole fertility thing is big business. 

@AandDM2014 Wishing you luck this cycle!

fivetimesnoluck

@BornReady The Prozac is new to me, just at a month of taking it. I had never heard of it linked to egg quality either, but since I have taken Lexapro in the past for anxiety, the thought of taking an SSRI didn't bother me.

I have googled it a lot and can't find much on it, but using scholar, I did find this reference by a practitioner of Traditional Chinese Medicine:

• Elevated Natural Killer (NK) cells and elevated Cell Designation (CD) cells and Altered Th-1/Th-2 ratios

All these factors can attack the fertilized eggs and prevent implantation, resulted in a miscarriage. Possible treatment for this may include LIT, Intravenous Immunoglobulins (IVIg), Humira, low dose Aspirin or Prozac.

SnobunnieMel

Sorry if this is a bit of a repeat question. For anyone who does progesterone supplements during their literal phase, how long after stopping them for AF to start? I had a BFN the day before AF would normally be due, so I stopped them and now just waiting I guess? With my last CP it took a while because of them but I wasn't sure if it was different for a normal cycle. 

BornReady

@SnobunnieMel I've only done it one cycle this far, but it took 4 days between stopping the progesterone and getting AF. It was an annoying wait.

fivetimesnoluck

Wondering how you're doing, @SnobunnieMel - did AF ever show?

As for me, I have a question: If you have had a previous IUI or other ART procedure, did you ask (or did your doctor recommend) BD in addition to the procedure, or do you abstain during the fertile window? I am going to ask tomorrow, but was curious about the group.

I feel like it couldn't hurt, right?!

roxgibbons

@fivetimesnoluck during IUI cycles the suggestion was to BD day of trigger then BD the evening of the IUI. The only time that didn't happen was once when the trigger was the day before because I had a dominant follicle that was way ahead and we didn't want to deplete DH's sample. The timing is essentially 48 hours before IUI, and night of IUI. I would sometimes even throw in the next day too and the RE said that was fine too.

BornReady

We had the same instructions as @roxgibbons. We were doing BD every 48 hours the week before IUI to keep his sample up and were told 48-36 hours before IUI and then as much as possible after the IUI (night of and morning after).  I had a feeling the morning of trigger that we would be triggering that night due to follicle size, so we BD as soon as I got back from the morning monitoring appointment. We have MFI so I didn't want to be less than 48 hours.

@SnobunnieMel I've been thinking of you too, hope all is OK.

SnobunnieMel

@bornready @fivetimesnoluck yes AF showed up about an hour after finding out my SIL was pregnant. Again. Great timing bitch. I'm in a pretty deep dark hole right now so I've been staying away this week. The BFN and the weekend and her news was already really bad for me and then I found out I'm a carrier for 3 recessive diseases, 2 of which are bad, early childhood fatality bad.  DH had to get the progenity panel done now to make sure he doesn't carry any of the ones I do. No one in my family has ever had them, I'm not of that ethnic risk group. Way to be the 1/300 and 1/500. Again. I'm just so tired of hating myself and hurting that I am going to probably stay gone for a while. We go back to the RE Friday but are no closer to a plan now that we have to wait on more tests. 

roxgibbons

@SnobunnieMel I am so sorry about your test results and the dark place you are in.  It's all so crappy and unfair-We've all been there and completely understand how you feel. Sometimes it just feels like too much and all you want is to catch a break in this shitty process.  I was there as well after my BFN on the last cycle and was getting tired of the disappointment, and for a couple of days I really wanted to just throw in the towel and say fuck it. 

My fingers are crossed that your DH's test results are clear so that even if you are a carrier, it's a non-issue for the future. If a break is what you need and to regain some semblance of normal, it's completely understandable- It's been a rough couple of weeks for you- many, many hugs to you. 

edited: for typos

BornReady

@SnobunnieMel So sorry to hear about your results. It shouldn't have to be this hard. I unfortunately know that feeling of self-hate and pain well, always around if you need to vent.

fivetimesnoluck

@SnobunnieMel I'm so sorry for all the shit piling up at once. Take all the time you need. I'm sending big love and will keep you and DH in my thoughts, hoping his results provide good news and that y'all find some light in the darkness. xoxo

SoonToBeMommaHowe

Lots of love for you @SnobunnieMel

Hopefulmommy1980

@snobunniemel I am so sorry so many bad things are going on right now. Sending lots of positive thoughts your way. 

AandDM2014

@fivetimesnoluck apparently my RE is a super weirdo and does two IUIs, 24 hours apart, every cycle. I've never heard of anyone else doing that. We were also encouraged to BD sometime after the second IUI before we went to bed.

Aera11

Oh @SnobunnieMel I am so sorry my heart is hurting for you.  Take extra good care of yourself right now. 

brooklyngirl18

@SnobunnieMel big hugs girl, I'm sorry you've had such a shitty go of it recently. I hope your dr can come up with a plan soon and you can focus on more positive things.

fivetimesnoluck

Thanks for the insight, ladies. Our recommendation is to BD day after IUI, but not before (to help concentration).

I am intrigued by your doctor's approach, @AandDM2014 - definitely different, but why not increase the odds?

My appointment this morning went well. I had one follicle ready to go, so I will trigger tonight and have the IUI on Saturday.

Fingers and toes crossed that the stars align.

AandDM2014

@fivetimesnoluck Yes, I think that is why he chooses to do it that way. They time it so that the first one is the day I'm going to ovulate, and the second one is the day after. It didn't really help us, but we have no idea what the quality of my eggs is, so that could have been why it didn't work.

chloe97

Don't mind me I'm stuck in the box.

 I had my CD 3 blood draw today- complete with 17 vials of blood. How I was able to drive afterwards, I have no idea. I was so nervous for today thinking I'd get my results this afternoon, but the nurse said that it will take 1-2 weeks and then I will schedule an RE consult to go over them. I also have my HSG and hopefully saline sonogram next week.

It occurred to me today that I may have set myself on a path that I don't want to go down. DH and I decided barring some sort of bad news from the RPL panel that we would trying again naturally. If my FSH/AMH is too high/low, they probably won't do IVF anyway. I carried the (chromosomally abnormal) last pregnancy 13 weeks, so it's very doubtful outside of DOR that there is anything they will find. The only major concern that I'm worried about is scarring, which is why I decided to be aggressive. 

This is is a tagent, but because my aunt on my dad's got diagnosed with breast cancer at 45 and died at 55, I got the BRCA gene testing done. It came back that I have some sort of mutation in my BRCA gene, but they aren't sure if it's clinically significant or not. So now, I have to sit here and wait to see if they ever clear the particular mutation from being one that is harmful and worry constantly I'm going to get breast/ovarian cancer in the next 10 years. I can't even qualify to have my breasts/ovaries removed prophylactically because it's unknown if I have bad BRCA gene. My Dr never explained to me that 1-2% remain in limbo and it just sucks being here.

This is kind of how I feel about FSH/AMH testing right now. Unless I have abnormally good results, all it's going to do is freak me out.  

roxgibbons

@chloe97 sometimes I miss the "ignorance is bliss" days. I feel those of us who have been through loss and have started down the path of working with an RE know so much (sometimes too much) that it seems like every result or possible path could lead to potential bad news or some unknown. On the infertility board there is a Low AMH/DOR thread and many of them did IVF and the majority of them are pregnant or had a baby. Depending on how bad the DOR is, IVF is definitely an option, so in the event you have DOR, there is hope so please don't give up on that. The key is the response to the meds. Fingers crossed you have some good results on your tests.

As for your BCRA, is the Dr going to look more into that or is it a wait and see at this point?

Hang in there, I know it's extremely hard and you are in good company- keep us posted.

Also- did you ever go see that egg quality nutritionist?  I think you mentioned you had an appointment with one.

BornReady

@chloe97 Glad you had the opportunity to do the bloodwork today, one step forward, right? My CD3 labs were an insane amount of blood work too, I was horrified when they just kept going. My RE does a similar thing with bloodwork. Nothing is put on the patient portal and they only go over it all in person at a follow up. A huge difference from my PCP and other doctors who update all labs. However, I suppose it's better than me googling levels without having someone explain everything.

AS far as the "path"... I hear you. It sucks knowing so much about your body and the likelihood (or not) of achieving and maintaining a pregnancy. For me it has added a whole new level of anxiety and grief, but there isn't much that will change. I just keep reminding myself I'm here and working towards my goal of a healthy pregnancy that results in a baby I get to live with and take care of.

I also second @roxgibbons regarding the DOR/low AMH thread on the infertility board, there is a lot of hope there.

Fingers crossed for you as you wander down this path.

chloe97

@roxgibbons and @bornready Thank you both so much for your thoughtful responses! You guys are amazing resources on this board. So I started a post that I never finished about the egg quality nutrition counselor. Basically, she was okay. Basically, told me how I was eating was good already but to cut out caffeine and chocolate. She was helpful with supplements, but I probably wouldn't pay the $125 for her if my insurance wasn't paying it. I could have just read It Starts with an Egg and walked in the store and asked about the supplements. 

My Dr went on maternity leave right after she requested the BRCA test and her stand-in made it seem like it was no big deal and at the time I was pregnant and had more pressing things to consider. I'm supposed to go back in September before we start TTC so I will probably ask her what sort of new clinical followup we will do. I think I will get twice yearly mammograms and yearly pelvic ultrasounds and CA-125 tests until we find out one way or the other. I don't want my parents to worry, but I'm thinking about asking them to get the testing. If mom shares the mutation, I will be far less freaked out about since my mom's side is pretty free of cancer.

SnobunnieMel

Nothing like finally having a few good days in a row then good old fashioned mail arrives to bring you back down to reality. Thank you free formula samples, for the reminder that I will not be having a baby in 9 weeks.

BornReady

@SnobunnieMel I'm sorry, this is all so horrible. Miscarriage is just loss after loss after loss and it can feel so overwhelming.

BrightenMySky

@SnobunnieMel that is so crappy.  

@chloe97 hugs, sounds like a lot to handle all at once.  Did you talk to a genetic specialist at all about the BRCA results?

@fivetimesnoluck fx for your IUI!

I have a question.  Has anyone ever taken estrace?  I just started it to prepare for IVF next cycle (unless against all odds I am pregnant this cycle with no interventions).  Dr said it's fine to take if I turn out to be pregnant, but my question is about grapefruit juice.  No one told me anything about it, but in googling, I see that grapefruit can mess with the estrace function.  Sadly I just got really into these grapefruit seltzer spritzers.  Wondering if it's ok as long as I don't drink one within a few hours of taking the pill, or if I should just not drink them.  

roxgibbons

@SnobunnieMel That's terrible! I'm so sorry you recieved that in the mail. It's a terrible reminder and unfortunately it seems at times we are surrounded by reminders of what should have been.  I know you've had a rough time recently and I'm glad to hear the last few days were better until your mail delivery. 

I'm CD 18 and no positive OPK. I am so damn confused. This is the first time I haven't had a positive OPK in a cycle. I am so bummed out. Did I miss it? I usually get a positive anywhere from CD 16-18. I'm on a break this cycle from meds/procedures and I am bummed out that my body is not falling into a rhythm. WTF??? I never had issues before getting back on track. I started Chinese herbs for egg quality this cycle  and I'm concerned that it's throwing my cycle off. Land of course like an idiot I'm not temping. I really hope this isn't a new thing for me to worry about. 

BornReady

@BrightenMySky I'm currently on estrace pill and patch. I wasn't told much about it, so I can't help much re: grapefruit juice. I'd be curious what the interaction there is. You could always ask your RE/nurse coordinator? I feel like i'm in such a paranoid place putting all of these hormones in my body that I'm trying to just go along with the "rules", but I would trust more what your MD recommends than anything. Maybe a good thing to ask the Infertility board too?