IF Testing and Treatment w/o 7.26

daisy0322

@mokay19 have you ever tried the steel ice cubes? They work really well!

@acleverusername Im sure it’s so stressful deciding to cancel or not hopefully the RE has good news at the next appointment 

optimistgardener

@acleverusername but apart from the lupron guide (thanks, btw, now I am worried that I am going to murder my students while i'm on this stuff!), i wanted to reply to the rest of your update. I hope your gut stuff is feeling better.  so much sympathy on trying to manage it in combo with the discomfort of stims. I'm sure it's so much worse while also bleeding. you're not wrong to try to get ahead of the late-stims constipation though. it got me in spite of my best efforts and it was really... unpleasant and took a long time to remedy. I think i would have been in serious trouble if i'd continued with the PIO for a fresh transfer. Forgive my asking a dumb question because I know we've talked about it before but remind me the reason you're doing a mid-luteal start over a standard day 3 start antagonist protocol? it's to avoid uneven follicle development, yes? I am sorry that TEW's question is unsettling. I'm sure in your shoes I'd be struggling with the same questions you are about how best to move forward right now. I can't help but think about my convo with my RE when I asked if he wanted to cut my doses considering how fast I was stimming, and he was adamant that it is better to just ride the established dose up to trigger rather than risk stalling out. I guess I'm beginning to learn how different protocols can be across clinics. I know you're thinking about it and I'd really hate for you to have to cancel a second cycle (although I'd understand if you did). I am crossing my fingers that your follicles show some good growth in your next u/s, and that your worries prove to be unfounded. maybe getting on the other side of the start of your cycle will be a help.

mokay19

@acleverusername I am open to supplements! I’m just not well-versed in things for lining since it hadn’t been an issue before. But it’s seemingly happening more lately. 

@daisy0322 ooh I have not tried steel... I’m intrigued though! 

@inthewoods23 how are you guys from the storms last night?  EDIT: just saw the weekly Randoms so disregard the question here 😂

acleverusername

@mokay19 have you talked about your doctor about switching to Letrazole? Clomid is known for thinning lining (it happened to me after 3 cycles... went from 8.13mm to 4.11mm... and these weren't consecutive cycles even!) Once again, I'm not the best person to comment on lining as it relates to FET, but here's a couple of links:

https://eastbayfertilityacupuncture.com/treating-thin-uterine-lining/
https://us.fullscript.com/u/protocols/VHJlYXRtZW50UGxhblRlbXBsYXRlLTkwNDU1

@optimistgardener re mid-luteal phase start, essentially starting in luteal phase is like "natural priming" because progesterone rise post ovulation, suppresses endogenous FSH release. So, then you're hoping that no FSH release, won't affect any of the antral follicles, so when you hit them with exogenous FSH, they'll all grow in sync. Obvi that didn't work for me. 

My update. Had my u/s this morning, and

yep, we're only looking at 6 mature follicles at retrieval (out of 12). So, I guess even when you don't have DOR, you can get single digit eggs. There is 1 other follicles that's 3mm ahead of others, and will be over-mature by egg retrieval (I have another 2-3 days of stims left). And there are 2 others, at 9mm, that are unlikely to reach maturity given that we're cutting my doses even further today (down to 75IU of Menopur). 

I'm bummed. TEW and I went back and forth last night about what to do, and she is feeling like I should cancel. Her words to me "the growth of follicles is telling me: may not be the best cycle." I gamed it out with my RE, and basically, if we get 6 mature eggs, he's expecting 80-85 fert rate, so 5 that fertilize. Of those, he says at my age, 40-45% are likely to make it to Day 5, so 2 Day 5. And of those, at my age, he's expecting 40-45% to be aneuploid. So, statically, I'm looking at having 1 genetically normal embryo. We could get lucky/unlucky and end up with 2 or 0. 🤷‍♀️

Anyways, given that I have only 1 egg retrieval left that's covered by insurance (2, if I do an oocyte freeze cycle, followed by an Egg Retrieval + Fert + Testing; but then I'd have to pay for transfers OOP), it's very tempting NOT to cancel. But I think I will go through with it and hope that all of the 300 supplements that I've been taking will have benefited in term of egg quality. But, I'm basically prepared for this cycle to be a total bust. 

Sincerely yours, 

Bummed Clever

optimistgardener

awww sh*t @acleverusername. Well, we're all cheering for your retrieval # to be higher than expected, for fert rate to be at the high end, blast rate to break the stats, and euploid % to be on the good side! (I, for one, am not counting out the follicle that your RE thinks will be overcooked by retrieval.) But this process is so tough. big weird stranger hugs.

kiki047

@acleverusername oooof. I just let out the breath I've been holding reading the whole way through your update(s). oh friend, I'm so sorry this is not turning out the way you had hoped. FWIW, I know our situations are very different and I was under-stimulated and you're bordering on over-stimmed, but given that this is now your 2nd go at this and knowing how far in you are already, I'd stick to your original plan of going through with it, seeing what information you can glean from it re: your fert rate, blast rate, etc... and pray. IVF math can really mess with your head, and I've been down that windy road before. We got suuuper lucky once, not so much the second time, but we wouldn't have known that if we didn't try. I get that the insurance piece is critical here but what if this is as good as it gets? I don't think either of us believes that, or else you wouldn't keep going back to it, but I don't know that the answer to a "ideal" or "successful" ER is to keep stimming to this point then scrapping the whole thing. In the end I know you're coming from the most informed place so you're going to do what you think is best, and it will be the right choice.  

My phones are ringing off the hook at work today so will have to come back later for more tags but I think it was you @mokay19 who was asking about stuff to help improve your lining? In addition to acupuncture and the most vile chinese herbal supplement my naturopath gave me, I was also taking 6,000mg of L-arginine, pomegranate juice, and trying to get at least 15 mins of movement/day to get the blood flowing. I want to believe the L-arginine was the most effective, but do some reading on it. It's only to be taken during the FP leading up to O, and shouldn't be taken if you have any heart conditions, etc. It's often used as a performance enhancer for things like weight loss or building muscle mass because of the effect it has on your metabolism and increasing blood flow. I took it for one cycle and that was the only time my lining was over 8mm (it was 11mm as of 3 days before my FET). 

mokay19

@acleverusername yes, I’ve taken Letrozole close to 10 cycles. I’ve done Clomid alone once and last cycle did Letrozole plus Clomid—which is what we’re doing again this cycle!
I’m sorry to hear about the news on follicles. Hoping the quantity is surprisingly higher!

@kiki047 thank you! I always think “I wish pomegranate juice was cheaper” but then I think what I pay on meds and doctors appointments and I think “it’s not thaaaaat expensive” haha

daisy0322

@acleverusername ugh I’m sorry that was not the news you wanted. I’m sure your super frustrated right now. I don’t think there is a right or wrong answer as to go through with ER or not. It’s really what you feel comfortable with. I’m glad (if I’m reading right) that you have one more covered ER though JIC

acleverusername

@kiki047 @optimistgardener @daisy0322 thank you! 🙏🏻I'll try and keep my hopes up. I'm back to the clinic tomorrow for another u/s. I mean, I've had a bunch of people tell me that on day of retrieval, they found other follicles. I don't know how that happens, but I sure hope it happens to me. Lol.  

@mokay19 Ah got it. I thought that Clomid + Letrazole were having opposing effects on one another, preventing multiple follicle growth? If it helps at all, Costco has pomegranate juice that is decently priced (though I'm blanking on what it is.) 

optimistgardener

re: pomegranate juice, my mom drinks the stuff by the boat load because a) there is some possibility that it may help stave off her cancer, and b) because it is a nice option for a woman who doesn't get to drink much anymore. anyhow, she says the cheap option is to go get the straight concentrate available at many ME and Asian import stores, and then water it down to your preference. she gets a kind that does not have added sugar. it's pretty tasty and especially nice mixed with seltzer water. i've never tested its benefits with respect to linings, though.
Edit: i believe this is the stuff https://www.sadaf.com/sadaf-pomagranate-concentrate-34-5660

mokay19

@acleverusername and @optimistgardener thank you for the pomegranate juice suggestions!

kiki047

@mokay19 good luck! I don't like the taste of pom, I find it too syrup-y and bitter but I diluted it with sparkling water and just sipped on it all day. Tbh though, I think it was the L-arginine that made the most difference. 

Just wanted to wish all my ladies a wonderful weekend. I'm off to a cottage on a lake for the annual family vacay. Wish me luck... it's not always that relaxing being stuck with 14+ family members for a week but we look forward to getting away every year and the location is very serene. I may lurk a bit next week but won't be around much. 

optimistgardener

have fun @kiki047! the 14+ family member thing sounds kind rough but hopefully you'll find a little peace and quiet out there.

acleverusername

@kiki047 Have fun at the cottage! I hope you "survive" being with some many family members. One of my colleagues came back from 2 weeks' holiday post-Christmas and accurately announced that "vacation with family is not a vacation." It's certainly the case for me. Lol. 

Update... might be triggering tonight or might go until tomorrow. Don't know... waiting for E2 results to make a call. Still on track to only get 5 mature eggs (out of 6). Also called the clinic and left a bunch of questions for the doc... waiting for the call back with in. Questions I had asked were:

1. Would a 450IU "boost" of Gonal-F have an impact on the "small" follicles? (I've heard of protocols with an FSH booster on day of trigger.)
2. Can we do a double lupron trigger: one tonight and 1 12 hours later, in addition to the hCG trigger to help with maturity? (This is something that CCRM in Boston does. Here is where I learned that I know more about biology than one of the nurses at the fertility clinic... she tried to tell me that trigger shot trigger the release of the egg from the follicle. 🙈I know that it does, but the whole point of doing an egg retrieval is to get them before they're released. So, the trigger shot triggers meiosis which is the final cell division / maturation of the egg. FML.) 
3. If we're not seeing good progress with the embryos on day 3, can we freeze day 3 embryos? 
4. If we get 3 of fewer mature eggs, can we freeze eggs only? (This will save me 0.25 of a Progyny cycle, which means I can do 2 more IVF retrievals + fertilization cycles thereafter.)

Anywho, currently waiting for E2 results and decision on whether or not we trigger today. 

Also check out this cool chart that doctor let me take a photo off that shows my follicle growth progression. Black dots are right-side follicles; red dots are left-side follicles. Cyan box is lining thickness. Magenta box is Right/Left follicle numbers. The red boxes are hCG, E2, and P4 readings, top to bottom. Med doses for days past are in yellow boxes; in grey for future days. 

inthewoods23

@kiki047 GL on vacay! Hope it goes better than mine did with only 6 people

optimistgardener

Rad chart, @acleverusername! Am I wrong in reading that there are 7 follicles above what I infer to be a maturity cut-off line? Does your doc assume the largest will be overblown? Because I would not make that assumption.

Spoilering for ridic IVF math:

I had 3 follicles above 20mm on the day of trigger. They were all successfully captured and at least 1 of them (and maybe more) fertilized since I had 5 of 7 fertilize out of the 7 mature collected (1 other was immature). The smallest of the 7 measured on day of trigger was 11.4.

acleverusername

@optimistgardener yep... doc thinks the largest one and smallest one aren't in play. He's even saying the 15mm one might not be mature. "Apparently" (using quotes because that's what the doc said, and I haven't confirmed in literature), luteal phase follicles take longer to mature. I.e. so you grow them out bigger. 🤷‍♀️

Also, highlight of my day is... MH learned how to put his own vitamins together! 🎉 But only because I made him this handy guide: 

optimistgardener

good work on training the husband! your doctor can be a pessimist if he likes and you're welcome to as well (I would certainly play that role in your shoes) but as the cheering audience, i'm gonna finally live up to my user handle and be optimistic that more of the eggs than the doc expects will make it to the finish line.

acleverusername

Thanks @optimistgardener! ❤️ I'm assuming you haven't heard back from your clinic yet? 

Btw, @kiki047 and @inthewoods23, I think it came up earlier this week re: YHs not taking their vitamins (or was it last week already?) Anyways, mine has a vitamin case, so whenever he doesn't take his, I know exactly the days he missed. Hehe. I also spy on him using "Find my" feature on the iPhone. Super helpful for tracking wondering Hs. 

I finally thought of my "underrated thing that I can't live without" and I hope it qualifies: my iPhone's reminder app. I literally could not function without it. 

optimistgardener

@acleverusername not yet! i have a heart attack every time the phone rings though, so that's fun.

acleverusername

Okay, the doctor called and gave me the green light to trigger tonight. So I’m just waiting on the exact instructions from the nurse about timing. 

acleverusername

OMG, H just asked if we can have sexy times on Sunday. I made sure to go into excruciating details about the procedure I'm about to have. 

optimistgardener

@acleverusername omg no! i hope you did not hold back on the details about the needle they're going to stick through the wall of your vagina while they go fishing around for your tremendously swollen ovaries. seriously. 🙄

if it helps talk him down, i had bruising and soreness around the entrance to the vagina for about 4 days afterwards. I'm assuming they were kind of using my body as a lever of sorts while they were rummaging around in there.

optimistgardener

@acleverusername but just gonna add (for your benefit, not your H), I felt fine pretty much immediately afterwards. I was woozy but in a not unpleasant way all day after the procedure and was fine for walking around and being functional the day after that. I used only 1 of the pain pills they gave me and transitioned immediately to tylenol thereafter.

keikilove

Another beyond hectic week, been trying to do tags for 4 days. Hope everyone is having a good week/weekend! I’m going to do just a few tags because it feels wrong not to. 

@acleverusername I’m so sorry the latest monitoring wasn’t as encouraging as the first. <Ignore that comment. It’s from earlier this week. I’d do a strike through since it’s no longer relevant but do t have the strikethrough button on my phone.> Clever, hooray for triggering tonight! I’m so excited for you to finally get to this point!! I know it’s been a real rollercoaster of a cycle but think you made the right decision seeing it through. I completely agree with everything Kiki said about going through with this one instead of delaying again. You also prepared really great questions for your doctor so that you can be prepared for scenario B, C, D depending on how retrieval goes. I echo all the good wishes @optimistgardener sent for even better retrieval numbers than anyone expects.💗🤞🏽💗

@kiki047 Have such a great time at the lake! I hope it is truly a vacation and that everyone appreciates being around family after the distance caused by the pandemic. And if any drama happens (as is known to be the case for all humans when many family members are involved) I hope that you and YH can escape into the serenity of the area and really enjoy nature. 

@inthewoods23 So glad that you got such good feedback from everyone with your vaccine dilemma. I heard all of your hesitation and understood your reasons, but am so glad that you pushed through those fears to get the shot anyway. FX it does wonders for your immune system.😉 Just as an FYI, I am having a delayed ovulation and can only guess it’s due to the vaccine. (Today is CD14: I was rationing my OPKs all week thinking that today would be Go Time, but the strips remain faint as can be & temps remain low. The new OPK box came today, thank goodness, but Sergio seems to have gotten lost on the way.) 

@acleverisername I don’t remember when you asked me this, but to answer: I haven’t had a recent LAD test to see how my levels are and whether I need another round of LIT treatment. We will probably get a LAD test in the next two weeks just to know where we stand. But timing won’t be the best for getting more LIT treatment.(It should be 3 weeks before TTC.) If we do it, it will have to be just a few days before transfer. TBD. Also, if we do one more egg retrieval it will be a normal follicular phase stims & egg collection followed by a fresh transfer. No more DuoStim, no more time for it with the new work schedule. 

@everyone else, I’ve been lurking a bit and happy to see some of you moving forward with treatment as well.💕💕💕 

I don’t really have a specific TTC update— just some super heavy personal stuff going on that I’m not quite ready to talk openly about. Sorry to be vague, but essentially we got really bad health news in the family this week (not me) and we don’t know if it means we have to stop this IVF process altogether or maybe speed it up before the health issue gets worse. This news combined with starting a new in-person job has me almost losing my composure. The stress has been beyond intense this week. There’s more to learn about the health issue at an appointment late next week. Until then I’m just trying to hold it together and get through the tasks immediately before me each day. I am due for an endometrial biopsy 5-7 days after ovulation, whenever that shows up, and hopefully we will move forward with just one more egg retrieval & a fresh transfer in one month. Not exactly sure if that plan will remain in effect. Maybe I can be more active here after that health appointment next week, once I know more. We will see… Thank you in advance for your good thoughts and positive energy.❤️

mokay19

@kiki047 I love Pom juice when it’s mixed 1/2 with water haha. Did you take L-argantine as a pill? I heard about that this week while listening to old fertility podcast episodes. 

@keikilove sending you positive vibes with all the news and changes that you have! 

optimistgardener

@keikilove oh no lady. I am sending you all I got. I know it's only of the most distant benefit to have someone say, "I know how it feels," but for whatever it is worth, I do know. Nothing about either process makes the other one easier, and in most ways, each makes the other one harder. This is true from the simple stuff like booking appointments and organizing daily life, to trying to address the physical stress you walk around with in your body all day, all the way up to thinking about big things and trying to make hard decisions. All I can say is that whatever decisions you make, they are the right decisions. Spend time with the person who has received the diagnosis. I hope they receive some better news at the next appointment.

All the hugs.

acleverusername

@keikilove sending you lots of hugs of support as your fertility journey takes this unexpected detour. Obviously, whomever it is, it is someone close and someone who means a lot to you, since it risks disrupting your fertility journey. Take time and care to process these new events; I will pray that you will hear some options at the upcoming health appointment this week. 🙏🏻


AFM, let me tell you, this cycle has been quite the rollercoaster, between airport OPKs, and potential cancellation, etc. Today, my dog got spayed (last week, I actually worried that our surgeries would line up on the same day; in a way that would have been more manageable). Now, with her being both in pain and on a sedative, we can't even board her like we were planning to. This morning, we had to juggle getting her to the clinic for check-in that started at 7:45, whilst also being somewhere where I could do my 2nd Lupron trigger at precisely 8:30am. I was half prepared to inject myself in the parking lot of the clinic. Luckily, we showed up early, and got checked in early, and I was able to make it to a coffee shop (planned stop) and the person who was in there just before me, vacated the premises just in time for me to pee and get my injection queued up. And so now, we also managed to get one of our friends to come hang out with our dog tomorrow morning because we haven't left her alone yet, since getting her back in April. So... yeah, there will be a gap between when we have to leave, and when our friend can come, so we're hoping the sedative is enough to keep our furbaby calm during that gap. Phew... I'm out of breath just typing this up. 

optimistgardener

@acleverusername oh yikes, that is a lot to try to juggle at once. Here's hoping your dog will be nice and calm tomorrow during the gap while she's there alone! I've got my fingers crossed for your retrieval tomorrow!

acleverusername

Thanks Optimist! 🙏 Forgot to mention that I also had to give MH a refresher on how to drive a standard transmission car cause my little Miata is all the car we have for now. The last time he drove a standard was 12 years ago. Also mine. 🤷‍♀️

optimistgardener

@acleverusername hahahaa. i also drive a stick. we are a superior people.

optimistgardener

@acleverusername sending good vibes today! hope the retrieval is easy peasy.

bows22

@inthewoods23 yay I’m glad you were able to get comfortable with getting the vaccine! I think I remember from when I got vaccinated you are at least 50% protected after the first shot (or maybe like a week or so after) but you definitely have some protection now!

@bumblebee0210 that is amazing news about your embryo! I hope you had a nice vacation!

@acleverusername I’ve been following your updates even though I didn’t have a chance to post this week and I’m glad you are going ahead with this cycle. Good luck today!

@zwink1 glad it seems like you won’t have any more roadblocks after you get the records transferred!

@mokay19 I’m glad you are able to finally get this cycle started!

@kiki047 have a wonderful vacation!

@keikilove thinking about you, friend❤️

inthewoods23

@acleverusername GL today!! Hope everything goes great!

@keikilove sending so many hugs friend ❤️

@bows22 that sounds about right. Glad to be at least partially protected! I did suddenly start having pain in the back of my left knee that only happens when I straighten my leg. It's better this morning. But I was a little freaked out about DVT. 😬

acleverusername

Update! Spoiler: good news! 

Retrieved 8 and all 8 are mature!!! 🎉🎉🎉

optimistgardener

@acleverusername yay!!!! my optimist vibes weren't wrong. that's friggin great news! now you get to relax on the couch all day and swat your husband away unless he comes bearing cool drinks, snacks, and no other intentions.

keikilove

@acleverusername I came here to wish you GL and instead saw your amazing news! Congratulations!!! 🎊🍾 🥳 

mokay19

@acleverusername great news on the 8 mature eggs!!! 

acleverusername

Oh and the clinic gave me chocolates as a gift! They were, erm, “themed.” MH is super impressed with how friendly, empathetic, and knowledgeable the whole staff were. He keeps repeating it. Let’s see if their lab is as good as they say it is (their lab is why I chose the clinic; the doctor I chose because of TEW recommendation.) Optimist… keep sending me those vibes. And I will for you for a positive phone call tomorrow.

zwink1

@keikilove, I'm so sorry for the bad family health news.  I'm sending all of my positive vibes your way!

@acleverusername, congrats, that is fantastic news!!!!  (Coincidentally, we ened up with 8 mature at our retrieval too.)  I'll have all of my fingers crossed for great fert results!  We only did one ER.  We were completely out of pocket so we knew before we started that we really only had one shot.

Edit: I accidentally posted too soon.