IF Treatment & Testing w/o 9/27

acleverusername · September 2021

This is a place for those of us who have already started TTC, but have started infertility testing and/or treatments. You can express your thoughts, feelings, and frustrations on infertility. TTC can be a long journey naturally, then add in the difficulties associated with infertility, and it becomes a whole new ball game. The road to infertility can be lonely, frustrating, and complicated, so let's make this a place where we can vent, ask questions, and support one another. Feel free to resurrect this thread at any point in the week if you have something to say. Treat this as an ongoing conversation.

Diagnosis (if you've been):

Status (WTO/TWW/TTA):

What are you doing this cycle? (Testing? Treatment?):

How are things going?:

Any questions?:

GTKY: besides Halloween, what are you looking forward to the most in October?

walkawaynee · September 2021

Diagnosis (if you've been): does age count as a diagnosis?

DOR and low Morphology

Status (WTO/TWW/TTA): TWW of last natural cycle before starting to prep for IVF. I am on honestly not sure if I ovulated. Last cycles unusually long and this time I got a random peak WAY early.

What are you doing this cycle? (Testing? Treatment?): Natural cycle. Had an Hsg at day 9. Need to go for some additional bloodwork before IVF prep.

How are things going?: feeling really relaxed and at peace with the choice to move forward with IVF.

Any questions?: no currently

GTKY: besides Halloween, what are you looking forward to the most in October? Fall break!

acleverusername · September 2021

@walkawaynee Welcome welcome! I love that you're jumping right in. Age as diagnosis absolutely counts! Most of us say AMA (advanced maternal age) if we want to be proper. Otherwise, it's "geriatric ovaries", or some variation thereof.

keikilove · September 2021

@acleverusername “Geriatric ovaries”?!?! I cannot and will not!😟🧐🤣 No grey hairs over here—I reject those insulting labels that had to have been created by men.😩

@walkawaynee Welcome! I’m in some AMA groups and know several ladies with the same age span as you and your significant other (SO). I think it’s great! I hope that you have success with IVF. I saw your intro about the boring bank job and now I see you’re looking forward to fall break. Do they have that in the banking world? Or is your SO in education? We are sooo looking forward to fall break in education!

Diagnosis (if you've been): RPL/RIF, DQ Alpha match, elevated NK cells & activity, blood-clotting mutations, AMA, DOR

Status (WTO/TWW/TTA): TWW after an IUI late last week

What are you doing this cycle? (Testing? Treatment?): I’m trying Neupogen again to see if it will help my body stop rejecting embryos. I’m also meeting with my Reproductive Immunologist tomorrow to ask her some things about my last failed embryo transfer (my estradiol and progesterone were sky high 10 days post-transfer, which hasn’t happened to me before).

How are things going?: Things feel a bit better today. MH went public with his cancer diagnosis and has been receiving a ton of support over the weekend. I’m much more private with personal things but I can see that he needed that support from others. @optimistgardener @gingermama29 @Shortstack930 @inthewoods23 @bows22I want to sincerely thank all of you for the kindness and support you gave me when I updated late last week.💕💕💕 (I find it way easier to share in this anonymous space than in real life.) It’s probably time for me to seek a therapist for both myself and MH, as this is just a bit too much to handle on our own. @optimistgardener Thank you SO much for the idea of the naturopathic oncologist. We’d also used one remotely when my mom was going through cancer, in addition to her traditional western medicine doctor. The naturopathic oncologist helped immensely with a supportive diet and supplements. But it never crossed my mind to contact her for our current situation with the fertility preservation. So thank you thank you for chiming in with that! I almost didn’t even ask the question but I’m so glad I did.

Any questions?: NATM

GTKY: besides Halloween, what are you looking forward to the most in October? Fall Break!😄

Edited to fix tags.

acleverusername · September 2021

@keikilove lol. I think that I would only use "geriatric ovaries" in a snarky way. @optimistgardener always has a way to describe her not-so-fresh ovaries, so I will defer to her for synonyms. I hope you weren't offended!

Btw, I stayed off TB this weekend, but I was thinking about your post last week. First of all, I am so sorry that you're going through all of this. If there's anyone who deserves a break, it's you. And not only do you deserve a break (i.e. not a Fall break; a LIFE break), you also deserve your THB. I cannot think of anyone who's done more to try and grow their family. I am hoping/praying/casting spells in hopes that it will happen for you soon. But, I also don't blame you for starting to look into surrogacy options. For us, it's still too early to be doing that, but I'd have to admit that MH and I actually "price-checked" this a few weeks back. I'm like you... I need to know what might be coming down the road and need time to prepare for that. Re: YH and semen preservation, does he have a reproductive urologist? I feel like that your question re: how good is the sperm after 1 chemo is best asked to him/her (hmmm... are there female reproductive urologists?) I feel like it would depend on the type and dosage of chemo. Anyways, I think @optimistgardener had great advice to give, and rooted in experience too. Me... I'm just shooting off my mouth. 🙏🏻

acleverusername · September 2021

Diagnosis (if you've been): Official - Unexplained; Unofficial - Hashimoto's, AMA, sporadically wandering sperm

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): ER # 2, mid-luteal phase start (so, starting around mid-October as I'm sure O will be delayed due to *TW* CP *end TW*.

How are things going?: Better this week; last week was rather brutal. *TW* Loss

I thought it was out of my system by the time our follow-up with our RE rolled around on Friday afternoon, but when he asked me how I was doing emotionally, the waterworks couldn't be held back. I really appreciate our RE; he and his wife did IVF for all their kids, so he's not only empathetic, he's also sympathetic. He mentioned that what happened to us also happened to them.

So, we had our consult with RE on Friday, and we've decided not to skip a cycle. The doctor didn't think we needed to, and TBH, I just want to get back on this train. We game-planned the rest of the year, and if my O is only slightly delayed (i.e. a week or so), we have the chance to do a transfer before year's end. Or at least _try_ for a transfer. My clinic does a modified natural transfer cycle to start (it will be cancelled if lining isn't thick enough), and doesn't believe in ERA, so there's no point in doing a mock cycle. The doctor basically told me that if modified natural doesn't work, then it essentially becomes the mock cycle (minus the biopsy, ERA, Receptiva Dx), and then we move on to medicated cycle, which wouldn't happen until next year because of lab closures over holidays. I think at that point, I would ask for a mock cycle.

So, this got me thinking... wouldn't it be GREAT if a whole bunch of us here had our transfers around the same time, and they were all successful and we'd all end up in the same BMB?! That is my Birthday & Christmas wishes for this year.

Any questions?: When should I start L arginine? Immediately after my egg retrieval? Also, has anyone tried TCM stuff for lining thickness?

GTKY: besides Halloween, what are you looking forward to the most in October? Well, it's my bday next week, so I'm looking forward to that. I'm tired of being 37. This has been a challenging year, and I really hope my 38th year will be better... at least personally-speaking. Professionally speaking I actually had a kick-a$$ year.

inthewoods23 · September 2021

@walkawaynee welcome!

@keikilove I'm glad you're H is receiving huge support after announcing his diagnosis. We each have our own ways of sharing personal things. Getting the support we all need is all that matters

Diagnosis (if you've been): unexplained, low morph, possible RI issues

Status (WTO/TWW/TTA): TWW

What are you doing this cycle? (Testing? Treatment?): biopsy on Friday, hopefully getting all the blood work taken care of next week and clinical package shipped to the immunology lab but that might depend on the pre-authorization

How are things going?: Slight panic over the weekend as the immunology's lab kit arrived on Saturday. Realizing I have just enough time to get the biopsy done this week stressed me the hell out. Has to be taken in the implantation window and I just ovulated Friday so my only options were Thursday or Friday. I'm taking DH to the airport on Thursday but my OB's office could fit me in on Friday. Might have to refrigerate the sample but I'm okay with that since missing the chance to do it this week would mean waiting a whole other month to have it done.

Any questions?: Can I get my lab work drawn and tested before the pre-authorization is finished? Does the review need to be completed by the time they bill insurance? When are you usually billed? Once the test results come back? I've heard some of it can take 3 weeks to come back and when chatting with an agent they said it can take up to 15 days for pre-authorization to be reviewed.

GTKY: besides Halloween, what are you looking forward to the most in October? WFH all month plus cooler temps. Minus the fact that the heat won't go on for a while so I'll be cold in the house forever.

hanshotfirst77 · September 2021

@walkawaynee Welcome!

@keikilove I’m so sorry about your last transfer and your husbands cancer diagnosis. But I am glad he is finding the support he needs. Rooting so hard for you and your family.

@acleverusername I’m so glad you have a supportive RE. It can make a world of difference when it comes to IF and loss. And that is so great you can get a transfer in before years end. Fx!

@inthewoods23 I hope you are able to get everything done in time and not have to skip a cycle. That can be so stressful.

Diagnosis (if you've been): unexplained secondary IF, unexplained RPL, PCOS

Status (WTO/TWW/TTA): benched pending testing needed before FET prep can begin

What are you doing this cycle? (Testing? Treatment?): I need to schedule my day 1 labs and saline Sono but I missed my window for this cycle so I will have to wait for next cycle.

How are things going?: life has been hectic lately but overall things are pretty good. I’m excited to get this show on the road. And now that pretty much every one here and my RE made me feel much more confident about my one and only remaining embryo I am feeling really good about upcoming FET.

Any questions?: natm

GTKY: besides Halloween, what are you looking forward to the most in October?

I’m really looking forward to going apple picking and I want to try making an apple pie from scratch. Plus I just love Fall so much in general.

acleverusername · September 2021

@inthewoods23 hmmm, not sure about doing anything before a pre-auth. In the past, I've always had to wait until pre-auth was approved before doing tests, but this was for MRIs and such, not for blood tests. This is probably a dumb question, but have you called your insurance? Glad that timing works out for getting the biopsy done at your OB this week! 🤞🏻

inthewoods23 · September 2021

@acleverusername I'm just like you too wanting to get back on the train. A break sounds great but it's not like we can just wait an extra week and get going. Stupid cycles. I spoke with my insurance yesterday who told me how long the pre-authorization could take. I might try to live chat with an agent tomorrow and ask if blood can be drawn before that's completed.

@hanshotfirst77 how much more time to do you have until you're back at CD1?

walkawaynee · September 2021

@keikilove so glad your H is getting the support he needs! My SO and I are opposites with this as well I am more private and everyone knows everything in his family so it's and adjustment and balance. I am sorry to hear about the diagnosis and wish you both so much positive energy! SO coaches Jr. High as a 2nd job so Fall Break means he will be home in the evenings (read: he will cook dinner)

@acleverusername 37 was absolutely my worst year so I feel you there. I honestly felt like that was the year I started to feel older.

@inthewoods23 I was able to do labs before I got pre authorized with thr understanding that if I was denied I had to pay out of pocket but I am sure all insurance is different

@hanshotfirst77 I have a saline sono coming up as well waiting for the RE to get back with me on the date. I LOVE apple picking. There aren't any places close to my home now and I miss going so much. I love everything about fall though (except pumpkin spice lattes oddly enough)

hanshotfirst77 · September 2021

@inthewoods23 probably not til mid October. But I haven’t been temping or tracking at all and with my PCOS my cycles can be all over the place. I wouldn’t be surprised at all if just when I need cd1 to come it totally won’t and I’ll need provera to jumpstart.

@walkawaynee me too! I actually am not a pumpkin spice anything fan. Maybe that’s an UO but I love apple so much more.

acleverusername · September 2021

@inthewoods23: you know, I think @walkawaynee is right about having to pay OOP if later denied. So, I guess at this point you should be asking: will you still go through with these tests if insurance doesn't cover it? FWIW, if that ends up being the case, insurance will still apply their generous "discount" on the amount billed to them, so the OOP wouldn't be anywhere what the quote to insurance is.

And yeah... re: getting back on the train.... CAN WE PLEASE JUST HAVE A BABY ALREADY?!

acleverusername · September 2021

@hanshotfirst77 Argh, I'm sorry that you missed your saline sono window and have to wait yet another cycle. But... it's one more of us that can potentially have a transfer around the same time and be on our way to a BMB. I vote for a mass exodus please!

optimistgardener · September 2021

@walkawaynee welcome! so glad you're feeling good about your decision to move to ivf. the folks here have so much knowledge and have really helped me through things as i embarked on the same process. what day was your random peak?

@keikilove I am thinking of your and YH. Thinking back to when my mom was diagnosed, I absolutely should have prioritized seeing a counselor just to help me organize my thoughts and feelings if nothing else. So I hope you are able to do what I didn't manage. I'm glad the naturopathic oncology recommendation was useful.

@acleverusername lol it helps me to feel just a weeee bit better about my situation that i can come up with a host of different ways to describe my increasingly decrepit ovary. But AMA and DOR work too.

I'm glad you're carrying on and not waiting a cycle. I can imagine that for every woman the "right" thing to do under these circumstances, but from what I know of you, it definitely seems like you'll do well by plunging ahead. And we'll all certainly appreciate your presence here.

@inthewoods23 wow I'm so glad you managed to sneak your biopsy in amidst everything else! that sounds heroic.

@hanshotfirst77 really hoping everything pans out perfectly for your transfer.

FYI nothing new is happening with me but I'll fill out the weekly update anyway because I kind of miss the ritual.

Diagnosis (if you've been): cranky ol lonely ovary, dimished ovarian reserve, probable endometriosis, scarring from myomectomy, etc.

Status (WTO/TWW/TTA): I believe I am technically in the TWW, but really I am benched. I ovulated a little bit later this month than last (day 12 instead of day 10), so I guess at least that is the right direction? My increasingly short follicular phases are making me hella nervous.

What are you doing this cycle? (Testing? Treatment?): Nothing much. I had thought about trying to convince my occasional donor friend to contribute, but finally opted against. My reasons: 1) After my terrible embryo test results I am now suddenly really anxious that if I did somehow manage to get pregnant naturally, I'd either miscarry or discover that I was carrying a fetus with serious genetic abnormalities. I am putting what little is left of my hope for a pregnancy wholly in the hands of science. 2) Actually reason #1 is not really enough. But what was enough was family being in town. It is remarkably difficult to organize a low-key sperm transfer.

How are things going?: I am insanely overwhelmed by the start of the term so am grateful that it is keeping my mind off of things. I am still managing to take my supplements regularly though!

Any questions?: NATM

GTKY: besides Halloween, what are you looking forward to the most in October? Returning to in-person teaching soon!

bumblebee0210 · September 2021

@walkawaynee. Welcome!

@keikilove Oh man. I was following your story over the weekend, and I am so sorry that you're dealing with all of this. I think it's one of those times you need to dial way way back on any expectations of yourself other than basic survival. I'm glad that YH was able to share and get some support, and I really hope that you guys will soon get some good news.

@acleverusername I am also trying for the by-end-of-year transfer I think (this is also an answer to @keikilove
from last week-- if this duostim does end up going at least ok (1-2 normals), we will likely move to transfer next. My hair is falling out and I think I am done.). Hoping we can be BMB friends!

@inthewoods23 I have no idea on the pre-auth front, but usually your doctor's office will know because they are doing the billing. But yeah for basic labs I would think it's fine?

@hanshotfirst77 Glad you're feeling good about the embryo! Hopefully you can get the show on the road soon...

I'll be back tomorrow with updates from my end (it's day 6!)

walkawaynee · September 2021

@optimistgardener I can only imagine that low key sperm anything is difficult with family visiting! I typically O around CD 13/14 but I got a peak on CD10 this time. I kept testing just in case it was a fluke but at CD 19 now with no sign of a surge coming.

optimistgardener · September 2021

@bumblebee0210 fingers crossed HARD for good blast rates.

@keikilove i think bumblebee has a point about going with survival mode for now. i don't mean to tread toes here but i wonder if it's worth mulling the possibility of putting transfers on hold until things settle out a bit. your stress levels must be crazy high right now, and for good reason.

mokay19 · September 2021

Diagnosis (if you've been): PCOS

Status (WTO/TWW/TTA): Limbo

What are you doing this cycle? (Testing? Treatment?): nothing

How are things going?:
**TW for discussion of death**

eh. I don’t even remember the last time that I checked in… last cycle didn’t work (obviously) and that same week they removed the vent from FIL so we spent 5 days at DH’s family’s place for the planning and services.

Then, this past weekend I had a bachelorette weekend in which I’m the MOH for. It was fine and dandy but I felt bad leaving DH even though he insisted that I go.

Now, we’re on a TTC break until my new job’s insurance kicks in November 1st. I hope we’ll just do injectables again and not mess around with oral meds but tbd.

Any questions?: natm

GTKY: besides Halloween, what are you looking forward to the most in October?

I don’t even like Halloween lol. But DH and I are going to Florida for a couple days later this month and I’m already scoping sushi places!

bumblebee0210 · September 2021

Diagnosis (if you've been): RPL, "borderline" DOR

Status (WTO/TWW/TTA): WTO (Stim day 2)

What are you doing this cycle? (Testing? Treatment?): ER # 6 Part 2 of a Duostim

How are things going?: 2 things are currently happening: my bast report from last cycle, and also my current cycle. Both are going very well, stats in spoiler

We got 5 blasts!!! I am over the moon. Grades are decent: 2 5AB, 2 5BB, 1 4BB. 2 (one 5AB and the 4BB developed on day 5, and the other 3 on day 6). For those of you keeping track, this is equal to the total number of day-5 blasts we got in our first four cycles combined. So we are thrilled.

This cycle: my clinic is not used to duostim (I think because I live in an area with mandated insurance coverage for infertility, which typically means cycles are spread out for insurance reasons). Man, I am a real novelty to the nurses! My baseline ultrasound yesterday, as expected, was bananas, but I think still points in a good direction. Basically, the issue is at baseline they can still see a lot of the follicles left over from the retrieval, and the new ones as well. I had 8 big follicles (almost certainly all leftover), and TWENTY-FIVE little ones. Some of these are likely leftover also, but my typical AFC (before last cycle) was like 8-10, so I still think there is a lot of potential in there. My estradiol was 30, so at least they will get to monitor that normally (hopefully!) we shall see.

Any questions?: It seems like some of you have had biopsied frozen embryos that were grade 3. Every time I have had day-5 blasts that were size 3, and they have waited for them to get to size 4 or larger (on day 6) to biopsy. Any ideas why different labs seem to do this differently? Nearly all my blasts are "day 6" blasts, but they were actually blastocysts on day 5 (size 3) jut not like fully expanded, and then typically they were size 5 on day 6. I'm wondering also whether to think about my day-5 4BB as "better" than my day-6 5AB, because that day-6 5AB was only like a 3BB on day 5. No idea!

GTKY: besides Halloween, what are you looking forward to the most in October? Fall in NE is the best, so just general cooling off/leaves/etc. Also we are taking a trip to Santa Fe for MH's birthday which should be fun.

kiki047 · September 2021

Continuing to lurk while in limbo, but had to pop in to give @keikilove a big hug. Oh friend, you have been through SO much, I think it's due time the universe gives you a break. I'm glad YH was able to go public and is finding some of the support he needs that way. I know MH really struggles with that, especially with the TTC stuff, because he doesn't feel like he has anyone to talk to when he's so fiercely private about everything. He's intensely jealous of the friendships I've formed through TB, though he's also very grateful that I have people to lean on. IMO therapy should be mandatory for anyone going through such traumatic and life-altering medical treatments, IVF included, because it is just so much for any one person to carry all by themselves. Knowing you, you've taken on all of the additional worries that YH would never think of just to give him the space to face chemo and therapy is such a safe, neutral space for you to unload without feeling like you're putting any additional burden on your inner circle. Of course you're welcome to continue to do that here but there are trained professionals probably better suited for that

As for your FETs, I'd be inclined to agree with @optimistgardener on waiting until things feel less <hair pulling, screaming into the void face> but of course I also understand that in TTC-land, waiting or postponing treatment(s) is also stress-inducing so that is 100% your call.

optimistgardener · September 2021

@bumblebee0210 *whistles in disbelief* lordy, lady, are you sure these are your same ovaries from earlier in the year? congrats on the miraculous transformation and have fun being a medical oddity for part deux of the duostim.

hanshotfirst77 · September 2021

@optimistgardener I’m sorry family being in town made things tough for you. But I understand how you feel with reason 1. I went through similar feeling with a friend that was willing to KD for me. But It’s also hard to have to keep waiting. Hugs!

@acleverusername Yes to a mass exodus please!

@bumblebee0210 that’s amazing results! Yay for all those blasts!

inthewoods23 · September 2021

@walkawaynee that's what I gathered when I asked my insurance yesterday. I'm guessing it's more likely to be denied if I don't wait for the pre-authorization.

@acleverusername weirdly when I asked if they could look up costs based on CPT code I got some really reasonable dollar amounts! I've seen some people in the FB group mention the tests for a couple mutations are a couple hundred dollars each but the guy I spoke with told me $64 for each. I don't know what to believe. Maybe our insurance is just that good? I really don't know. Looking up the details "diagnostic testing" is listed so... maybe they cover any diagnostic type test???

@optimistgardener yeah I would have been so ticked off if it turned out that I was just past the window. Thank god for ovulating 2-3 days later than normal this cycle. I was getting mad last week when my OPKs weren't getting darker! lol. I guess my body just knew it was for the best!

@bumblebee0210 you know, I suppose I could make an appointment at Quest for the basic stuff and go back another time for the blood draw for the genetic mutation tests. Wow 5 blasts that's amazing!! FX a good number are normal!

zwink1 · September 2021

@keikilove, so happy to hear that your H is getting the support that he needs as he embarks on this journey. Having the right support can be so crucial to having a positive outlook.

@inthewoods23, getting everything lined up can be so stressful. I think for bloodwork specifically, it depends how they code it in their system. I've done treatments both with and without insurance coverage, and in either instance my REs always coded prep work - bloodwork, the HSG, saline sono, etc. under diagnostic testing so insurance covered it even if I didn't have IF coverage.

@hanshotfirst77, ugh. I feel you on missing thr testing cutoffs. I missed my saline sono window by like a day and had to wait out the next cycle. Luckily, my cycle cooperated and my wait wasn't that long. I'll be hoping yours is short too!

@bumblebee0210, congrats on the amazing blast news!!!!

Diagnosis (if you've been): primarily MFI (plus what's being categorized by my current RE as an ovulatory dysfunction on my end)

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): Treatment! I started Lupron prep for my FET last night. H is retrieving the snow globes and moving them to our new clinic Thurs, and my last BC prep day is Fri so FET cycle will officially start shortly after that. Given that we scheduled our initial consult with the new RE in May, it feels like it's taken half a century to get here.

How are things going?: IF wise, good. Everything is lined up and ready to go and now I just have to pass my COVID test Friday and we're off. Personal life wise, meh. I was MIA last week largely because of work. My work situation has deteriorated over the last couple of years and this most recent event was sort of the last straw. I don't neeeeeddd to make a change, so I won't do anything drastic right now (especially since my current insurance mandates IF coverage), but I'm going to be a bit more proactive about searching out new opportunities.

Any questions?: not currently

GTKY: besides Halloween, what are you looking forward to the most in October?
The last fall farmers' markets of the year, and last couple of flea markets and barn sales. I always like this time of year but also hate it. Mostly for the same reasons.

LJMoon6 · September 2021

@walkawaynee I’m glad you’re feeling confident moving forward.

@keikilove I’m so happy YH is getting so much support after going public. I can’t imagine navigating all those emotions. Is there absolutely no chance that his sperm can rebound once he’s done with chemo? I’m glad you’re thinking about seeing a therapist. The strength it takes to know when everything is too much is incredible. I admire you.

@acleverusername *TW I’m so sorry for your loss. TW* I’m so glad you have a doctor that understand all the emotional aspects of this journey. I’m glad you’re jumping right back in and you have a great plan for retrieval and transfer. And even though I just joined back in, I would love to be a part of the mass exodus too lol.

@inthewoods23 I’m so glad you were able to get the biopsy scheduled! Remind me what this is for again (I’ve been lurking here and there but I’m sure I’ve missed a lot). And I have no advice about the pre-authorization stuff, only to say, insurance stuff sucks! I hate the hoops they make you jump through.

@hanshotfirst77 I’m glad you got the reassurance you needed and have some confidence moving forward.

@optimistgardener I’m glad the start of the semester has been keeping you busy. I can’t imagine doing a sperm transfer at all, let alone trying to hide it from family in town. When will you be starting a new retrieval and, remind me, are you changing any protocols for your next cycle?

@mokay19 *TW I’m so sorry for you and your family’s loss. TW*

@bumblebee0210 Holy moly! Those numbers are insane! FX that his second half continues in a positive direction.

Edit to add:

@zwink1 I’m so sorry your work situation has fallen apart. Do you think it will be easy to find a new job in your field? My supervisor just officially announced his retirement and we’re all super nervous about the change and what that will mean for our work dynamic. Change is hard and scary!

LJMoon6 · September 2021

Diagnosis (if you've been): Unexplained

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): Going in for a baseline scan to hopefully do our 3rd IUI. I’m worried there will be a cyst that will cancel the cycle but I’m prepared to ask to do a natural IUI cycle instead. They’ll likely say no to that though.

How are things going?: Blah. Not well. Last week was rough. I thought we were done trying with the RE for the year but I re-ran the numbers and we should be able to afford a couple more cycles. If they don’t work then we’ll be looking to change clinics next year.

Clinic drama in spoiler because I don’t know how to shorten it all lol:

Every time I get off the phone with the clinic, I’m in tears. I just never want to go back there again.
They are super condescending and have generic responses ready for all questions. There also seems to be a lot of confusion and no communication between staff.
For our first IUI I sent an email asking about concerns of the IUI potentially needing to be done over the weekend and if they would still do it. The nurse said no, they don’t do IUI’s on the weekend. But then when I went in for my baseline appointment the nurse said absolutely and that it would be “unethical if they didn’t.” Ok, great. So it sounds like they don’t like doing them on the weekend but they will if they have no other choice.
Then when I went in for my CD10 scan I had 5 follicles all around the same size (3 at 12, 2 at 11.5). They wanted me to trigger 3 days later (on a Sunday) without a follow-up scan… even though they have a cancelation policy of 4 or more. When I brought up my concern of not wanting to birth 5 children at once, the nurse came back with “that’s the chance you take when you’re doing an IUI.” She also went on to say contradicting statements. When I asked how much follicles grow each day she said about 1 every day but once they reach 12 they usually grow 2 every day. I also asked if we could delay the trigger by a day so that they could grow a little bigger and then we could do another scan, she said no because by that point all 5 of them would be mature and we would need to cancel. But if you run the numbers she gave me on how much they grow, they would have all been mature by Sunday anyways. I also told her I would rather cancel than have 5 babies at once and she asked if I would like to cancel now and wouldn’t let me schedule the follow up scan.
My second IUI went nearly perfectly (we lowered my dose and I only produced 1 follicle). Until my LH started surging an hour before my trigger shot. My surges are usually strong and fast so I knew I would be ovulating the next day, accompanied by my typical ovulation cramps. I did the trigger like planned but called the clinic the next day. The nurse said it wasn’t surprising that my OPK turned positive since they saw my LH rising the day before with blood work. (I thought the whole point of doing the blood work was to adjust timelines if indicated!? And the nurse just confirmed they saw it rising. Did someone drop the ball and not even look at my test results?!) Anyways, they didn’t move my scheduled IUI up at all and I’m nearly certain we missed our window.
When I got the call the beta was negative and to go over the next cycle plan, the nurse told me to stop using OPKs because they’re unreliable and that the cramps I were feeling were from the increase in estrogen. Even though I’ve been using these same OPKs (confirmed with bbt) and been having ovulation cramps since I started tracking. Obviously, they are the experts and I’m trying to trust them, but I feel like I just keep getting talked down to.
This cycle they wanted to move my dose back up again. When I brought up concern about producing 5 follicles the nurse was a little loss for words and said she would talk to the doctor and we can talk again at baseline. I also asked that if my OPKs turn positive again before my trigger if we could do back to back IUIs and she basically said no. That that was an “old school” approach, and she hasn’t seen that done at this clinic before.
Anyways. All that to say… I’m beyond annoyed with my clinic and just want to be done. But we’ll stick it out a few more cycles and then re-evaluate.

If you made it through that… bless you! I’ve been needing to get that all off my chest.

Any questions?: Is there any difference in taking the same dose letrozole/clomid on different days? For example, I took letrozole CD3-7 and produced 5 follicles. Removing cycle to cycle variation, would taking it CD5-9 potentially give me less?

GTKY: besides Halloween, what are you looking forward to the most in October? We love going to this corn maze close to the house. It usually takes us an hour to get through. Also, all the apple cider! Yum!

bumblebee0210 · September 2021

@LJMoon6. It sounds to me like maybe you want to stop communicating through the nurses if possible? Presumably there is a an RE or at least an NP who is making actual decisions. Can you talk to them about your concerns? I am here for your choice to switch clinics, but in the meantime, talking to the doctor directly will likely clear some things up.

CatGifsRock · September 2021

Diagnosis (if you've been): RPL, AMA, only one ovary, unexplained infertility

Status (WTO/TWW/TTA): egg retrieval in my first IVF cycle was yesterday.

What are you doing this cycle? (Testing? Treatment?): first IVF cycle! Hcg wash tomorrow and hopefully there will be an embryo to transfer on day 3 (Thursday).

How are things going?: Not that well

I had 7 eggs retrieved and was happy for that, but today the embryologist called and said that only 3 were mature, and only 1 fertilized. All those injections! all the cost! and for one embryo. Grow, baby, grow. Still a small chance.

Any questions?: Why are my eggs immature? They were 10-22mm at my last u/s (Friday), and I stimmed Fri and Sat, then triggered with Hcg early Sun AM for Monday retrieval.

GTKY: besides Halloween, what are you looking forward to the most in October? Having even a snowball's chance of getting pregnant.

gingermama29 · September 2021

Coming back for tags

Diagnosis (if you've been): PCOS

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): NTNP

How are things going? Things are good. I spoke with my OB and he agreed that seeing a fertility specialist was a good idea, especially since I would be considered high risk at this point given my losses. He actually recommended me to the one that he and his wife saw when they were TTC. I called them and have a tele-med consult appointment scheduled for Oct 25! It feels good to be taking the next steps and hopefully getting some answers.

Any questions?: anything I should ask or need to know for my consult appointment?

GTKY: besides Halloween, what are you looking forward to the most in October? Cooler weather and changing leaves!

gingermama29 · September 2021

@walkawaynee welcome!! Glad you’re feeling at peace with IVF.

@keikilove I’m glad things feel a bit better today. It’s a lot to deal with and it might not hurt to have someone you trust to talk to about it and process feelings. Still sending hugs and positive vibes your way!

@acleverusername sounds like you have a good plan with your RE! FX you can get a transfer in before the end of the year! I love the mass exodus to a BMB idea!

@inthewoods23 ooof that’s a tight window but I’m glad you’re able to make it work! Sending all the positive vibes for your biopsy!

@hanshotfirst77 sorry you missed the window for this cycle but I’m glad you’re feeling better about your upcoming FET!

@mokay19 sorry you’re in limbo. I hope the next month flies by so you can get rolling with treatment with the new insurance.

@bumblebee0210 that’s awesome news! So excited for you!!

@zwink1 sorry to hear about your work situation. That is so stressful. I hope you can find something better quickly!

@LJMoon6 sorry you’re having such a difficult experience. That’s so frustrating! I don’t blame you for wanting to switch.

LJMoon6 · September 2021

@bumblebee0210 I think that has a lot to do with it, re: speaking to the nurses and not the RE. The only time I’ve actually spoken to my RE has been during the consult. Everything else is done by the nurses. Scans, blood draw, communicating instructions, and even the actual IUI. I really don’t understand why even just a follow up phone call by the RE isn’t done. One of the nurses I was talking to could definitely tell I was getting frustrated and offered for me to schedule a follow up appointment with the RE… But that would have delayed us starting our next cycle. Which I don’t want to do.

@gingermama29 I'm so glad you got an appointment scheduled so fast! That's great!

acleverusername · September 2021

Omg so much activity today. I have to come back for more comments but for now I wanted to drop a line to “talk @LJMoon off the ledge.”

Lady friend, we’re here for you. Trust me when I say that nurses don’t know much about anything. The number of times I got off the phone with my nurses and rolled my eyes as I knew 💯 that what she said was wrong…. Well there are many such occasions. They are trained to read out the results but rarely are they equipped to do anything more. So, a few things…

1) About having 5 kids… honestly the chance of that happening is infinitesimally small at our age (I think we're same age). It’s not like each additional follicle gives doubles, triples, quadruples the success rate of IUIs. Sadly, it doesn't work like that. What I can tell you is you should watch this video from TEW. If you don't have time to watch, look at this graph... it outlines chances of success of IUI by # of follicles and age, as well as absolute / relative risk of multiples by age/# of follicles. She talked to another doctor who did a study that demonstrates what amount of follicles are "safe" for women at any given age. For context, I did a super-ovulation cycle with TEW in March, and I ovulated 4 follicles. We also did double insemination. I asked what my chances of success were and TEW said about 10-12%; and she said that with 1 or 2, it would have been less than 10%.

2) About ovulation soon after your LH surge. Keep in mind that before your follicle releases the egg, the oocyte still need to go through meiosis which takes ~1 day. So, even if you have a quick surge, doesn't mean that your egg is released quicker. From this article: "The resumption of meiosis (so called nuclear maturation) occurs 14–18 h after the beginning of the LH surge; meiosis I is completed within 35 h and the oocytes reach the metaphase II stage (MII) [16]."

3) On the topic of switching clinics, YES absolutely do that. Remember, I'm on my 4th clinic (the last switch due to insurance but you get the point). You are spending too much – emotionally, physically, mentally – to be treated like an afterthought. Even if the nurses can't give you answer, someone at the clinic should. I would agree with @bumblebee0210 about talking to the clinic director about only dealing with an NP, a PA, or directly with RE. Think about the stress that you're experiencing having to deal with the nurse who can't give you the answers you're looking for. I know it's easier said that done, and ultimately, you need to listen to your gut.

Anyways, I hope all of this helps. I'm happy you're back here. Ask us ANY questions. You know how much I love to get into the scientific nitty gritty answering ppl. Lol. *Hugs*

Edit: okay, we're not the same age (just looked at the Newbies intro thread). LOL. But I'm not changing what I wrote... hopefully the sources I've cited will help.

acleverusername · September 2021

@bumblebee0210 got some juicy info for you re: your question direct from an embryologist!

It’s up to the embryologist who is doing the actual biopsy procedure [when to biopsy the embryo]. Sometimes a 3AA has enough trophectoderm cells we are comfortable with removing.. and sometimes it’s not enough.

No advantage [to waiting until stage 4] that I am aware of, just level of comfort and the amount of cells during this stage of expansion versus a 4, etc. The funny thing is there is a range of “3” and “4” in terms of how expanded that zona pellucida is. I’m sure I’m not the only person who has graded a small 3AA and a pretty nice big 3AA that’s almost a 4.”

And for your question about what “to think about my day-5 4BB as "better" than my day-6 5AB, because that day-6 5AB was only like a 3BB on day 5”… I’m sure give seen this: https://www.sensiblesurrogacy.com/quality-grade-of-embryos/ I think it’s the ultimate grade of the embryo that matters. So your 5AB > 4BB. And a 3BB would have been slightly worse than 4BB.

Finally, Fertility IQ states that the number in the grading is least predictive of the ultimate success; the inner cell mass grading is most predictive; and trophectoderm is 2nd most predictive. Besides that, most of the literature I’ve seen says that Day 5 embryos tend to be more successful than Day 6.

Btw, do you know the sex of your embryos? There was some mention of female embryos being slower growing, and I wonder if that theory held up for you. It did in our case, though sample size is 3.

I hope this helps!

bumblebee0210 · September 2021

@acleverusername. Interesting! My day-3's were never 3AA-- I think my first euploid 5BA was a 3BC or something on day 5, so probably not biopsy-able. I just think about @hanshotfirst77. and her 3BC or whatever it was embryo and I'm like "girl, all my 5's are just old 3's!" To be fair, I haven't yet tested them out so not sure whether that is reassuring or not! In our previous cycles, we never got any biopsied on day 5-- they were always like a 3-whatever on day 5 and then a 4 or 5 by day 6. Both of our euploids and our mosaic were male, but again, N of 3 (I don't know the sex of the aneuploids). This was the first cycle where we ever had anything biopsied on day 5-- the 5AB and the 4BB. Then three more on day 6. Maybe we will see if there is any sex correlation this time around with PGT testing.

ETA: I am about the same age as you, and I am about the same age as @LJMoon6, so by the transitive property...

hanshotfirst77 · September 2021

@acleverusername @bumblebee0210 this is interesting. Granted I’ve only done one ER so far, but my RE wouldn’t do any biopsies until at least day 5 but actually let some of mine go to day 6. I need to look it up but I know of my 4 blasts, 2 were day 5 and 2 were day 6 but only 2 ended up being normals so idk what day they were. And I think this makes sense for my age. I was 33 (almost 34) when these embryos were made and at each stage about half made it.

zwink1 · September 2021

@LJMoon6, I'm not sure how easy it will be to find something in my field... but then, I'm not even sure that I want to stay in my field. If I do, I'm going to have to segue into a different type of role than what I'm currently doing so that might make things harder, but I know plenty of people who have done what I'm looking at doing so it should work out. As for your situation, I hope that things go smoothly. Management changes can always be tough and my last 2 job changes were a direct result of shifts in Management.

More importantly, to your clinic drama, I agree with @acleverusername, if you're not comfortable where you're at and don't think you're getting the proper care, absolutely switch!!! This is one of those things where there's too much invested financially, emotionally, and physically to not feel 100% comfortable where you're at. I have been lucky to find a new RE that I am equally comfortable with, but when my last RE announced that she was leaving the area I really struggled with where to go from there and it definitely delayed me from moving forward. Given everything that had happened, I had a lot of trust in her and replacing that was daunting, but I feel like that level of trust is important for this kind of thing and you should absolutely be able to have that in your care team.

LJMoon6 · September 2021

@acleverusername Ok. First off, thank you thank you thank you! I needed that kick in the butt to chill out. What was missing from the nurses was the science behind their comments. Being in STEM, I need a little bit more than a generic comment of “oh, it’ll be fine.” And I shouldn’t have to dig through scientific journals to decode their comments. I knew I should have come back on here sooner. Bouncing all these concerns off of you guys would have helped tremendously, instead of letting them all build up. But I knew I didn’t have the time to dedicate to it this summer. But man, am I glad to be back!

1) Oh yes. I was being a bit dramatic when I made the comment about having 5 babies at once lol. I knew the chances of that happening were pretty low. Thank you for sharing the chart and video (I haven’t had a chance to look at the video yet). That will help soooo much for this next cycle since they’re increasing my dose again. So according to that chart, if all 5 follicles were mature (>14mm) and I had success, I would have had a 30% chance of having multiples. Yikes. That’s still terrifying!

2) Thank you for sharing that article. I read something similar when I was going through the cycle. It gave me hope. But when it didn’t work I turned bitter lol, and I needed to blame the failure on something. My question is, when is “the beginning of the LH surge.” Because I’ve had a nurse tell me that by the time I get a positive OPK it is usually delayed from the blood test (I’m assuming it takes a little longer for LH to reach your urine vs your blood). So, for example, they said my blood was already indicating a rise in my LH Tuesday morning, but my OPK didn’t turn positive till Wednesday night. When would the clock start ticking, so to speak? That’s probably a question that can’t be answered and is getting down to the hour by hour life of an egg. Either way, it was probably fine. Everything is just an average/best guess and can’t really be known for each individual person, especially during an IUI. Which makes it an even more frustrating process.

3) Thank you. I want to switch clinics and be somewhere that I feel confident with. Of course I’m hoping we have success before I actually have to go through that process. The convenience of already being set up with them and them being so close is nice. I will see if I can get a follow-up appointment (or at least a call) from my RE this cycle. Thanks for the suggestion/push (and @bumblebee0210 too).

inthewoods23 · September 2021

@zwink1 the waiting game sucks! I remember the wait from my ER in June to FET in September. Getting the OK to start the meds for the FET at the end of August was a big huzzah!

@LJMoon6 I've started seeing an RI (reproductive immunologist). The biopsy checks for 6 different immunology markers. As you know, the immune system has to do all the right things to allow implantation to occur with embryos being considered foreign bodies. If you wanna learn more about it, it's called a decidualization score. Scoring low is bad meaning I don't have the markers indicating my immune system isn't suppressing properly. I really feel you with the dislike with your current clinic. I'm now fully intending on getting pregnant naturally now that I know that's possible. I did not like my RE's bedside manner when I saw her *tw* in the early days of my PG last year that ended in MC *end TW*. I really hope I never have to transfer another embryo with them.

@CatGifsRock if I had to guess, I bet those follicles measuring 22mm on Friday were well overmature by the time it was Monday. My largest follicles we're maybe 18 when I did the trigger shot. I think a third of my eggs ended up not being mature but I only did half dose of the trigger to prevent OHSS. I'm sorry only 1 ended up fertilizing 😔

@gingermama29 I'm so happy you got the referral!!

acleverusername · September 2021

@LJMoon6 I totally get the need for the "why"; you're in good company here with at least @bumblebee0210
@keikilove and @optimistgardener being like that. And I'm sure others here are too! Sadly, the nurses don't do this kind of research and reading, so we're glad you're back here. To answer your questions further:

1) You read that chart correctly; at your age, you have a much higher risk for multiple, so I would NOT recommend you proceeding with an IUI if you have more than 2... maybe... 3 follicles. For someone in my age category, 4 or 5 follicles is well within tolerated risk. But yeah, your eggs are still young!

2) Yeah, so the start of the LH surge is tricky, cause you're literally have to do a blood test every hour to pinpoint it exactly. And obviously peeing every hour would mean you're using a diluted sample. So that's why most OPKs say that "you ovulate 12-72 hours" after your surge begins. Depending on the type of OPKs you're using (threshold-based or semi-quantitative), by the time you "turn a positive" your LH has been rising. Threshold based tests have a minimum threshold of sometimes 25mIU/mL and sometimes 40mIU/mL, so your LH needs to be OVER that amount before you get a positive. Also depending on how often you test (if it's once a day), your surge could have started right after you tested last, so by the time you test next, it will have ben 20+hrs since the start. If your blood work showed that your LH surge was starting on Tuesday, then my best guess that ovulation window was mid-day'ish Wednesday. The other thing to keep in mind that washed sperm doesn't keep as long as non-washed sperm. It starts to lose its potency 6-12 hours after insemination, although it can live up to 24-48 hours inside the uterine tract. So... there is a chance your timing was ever-so-slightly off, but I think it was pretty much bang on. BTW, I know all of this because I had exactly the same concerns, feelings, about my IUI in Feb of this year. So I canvassed the internet in search of answers and can now pass that on to you and others.

3) Can you start looking for a new clinic in parallel? At least that way you're working towards a Plan B in case you're not successful this time around.

Hope this helps!

I still want to get back to all you other ladies, but work is crazy, so I'm doing a little bit at a time.

inthewoods23 · September 2021

My eyes are practically glazed over from all this talk but as an engineer I'm also like

Image: https://us.v-cdn.net/5020794/uploads/editor/nz/d7kk09e1thaf.gif

❤️❤️

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