IF Testing and Treatment w/o 10.25

bumblebee0210 · October 2021

GL @zwink1!

@acleverusername when is your tentative ER? I want you to do your transfer super fast because selfishly I want to be in the same bmb (but also it's about time!). Also-- I agree with @optimistgardener. that you need to be on serious self-care duty for the next week or two at least.

Speaking of which-- have any of you followed Robyn Birken? She has a podcast and a website and some pay-courses I think. I found her through hilariously infertile, and I find her to be pretty in tune with the type-A TTC brain and pretty helpful in her tips for staying sane.

AFM: Got the call on the last embryo-- complex abnormal. I fully expected this-- the embryologist told we it was super weird "but still worth biopsying" I was like ok no. I was hoping to get to my magic number (5) before transfer (and also balance out the sex ratio a bit), but I'm still happy to be moving onto transfer, especially with all of the encouraging stats about mosaics (we have 4 normals, 2 low-level mosaics).

It's interesting that my eggs did seem to be very low quality on the second round of the duostim-- 9 retrieved and 0 normal blasts. This was also true about my second and third rounds back-to-back (10R/0 normals, 2R, 0 fert). My two best rounds were after birth control (weirdly enough), and my other one that produced a normal was after EPP. It's possible that my ovaries just need a break between cycles (perhaps my mega-doses of gonadotropins do something to the early-stage follicles). Anyways, you all know I am hesitant to analyze data with very few observations, but it's an interesting pattern for sure.

I think if I were to do another retrieval (not sure if I will attempt one before [hopefully] transferring for the next one), but if i did I think I would do antagonist with BC, maybe twice with a month in between, then FET.

gingermama29 · October 2021

@zwink1 thinking of you today! Good luck!

inthewoods23 · October 2021

Good luck today @zwink1!

Stupid insurance rant ahead. Putting it in a spoiler in case it gets long

There's been so much back and forth whether or not the genetic tests require pre-authorization for my insurance. Most of the time I've contacted them has been through the live chat feature since I can't exactly sit on hold on the phone while trying to do my job, which is partly taking customer phone calls. Every person there has told me yes, pre-authorization is required.

The medical assistant has called my insurance and was told it requires pre-determination, not pre-authorization. Essentially it's the same process, but this is just to say whether or not these tests are consider medically necessary.

Fast forward to yesterday when I called ReproSource - the lab that will do the genetic tests because the medical assistant told me that they handle everything with insurance since she wasn't getting anywhere with my insurance. Well, when I talked to them yesterday, the insurance stuff just involves the billing. Nothing with the pre-authorization. So before putting down a stupid non-refundable fee I said I would contact my insurance one more time to confirm this pre-authorization thing. The person I talked to on the phone gave me the same thing - that it requires pre-determination, not pre-authorization. So with that, and knowing that ReproSource couldn't get one of their mobile phlebotomists to me for another 3 weeks, I'm going to push for my clinic to submit the stuff for the pre-determination, ask that it get expedited so it only takes a few days instead of weeks, and hopefully get our blood drawn at Quest sometime next week or early the following week.

AAAAGGGGHHHH. Can I just get this done already????? It's the last thing!!!

Angry Girl GIFs Tenor

ETA: after getting off the phone with my insurance I had an absolute meltdown. Just bawling my eyes out. DH thankfully came home shortly after and comforted me. I'm so frustrated by how long this is taking.

optimistgardener · October 2021

@bumblebee0210 i'm sorry about the embryo news but i know you were prepared for that. as for your observations about outcomes from retrievals after "rest" periods vs. after BTB, this meshes with a few things i've read not about euploidy rates per se, but just about cycle outcomes from a purely counting perspective. it also meshes with what my RE says (although who knows, i sort of just think he's justifying things so they can have their clinic calendar set up for 1month retrievals/1month transfers) about wanting his patients to have a "break cycle" between retrievals. I won't be able to find the relevant literature this morning, but maybe i'll dig around later.

hanshotfirst77 · October 2021

@zwink1 good luck today!!!

@inthewoods23 ughh insurance is the worst!

@bumblebee0210 sorry about the abnormal results. It’s hard not to get hopeful. Hugs.

inthewoods23 · October 2021

@bumblebee0210 that sucks that the embryo was complex abnormal. Time to look forward towards your FET!

@hanshotfirst77 omg that gif is perfect!

optimistgardener · October 2021

@inthewoods23 i didn't see your post before. solidarity with insurance. and @hanshotfirst77 that's the best gif ever.

acleverusername · October 2021

@optimistgardener / @bumblebee0210 thanks for giving me a reality check re: needing some self-care time. I am planning to be very kind to myself leading up to my ER which is probably Monday or Tuesday. @bumblebee0210 I really don't think we would end up in the same BMB... cause when we gamed things out with the RE back in Sep, it was looking like 1st or 2nd week of Dec for a transfer. And, of course, there were a whole bunch of hoops to jump through after that.

@bumblebee0210 I know you're putting on a brave face re: genetic results, but it's OK to mourn to this embryo. Sending you hugs. I really hope you won't need more ERs though. REALLY hope. Thanks for the podcast recommendation. I'll check it out.

@inthewoods23 I am sorry dude. I can understand how you feel. I would be shouting at the clinic ppl at this point. Sending you creepy internet support hugs.

+1 to the gif choice @hanshotfirst77. Excellent.

zwink1 · October 2021

@inthewoods23, I think part of it too is that it feels shorter for him because he's not the one getting shot up, lol. But you're right, sort of like what @acleverusername brought up, it's so weird because it seems like it takes for ever to get moving and then all of the sudden a "big" step flies up on you!

@bumblebee0210, I'm sorry about the bad news on your embryo. Even going in prepared for it, it's still tough news.

Thank you all for the well wishes!! Things went mostly fine with only a couple of hiccups, and a snowglobe has officially been relocated. So, now we wait...and I'm already impatient.

Edit: accidentally posted too soon.

acleverusername · October 2021

@kiki047 curious: did you get your full flow? What did the clinic say?

kiki047 · October 2021

Sorry guys, this week has gotten away from me a little. I've been lurking. Hoping to find some time later to update once we get our Day 5 report sometime today.

@zwink1 I can relate to things going "mostly fine", so hopefully that means all the hiccups have already happened and it's smooth sailing from here! FX!!

@acleverusername I echo @optimistgardener's sentiments in finding some ways to practice some self-care this weekend, whatever that looks like, because this process is just all-consuming in every way, and you've already taken a beating these past few months. You've got this. You're ready for this.

Thank you for the tag re: Meaghan Doyle. So without giving too much away, I've had a few conversations with Meaghan as she is the genetic counsellor at MFC, where I had my last 2 ERs. I was not a patient of MFC though, my RE just had an arrangement with them to use their facilities. As for my current status, I went in yesterday and had BW and US done and my RE has concluded that my hunch was correct and this is, in fact, a withdrawal bleed and not an actual period. Which is good, because we're hoping to have a better idea of how this cycle went before we launch ourselves into another one.

Spoilering the rest for length. TLDR: There are some cost-saving measures we can take advantage of if we do back to back cycles.

One of the reasons for back to back to back cycles is because they have a flat rate for PGT on the first 8 blasts (and $250/embryo thereafter). If we didn't get 8 from this cycle then we would have an opportunity to batch them with subsequent cycles to save a bit of money that way. He also offers a 3-for-2 program where you pay for 2 cycles and get 3... so the question then becomes, if we get what we want from just 2 cycles, do we do the 3rd just because? As we all know, it's no walk in the park so that part will really come down to how I'm feeling and what our numbers look like once we get some PGT results back. It could go either way.

LJMoon6 · October 2021

I’ve been in a funk this week. I started typing out replies but I just sound like a robot, so I deleted them.

Diagnosis (if you've been): Unexplained

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): We decided to go for another IUI, even though we will be paying for some of this cycle completely OOP. We’re just giving it one last hail mary before taking a break. This will be IUI #4, all back to back, so a break is definitely needed.

How are things going?: In a mood this week and can’t shake it. I think it’s a combination of holidays looming and knowing we’re going to be done with treatment for a while. I also don’t feel supported by my clinic. I had a very long conversation with the nurse who called me with my beta results on Friday. I let her know how frustrated I have been with the clinic (more on that in spoiler below). I let it all out. And she was kind and listened and sympathized. But at the end of the day, nothing will change.

I sent an email last week, asking about changing the recommended protocol for our next cycle. Didn’t hear anything for a couple days so I sent a follow up email. Still nothing. Finally when the nurse called I mentioned the email and she informs me that the email is no longer being used… um. What?! Don’t you think you should set up some automatic reply then?! I understand their reasoning behind not using the email any more but FFS. When I finally do get an answer about changing the protocol, it’s all a big NO. No, we can’t add anything to my cycle to thicken my lining on the higher dose of letrozole. No, we can’t try starting on CD1 or 2. And, no, we can’t try an extended low dose approach either. And if I want to discus it further, I have to schedule a phone appointment with my RE, skip a cycle while I wait for the appointment, and get charged for the phone call. I get that the doctors time is valuable. I get that she’s busy and has a ton of patients… But I’ve had email and phone conversations with my other doctors before that I don’t get charged for. Why is it that the only way I can have a conversation with my RE is through an appointment? Where is the patient care?!

Anyways. This is the last month we will be dealing with this clinic, regardless of the outcome. And it can’t come any sooner.

Any questions?: nope

GTKY: What's your favorite topping for a caramel apple? If you're not a fan of caramel apples, then what is your favorite fall treat? Don’t care for caramel apples in the traditional sense. But I do love a good slice of apple dipped in a caramel sauce. Yum!

bumblebee0210 · October 2021

@LJMoon6. Sorry you're in a funk-- I think it's a really natural part of the TTC process and its good to recognize that like... this is stressful and a lot of times it will feel bad. also just speaking for me here, but I think the "respond to everyone every time" norm can get a bit out of hand with such a big board, and I also sometimes skip it, especially if people are like "nothing to report, going to a phillies game this weekend". I think the conversation naturally flows toward people going through things and needing support or cheering on. Also you should 100% change clinics if it's feasible.

@kiki047 Looking forward to those day 5 stats! Hopefully it will be amazing, but remember even if your blast *rate* is not as high as you hoped, you have so many to work with it's really likely you have some good ones in there.

AFM: lining check this morning was at like 6.8, which is annoying because at my clinic they like to see 7 or greater. Still I think I'd rather have them check back in a couple of days than just push it along, since we are literally using our best embryo from 6 ERs, and I do not want to give it anything but the best shot at sticking. I know this isn't that big of a setback, and I'm actually on kind a low dose of estrace relative to other protocols I have seen (just 2 mg twice daily, orally), but I was surprisingly bummed this morning when I saw it, because I think I just felt like our big hurdle was getting the euploid embryos and after that it would all be smooth sailing. I know that is naive, given the experience of ladies on this board, but I think it was a coping mechanism to get me through that part of the process. Now that I'm on this side I'm like "oh yeah-- all of the other things". Anyway, I'll know more about the plan later today, but I was really hoping they would just be like "AMAZING UTERUS! PUT A BABY IN THERE STAT"

ETA: For those of you who have done FETs-- do they check/report the lining again on the day of transfer? And does it typically grow? Of course I was pubmed-ing it as soon as I got out of there, and it seems like a lining above 8.5 or 10 is ideal, *but* that is measured on the day of transfer, so I am not really sure how to translate.

acleverusername · October 2021

@kiki047 I was driving to my clinic this morning thinking about you and the fact that it's Day 5/6 for you today! I hope you only get good news. RE: doing 3 cycles, would the clinic let you wait for the 3rd if you did 2 back to back now and would have technically "earned" the 3rd free cycle? Re: your convos with Meaghan... were they positive?

@LJMoon6 yes, please switch clinics! I forget... is IVF an option of you at some point? Or does your insurance only cover IUIs? Also, not sure how you feel about it, but... erm... a bunch of us have been known to "freestyle" our protocols a bit, so as long as you're comfortable... you can always take matter into your own hands. Just a thought.

@bumblebee0210 GAH! I'm bummed that your uterus wasn't perfect. You're doing a fully medicated FET though, right? So, they will just keep you on estrogen until the lining gets to the right level?

AFM,

Currently sitting at a cafe across from my fertility clinic, waiting to connect IRL with another lady whom I met on the R e d d i t infertility forum after her appointment there. I am continuing to be "cautiously optimistic" following my u/s this morning. Spoilering:

We still have those 13 that is looking like our "cohort"... all between 7.4mm and 10.9mm; there are 3 others that are 14.4mm, 13.5mm, and 13.4mm which we likely have to let overmature. However, doc is likely going to reduce my dose again either tonight or tomorrow, and maaaaaayyyyybe that'll slow down those 3 a bit, and we might actually get a mature egg out of them. Who knows! But this is definitely a great looking cycle so far.

I'm back on Sunday for my next ultrasound.

bumblebee0210 · October 2021

@acleverusername. Yes-- fully medicated, so likely like 2 more days of estrace and another look, but I'm a newb at this so I don't know. Also, my clinic times it so there are no transfers on weekends so it could be 4+ more days and then a check. Also great stats!! I love how like in the weeds you are with the doc on the evolving follicle stats. Hoping it's your last ever ER!

hanshotfirst77 · October 2021

@bumblebee0210 when I did my FET I was frustrated with my lining which was very similar to yours. And I remember hearing about other peoples being like 10 and 11 and I was barely the acceptable 7. But my RE insisted to me that it was fine. I don’t recall that they checked it again. And I had borderline low progesterone too even on PIO and suppositories which worried me but they also insisted it was still ok. TW PG mentioned

And that FET was successful

Anyways FX you get that perfect uterus all clear!

@LJMoon6 it can be intimidating sometimes when this board is hopping. Don’t feel like you have to respond to all. And your clinic sounds like the worst. I’m so sorry you’re dealing with that. Remind me are you considering IVF?

feather_heather · October 2021

@bumblebee0210 - YGPM

shortstack930 · October 2021

@bumblebee0210 so for this FET I went for a lining check on a Wednesday and it was 6.7 I think. The nurse said they like to see at least 6-7 so they were good with just scheduling my FET for the next Friday (a little over a week after) because they said by then the lining should be good. When I went for the FET they didn’t tell me what the lining measured but the ultrasound tech said it looked nice and thick.

@LJMoon6 I am so sorry you’re having so much trouble with your clinic. If you’re able to switch then that is definitely a good idea if you’re not being supported the way you should be.

@acleverusername that sounds like a great update! I’m optimistic for you also! How did your meet up go?

zwink1 · October 2021

@LJMoon6, I'm sorry that you're in a funk, it sucks, but is also totally normal and you're not alone. Agreed, absolutely do not feel required to respond, everyone needs a break even from things they like/appreciate. And as others have said, if you're not feeling supported, absolutely make a change if that's an option.

@kiki047, anxiously sending you all of my good vibes for great news!

@bumblebee0210, I did not have a second lining check and they didn't check it again at my FET, so I can't confirm whether it thickened. Anyway, the Estrace should continue to help it thicken (obviously it eventually reaches a max, but that's its primary job). They have a little bit of wiggle room scheduling wise for when thr FET has to happen to allow things to get where they're supposed to be.

Unrelated - but is this obnoxious Halloween ad glitching out anyone else's app?

keikilove · October 2021

Happy Thursday everybody! Add me to the group of members that’s been lurking but was so overwhelmed by the number of posts here that I couldn’t even start to tag folks.

Just jumping in for a moment to say @zwink1 Sending you good energy for this TWW. So exciting!

@kiki047 I said it in PM but YAY for those retrieval numbers—absolutely AMAZING! I am so happy for you. Hoping to hear a great update from you soon. No pressure!

@acleverusername Hooray for such a promising cycle! I hope it all continues to go well.

@bumblebee0210 Your dose of estrogen sounds very reasonable. Will your clinic allow you to increase it? It’s also normal to take up to 8 mg per day before FET to thicken the lining. Vaginal viagra is another option to thicken it. Some swear by pomegranate juice and Brazil nuts as well. Not sure if that’s truly effective.

@inthewoods23 I’m so sorry about the insurance nightmares! Why does insurance have to be the worst?! I hope it gets worked out soon. And I LOVE that you opened up to your folks about your TTC journey. Very proud of you.

@LJMoon6 OMG, I’m so angry for you right now. I hope you are able to get some decent care during this last IUI before switching clinics. I’m with Clever: take things into your own hands with your protocol if you need to. The clinic doesn’t need to know, especially with something as minor as the Letrozole. (Although the thin lining issue could cause problems. I didn’t think Letrozole did that to the lining but I guess it’s different for every body.) Feel free to PM me if you want about the various things I’ve tried.

AFM I’m just having another insane work week with very little sleep. I’ve also been dealing with an insurance battle like ITW23, so time consuming and frustrating. In my little free time I’m researching surrogacy and another med that might help with implantation. I will do a full update later this week or maybe on the weekend. I can’t seem to ever find the time these days during the week. Basically my last retrieval was a shocking disappointment and I’m just looking forward to starting the second part of the DuoStim in the next couple of days.

optimistgardener · October 2021

just popping in to give @keikilove another great big hug.

bumblebee0210 · October 2021

@keikilove Oh man I'm so sorry-- I remember your follicle count was good, and getting disappointed after you get your hopes up is just the worst. Hoping your next round makes up for it.

AFM: They are putting me on estrace 3x day and having me come back in 2 days. It's helpful knowing that other clinics go ahead with transfers with linings above 5 mm, so I'm not too worried. Everything is just shifted back 2 days, so tentative transfer is now next Friday (11/5)

zwink1 · October 2021

@keikilove, sending you all of the virtual hugs that I can. I'm sorry you've been having a rough week at work on top of everything else.

@bumblebee0210, I'm glad you have a plan! That seems completely reasonable given how close your lining was. How many days have been on the Estrace so far?

kiki047 · October 2021

@bumblebee0210 I did not get a lining report on the day of my FET, only at my last lining check 2 days prior at which point they want to see that it is trilaminar. I will say, when my lining was < 7mm at my last check for my first transfer I was given the option to cancel at that point and either switch to a TI cycle or just scrap it all together but we opted to go through with it at the time. My medicated FETs have always been 2x 2mg estrace twice daily, increased to 3x a day (vaginally, blah) plus a patch when I was spotting. I hope you get some good news at your next check.
@keikilove sending you extra love to get through the latter half of your duostim.
@LJMoon6 ugghh I'm so frustrated with that clinic on your behalf. I'm glad this is your last round with them because I say good riddance! I don't remember what you said about switching - do you have other options in your area/network?

I still don't have my final final report, yesterday's "final" report was not what we hoped for, and the nurse gave us a goddamn heart attack because she was missing an entire page. Basically she excitedly told us we had 5 blasts that looked good and were biopsied and frozen. And just left it at that, I guess waiting for us to be thrilled? We sat there in stunned silence, because 23 down to 5 is a huge drop. We expected to lose some but not that many. When I finally found the words to ask what happened to the rest of them, she said there were "a few more" that they were watching to day 7 and they would call me [today]. At which point I asked how many were definitely out of the running? and that's when she realized she was missing a page. She called me back an hour later and on the 2nd page there were 2 more blasts, so 7 all together, plus 8 more that were still under observation, and 10 that were definitely arrested. We're holding our breath for the other 8 but 7 is... good.
I know I can't and shouldn't compare cycles but in the past we've only ever lost 1 each cycle that didn't make it to blast so although this is a much bigger sample size, that was a big blow. I was flustered and upset at that point so I didn't ask about grading, etc.

optimistgardener · October 2021

@kiki047 ugh what a combination of bad nurse delivery and not the great news you were hoping for. i've got my fingers crossed that a bunch of those other slow-pokes pick up the pace a little bit and you wind up with a satisfying crop from this cycle.

bumblebee0210 · October 2021

@kiki047 Oh man I'm so sorry-- I think the other young-uns can chime in (@inthewoods23), but I think it's much more common to lose many more when your cohort is so big. A typical blast rate (from fertilized eggs) is 50%-- and it looks like you will end up pretty close to that. When your cohort is small, it's still 50% but noisier-- so you can get like 5 fert and though you "should" get 2-3, it's not that weird to get 4 or 1 (or 5 or 0!). The larger your sample, the likelier you are to be right about average (because 1 or 2 in either direction swings you less). Also-- I wonder if those late-fert eggs never made it, so your "real" cohort was like 18 fertilized. I know this isn't what you hoped for, but I think it's really, really uncommon for people (even egg donors) to get more than like 5 or 6 blasts in a cycle, so to have 7 already is fantastic. I would try to focus on that and onto the next cycles. Hopefully you'll get good news on the PGT testing and you'll only need one or two more ERs ever. Getting hopes up is the *worst* part of this process. Hugs.

optimistgardener · October 2021

@bumblebee0210 is always right there with the good stats insight.

hanshotfirst77 · October 2021

@kiki75 ugh I’m sorry for the way that nurse delivered your news. The drop off is one of the worst parts of the process. But echoing what others have said, I think it’s still very positive results. 7 is great and having more that can still make it is great news too. Fx for more blasts and that as many as possible pass testing.

AFM saline Sono was this morning. My ute passed woo! I’ve done this a few times but jeez it hurt getting to my cervix today. Thanks tilted uterus. And I forgot to take the ibuprofen before hand. But yay for the all clear.

laura-kay · October 2021

@acleverusername

Still lurking,

but temporarily holding off on posting regularly for an emotional break. We paused treatments for a bit so that we could enjoy some family vacations, work changes, and just a bit of time to focus on our relationship as a couple.

Thank you for the video! I will be watching it. It’s good timing, as we are prepping for at least one more try.

laura-kay · October 2021

Also, I’m cheering you all on!! I may not be writing each week, but I am thinking of you all and hoping all goes well!

acleverusername · October 2021

@keikilove girl, I just got chewed out by @bumblebee0210 & @optimistgardener about self care, so I just feel like paying it forward now. What ARE YOU doing for self care? Your every update leaves me feeling 😵. Okay, that was tough love. I am so sorry your first retrieval was such a bust; I look forward to your update this weekend, and in the meanwhile sending you growth thoughts for the 2nd part of DuoStim.

@shortstack930 The meeting went really well! It's so weird/nice to meet someone IRL. Our cycles are 1 day off, and she's going into a transfer right after, so it's nice to have a local IF buddy going through the same stuff.

@kiki047 WOW... that nurse though. Frig. I would have been so upset/mad/not-sure-what if I'd gotten those kind of news. Gah. I don't even know what to say. Also, @bumblebee0210 said everything what I could have said, only backed by stats. I do know of ppl who've gotten like 12 blasts in a cycle, but they were all in their late 20's. And I'm pretty sure that your being 35 instead of 34 wouldn't have made a difference. Plus, this is still WAY more blasts than you've had in any other cycle before, right? So, attrition aside, I think those are excellent number. When you get the final report, please share the grading.

@hanshotfirst77 Woo for a nice ute! I'm sorry it hurt though. If it's not one thing, it's another.

@bumblebee0210 So happy that your clinics upped your estrace dose. Hopefully that'll do the trick. As for delay, selfishly, it just makes it a bit more likely than we might be in the same BMB. Teehee.

kiki047 · October 2021

@bumblebee0210 thank you, friend, I needed to hear that and you're right, that puts everything into perspective for me. I forgot what a rollercoaster this is and maybe I was a little too cocky going into it feeling like a seasoned veteran and assuming that the highs and lows wouldn't get to me the way they did.
@hanshotfirst77 YAY for clear ute! Sorry about the discomfort, I also have a tilted uterus/cervix so that is no bueno. Hopefully that is the last saline sono you'll need for a good long time.
@laura-kay glad you're taking some time for yourself! It's still an essential part of this process, and is something that I think is so often overlooked because of the PTSD we all have from forced downtime, as opposed to choosing to take a step back. Good luck with prep for your next cycle, we're here if you need a shoulder to lean on.
@acleverusername it actually isn't "way" more than we've had in the past - the first cycle we only got 5 eggs, 4 mat/fert, and 3 blasts. Second we got 8 eggs, 7 mature/fert, 6 blasts. So 9/26 is only 34.6% vs 75% and 86%. That said, we know everything about this cycle was different in terms of protocol and intention. My old RE was extremely cautious, where this one is aggressive. Really makes you wonder though, is there a happy medium? Would we get just as many blasts from a slightly scaled back protocol to try to prioritize quality vs quantity? I'll be asking him that next time I talk to him, which at this rate sounds like will be at the start of my next cycle unless I want to book an appointment to go hang out in the waiting room for 4 hours sometime next week to ask him a question.

Our Day 7 update is that we got 2 more, so 9 total. When I back myself out of my irrational gut reaction of "oh god what happened?!" then I know this is great, we are extremely grateful to be in this position. I know this is not a bad result by any means so I am absolutely not complaining, just shocked.

They would not tell me grading, they said the Dr likes to go through that with us, and as I said above, if I want to talk to him I have to book an appt. So here's my new dilemma. Remember I mentioned about batch PGT testing the embryos? The part that they left out about that is that they meant we wait until we're done all 3 retrievals to do the PGT, not just until we meet the minimum of 8. The cost savings isn't super significant in the grand scheme of things, but I guess the reasoning being that we already know that with my age and history we can expect that only 50% will be euploid, so either way we want to have around 20 blasts total to test, which we did not get from one cycle and like won't get from just 2. So it doesn't change the game plan, it just means we won't have any answers going into the next 2 cycles.

Now I think you ladies are like me, and you would want to know. I WANT to know, but do I NEED to know? I guess not. It doesn't change anything. Maybe knowing will just put more pressure on the next 2? But will it drive me absolutely crazy in the meantime?

Image: https://media.giphy.com/media/3og0ISDmwZW0z7W7HW/giphy.gif

acleverusername · October 2021

@kiki047 ahhhhh. I knew that as a percentage of total embryos you had higher blast formation before, but I didn't realized that you had 6 blasts at one point. Alas, I know you know that 9 is good, so nothing much more I can say here. I bet you'll have a lot of questions for the doctor!

I have to understand the whole financial aspect of this. Are 8 embyros included in the cost each cycle? Or across all 3 cycles? How much would it cost you to send 3 batches of embryos for PGT testing? If I understand correctly, sending this first batch would be free + $250 (for 1 over 8). What's the flat free for having 8 embryos tested at one time?

optimistgardener · October 2021

@zwink1 so excited for you! it seems like i need a lot of fingers and toes to keep crossed for folks around here but i've got some crossed for you in particular.

@hanshotfirst77 hurray for the clean sono result! i'm so sorry about the painful cervix breach. ugh, so crampy and weird. i try to be a stoic mostly but when things get painful on the gyno table i have been known to screech. it's a special kind of uncool pain.

@laura-kay hey friend! 👋 i'm so glad you've been able to take a bit of a break for your self and for family stuff. what @kiki047 said is so true about how we all have ptsd from the enforced breaks in ttc, and sometimes forget that self-chosen breaks can be really important.

+1 to @acleverusername about @keikilove's updates giving me a big case of the "oofs" from afar. No one needs to tell you that you are really, really good at juggling just a massive and unfair pile of sh** that has fallen on you unbidden. I hope you're able to find ways to take deep breaths when you can. remember that you're also a caregiver right now in addition to all the other things you are, and caregiving all by itself is a full-time job, even when it doesn't appear to be. you don't want to burn yourself out. don't feel like you need to do all the things at once. go ahead and be ok with doing some of the things in a half-assed fashion. you've got all the permission you need.

@kiki047 i know it sucks to deal with those attrition rates but still: 9 embies! awesome! looking forward to seeing how the next one goes for you.

bumblebee0210 · October 2021

Just a quick update here: The extra estrace (or just time) did its job and my lining was 7.75 mm today, trilaminar, quiet ovaries, etc so I'm a go for next Friday. PIO starts tomorrow at 11 AM (seriously how do they come up with these times?). Pumped!

@kiki047 I hear you on the "happy medium" and you may be right-- but remember in the end all you want is euploid blasts, so I would focus more on the number than the rate. I'm guessing it's more likely that the extra drugs helped recruit more follicles that weren't as good, and/or this doc might also be more aggressive about collecting littler ones, etc, rather than them actually affecting the quality per se. But who knows. Either way, 9 is great. Also-- I am surprised their default is to batch them because it involves thawing and re-freezing for the biopsy. My doctor said "if you can afford the extra biopsy/courier fee I would send them all as they come" so that's what we did. I mean we were working with waaaay fewer embryos so losing one in a thaw was maybe scarier for us?

keikilove · October 2021

@kiki047 Thank you for sharing your results with us.💗 It feels very personal sometimes to share all this info every step of the way. That being said, you do have quite the dilemma. You know that I’m too impatient with all of this and could never wait for all retrievals to be done before knowing those results. My need to know would have me testing each round. Good luck to you!

@acleverusername & @optimistgardener Thank you both so much for your sweet words and understanding. There’s even more going on than I’ve shared, but I honestly feel that every update from me is so full of drama that I will spare you all the details. I am trying to do self-care by at least taking walks at sunset and such. Thank you again, and sending love right back to y’all. ❤️ 💜 ♥️

ETA: @bumblebee0210 We were writing at the same time, I missed your update. So happy to hear that the increased Estrace did the trick for your lining! Good luck with the PIO shots (At that very specific time lol) and fingers crossed that it is a super smooth transfer next Friday! Woohoo, it's been a long time coming!

Going to quickly add my update before the day gets away from me. I promise myself and everyone here that I will come back for additional tags! This is related to my ER a week ago.

Diagnosis (if you've been): RPL/RIF, Elevated NK cells & activity, DQ Alpha Match, multiple clotting mutations, AMA, DOR

Status (WTO/TWW/TTA): WTO--another retrieval soon

What are you doing this cycle? (Testing? Treatment?): I started shots yesterday for my second part of this DuoStim cycle.

How are things going?: Things are ok. I was super down last week after my disappointing ER, but now it's like "Eh. On to the next."

Any questions?: Shoot, I had one yesterday for the group and now I've forgotten it. Will hopefully come back to me and will post it later...

GTKY: What's your favorite topping for a caramel apple? If you're not a fan of caramel apples, then what is your favorite fall treat? They're not a big thing where I live. I've only ever had the red candy apple (ugh) and a plain caramel apple (yum). Nuts seems like an ok addition. But I'd rather have candy corn. Come at me.

So the recap on the last retrieval is that I had shared that my local RE did my monitoring and saw 8 follicles. This was better than what my RE in Mexico had seen at baseline (7). So I was happy with the 8 and how the cycle was progressing on my new protocol: I had asked my RE in MX if I could try something a bit more aggressive than what we'd been doing and she agreed. So I started with a few days of Letrozole and Follistim, then had the good monitoring appointment at my local RE (over a hundred miles away, I have to take a flight to see her). Then I posted here in the IF thread that if I was timing everything right, my RE in MX would tell me to trigger on Thursday for a Saturday retrieval. I even said how proud I was of myself that I had started to figure out my patterns in these stim cycles and that it was enabling me to take fewer flights and plan them out better, etc. Well, my friends, pride comes before the fall.

I had monitoring at my local RE on a Monday. I had two big important work meetings on Wednesday and couldn't miss them, so I went to work and then flew overnight Wednesday to arrive in San Diego on Thursday morning. I got to my RE in Mexico for monitoring and she kept saying "Wow....Wow! They're too big. I wish you could've gotten here yesterday. I would have told you to trigger then for a Friday retrieval." WTAF. How in the world did my follicles almost double in size in 3 days?! Apparently, if I had been able to return to my RE in MX on Wednesday, I would have stimmed for just 7 days before retrieval. That is way faster than my other cycles.

This has never happened to me before. I’ve done 8 cycles and never ever stimmed this fast. I usually stim for 11 days on average, sometimes 10 and sometimes 12. Never ever has my body been ready after 7 days of injections. I guess the new protocol really worked. FML that I got there a day later than I should have!
More details and cycle results if interested:

Anyway, I'd already been taking Cetrotide; my RE had me take another Cetrotide at that very moment after the ultrasound because she was afraid I'd ovulate early. She made me nervous about the cycle and all my hopes for my best cycle ever went out the window. I had lots of cramping the night before the ER, and did my usual worrying that I might be ovulating, then the pain went away in the early hours of the morning. When I woke up last Saturday to head in for the retrieval the cramping started up again, intensely. As soon as I arrived at the clinic they were ready to take me into the operating room, so I forgot to ask to have my bloodwork done as I had wanted to. (They always do bloodwork on trigger day but they don't always do it on retrieval day).
We did the ER and she only got 5 eggs. I asked what happened to the other 3 that were huge. She said there was only 1 other follicle and she aspirated it but there was no egg. So I don't know if I really did ovulate the other 3 eggs or what.... such a bummer. And on top of that, of course I wasn't tracking anything so I don't even know how to pinpoint what happened. If I'd done bloodwork that morning I'd at least have been able to see if my estrogen had dropped or whether my progesterone had increased. Missed opportunity! However, my Fitbit shows that my temp did a big drop two nights before retrieval, and then a huge 4-degree temp drop the night before ER. Also, my heart rate was increased on trigger day, and then it was the highest it's been all month the day before retrieval. These are my normal patterns when I ovulate. So now I really believe that I did in fact ovulate some of the eggs early, as I've always feared might happen. But my RE says the when a person ovulates early before retrieval, she usually ovulates all the eggs at once. So I don't know and have to just let it go....

Also, the overall results weren't good so I don't know if the more aggressive protocol impacted quality. I wanted to grow all to Day 5 but by Day 3 I had just 2 that looked really good and 1 that was slower-developing. So we froze and 8 cell and a 7 cell, both with no fragmentation. I feel like I'm no closer to knowing the root of our issues. I have quite a few frozen Day 3s now. I am going to push these next embryos to Day 5 if they will get that far.

Let it suffice to say that I will be arriving in Mexico early for this next retrieval. End of story.

acleverusername · October 2021

@keikilove I’m just over here giving you a big hug. I’ve also had my pride get the best of me during this process as I’ve shared. Argh. I am just really sorry this happened to you. Hopefully retrieval #2 will go MUCH better. 🤞🏻🤞🏻🤞🏻

@bumblebee0210 LOL @ your excitement for PIO. Yay for confirmed transfer date!

optimistgardener · October 2021

@keikilove oh cripes! how terribly frustrating with your fast response to the stims that you feel like you may have missed your window and even ovulated early. I worry that i'm going to stim too fast and they'll miss me, also (what with my stims usually taking place in a narrow 5-6 day window). Please take what peace you can from those evening walks.

acleverusername · October 2021

Came across this today. It's a good read: https://cupofjo.com/2021/04/jessica-olien-infertility-comics/

optimistgardener · October 2021

it is a good read. thanks for sharing @acleverusername

IF Testing and Treatment w/o 10.25

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