The Today Show and Transfer Regimen

MY DOCTOR, DR. SILBER, WAS ON THE TODAY SHOW!!!

Tuesday morning a friend's mom called her at work (our work) and told her she thought my doctor was on The Today Show. I ran to the break room and turned the TV on. I had already missed half of it but thanks to the Internet I was able to watch it all.

Now I know Dr. Silber has been on TV several times in the past but this time they preformed an egg retrieval live for the first time ever and showed the process of inserting sperm into the eggs. I saw all those people just 3 weeks ago, Dr. Silber, the nurses, the ultra sound tech and the girl drawing her blood! They even showed the guy sitting in the room waiting for them to wheel his fiance back in. I wonder if Ryan looked that nervous? Probably not this time but maybe the first time. So cool!

Here is the link to the article and the two video segments.

http://www.today.com/moms/why-im-doing-ivf-live-tv-one-womans-fertility-journey-4B11235075

{Disclaimer: Yes I wish this couple would go to the courthouse and get married, have a wedding ceremony later people!}

I can't wait to hear the update on their fertilization!

I HAVE A DETAILED SCHEDULE FOR THE TRANSFER!

Birth control pills begin: TBD (depending on my next cycle start date)

Lupron injections of 10 units daily begin: November 18

Birth control pills end: November 21

Estrace pills 4 mgs twice a day begin: November 29

Vivelle dots (3 dots applied to abdomen every M, W & F) begin: November 29

Blood test for hormone panel & ultrasound to measure uterine lining (locally): December 9

Lupron injections end: December 12

Progesterone 2 cc injections begin: December 13 (these will continue until my blood test and if I am pregnant will continue everyday for 10 weeks)

Ultrasound to measure uterine lining (in St. Louis): December 13

Frozen embryo transfer: December 16

Quantitative Beta HCG blood tests (ie pregnancy test!): December 27 & December 30

Whew! That's a lot to keep up with. Lots of shots this time. I knew that was coming though. I did an estimate and if I am blessed with pregnancy it will be roughly 110 straight days of shots! But if that test comes back positive I will gladly take a shot in the hip everyday! Ryan is gonna have to get tough because he will have to give them to me. The progesterone shots have to be in the hip.

For the last week and a half I have been having a pregnancy dream almost every night. The strange thing is that I haven't had a pregnancy dream that I can remember in over a year! I have had maybe 2 or 3 dreams about babies but none that I am pregnant. All this time, tons of medicine, countless trips to the doctor, countless ultrasounds and blood work, 5 inseminations, 2 egg retrievals and NO PREGNANCY dreams! It's so strange when I think about it. I pretty much day dreamed 24/7 of being pregnant but no dreams at night. I guess my conscious is finally confident enough that I will be pregnant someday soon. I love these dreams. I wake up so happy. Some of them are really happy and some are stressful. I dreamed last night that it was time to go to the hospital. Ryan wouldn't quit talking to everyone around us and kept trying to get things done before we left. I kept looking at my belly and telling him that I didn't think it was time because my belly only looked like I was about 4 months pregnant. I asked him if I had any ultrasounds and he said no. I panicked and said "how can I be ready to deliver if I have never even had an ultrasound?" And of course he was not worried at all and told me it would be fine. Then I woke up. I had one dream a few nights ago that we went in for an ultrasound and the baby was sucking it's thumb. I was sooooooo happy when I woke up from that dream. I cannot wait to hear a heartbeat. I cannot wait to see a baby move on the screen (instead of just looking at follicles on that screen). I hope these happy dreams continue, they give me confidence.

It's getting exciting!!!

Today is my last day at work until after my retrieval! Tomorrow morning we are off to St. Louis to meet with the OB that will be doing my egg retrieval. Then Friday morning I will have my 2nd monitoring ultrasound and blood work.

I had the first monitoring on Monday. My doctor said the ultrasound of my follicle size was right where it should be. I still only had 2 follicles in my right ovary and 5 in my left. I was hoping for more this time but I guess it's better than less. They were tiny, which they are supposed to be in the beginning of a cycle. Then hopefully they grow real big!

The blood work Monday wasn't so great! I got stuck 6 times by 4 different people, almost fainted, spent an hour in the blood lab drinking juice, sitting in front of a fan and having warm towels wrapped around my arms before the supervisor of the lab finally got some (not much) blood from the top of my hand. She told me it was enough to do my hormone panels but not to test for the HIV, Hepatitis, Rubella, etc. Which I was fine with, I knew I could do it in St. Louis on Friday. But then later that day the nurse from Dr. Silber's office called and said the lab told her they didn't have enough blood to run the hormone panel. Dr. S said it was okay, we would just wait and see what my levels were on Friday. But man all that for nothing! Oh well! The lady who finally got my blood said that it was probably because I was so cold. My already extremely tiny veins were hiding. Yup I was freezing at 7:30 when I first walked in and by the time I got to the blood lab it was 9:00, so ya I was froze to the bone by then! Oh well.... just a tiny bump in the road. I can handle tiny bumps! :)

I am not really nervous yet, mainly just excited! However, I do admit this week a little anxiety has started to creep in a bit. The "what if's" have tried to ruin my day a couple of times. But I am really doing pretty good at stomping them out. I can tell Ryan is getting excited too. I am certain he worries too but I don't think he is ever gonna let me see that. He is always so positive! Last night I told him that I was starting to get anxious and of course he asked about what. Ha. I said "I don't know, like what if we don't get any eggs, what if we get some but none fertilize, what if some do fertilize but they all die, what if everything goes smooth and I get pregnant in the Fall like planned but then I miscarry." His reply "Baby we knew going into this that it wouldn't be 100%, we don't know until we try." Yup he's right! Then he said something along the lines of we have to think positive and take one day at a time. Which I really honestly feel like I have been and I really do have to pat myself on the back for that! Because after we left our first consultation with Dr. S, the whole way home I thought to myself how am I ever gonna do this without stressing, worrying and panicking the entire time. That was April 5th, two months ago! So I think I have done pretty darn good, I made it a whole two months before I let the "what if's" start creeping in. It's strange really because that is not my personality at all. I feel like I have done so much better than I thought I ever could.

And don't get me wrong I am still positive about next week. I think when you are doing IVF you almost have to be, otherwise you wouldn't get through it! That and pray and trust in God and his plan. I know this plan was designed for us. I know that we can handle this. I know that it has grown my faith, our marriage, our awareness of our health and is preparing us to be amazing and grateful parents.

Anyway back to my schedule, we should be coming home Friday after my monitoring appt. We will then have to be back to St. Louis Monday morning for monitoring again. We will do blood work and ultrasound at least every other day until the doctor says it is time to get my eggs! EEK, exciting! It's okay if you think I am crazy for being excited about being put under and letting a doctor stick a needle into my ovaries. No I am not worried about that, only about what he says when I wake up! Since people have had questions about how that process is done (I think they have trouble wrapping their minds around it) I have included a picture. The doctor will use an ultrasound probe to guide the needle into each follicle and extract the fluid inside which also contains the egg. (I wish my ovaries looked like this! Mine are no where near that full!)

After they get the eggs out they will inject each one with sperm. Like this

 



Then they will be put in a dish and monitored each day by an embryologist. The goal is for each of the eggs to fertilize. Even though they place the sperm into the egg, that doesn't ensure that it will fertilize and turn into an embryo. But I am praying like crazy they all do! They will know by the next day how many have fertilized. On the second and third day they check to see how good the embryos are growing. The prayer then becomes that by day 3 all of the embryos look like the 8 or 10 cell embryo in the picture below. Those babies are a thing of IVF beauty! Hopefully if everything goes well we will get to see pictures just like these of our future babies. :) :) :)

I will try to make a quick post after each monitoring appt to keep everyone updated on how things are going. Thank you to all of you who have been praying thus far! Now is the time we need your prayers more than ever, prayers for good egg quality that turn into excellent embryos!

Poor Ovarian Reserve...

It has taken me a few days to be ready to write this post. For one, it was way too nice out this weekend to be inside on the computer and I have the sunburn and sore muscles to prove it. (But my yard looks much better!) Secondly, I needed processing time.

Before I go into details of my appointment, I want to say I love Dr. Silber and the whole staff! They were all so nice, just like everyone says. I was not disappointed. :)

My ultrasound appointment was at 2:00 and my appointment with Dr. Silber at 3:00. The purpose of the u/s is to look at the ovaries, get an antral follicle count in each ovary and measure the uterine lining. The follicles are where the egg(s) grow and the antral follicle count is an indicator of your remaining reproductive years.

The girl performing my u/s was so sweet. She asked if I had ever had a trans vaginal ultrasound before. I told her yes, close to ten of them! I didn't ask any questions while she was performing the u/s because I knew that she wasn't supposed to tell me anything, that Dr. Silber wanted to know the results and discuss them with me.

When our name was finally called, I was so excited. I knew I was about to meet an amazing person. Someone who has helped so many people. He introduced himself and we sat at a small round table. The first thing he noticed was Ryan's Razorback shirt and Cardinals hat. He commented on them and then gave his brief spill about the infertility epidemic. Then he said something that I was not expecting at all. "Well your antral follicle count was 7, which tells us that you have a low egg reserve." I about fell out of my chair. I looked over at Ryan and he had the same look I am sure I had.

He went on to explain what exactly that meant. Basically I do not have as many eggs as I should at my age and that is why I haven't been able to achieve pregnancy on my own. I asked him what the count should be at my age and he said at least 20! Oh my. He said that I had two in one ovary and five in the other. That the count would vary with each cycle but that I would never have the normal amount. I told him that this was the first time I was ever hearing this (even after going to Little Rock for 6 months and having approximately 8 - 10 previous ultrasounds). I told him that they never told me my follicle count but that they would measure the two or three biggest ones each time. He said that was because the doctor was the one doing the u/s and that they don't take the time with each patient to do a complete ultrasound. [What?!?! Does this make sense at all?!? It took less than 15 minutes and is non-invasive and affordable!]

This is the chart that will forever be burned into my memory, that left a hairline crack in my heart:

I fall in that last line, the line that has a lovely dash under years until last child. But praise the Lord for creating people like Dr. Silber. People's whose passion for science and others has helped people like me fulfill their dreams! I know that from this point forward in our journey that we are in the two most capable sets of hands there is: God's and Dr. Silber's! And for this I am grateful!

His plan for us is to do several back to back cycles of minimal stimulation IVF. He thinks that we will need several cycles in order to retrieve enough eggs and store up as many embryos as possible. Mini IVF is like traditional IVF minus the daily injections of hormones for months. He said that I would not benefit from these high levels of hormones. That the purpose of them is to produce a high egg count for retrieval. But that even with the massive amounts of hormones my body would probably not produce any more eggs than usual. The goal of mini IVF is to recruit a only a few high quality eggs. The harvest, fertilization, culture and transfer of those eggs/embryos does not differ from routine IVF.  We are shooting for quality over quantity! He has hopes that based on my age my eggs should still be of high quality. Of course, there is no guarantee of this. But we won't know until we try and I have to keep the faith and think happy thoughts about my eggs until then!

So here's the way that mini IVF works:

• Call the clinic on day 1 of my next cycle {end of April/beginning of May}
• Begin and end birth control pills on days instructed by my coordinator (sweet Joan), somewhere between 21 to 28 days of birth control pills
• Start period {end of May/beginning of June}
• On day 3 of cycle begin 50mg Clomid and continue until ultrasound monitoring shows the follicles are ready for ovulation
• On days 8, 10, and 12 add in 150iu of Follistim (FSH injections)
• Begin monitoring (blood work and ultrasound) when instructed
• When blood work and ultrasound look good we will do the egg retrieval {target date June 14}
• Eggs that are retrieved will be injected with sperm by a needle (ICSI)
• Resulting embryos will be frozen by new technique of vitrification

Dr. Silber wants us to do the process a few times to get as many embryos frozen as possible before making any transfers. This is because even if we have a handful of embryos there is no guarantee that those embryos will implant in my uterus and form into a baby. And also because if I were to get pregnant within the first couple of transfers (placing embryos in the uterus) I need to have some embryos frozen for future babies. I need to do this in order to insure I will still have a chance of having another child if I become pregnant during the first or second transfer. Because if I was to get pregnant but didn't have any embryos left for the future I may not have any eggs by the time we are ready for another child.

I am hoping we will get several excellent embryos and not have to do more than 3 rounds of retrieval. He would be happy if we could get at least 4 or 5 eggs during each retrieval and even more happy if all or most fertilize and turn into embryos. This is where we will find out the quality of my eggs. The number of eggs retrieved each time will vary as will the embryo count. The goal at this point in the journey is not to get pregnant but to get as many Walker baby embryos frozen as we can!

After Dr. Silber and we are comfortable with the amount of frozen embryos we will do a transfer. The number of embryos transferred would depend on the quality of the embryo. These are things to be determined. However, they will not preform a transfer until 3 months have passed since your last retrieval. Therefore, we are looking at winter as the earliest possibility of a transfer.

I tried to explain it the best way I could but if you would like to learn more you can go to Dr. Silber's website: http://www.infertile.com/infertility-treatments/ivf-in-vitro-fertilization.htm

There will be more posts once I get more information. I expect our huge package of detailed instructions at the beginning of next week. The inpatient, information starved side of me wishes I had this in my hand already! But the side of me that will get me through this says "one day at a time!"

Side note: I went to bed early last night because Ryan was watching the NCAA championship game and I was exhausted. Anyway when he did come to bed he went on about how good the game was and then said "Oh and I read your blog. It is really good babe." :) :) :) I had told him a couple of weeks ago when I started it but he never asked to read it and I never asked or pressured him to. This melted my heart. Again thank you God for him!