To ICSI or Not to ICSI?

During IVF#1, we went in blind, not knowing what the outcome would be for fertilization. The embryologist recommended we fertilize 2/3 of our eggs using ICSI and 1/3 via conventional IVF.

For those of you who aren’t familiar with these terms, conventional IVF is when they place the eggs and sperm together in the Petri dish and let fertilization happen on its own.
This allows the stronger sperm to fertilize, and the normal eggs to be fertilized.

ICSI, which stands for intracytoplasmic sperm injection is when the embryologist selects which sperm he/she deems to be the “the best”, and then manually injects that single sperm into the egg to fertilize it. There is a different kind of selection here, as it is based purely on the embryologist’s observations of morphology and motility. Less natural selection here, as the race to the egg and process of penetrating the zona pellucida (shell of the egg) is bypassed. Potentially, crappy sperm and crappy egg can fertilize and be fertilized by ICSI, however, if you suffer from fertilization failure (hard to penetrate eggs or sperm that can’t dissolve the shell) ICSI can make a positive difference.

These were our results from last year’s IVF:

Now, the grades of these embryos were all very good, except for one which was fair. The “best looking” embryos were ICSI fertilized. We don’t know which ones were chromosomally normal, but know that the pregnancy (and subsequent miscarriage) in July/August/September was of a chromosomally normal female embryo.

Since egg retrieval is coming up next week, we have to decide how we want to fertilize our eggs. I want last year’s IVF to be a learning opportunity. The embryologist thinks we could do all conventional IVF since we did have fertilization occur properly this way. Conventional IVF also allows natural selection of normal eggs and normal sperm as well. Overall live birth outcomes are the same whether you do IVF or ICSI, even if IVF yields less embryos.

This compares the use of ICSI over Conventional IVF in several different causes of infertility, and finds that ICSI is only beneficial in cases of male factor infertility.

Right now we’re leaning toward 100% IVF, but our RE thinks we should still do some ICSI, without giving a real reason. He says it depends on our numbers on retrieval day. We are not naive to the fact that doing ICSI means they can charge $1250 more.

And then there’s this, which seems to say that there’s little to no risk from doing ICSI, so why not do it.

Another factor is that we are not using the same anonymous sperm donor as last IVF, so it is unknown how well this sperm will fertilize our new batch of eggs. But seeing as how our sperm is coming from a sperm bank, we can assume the motility counts are decent.

I would love your feedback and experience as we make this decision.

IVF#2: After 7 Days of Stims

So I’m at that point of bloatedness now where it hurts to pee and poop. My ovaries are each packing in 10 follicles that are on average, a centimetre in diameter each. In the morning, the bloat isn’t so bad, but by the night time, I feel like someone has pumped my belly full of air, creating a very high-pressure system. It hurts to twist or turn too quickly, and rolling over in bed has to be done very carefully. It takes me forever to empty my bladder, because bearing down feels like I’m squishing my ovaries. Pooping, well, you can imagine how difficult pooping is too.

I had monitoring again today, and have a lead follicle at 14mm, so I start coming in daily now for blood work and ultrasound. I hope things progress fast, because my cervix is getting very sensitive to the poking around, I’m running out of veins, and just had to buy another 900IU of Gonal-f and vial of Lupron. These drugs aren’t cheap!

Plus, stimming for 14 days last time nearly killed me- both the wait, but also the amount of monitoring and the OHSS. 36 follicles was just crazy!

So here are today’s stats:

Those follicles are growing, and more importantly, they are growing all within the same range of sizes. I hope all 20 make it to a good diameter so that they’re all mature. Last time, even though I had 36 follicles, only 19 were mature enough.

What I’m really enjoying right now is comparing my stats from this IVF to those from last year: after 13 days of stims, and after 14 days of stims.

Judging from how things progressed last year, I predict that I’ll be triggering on Tuesday, and retrieving on Thursday. That seems so far away, and a long time feeling so bloated, so of course I’d be thrilled if things progressed quicker this time around.

Another update tomorrow!

Juno the Dog’s Adventure in Chocolateland

Juno, our husky/lab/retriever mix is an exceptionally beautiful dog.

Gorgeous right?

However, being part ravenous food monster Labrador retriever, she is also a gluttonous pig that is fixated on food, despite pretending not to be looking. She has her favourites, of course:

These items should never be left on the table within reach of the dog!

But generally, she doesn’t go after our food. We can set a plate of dinner on the ottoman in front of the couch (knee height), and leave the room, confident that neither dog will touch it. We can drop food accidentally on the ground, and neither dog will approach it (unless given the “okay” command). Overall, we have very good dogs who we can leave unattended, and come home to nothing missing or destroyed.

That is, until yesterday….

When I came home after a long day of appointments and grocery shopping, and NO DOGS CAME TO GREET ME AT THE DOOR. This is highly unusual, so I knew something was up. (Juno experiences copious amounts of self-inflicted shame when she does something bad, and her guilt causes her to hide and not make eye contact with us.) I looked around, and found a crumpled sheet of used parchment paper, and then I remembered.

I had made a tray of very scrumptious gluten-free fudgy brownies two days before, and because they’re so decadent, DW and I had been chipping away at them slowly.

You can find the recipe here.

Normally, we place things like this out of reach, but because I was in such a rush yesterday (slept in remember?), I left the remaining brownies on the kitchen table.

Well, she must’ve gotten into them, because not a crumb remained. Even the knife used to cut them was completely cleaned off.

Of course you all know that chocolate is very toxic to dogs, so after the initial shock and disappointment, I started to worry- how much had she eaten? Is she going to be sick? How toxic is chocolate really? And then I found this dog-chocolate-toxicity-meter. And not knowing how much Juno weighs, or how much brownie actually remained, I kind of guessed a bunch of parameters, and input those values. I subsequently called DW, freaking out.

But while talking to DW, got more accurate values, and got this:

The dog looked fine. She wasn’t panting, or acting weird at all. Actually, her and her little sister started begging for their dinner… At 3:30pm!

So we left it at that, and took them for a nice off-leash hike at the conservation area. Juno was fine, but no fudge poops to be seen yet.

And then this morning at 6am, she barked at the door desperately (unusual, as she usually sleeps in until we get up). I let her into the backyard, and hoping she had a nice big chocolately poop. I haven’t checked yet though.

So far she seems fine. I think the cocoa threat has passed. She is sleeping like a tipped cow in the living room, still getting up every 30 minutes to bark at someone on the street.

I’m extremely pleased that Juno doesn’t share her steals with her little sister Clementine. The last thing I need is to try to induce vomiting in a chihuahua-pug with very sharp teeth!

Lesson learned: Don’t leave food on the kitchen counter, especially when in a rush to leave the house! That dog can’t be trusted!

IVF#2: After 5 Days of Stims

Just a quickie today, but I wanted to update y’all after today’s monitoring appointment.

Yesterday, I went in for my intralipid infusion, which took about two hours, and involved me being hooked up via IV to a bag of what DW calls the “special mayonnaise”. At $750 a pop, out of pocket, it is also an expensive mayonnaise. I have very few superficial veins, and it took the nurses four tries to tap a live one. They eventually had to go for one in my hand, which hurt a lot, and with the Aspirin that I’m taking, bled a lot afterwards.

Yesterday, I also noticed globs of egg white cervical mucus, which tells me my estrogen levels are high. Each of the little follicles in my ovaries release estrogen as they mature, contributing to the clusterglobs in my underpants. I anticipate that it is bound to get messier by the day. Lucky for you, I did not take pictures of this, as I might have been tempted to post them.

Today, I ran from appointment to appointment. I had really bad insomnia last night (probably due to high estrogen levels, which messes up my sleep every cycle), and took 50mg of diphenhydramine hydrochloride (Benedryl) at 11pm. Benedryl makes me super groggy and I was laying in bed like a zombie this morning, almost missing my monitoring appointment at the fertility clinic. Over the course of 15 minutes, I managed to shower and dress, set up the crockpot for pulled pork, fry some eggs (sunny side up), butter some gluten-free toast, and make myself a protein shake. I also made it to my appointment only 4 minutes late. Phew!

At the clinic, I had blood work and ultrasound done, which revealed 10 follicles on each side (20 in total!), 4 of which are 10mm or larger. They still have a ways to grow, so I go back in on Friday for my next monitoring.

I’m happy with this number, and now just want them to grow into big fat juicy follicles. Last IVF, I ended up with 36 follicles, with only 19 being mature. This time, since we are doing a fresh transfer back into me, I hope I am not overstimulated, but still have a good number of mature eggs to make good quality embryos. *Fingers and toes crossed*

After monitoring, I rushed downtown to my acupuncture appointment. I’ve got a whole bunch of herbs that I need to take to increase my kidney yang, as my pulse was a bit slow and weak. I also had an acupuncture treatment, which was nice. My TCM doc is a bit of an odd duck, so it’s always an interesting treatment.

Next update on Friday!

IVF#2: After 3 Days of Stims

(Clementine, keeping the eggs warm)

Things have been busy over here at the mamaetmaman household. My in-laws visited for the weekend, which is normally very nice, but I was feeling kind of hormonal (literally), and would’ve preferred some time alone with my wife. It’s weird, I have been feeling this internal restlessness, which has been making me yearn to travel more than I already do. It feels like a passion burning inside of me. Except that I’m kind of in the middle of an IVF stimulation cycle, and the only things even remotely interesting inside of me are these ovaries, which I am starting to feel.

Today’s Stats: (after 3 days of 225 units of Gonal-F)

Uterine lining: 6 mm
Follicles: 5 on L, 6 on R, all very small

They’re bumping up my meds tonight to 250 units of Gonal-F, and I go in on Wednesday for more monitoring. Tomorrow, I have an intralipid infusion. Fun times.

Grow grow grow little follicles!

Ack! Why all the Mistakes?

So I got another call just now that they made a mistake, and I don’t start my stims until tomorrow (CD3). It’s not a big deal, but I’m just annoyed that they can’t get their shit together.

That is all.

IVF#2: CD2: Baseline Ultrasound and Bloodwork

So the clinic called me yesterday and pushed my baseline appointment to today, cycle day 2.

Here are today’s stats:
Endometrial lining: 5mm
Antral follicles: 5 on R, 6 on L (funny how it is different than two days ago- technician variability!)

I start stims tonight!
Stay on 10 units of Lupron in the morning, and start 225 units of Gonal-F tonight!

I go in again on Sunday (stim day 4) to see how things are responding (blood work and ultrasound).

AF Found! *And Next Steps*

Finally, after 37 days, AF has returned!

I’m just waiting to hear back from the nurse about next steps.

Thanks for all of your support in willing AF to come!

That’s all for now.

*Update*
I go in on Friday (day 3) for baseline blood work and ultrasound again. It is likely that I will be starting my stims this day!

Intralipids have been tentatively booked for Tuesday (day 5 of stims).

I have acupuncture on Wednesday (day 6 of stims).

Yay!

Investigation into the Case of the Missing AF

Well folks, it has been quite the day!
DW and I both seem to have some kind of mild flu. I never get the flu. And this year, I actually got the flu shot!! Wtf? The last time I can remember having it was sometime in 2005, and it was complete with bedsheet-soaking fever and chills, loss of appetite, and diarrhea. It lasted about 3 days, and cost me about 7lbs of my already emaciated frame. Luckily, I am no longer this skinny, and this round has not come close to being that bad. For me, it’s still a mild fever and chills, body aches, and my favourite: the runs. Seriously, I tore into a new package of toilet paper recently, and stocked the bathroom with two extra rolls. Just in case.

Now, feeling like shit would be a whole lot nicer if I knew where the fuck AF has been hiding out. Yes, it has come to this. I know I’m starting to sound like a broken record, or like your significant other nagging you about why it’s necessary to keep 13 bottles of supplements on the kitchen counter permanently, but I am seriously frustrated.

Let me put this into perspective for you.

This is what the Long Lupron Protocol for IVF is supposed to look like:
Day 21 Precycle: start Lupron and stay on it until near the end of IVF stims
Day 28 Precycle: get period –> this becomes Day 1 of Treatment Cycle
Day 3 Treatment Cycle: start stims (Gonal-F for me), lower Lupron dose
Day 13-15: HCG trigger
Day 15-17: egg retrieval

This is what it looks like so far for me:
Day 21 Precycle: start Lupron (and Provera because not yet ovulated)
Day 28: no period
Day 29: still no period
Day 30: still no period
Day 31: still no period
Day 32: still no period
Day 33: still no period
Day 34: still no period
Day 35: still no period
Day 36 (today): STILL NO PERIOD!!!

Notice how in an ideal cycle, you’re on the high dose Lupron for 7 days before your period, but I‘ve been on Lupron for over 15 days now. Lupron causes weight gain, headaches, and major irritability. So yeah. I’m kind of losing my mind.

Early this morning, I went to the fertility clinic for bloodwork, a full bladder pelvic ultrasound, and a transvaginal ultrasound to figure out what the hell is going on. This appointment went well.

The ultrasounds revealed that:
– my endometrial lining is 8.4mm thick
– I have no cysts (hallelujah! I was so worried about this)
– I have 14 antral follicles (6 on the R, 8 on the L) just chillin’, waiting to be stimmed

Last year, during our baseline for IVF#1, I had 16 antral follicles, so time does seem to be showing an influence here. I was reading a research paper on antral follicle numbers, and apparently they are grouped into three ranges: less than 3 (poor ovarian reserve) , less than 6 (average ovarian reserve), greater than 9 (high ovarian reserve). So with 14, I’m still looking really good.

I still had to wait for the bloodwork results, which would be available this afternoon.

By the early afternoon, I got a call from the head nurse.
Apparently, my blood results were in, and they were abnormal:
Estrogen 360 (way too high, should be less than 250)
Progesterone close to zero
She wanted me to keep on the 10 units of Lupron for another week, and then we would recheck my levels.

I thought this was really weird. It didn’t make sense because I was definitely feeling my classic progesterone signs- sore breasts, back ache, dairy cravings. So before she could hang up, I asked more questions, really nit-picking about the values, which required her to go back to her computer and consult my bloodwork results.

There was a pause. An extended silence.

And then she spoke.

She had planned my next steps based on the WRONG results!! Those results were from my pre-Lupron scan, not today!! My results from today had not yet be logged, so more waiting…

I took the dogs shopping, as Clementine needed a new winter coat. Then I took the dogs to the conservation lands for a hike. The paths were all iced over, and I was glad to have my grippy strap-ons (for my boots). When we got back to the car, I noticed that I had a voicemail from the fertility nurse (no missed call- she sent it straight to voicemail):

My levels for today were actually:
Estrogen 74 (nice and low- they want it to be less than 250 to be cleared to start)
Progesterone 1.71 (nice and low- period should be here soon)
My period looks to be due any day now, with my progesterone being so low, so they want me to just call when my period shows up, and then I guess I go in again for my baseline (I actually hope I don’t have to, since everything looks good today).

I found this online, and really liked how it presents estrogen and progesterone levels throughout a typical cycle:

Also, my BBT temp went down a bit today:

So all signs- blood, temperature, and ultrasound- point to AF coming soon. But I’m checking every chance I get, and soon can’t seem to come soon enough.

Honestly! Still Waiting for AF!

I consistently have 31-32 day cycles. Today is day 35. I finished a round of Provera about 8/9 days ago, which was supposed to bring on AF last week. My temps remain high, my nipples are super tender, my back hurts, and I’m super emotional.

This needs to end.
AF where are you??

I emailed the nurse on Friday, to ask how long we should be waiting for AF, and she said if I don’t get it by Monday January 19th (today), to call her and we will have to investigate. She also told me that they don’t need AF to show before starting stims. This kind of scared me, and delighted me at the same time. So of course, I scoured Google for examples of this, and sure enough, IVF stim cycles are commonly started with or without preceding periods. Now, since we plan on doing a fresh transfer, wouldn’t this be like sleeping in bedding that hasn’t been washed since last month? Okay, bad analogy, but you know what I mean.

Anyway, I called the nursing line and left a voicemail about not yet having a period, and I’m waiting to hear back from them. What I’m anticipating is that they will have me in for blood work and ultrasound, and then one of the following outcomes will happen:
– my hormones look great, and we go ahead and start stimming
– my hormones look not great, and they make me wait or take Provera again
– ultrasound reveals a functional cyst and they either aspirate it, or cancel the cycle

I certainly feel the effects of progesterone, so my gut feeling is that AF will happen eventually, but that I am just experiencing a very long luteal phase (Lupron can delay AF too). I do worry about being on Lupron for so long, as it can cause oversuppression, and then I’d need higher doses or longer stimulating with the Gonal-F.

Here’s my BBT for those of you who enjoy these types of things (I know I do):

Anyone have experience with starting stims without a period beforehand? I going nutz over this. Please send sanity vibes. This waiting is seriously killing me. Merci beaucoup!