Busy week - Finally Moving Forward

It has been a busy week, so I am only now getting around to updating our blog. Sorry to anyone who is still actually checking in on us.

I had my fourth beta test on Wednesday, and I am very pleased to say that my HCG levels are now down to ZERO. I am finally "un-pregnant" and am able to move forward with treatment.

Matt and I had our follow-up / consult with the RE on Friday. She said that our IVF was absolutely "ideal" from a medical perspective. It was perfect. The fact that I miscarried was a fluke. The doc said that not all embryos are meant to be a baby, and that mine was one that wasn't meant to be. She feels that our chances are still very good to get pregnant and have a child. She is a straight shooter, so the fact that she is so hopeful makes me feel optimistic (albeit cautiously optimistic). The success rate at this clinic for frozen embryo transfers (FETs) is about 30 to 40%. Dr. Browne, our primary RE, has now given us the green light to move on to our FET.

At the start of my next cycle (which will be in the next one to three weeks) I will begin birth control pills (BCPs). The BCPs just "quiet" my reproductive system and give a good baseline to start the process. I will be on the BCPs for 21 days. After ending the BCPs my cycle should start again in three to five days. With the start of that cycle in October, I will have to go in on my "day 2" for a baseline ultrasound and bloodwork. If everything is in order, then I will begin del estrogen injections. These will be intramuscular (IM) injections that I have to receive once every three days. After twelve days I will go back in for another ultrasound and more bloodwork. If my uterine lining looks good, then I will proceed with progesterone in oil (PIO) IM injections. These will be daily injections, just like I had to do with my IVF. After five days of PIO IM injections, I will be ready to go in for my transfer. On the day of transfer we will travel to Rockville, MD to the main Shady Grove clinic location. The embryologist will start by thawing two of our embryos (we have five frozen). If both survive the thaw, then those will be the minis that we put back in my uterus. If one or both don't survive, then they will continue thawing until we have two embryos to put back. After the transfer, I will be on 24 hours of bedrest again, followed by a few days of light activity. I will have to continue doing the PIO IM injections up through the pregnancy test. If I am pregnant, then the PIO shots will continue for a LONG time. If not, they will stop, and that will be that.

So - that is our protocol in a nutshell. The FET will actually take place in the beginning to middle of November, depending on when my cycles arrive. We will keep you posted as we forward with our next attempt at starting our family.

Blood Test #3....still going....and going...

Well, I had my third "post D&C" blood draw today. My beta HCG numbers dropped from 42 down to 14.1. The numbers must be below five to be negative, so I still have to go back for one more needle stick. Ouch! Oh well...next week's test should be the last one. We also have our follow-up / consult appointment with our RE next week on Friday. We will discuss the miscarriage and our next steps at that time. Hopefully we will be on track to do the FET at the end of October...we'll have to wait and see.

Blood Test #2

I went for my second "post D&C" beta test today, and my hormone levels are now down to 42. They still need to get below 5 before I am done with bloodwork. Anything less than five means "not pregnant anymore". I have another blood draw next Wednesday...hopefully it will be the last.

Blood Test #1

I had my first post D&C blood test yesterday. My beta-HCG levels are down to 129. This is a HUGE drop, which is what they would expect. I have to go back in one week to have my levels checked again. They need to have my levels be less than five (a technical negative) in order to clear me for any upcoming treatments. So - next Wednesday it is back to the RE's office again. Hopefully that will be the last time prior to our follow-up and consult on September 15th.

No More Restrictions!

I had my surgical follow-up yesterday with my OB. She said that everything looks good, and I should not have any problems moving forward. I have been "released" from my restrictions, and I am now free to begin working out and leading a normal life again. I am past the point where I could get an infection, so nothing more to worry about here. She also noted that it probably was not necessary for me to have a RhoGAM shot (for Rh incompatibility) after my early ectopic pregnancy / miscarriage. Now that I have had a later miscarriage and received the RhoGAM, I will have to have RhoGAM shots if I have any bleeding in future pregnancies. This will keep my body from attacking the baby's cells if it is Rh positive. Anyway...

Next week I will be going back to the RE's office for blood work. They want to make sure that my pregnancy hormones are dropping off appropriately. If so, we will then be cleared to move on to a frozen embryo transfer (FET) in a couple of months. Right now we are working diligently to plan our trip to Colorado in October and are just trying to be a "normal" couple (no shots, ultrasounds, pills, etc.). More than likely, I will begin suppression (birth control pills / lupron shots) with my October cycle. If that happens, we will probably do our FET in November. We have five frozen embryos left to use...so we might as well use 'em.

Road to Recovery

I had my D&C (dilatation and curettage) performed on Wednesday. I have been recovering at home since that time. Overall I feel pretty well. I think the option of surgery was the right choice and will be much easier to handle versus the alternative (natural miscarriage).

My pre-operative lab work showed that I am blood type A-. The negative stands for "missing the Rh factor". Essentially, it means that I have a rare blood type. Only 15% of the population is shown to be Rh negative. Now, the interesting thing is that Matt is Rh positive. If we do conceive, it is more than likely that the baby will be Rh positive. This can be a bad thing, because my body would recognize the Rh positive factor as a foreign body and would attack it (situation called Rh incompatibility). This situation can be avoided or mostly avoided given modern day science. A first pregnancy is not a risk, given that I wouldn't have produced any antibodies against the Rh positive baby yet. Anything after a first pregnancy can be dangerous, unless you are given an injection of RhoGAM. This injection kills off any Rh positive red blood cells in my body so that I do not create the antibodies to do this in the future. Confusing? Well, it is a bit confusing. Anyway...I was given an injection of RhoGAM after my D&C to help protect any future pregnancies. The one worry that we have at this point is that I was NOT given a RhoGAM injection after my ectopic pregnancy / miscarriage. My nurse at the fertility clinic is looking into this situation for me, as she believes that the injection is not necessary until you are at least 7 or 8 weeks into a pregnancy (which I was not at that time). I am hoping that this is the case so that we have not jeopardized future pregnancies with the possibility of Rh sensitization. Still confused? Sorry! The important thing is that I am not.

Outside of all of this, I am physically and emotionally starting to heal. Each day is a better day, and will continue to be so, I am sure. I have a surgical follow-up appointment with my OB next Friday. I have a follow-up and consult with my reproductive endocrinologist (RE) on September 15th. By that point in time we will be deciding if we are ready to proceed forward with any next steps (i.e. frozen embryo transfer) or not. If we do decide to move forward and jump into this again, I think it will be our last time. Hopefully everything will work out, as I continue to believe that everything happens for a reason.

From Bad to Worse

It is with great sadness that I share the news with you that we have officially lost the pregnancy. Our ultrasound today showed no fetal cardiac activity, the placenta has detached, and the sac is showing signs of collapse. I am scheduled to see my OB tomorrow for a repeat ultrasound and for a pre-op appointment. I will likely be scheduled for a D&C later this week.

I want to thank everyone for supporting us through this difficult journey. It is a sad day for us, and a frustrating end to an even more frustrating process. Outside of taking time to recover and grieve, I am not sure what we plan to do in the future regarding any further fertility treatments. We will take this process one day at a time and come to a decision sometime down the road. During this time, it is ok to feel badly for us, but I ask that you do not feel sorry for us. Life is not always fair, and we are all given difficulties to face. This just happens to be one of our difficulties. Thank you.

The Bad with the Good

Today we went for our second sonogram with the RE. The good news is that we had a visible / detectable heartbeat and that the gestational sac, yolk sac, and fetal pole had all grown just as they should over a one week period. The not so good news is that I am measuring a full week behind (I am 7 weeks and 2 days pregnant but am only measuring 6 weeks 2 days pregnant). The crown to rump measurement today was 5mm, up from 2mm a week ago (apparently at our first sonogram one week ago we were only measuring at 5 weeks 2 days pregnant instead of 6 weeks 2 days pregnant). The RE stated that she has seen plenty of women measure behind and still have a viable pregnancy and deliver healthy babies. Right now it is a positive sign that the growth over a one week period was typical growth. However, we must be cautiously optimistic at this time as things could also go the other way, in that the pregnancy could just stop progressing.

We will be back at the RE's office next Monday for a third sonogram. It is all of our hopes that the growth will continue just as it should, or, even more optimistically, bridge the gap. We also hope that the heartbeat continues to get stronger. If these things do happen for us, we will be released to the OB for the rest of the pregnancy. If not, we will have to deal with the situation that presents itself and move forward.

ONE M&M mini in the Oven!

Well, we are back from our first sonogram, and we are elated to share with everyone that there is only ONE M&M mini in this oven! In the above photograph, the darkened (black) oval is the "sac" that holds the mini. The little blob at the bottom of the sac is the yolk sac which will feed the mini until the placenta is fully formed. The tiny little rice shaped blob above the yolk sac is the fetal pole. The fetal pole is what will become our baby. So - for now we have all of the right parts! We were not able to see the heartbeat today, but it is still a bit early for that. Generally the heartbeat is visible by 7 weeks. I am scheduled for my next sonogram a week from today, and hopefully there will be a heartbeat at that point in time. We will keep you posted.

I am happy to announce that I will be done receiving Progesterone in oil intramuscular injections as of August 11th. At that time I will be switched over to Prometrium, which is NOT a shot! I will continue the Prometrium until August 25th, and then no more hormone replacements at all! The only thing that I will have to continue after the 25th is my prenatal vitamin...I can handle that! I am scheduled for my first OB appointment on August 25th, so we hope that all continues to progress well until then.

Third and Final Beta Test Results!

Today was my final beta test. My previous beta HCG number was 1650. After your number passes 1200 it is supposed to take between 3 and 4 days for it to double. It has only been three days since my last beta, and my number has increased to 3657...which is more than double. Everything is still progressing just as it should, if not better. Our number is still above average, so there is a chance that more than one of the minis decided to call my belly home. We will find out officially one week from today when we have our first sonogram. That appointment is scheduled for 9:30am.

(if anyone is interested in learning more about beta HCG numbers, or would like to see how ours have compared to the averages, feel free to check out this informative website: http://www.ivfer.com/hcg.htm)

I am doing well. The stim drugs in combination with my pregnancy hormones has caused my lower abdomen to become a bit distended. I feel fine, though. I am more tired than normal but am functioning well overall. I have not had any sickness as of yet, but that can creep up at any time. I don't mind any of my symptoms, though, as I am just happy to be in a situation to have the symptoms in the first place. No complaints here!

We will let everyone know the results of our sonogram sometime by Monday afternoon. If all goes well at that appointment, hopefully we will be able to start relaxing and enjoying the pregnancy even more.

Beta Results #2

Well, today was the second beta test to see how our HCG number was increasing. My nurse informed me that they like to see a 60% increase over the first number. (Our first number was 945, so a 60% increase would have been 1512.) Well, we aren't messing around here, so we threw up a big ole' 1650...almost a 75% increase. The pregnancy at this point is progressing quite well. The average beta number at this stage is around 1200, so we are beating the averages all around.

Monday will be the third and final beta test. If things are still going as well as they have been, then we will be ready to schedule our first ultrasound for around the six week mark (when we will find out if just one or both of the minis dug in). We'll continue to keep you all posted!

THE RESULTS ARE IN!

This is a picture of a home pregnancy test that I did this morning. We have had positive results going back about seven days, so we have been cautiously optimistic. We were looking forward to the beta test today to get confirmation and to find out how strong our "number" was. Well, it was great news. At 13 days past a 5 day embryo transfer, our HCG number was 945! According to one website, the average number for a positive test 13 days past transfer is 522. Anything over 100 is considered a decent number, so we blew both of these numbers away. This is a very good sign that this is a strong and viable pregnancy. Today I am officially 4 weeks and 4 days pregnant. If everything goes well, our estimated due date (according to one online calculator) would be March 16, 2007.

I need to go back on Friday and again on Monday to have additional blood work done. Per standard procedure, the doctor wants to make sure that the HCG numbers double every two days. Once I have my beta completed on Monday, and if everything is still on track, we will be able to schedule an ultrasound for about my six week mark. At that time the RE would look to see how many sacs are in the uterus (one or two) and if we have a heartbeat(s) yet.

We wanted to use this site to congratulate all of the grandparents, aunts, uncles, cousins, and friends to be! Just to let you in on a little secret, we have come up with some potential names for our baby (or babies). These are the number one choices for a girl or a boy...I'm sure you will agree that they are just splendid!

• Girl: Judith Joanne Ritter
• Boy: Jerome Robert Ritter

Runners up for the list are as follows:

• Girl: Woodrina Hayes Ritter
• Boy: Santa Pizza Ritter

Of course we would welcome any input regarding our short list, but we are fairly certain that these are the best options....aren't they all just beautiful?

(disclaimer: for those of you who don't know our senses of humor all that well, we have to admit that these names are a joke! As lovely as they are, we will not actually be using them for our child (children). Thank you.)

Stay Tuned!

Only two more days until the beta test! Wednesday afternoon will be the big announcement (one way or the other) on this blog. Wish us luck!

The Waiting Game

Well, as you all know, we are still waiting for our upcoming beta test on July 12th. Only six more days to go, so it isn't too bad. I am feeling much better these days. My hips and butt only mildly ache, and the shots seem to be getting more comfortable. I hope things stay this way. Matt is traveling this week and driving race cars down in Alabama, so I have to have a friend (who is also a nurse) come over and shoot up my behind. I am lucky to have a back-up for when Matt is not here. I am fairly tired at various parts of the day, and I am a bit short of breath. These things are both quite out of the ordinary for me. The progesterone injections can cause fatigue, so I am blaming them for the moment. Not much else worthy of mention right now...so, onto the 12th already!

Frozen M&M Minis

Good news! Of the nine "leftover" embryos that we had on Thursday, five made it to the cryopreservation stage! If this cycle does not work for some reason, at least we have these five frozen minis left that we can use for a frozen embryo transfer (FET) some time down the road.

tick tock...Tick Tock...TICK TOCK

We are three days post transfer, and all we are doing is waiting. Tick tock.... I am feeling much better these days. Tick tock.... My bloating has mostly subsided, and my abdominal area feels almost back to normal. Tick tock... My only complaint is still the soreness in my hips / butt due to the daily IM injections. Tick tock... I am dealing with it better, though, and am just pushing forward. Tick tock... Only ten more days until the beta test and then we can celebrate or move forward to our next steps. TICK TOCK...

The M&M Minis!

Yesterday, Matt and I went to "pick up" our M & M Minis at the Shady Grove facility in Rockville. Of the 16 eggs that had originally fertilized, 6 made it to the blastocyst stage and five made it to the pre-blastocyst stage. We made the decision to put back only two, leaving us with nine leftovers that will continue to be monitored. Any embryos that are still doing well in a few days will be cryopreserved for potential future use. I am now done with my 24 hours of bedrest, and I must begin my 2 to 3 days of light activity. During our wait until the beta test, I must still take a prenatal vitamin, a baby aspirin, 2 estrace tablets, and my PIO intramuscular injection every day. I am feeling just fine, outside of the fact that the PIO shots have the same effect as arthritis...make me very achey in my butt and hips and forces me to walk like an old woman. If it weren't for that, all would be right with the world!

Pictured above are the M&M Minis that we put back. In two weeks we will know if they are planning to stay with us or not. We will keep you posted!

(photo image of our day five blastocysts graciously provided by Martha Anderson of Shady Grove Fertility Reproductive Science Center of Rockville, MD. Thank you, Martha! Dr. Stephen J. Greenhouse must receive credit for putting the M&M Minis back where they belong!)

Blastocysts come home tomorrow!

Tomorrow is the big day when we go to collect our little blastocysts. Our appointment is scheduled for 11am at the Rockville, MD clinic location. We need to arrive at the clinic by 10:30am. On the trip in, I need to drink approximately 36 oz. of fluid, preferably Gatorade. It is necessary for me to have a full bladder for the egg (blastocyst) transfer. Once I am ready for transfer, the RE will insert a sterile catheter through the cervical opening and into the uterus. They will place the selected blastocyst(s) into the desired location in the uterus and then the catheter will be removed. I need to lay down for at least 20 minutes and then I will be released. I must remain on bedrest for a 24 hour period following the egg transfer. I plan to gather a good collection of books and magazines today for my down time. The 24 hours of bedrest are followed by two to three days of light activity. After this time, I should be able to go back to my normal routine.

My nurse will be calling on Monday of next week to let us know how many blastocysts were cryopreserved. Any that make it to this stage could be used down the road.

We are scheduled for our beta test (test to check for levels of beta-HCG, or pregnancy hormone, in the blood) on July 12th. If the test comes back positive, then we celebrate. If it comes back negative, we are already scheduled for a follow-up appointment with our RE on July 26th. At this appointment we would talk about any next steps that we might take, such as FET (frozen embryo transfer).

"How to give your horse an intramuscular injection..."

In my search to justify my pain related to PIO intramuscular injections, I came across this weblink. I did a Google search for "intramuscular injections PIO" and the above quote was splayed across the screen under the title: useful links. I had no idea that learning how to give my horse (which I didn't even know that I had) an intramuscular injection would help me in any way, but who am I to judge? Isn't the internet a god in a sense...all-knowing? Isn't it supposed to provide me with all the answers that I seek? Ah...or do I actually have to disseminate the information that it so willingly provides? I am going with the latter. I will skip learning how to shoot up my non-existent horse for now.

My actual quest was to find information that would help me to rationalize and to justify my fear of the PIO shots. I kept telling myself that I was a being a total sissy....that I dreaded these shots for no reason. Everybody is doing it (well, everybody in the IVF world, that is), right? So - what is the big deal? I didn't often hear other people complain about these injections, so I thought that my fears and pain must be irrational. Apparently, though, I was wrong. Through my internet searches, I have learned that I do not lack for company at this party. Women across the infertility world are banding together to compare notes on the side effects of these injections and tips for avoiding the unpleasant ones (which, frankly, they all are).

I have learned that regardless of what you do beforehand, afterward, or in the middle, that you will end up sore. There will be bleeding. There will be bruising. There could be lumping under the skin. This will not get better during the duration of the time that these injections are necessary. You must only get more clever in your attempts to avoid hitting a previously injected site, as this will just make all of the side-effects that much worse (this feat, however, is nearly impossible given the potential timeframe for the shots). Some general tips for making the most of it:

• Thoroughly warm the oil prior to giving the injection. This will thin the oil and make it easier to inject. You can warm the oil by placing it in your bra for ten minutes, or by running it under very warm (not hot) water.
• Make sure that the person who is administering the shot gets the injection site pulled as taut as possible. This will help to eliminate some of the potential bruising involved.
• Always remember to pull back on the plunger once the needle is inserted to check for blood. Blood would be a sign that a vein has been hit, and this can cause serious problems.
• Inject all of the oil slowly and steadily.
• Pull the needle straight out after completing the injection, and do this quickly.
• Apply gauze or a bandage, and gently massage the oil into the muscle.
• Apply heat (heating pad or warm washcloth) as you massage. This will keep the oil thin and help it dissolve into the muscle more easily.
• Walk around, walk up stairs...do whatever you can to keep your muscle loose. This will cause less aches and pains in the morning (although not much less).
• Avoid punching the person who has given you the shot. They are only doing their "job", therefore retaliation would be seen as less than called for. Remember...your partner is suffering through this process, too (yeah...right!)

Even by following these instructions, women have complained that they still have sore spots MONTHS or more after receiving their last shot. So - we pay a great price to gain a great reward. Hopefully any children produced via this process will appreciate later in life the true sacrifice of their mothers. If not, I do think it is fair to punish them for their insolence....well, ok, maybe not. But - I do think bigger presents would be in order for Mother's Day for sure!

No Transfer For Us Today!!!!

This is fantastic news. We have officially been pushed off until Thursday for our embryo transfer. This means that at least the majority of our embryos are still dividing and progressing well, so we will be doing a five day blastocyst transfer. Given that we will be doing a five day transfer, we will only be putting two embryos back.

I haven't heard back from my nurse yet to find out how many of the embryos are still going strong, but I will update this post as soon as she calls!

Today is the first day since my egg retrieval that I am feeling almost human again. These last few days have been very difficult for me physically, but I am turning the corner. Now, my biggest complaint is that my backside aches all of the time. As soon as one side starts feeling better after receiving a PIO injection, it is time to get shot up on that side again. I am very willing to look at this as a happy problem to have if we end up pregnant in the end.