After a great first cycle with Shady Grove (http://leagueofextraordinaryuteri.weebly.com/bum-uterus-blog/post-transfer-wrap-up) but a failed FET with a PGS embryo (http://leagueofextraordinaryuteri.weebly.com/bum-uterus-blog/onward-to-another-acronym) we were back to square one with a bum uterus again. Why didn't the transfer work? Dr.Levy noticed that my lining was much better on a stim cycle so suggested we use our second IVF in our package to do a stim cycle but transfer a frozen, tested embryo. The lining cooperated (my follicles didn't http://leagueofextraordinaryuteri.weebly.com/bum-uterus-blog/ivf-fresh-frozen-hybrid-retrieval-results) but holy cow- the first ever postive pregnancy test I ever had happened.
We had our transfer on Super Bowl Sunday- the Panthers were playing. Dr. Levy wouldn't be able to do the transfer. It turned out we had an all women staff helping with the transfer that day. They showed us the picture of our embryo- our very first hatching blast, perfectly reincarnated from the freezer. We watched the ultrasound screen as the pushed in the embryo. But as we sat there giving it a minute to settle- they informed us that the embryo was stuck in the catheter. They had to wash it out of the catheter, and try to insert it again. My heart sunk. Did we just damage the embryo? They assured me that that baby would be fine- and that pregnancy rates were no different. I still felt discouraged- after such a bad cycle - I was thinking that we wouldn't even get pregnant and would probably end up hardly even banking any embryos either. We decided to nickname our embryo "sticky" for getting stuck in the catheter.
I woke up one Monday morning, a long Presidents' Day weekend, the day after Valentine's Day, 8dp5dt- I had this terrible abdominal pain. I honestly thought I had ovarian torsion from my recent IVF. I almost went to the ER but the pain went away within 10 minutes. Later that day I had brown spotting- and I thought the worst. I just decided in the middle of the afternoon to pee on a stick- without even holding to concentrate it. I was really expecting to see a single line. At first nothing showed up. Then a minute goes by- and this faint line shows up- a squinter! I'm in shock. I know it is real because I've never even seen a second even vague line. Trembling I take the test to my husband and try to tell and show him that we have a positive test- but I'm not making any sense because as soon as I open my mouth, I'm sobbing. He looks at the test and obviously isn't a "student of the sticks" and he thinks there isn't a second line. I'm trying to explain a squinter to him- but gradually the line is darkening. We hugged and agreed that we were going to be happy about this for as long as it lasted even if it didn't last long.

Before the test, I noticed my OHSS returning- and thought it might mean that I was actually pregnant, but every other 2ww I'd convinced myself that I had pregnancy symptoms and i never actually had a pregnancy. This time, I had no other symptoms besides the OHSS- severe bloating and abdominal pain.
My Beta on 12dp5dt came back at 370, then 1194 three days later.
Now I'm 25 weeks and I'll start writing a pregnancy blog on a different page on this site :)

This cycle was very complicated. I'll leave out the graphic details.... but all in all- not the worst and not the best retrieval  results I've ever had- (all that matters anyway are hoe many make it to day 5 and are normal).

 Dr. Levy nicknamed me "Tricky Ovaries" because they gave us so much trouble this cycle. I didn't respond to the lupron trigger which is really odd, because last cycle with Dr. Levy (my best cycle) I did a lupron trigger and it was fine. The only thing I can possibly think of that was different was that it was a compounded pre-filled syringe instead of the Two-Week Kit from which I took an aliquot last cycle. The day after the lupron trigger, my LH levels were only 5 (they were 29 the last cycle when I triggered with lupron), and my progesterone was rising too; it measured at 4pg/mL. Usually these two rise together, so they actually couldn't really tell if I responded or not, so they opted to do a retrieval based on the lupron trigger, but re-trigger with HCG (5,000 units) and do a 2nd retrieval if they didn't get any eggs at the first retrieval. For the lupron retrieval, they drained 3 (precious) follicles, took them back to embryology while I was still under anesthesia and looked for eggs. They didn't find any- meaning that the trigger hadn't released the eggs from the follicles. There might have been eggs in the follicles but they weren't unglued yet. So they woke me up and I went in the next morning for another egg retrieval. The "good" thing was that another day without triggering meant another day for the follicles to grow. Dr. Levy wanted to give them one more day anyway but triggered because my progesterone was rising too quickly (the point of this cycle is to ready the lining with stimulating meds and progesterone rising too fast would not be compatible with the frozen embryo transfer). I woke up from egg retreival so worried that the cycle didnt work. From what I remember about the last cycle- I thought they would have told me by then so I thought something was wrong. My hubby walked in and I said- "THEY DIDNT GET ANY EGGS!" He obviously was shocked, then the nurse was like-- "What are you talking about? They haven't even had time to look yet. We don't have the report." Minutes later, they tell us that we got 10. I was happy with the number- it was higher than the majority of my cycles, but not as high as last cycle. Obviously, I start calculating how many might not be mature, how many won't fertilize, how many won't make it to freeze and how many won't be euploid. 

Anyway.... The dotted line at 14.5mm represents the size of follicles that had mature follicles in them at retrieval, so I predicted that even if more eggs were collected than above that line, only the number above that line would likely be mature. Based on my prediction with the HCG trigger after 13 post starting stims- I'd have guessed they'd collect 13 eggs and 10-11 would be mature eggs. But since 3 follicles were drained, so we we'll never know if my predictions were correct.. Last cycle 12/14 were mature and 11/12 fertilized, that's 83% mature which would be 8.3 eggs this time and 91% fertilization which would be 7 out of 8 of the remaining... Last cycle, of the 11 fertilized, only 4 were PGS normal which translates to 2.5 normal embryos. So a coin toss- 2 or 3 in best case scenario. ​

I was watching Brave after the second retrieval. Later at dinner, I was joking with hubby about table manners and he said it was fine because he was Fergus putting weapons on the table and I was Elinor, yelling at him to take them off the table. I laughed and said that it was a good thing our kids weren't at the table to learn from him. We both looked out the window knowing that our embryos were just a block away being lovingly cared for by Shady Grove. Elinor had triplets... wonder if they were IVF babies ;)  We might have more in common than I thought. 

Here we are at Day 11. Worrying to the max. 
Although my ovaries have never been so packed before- they counted 30 total follies (14 on the right and 16 on the left), the estrogen seems to have stopped rising quickly, and consequently, the lining hasn't grown either. 

If the estrogen stalls out completely, it's not good for the egg quality and they'll want to trigger to salvage the cycle. The problem is that I've got a lot of small ones that are slow growing. They need a couple more days of stimulating medications. If we triggered tomorrow night (Monday, day 12 of stimulating meds), best case is that I'd have 8 mature, and that's a long shot. That's based on egg retrieval last cycle when 12 out of 14 were mature. If I look at the measurements of the follicles at trigger, that would roughly mean that the ones over 14.5 mm contained mature eggs. 

I'm worried that this cycle is just going to be such a wash. On top of that, this long stim cycle is just making me miss so much work, which is making my anxiety so much worse. ughhhhhhhhhhhhhhhhhhh.

I arrived to Shady Grove last night, driving over 5 hours from NC. There is so much snow here! Piled so high on every corner that you can't see around it when making a turn. Feeling so thankful to Shady Grove for keeping our frozen embryos secure through the 30 inch snow storm. 

I've been having bubbling anxiety the for the past few days because this cycle feels so different. 

1. My estrogen isn't skyrocketing like it normally does. 
2. It seemed like there were a lot less follicles than I have had in recent cycles using a similar protocol. 

BUT I'm feeling better after they scanned me today at Shady Grove. I went from having 10 follicles on day 7 when they scanned me at UNC to having 20 follicles when they scanned me here.  The difference still is that my follicles are a couples days behind my last cycle. If they don't up my meds, I'm not seeing how they're going to get the average follicle up to 18 even after 12 whole days of stims, with a day 13 trigger... But we shall see. 

The other good news is that my lining is almost to their minimum lining for transfer. It's at 7.37 mm today, and I'm expecting it to be over 8 when they scan again. The good thing about stimming for more days means that my lining has a longer opportunity to grow. Grow lining grow! This is, of course, the point of this cycle- the "Fresh-Frozen Hybrid" where they prep the lining with stimulating meds, harvest the eggs for IVF/ICSI/PGD, but transfer a PGS normal embryo that was frozen last cycle.. ​

Estrogen made a nice jump too.. 

Queue obsessive over analysis of any data that I get related to this IVF cycle... 

These are the smallest my follies have ever been on day 5. The nurse predicted that I'll stim on day 11 based on their current sizes. They say usually after 10-12 days, but the last cycle (my good cycle) I triggered on day 9.... Hence my worry. Why WHY WHYYYYY is this cycle so slow? Is it going to be a bad cycle? I already have way fewer follicles than I did at day 5 last cycle. Oye.  Also.. Estrogen was only 232 pg/mL today... versus 1015 pg/mL on my good cycle.... Usually my estrogen levels fly up. This had been the trend for all my IVFs until now. 

Lining actually looked ok to me- was measuring 5.5mm and trilaminar. At baseline, before my period, it was at 3.5 mm. So it looks to be putting on some growth. 
I'm trying to convince myself that this cycle is will be good because it is different- it has never worked in the past and maybe this is what needs to happen for me to get pregnant. Here's hoping.. 

So- if you remember, I was gearing up for an ERA Biopsy that was supposed to tell us why The Little Uterus That Couldn't wasn't letting embryos implant... I'm not even going to go into the horror story that was my actual biopsy- but lets just say Tweedle Dee and Tweedle Dumb (not a Shady Grove clinic) never got any tissue so all that work and money and pain lead to ZERO results. No information about my uterus. So Dr. Levy suggested that we try to prepare my uterus for implantation by going through another IVF cycle. In the last cycle I did with him, my lining looked really good. For some reason, I make a TON of estrogen and my lining is ok on stim cycles where as using just estrogen (IM and vaginally) for the FET, it just doesn't do much to my lining. So instead of transferring any fresh embryos from this stim cycle, they'll put back a frozen one that we already had genetically tested. Any embryos that we make from this cycle- we will have tested so that they could be transferred to a carrier if that is what we need to do. 
So I go in for my baseline ultrasound on Monday (tomorrow, MLK day 2016), and hopefully we are ready to rock and roll. Trying to remain positive and low stress, but that has never been super easy for me. 

Quick update: I'm on day 3 of a 5 day progesterone. My biopsy for the ERA test (ivigen) is on Friday morning. We are really cutting it close for having any chance to have a transfer before the clinic shuts down for Christmas. It was supposed to work out seamlessly, as all fertility treatments start. They started me on a higher dose of estrogen: 3 vaginal estradiol and Del Estrogen shots every 3 days. They thought for sure that i would be ready on the 3rd week of this regimin but I was only a 7mm! 3 more days with one extra vaginal esterace still only got me to 7.5mm.. So The biopsy that was eventually pushed back by a week and a half. Ughhhh. That puts the actual transfer on the 21st of December if they can jack up my lining in 3 weeks... If not, maybe Dec 24th for a transfer. The whole thing really sucks because we planned this trip to Florida for Christmas vacation and we don't want to cancel because --- as it the reality of fertility treatment- it might not happen when they think it will happen. As usual nothing is a sure thing. 

So I've been feeling like this all isn't worth it and Id rather just have a Maserati as my Infertility Consolation Prize, and just be done. I know that is a horrible thing to feel- but it is just absolutely how I am feeling. 

Here I thought I knew all the acronyms in the infertility world- then Dr. Levy from Shady Grove throws "ERA" at me. 

Our first FET at Shady Grove was not successful. We always were having this debate until we had genetic testing- was it my eggs or was it my lining that was causing failed transfers? Dr. Levy said that since I responded better than expected getting 4 euploid embryos- he now thinks that the smoking gun is the lining after this transfer didn't work.

Dr.Levy called and said "ok you two are scientists and I'm sure you both have a ton of ideas about what to do next, so let's hear it." LOL. Clearly he is thinking way too highly of us. We thought that he only gave us a 55-60% chance that it would work, so we guessed we just had to roll the dice again with our other frosties. He doesn't want to transfer more embryos until we know more information about my lining..... 

Introducing the ERA "Endometrial Receptivity Array". A biopsy of the lining is taken after a full mock cycle and gene expression at the lining is measured. They look at the expression profile and can (SOMETIMES) determine whether your lining is in the right window for implantation. If the suite of gene expression looks one way- maybe you've been transferring embryos too early- or too late- so during the next cycle, they transfer the embryo according to results of the ERA. 

I haven't done a ton of research yet- because I've been pretty busy- but I am skeptical of this test (not to mention that I have no idea what kind of costs I'm in for). I'm guessing they don't know much about the actual genes that they are looking at- just that there are certain genes that are expressed at different levels before, during and after the optimal implantation window. They are looking for a certain pattern after a mock cycle (estrogen priming, and 6 days of progesterone). I guess because I haven't heard of anyone doing it- or having success with it- I just feel like we won't really get much out of it. 

Here are the 2 main reasons I am into this treatment that have NOTHING to do with the results of the test:
1) No birth control  heading into the mock cycle and the "real" FET cycle starts right after the mock cycle ends - no birth control again. I really feel like the birth control over suppresses me. This will give my tiny lining a break. 
2) The biopsy has a therapeutic effect - it's like an endometrial scratch- that also has been shown to help implantation probably by increasing blood flow to the biopsied area. 

Here is the explanation from IVIgen, the company that does the test with Shady Grove. 

The plan now is that I start estrogen to prep my lining. Since it took forever last time, they are not even going to check the lining until 3 weeks of estrogen. If it looks good (> 8 mm) then I take progesterone for 6 days and get the biopsy here in NC. I'll have it sent to IVIgen while I wait for my cycle to start. I'll start again with estrogen for another 3 weeks for the real transfer cycle. By then, we should know how many days of progesterone to take before the transfer, then we'll head to Shady Grove. It's pretty close to our vacation that we have had planned for Christmas. So I'm really really hoping that all this is finished before that because we really need a break. How happy would I be to find out we were pregnant in Florida! Merry Christmas hopefully. We've already had one of those vacation marred by a BFN.
​

No- It's not late implantation. No- it's not just a slowly growing embryo. No- I am not one of those lucky women who get BFNs leading up to Beta and then BOOM- BPF. This is the same thing that always made me so angry before infertility treatments- as I would just be getting my period, I'd get the whole "Maybe its just implantation bleeding!" No. It was never just  implantation bleeding- it was always my period and I was never pregnant. 

I am not holding out hope that I will be one of these stories where:

• they got only got a positive pregnancy test after beta
• the home pregnancy tests never worked for them but they were actually pregnant 
• didn't get a BFP until 13dpt

Why should I hold on hope when the odds of my results changing by this Tuesday are so small. I'm ready to move on. 

​But.......................... just to be sure- I took apart the test just to make sure it there wasn't a HINT of a line that maybe it wasn't reporting. But.. no. No second line. Just the control line. 

I gave into POAS this cycle- which I hadn't done with previous cycles. I really wanted to finally, for once in my life- see that elusive second line. As it never made an appearance, I wish that I had never tested because my beta test is still 3 days away. Normally people have beta tests on 9dp5dt (14dpo) but I asked my nurse why SGF does it 13dpt, and she said that they get a more definitive and less borderline answer from later betas (mostly to rule out false positives/ chemical pregnancies). So I'm still doing progesterone and del estrogen injections and still taking estrace. Pointless and painful. At least my husband is back and can give me the shots in the butt- it was getting pretty hard to walk after many thigh injections.

So why am I throwing in the towel when some would say it is too early?? There is a lot of information online about when people get their first BFP on a HPT. Not only do we have the infertiles collecting data but a huge amount of data comes for surrogates. Below is a pretty representative graph of women getting BFPs between 4dpt and 8dpt. There isn't even an entry for 9dpt. My conclusion that is that if it sticks- you'll be able to see it on a FRER (First Response Early Result) pregnancy test at 9dpt at the latest (unless you are a very small percent of miracle women who get later BFPs, which- let's be realistic- that isn't me..)

​5dp5dt This is my last day off of work. I didn’t have any coffee and developed a huge headache right before bed. I didn't feel any “signs” all day…  I slept for most of the day, trying hard to relax before had to go back to work. I really thought I would be able to see a squinter this morning. But again it was stark white on the HPT (an expired Wondfo)...
The progesterone shot that I gave myself in the leg last night puffed up and I thought it was getting infected. It was a new bottle and the shot before in my leg with the almost used up progesterone did not cause this reaction (the one when I hit my bone). So maybe I was allergic to something in this new bottle, but why would the two bottles be very different? I also dropped this one on the floor before I used it. I was amazed the glass didn’t break. But there were all these microbubbles that I couldn’t get out. I injected anyway- and I was timid putting the needle in because of the bone issue last time. So maybe I didn’t go deep enough? I talked to my aunt who is a nurse and she said it's probably not a big deal. Watch it and follow up with doc if it gets worse.

​I had progesterone injections in my butt for my first IVF and FET. I remember that my butt was soooo hurt- day after day just getting sorer and sorer. But this time around my butt shots haven't been hurting (DH must be getting super good). But the ones in the leg are now hurting just like the butt shots used to: when you’re walking you can feel the muscles where the leg got the shot. Maybe I don’t feel the butt shots anymore because I don't have any butt muscles anymore. Or maybe I'm just bad at giving them in my leg- which is probably true because I dread it now every day (since hitting the bone) and because I'm scared to do it, the needle goes in a little bit slower.

6dp5dt HPT is still stark white, not even a hint of a squinter. Worried because my guts feel like they do right before my period. In that past when I have been on progesterone I’m super stopped up… so is this a good sign?? Been having cramping and some sharp pains in the lower abdominal area today. But is it just angry intestines?  
I slept pretty well except for a few bad dreams of being in situations where I couldn't avoid stepping through fire ant nests or being bitten by snakes.

1. Hiking with some people, I’m the last to pass this obstacle and I see that it’s covered with snakes. In trying to get over it, I get bit by three venomous snakes and they wouldn't let go. As I try to walk for help, I am also trying to remove the snakes from my body by pinching their heads- but they only quickly let go and bite me somewhere else.
2. At a family reunion outing, I inadvertently walk somewhere that have to walk through fire ant nests. But the whole time no one else is getting bitten, nor bothered by the ants at all. No one even realized they are there.

Actually I just realized the theme throughout these dreams is that although I was with other people- I was the only one being bitten by the ants and the snakes. I obviously feel alone and under attack by my infertility. It's funny because IRL I don’t have a huge fear of ants or snakes- which I guess is how I also feel about y infertility: It’s not scary, it is just a pain in the ass and if you get bitten, you have to deal with.
​
So I finally picked up GOLD STANDARD FRER HPTs from Target. Thinking the whole time “What fertile would EVER buy TWO $13.99 2-packs of pregnancy tests??”. They were on sale from Target with a 5$ gift card with purchase, so thank you Target <3 the infertiles. 

My puffy progesterone shot is looking better today. The next shot I did did the same thing-- so it appears to be what happens with the progesterone shots that I give myself in the leg. Weird because the very first shot I did in my leg didn’t leave a blotchy raised spot.  Maybe it was because I have been afraid to go too deep and accidently hit a bone. Perhaps it’s not getting in far enough. I picked up new needles tonight that are only an inch long instead of an inch and a half long. Tonight will be 4th shot since “bone hit” but the first night with happy needles. So we shall see.

Back at work today...
It was my first day back at work and two people that I work closely with know that I just had a transfer. It’s weird for me because I have completely different feelings about each of them wanting to know the results. One of them- I just don’t mind talking to at all- but the other one- I just don’t know- I don’t want to HAVE TO disclose anything right now even though I know they are very interested. So I was dreading for this one person to ask me about it. Even if I knew, I don't want them to be among the first people to know. I don't want to tell anybody until we’re three months pregnant. But because I told them about the transfer, I feel like I'm trapped into disclosing the results, whatever they may be. It's like you want to tell people sometimes- when you’re hopeful and going through treatment but you wish that they would let you come to them when you wanted to talk. IF SOMEBODY ASKED ME what I WANTED – I’d suggest that they just say something like “hey I'm thinking about you and hoping everything is OK”… and I could just say “thank you” and walk away. I guess it would be a totally different story if I had actually got a positive test by now. But I guess since I'm expecting to have to tell this person that it didn't work- I'm dreading having say it.
UGHHHH and today I wore a shirt that I really shouldn't have. All day I felt like everybody was looking at me like oh she's probably pregnant but I'm thinking no I just haven't exercised in a week and I’ve been stress eating. Stop thinking about my reproductive status, BIOTCHES.

I'm also beginning to feel really conflicted about writing my blog about my results. So I'll probably just stop writing for a little while after this post. If in the awesome event that I get the BFP, I do want to be careful with it. I want my husband and me to be able to enjoy it and I want to share our joy with our family. I would not like people at work to know until I am in a safe time. I don't want to jinx it in any way.  Anyway… Hopefully you'll be hearing from me in a while and that I have good news.