Existential Frustration

Life has lost its meaning. I’ve lost my purpose and significance of my existence. Sounds so dramatic, I know, but I just feel like I will never get pregnant. I am not sure if I am delusional but it seems like everyone around me is pregnant. It hurts so much. It is so sad but this infertility burden turned me into someone else. Someone who has lost that vital passion for life. Someone who is envious. I’ve never been like that! Life is not as interesting as it once was. Yet people do not understand, especially those who did not have any problem conceiving. What am I supposed to say to “You’re so lucky you don’t have kids yet, it’s a lot of work. I need a break. Do you want to take mine since you can't have your own?” Their insensitive, brainless remarks, like “you just need to relax” or “you’re still young” do not help. They do not understand that relaxation is not a medical treatment of infertility.

The most hurtful thing is when people that have kids say that they wish they didn’t have them. This world is unjust. They wish they could have my freedom and opportunity to go wherever I want and to have more funds available for themselves. When I hear that my heart bleeds. I know it does, I can feel it. I don’t want to travel because when I come back home there is silence of the empty walls around me. I have no one to share my stories with; I do not have someone missing me here. I go to work and I don’t know why I am trying to succeed in it when I will have no one to leave its rewards to. I’ve lost my drive. I’ve always had it and I’ve lot it. It’s hard and it is so much harder when people around you just don’t get it. I look at the old pictures of myself and I don’t recognize that person; the person with a sparkle in the eyes and a smile. I don’t know if my face is capable of that anymore. How sad. Sad of what I’ve become.

And no, I will repeat it again and again until no breath comes out of my lungs - I will not relax, take it easy, go on vacation, forget about it, move on or wait until a miracle happens until I have a child in my arms. And I don't believe in miracles. So everyone who wants me to pretend to be a happy cheerful clown can just wait. I am sad now and I will take my time being sad. I will not put on a smile. I will keep on doing every other possible medical procedure until I am where I need to be in life. A mother. So I guess after all, I do have a drive….

IVF#3 - Canceled - High Prolactin

IVF#3 - Canceled !!!!!

I have high Prolactin - 36.6

Additionally to being diagnosed with our unexplained infertility, that affects only 20% of all couples that stuggle with infertility, I have another unexplained syndrome.

After excluding all the possible causes like prolactinoma for which I did MRI, to by doing various blood test and excluding PCOS and hypothyroidism, in which an inadequate amount of the thyroid hormone is produced - I also fall in about 30% of the cases, in which the root cause of high prolactin is also unexplained.

What! Can you beleive that!

It's either I have some mysterious biological functions or our medical diagnostic test are not advance enough for my alien body!

PUREGON vs. GONAL-F

Tottaly Obsessed!

I start stimming this Monday. I am also very interested on the outcome of my ER this time. I think I am definitely on higher stim dose now, just a slightly different medications. I am on totally different protocol and being a nut like me, I spent most of my weekend researching medical data available on the net. Not like it will help me have better results, just being nosy. Here is some of the stuff I put together for anyone else interested.

It is long, sorry, just had to share

Before I WAS ON:

Gonadotropins (Follicle Stimulation) injections of:
Puregon 200 IU

GnRH antagonists (Ovulation Prevention) injection of:
Orgalutran 250 mg

Result: 5 eggs retrieved, 3 mature, 2 embryos transferred on day 3 (both 8 cell grade 1 no fragmentation, even cell division)

I WILL NOW BE ON:

Gonadotropins (Follicle Stimulation) injections of:
Gonal - F 225 iu
Menopur 150 iu

GnRH antagonists (Ovulation Prevention) injection of:
Cetrotide 250 mg

Result: Coming Soon


I did some research and gathered some information from various published medical studies/articles, since I have to know everything as to what I’m injecting into myself. I guess I am a control freak! Anyhow, here is some general info on my follicle stimulation drugs if anyone interested:

PUREGON: Follitropin beta belongs to a class of medications called gonadotropins. Follitropin beta contains a hormone similar to the human hormone, FSH (follicle stimulating hormone). For assisted reproductive technology procedures, the usual initial dose is 150 IU to 225 IU daily.

GONAL-F: Follitropin alpha belongs to the class of medications called gonadotropins. It is a synthetic version of the naturally occurring follicle stimulating hormone (FSH), a hormone produced by the pituitary gland that helps egg development in the ovaries. Doses usually range from 75 IU to 450 IU (5.5 µg to 33 µg) per day. For Assisted Reproductive Technologies, therapy with Gonal-f® should be initiated in the early follicular phase (cycle day 2 or 3) at a dose of 150 IU per day. Treatment is usually started at a dose of 150 IU or 225 IU (depending on your circumstances) once a day. Usual range is 150-300. Doses larger than 450 IU of FSH per day are not routinely recommended.

MENOPUR: Menotropins are a mixture of naturally occurring hormones that include follicle stimulating hormone (FSH) and luteinizing hormone (LH). The recommended initial dose of menotropins is 225 IU injected under the skin daily for a maximum of 20 days. The dose may be adjusted according to your response, but should not exceed 450 IU.

PUREGON vs. GONAL-F: Both of these medications are made from highly purified human Follicle Stimulating Hormone prepared by recombinant DNA technology. Both are non-urinary products and contain only FSH. There is no LH component. Meanwhile, two published direct comparisons between both follitropins (Tulppala et al., 1999 ; Harlin et al., 2000 ) justify the conclusion that the slight differences between the two molecules do not have any clinical significance. The fact that in the IVF studies, the odds favor follitropin alpha and not beta appears to be mainly due to the fact that, compared to the follitropin beta studies, the control patients perform significantly worse in the follitropin alpha studies (difference: –5.5%; 95% confidence interval: –10.7 to –0.3%; two-tailed P = 0.037). This should have been recognized by the authors.

American Journal of Obstetrics & Gynecology. 189(2):342-346, August 2003. Williams, R. Stan MD *; Vensel, Theresa MD; Sistrom, Christopher L. MD; Kipersztok, Simon MD; Rhoton-Vlasak, Alice MD; Drury, Ken PhD

Abstract:
OBJECTIVE:
Our purpose was to assess the efficacy of two recombinant follicle-stimulating hormones, follitropin beta (Follistim, Organon, West Orange, NJ) and follitropin alfa (Gonal F, Serono, Norwell, Mass) on pregnancy rates in varying age groups of women undergoing in vitro fertilization (IVF).
STUDY DESIGN:
Three hundred sixty-five IVF cycles were retrospectively compared, 233 by use of follitropin beta and 132 by use of follitropin alfa, both after gonadotropin-releasing hormone agonist down-regulation. Assignment to each medication was indiscriminate. The primary outcome measured was pregnancy evidenced by fetal heartbeat on ultrasonography. Secondary outcomes included days of stimulation, ampules per patient cycle, estradiol level on the day of human chorionic gonadotropin administration, total follicles present on the day of human chorionic gonadotropin administration, follicles greater than 14 mm, oocytes retrieved, mature eggs, fertilization rate, and embryos transferred. Outcomes were stratified by age, including women less than 36 years old, 36 to 39 years old, and more than 39 years old.
RESULTS:
There was no significant difference between follitropin beta and follitropin alfa in either the primary or secondary outcomes, although the pregnancy rate was significantly decreased with advancing age.
CONCLUSION:
Success rates are similar, when stratified by age, in women undergoing IVF with either follitropin beta or follitropin alfa.

Here we go again...IVF#3

Had my follow-up/review appointment with RE today. So once AF arrives from this "natural" cycle, which I am not hoping will work...

We are doing it again! Yep! All over again!

July 2008 - IVF#3

Hoping to get more eggs and this time, not going to be on BCP or any kind of pre-suppression because last IVF did not do any good for me and I was over suppressed. Also, if everything goes well, we're going for a 5 day transfer this time.

All of my medications were switched, which is good. So now I will be on:

Gonadotropins (Follicle Stimulation) injections of:

• Gonal - F 225 iu
• Menopur 150 iu

GnRH antagonists (Ovulation Prevention) injection of:

• Cetrotide 250 mg
  

Trigger injection of:

• Ovidrel 250 µg (10,000iu)

After ER

• 81mg Aspirin

After ET

• Progesterone (intramuscular injections) 50 mg daily

Implantation Failure???

I think I might be...nuts

I am doing something weird and yes I know it, so please don't be shy if you think I've gone bonkers

Somewhere deep down in my heart, I believe that the reason why I am not getting pregnant is because I have implantation failure. I think that even though my eggs get fertilized with my husband’s sperm and create normal embryos (as shown by IVF) they are just not able to implant either due to NK natural killer cells or because of blood-clotting.

My RE will most likely will not agree to go the blood-clotting test and NK activity test which have been studied as the cause of many unexplained infertility cases. In fact, some researches believe that it is "implantation failure”, and not poor egg/embryo number or quality that is often the root of the problem.

“Considering its importance, it is not surprising that failure of proper function of this immunologic interaction during implantation has been implicated as a cause of recurrent miscarriage, late pregnancy fetal loss, IVF failure and unexplained infertility. A partial list of immunologic factors that may be involved in these situations includes: anti-phospholipid antibodies (APA), antithyroid antibodies (ATA), and, perhaps most importantly, activated natural killer cells (NKa). Presently, these immunologic markers can be adequately measured by only a few (less than a half dozen) highly specialized reproductive immunology laboratories in the United States, from patient blood samples.”

So,

I did a research about therapeutic doses of aspirin and now I am taking 81mg everyday. I am also going to be using Pre-Seed when we BD and I am taking something to help with CM (Guaifenesin). Aspirin is suppose to help with uterine lining and help with even blood-flow (decrease clotting).

“For these patients, and even many without endometrial lining issues, we will typically recommend that she take a baby aspirin per day (81 mg) starting with gonadotropin stimulation. The rational for the use of baby aspirin is that on a micro-vascular level, vasodilation and decreased blood platelet aggregation occurs and therefore improves blood flow to the uterine lining, providing a lining with functional improvement. Blood platelets are the blood cells, which promote blood clotting. Two well designed studies confirm the benefit of baby aspirin use in improving pregnancy rates for patients with endometrial linings <8mm.>

Also an interesting fact that it has been found that aspirin, when taken 12 hr prior to donation of the blood sample causes an 80-100% reduction in the NK cell activity.

IVF#2 - BFN

Wednesday, May 28, 2008

This cycle was a bust!

Even though we have unexplained infertility and had two good embryos transferred.

My BETA today was 0

Just as I thought

What next?

Going to try to take a a break if I can.

We've tried before, but it is so so hard to stop dreaming that one day I will hold a baby in my arms. How can I give up that dream and just "take a break", forget about it?.....How can I? Could you? If you were in my shoes...I bet you would not....

IVF#2 - 1 day post ER

Got my update

5 eggs retrieved
3 mature
2 fertilized



This is only day 1 after retrieval

I don't think they will make it to even day 3 transfer

IVF#2 - CD 12 - RETRIEVAL

5 eggs retrieved.

4 from my right ovary
1 from my left ovary

The retrieval wen smooth. We came in at 7:30am. I was called in to the prep room. Changed into hospital gown and was right away was hooked up to glucose (sugar water) and sodium (salt water) IV. My husband was called to produce a sample. Around 8am he was allowed to come in to the prep room. We stayed there until 9:15am. After that we were taken to the procedure room and I was administered sedative medication as well as the pain medication.

Sedation drugs used:
Fentanyl - a powerful opioid analgesic
Metazoline - sedative

My doctor came in and together with an ultrasound technician, they did an ultrasound to double check my follicles. Then a spectrum was inserted and a gauze with topical anesthetic was applied. Minutes later I felt a sharp needle "down there" which was some additional local anesthetic.

The procedure started. Me and my husband were able to see on ultrasound screen my eggs "shuffled" around in my ovary. Then my doctor picked out the big ones and I felt a lot of pressure and poking/pulling sensations on the ovary. Eggs were sucked out through a tube and given directly to an embryologist through a little glass window that was connected to the embryology lab.

Later I was whisked away to the recovery room where I stayed for 1 hour.

Feeling bloated and have a constant feeling like I need to go to the bathroom. Also some other things that I will not mention since its too much information ;-)

Now wait until tomorrow afternoon for my RE to call with the results of cell devision and fertilization. I am not sure if my eggs will make it to 5 day transfer. We might just have to do a 3 day. We'll see...

IVF#2 - CD 10 - Trigger

Ok.....scared now. Tonight I am suppose to take my last injection of Puregon 200IU and finally trigger with Ovidrel (HCG) @ 9:30pm. Scared because RE told the nurse to "advise patient that she only has 4 follicles for retrieval"....to me sounds like a warning before a disappointing fall....we'll see how many eggies we will get. I hope I will end up with at least one embryo for the transfer. I truly hope...

My stats today:

Right Ovary - 2.1/ 1.9/ 1.4/1.3/ 1.3 + 2 small ones = 7 follicles
Left Ovary - 2.0/ 1.3 + 2 small ones = 4 follicles
Uterine lining - 0.9cm

Taking last shot of Puregon 200 IU + Ovidrel (HCG) @ 9:30pm

Day 11 (May13)

Just bloodwork

Day 12 (May14)

Egg Retrieval @ 9:30am

IVF#2 - CD 9

I now have ultrasound and bloodwork everyday at 7am. Lack of sleep is really getting to me.

It seems like I made a right decision to fight for my cycle to stay "alive" because my leading follicles slowed down in growth a bit, while the other ones are catching up. Now it seems like ER will be as schedules. Just thinking that if I was not persistent in persuading my RE not to cancel, I would have been doing IUI now instead of this. I really hope I was right, and if I was this is just another example that you should sometimes listen to your gut instincts rather than to your doctor.

Here are my stats as of today:

Day 9 (May11)
Estrogen - 2481
LH - 2
Prog. - 9.9
Right Ovary - 1.9/ 1.6/ 1.3/1.2/ 1.1 + 2 small ones = 7 follicles
Left Ovary - 1.8/ 1.0 + 2 small ones = 4 follicles
Uterine lining - 0.9cm

IVF#2 - CD 7 - Almost Cancelled!

So frustrated and upset!

I am now on my day 7 of IVF cycle.

My doctor was about to cancell it because she said that my follicles got into "groups" of mature ones and immature. She wants them all be at the same level. I put up a fight with her not to cancel.

I said - "I am progressing well and I still have 5 more days of stimulation to go, and my estrogen level is good, I already have 6 follicles. They might grow more in 5 days. Please let's wait and see and if not, I think 6 follicles is enough for ER. I'm willing to risk."

She said - "Only because you are young, I am willing to give it a try and go to ER even with 6 follicles, but that decision is up to you. You night end up with no embryos to transfer, that would be a waste"

My ER is scheduled this Thursday, May 15. So upset and scared now. Tired of waiting. This is second attempt and this crap again??!!

Here are my stats so far:

Today - Day 7
Estrogen - 1515
Right Ovary - 1.5/ 1.2/ 1.1/ 1.1 + 3 small ones = 7 follicles
Left Ovary - 1.6/ 1 + 2 small ones = 4 follicles

IVF#2 - CD 5 Stats

So I went today. My lining is 0.8 cm. Not sure if that's good or not.

I have:

5 follicles on right ovary @ 1.3 / 1.1 / 1.0 + 2 very small ones
4 follicles on left ovary @ 1.5 + 3 very small ones

Because I already have at least one "leading follicle" over 1.2cm, I started my Orgalutran today to prevent me from ovulating.

Back for ultrasound Friday, May 9 (CD 7)

IVF#2 - CD 4 Stats

I had my CD 4 blood work done to see my Estrogen and it was at 652 today. The nurse had asked me to come back again tomorrow for blood and ultrasound. They want to see if I have a "leading follicle" of at least 1.2cm and if I do, they will add Orgalutran (delays ovulation) to my Puregon shots. We'll see how it goes. Just an update.

IVF#2 - Base Ultrasound

Today had my base ultrasound for antral follicle count. Scheduled Day 0 for IVF. My cyst is gone!!! Well, at least the ultrasound technician did not see it. I'm very happy.

I had:
5 follicles on my right ovary
4 follicles on my left ovary

Start Puregon (200iu) May 3 - CD 1

Wow, Puregon is expensive - $223 CAD per shot (200iu)! Wow!

Next B/W & U/S May 6 !

IVF#2 New Protocol

I just got back from my RE and was very happy because she changed my protocol from "Long" to "Antagonist". I was switched from Suprefact to Orgalutran. This cycle will also be shorter because my est. ER is May 15 (!).

About my cyct, my RE said she will "ignore" it if it's less than 4cm and if it grows, then she will "drain" it and still get on with my cycle. This makes me happy, because even though this is my IVF#2, I really did not get a chanse to even finish IVF#1 and did not even get to do stimulation phase of it.

Here are my dates:
Start BCP - April 4
Last BCP - April 30
Day 0 - May 2
Retrieval (est.) - May 15
Transfer (est.) - May 19

IVF#1 - CANCELLED

I am very sad today…started crying at work and just left…because….

I went for my repeat Day 0 ultrasound today and they found that my cyst on my right ovary grew from 2.2cm to 3.2cm in just 6 days. So, my IVF#1 cycle is canceled….All those birth control pills for 31 days and injections in the stomach for 3 weeks is for nothing. Now I have to stop all my medication and wait for my period to come. After that, it’s all over again – birth control in April, injections in May and MAYBE I’ll get ho have IVF egg retrieval and embryo transfer in June. That is IF my cyst goes away. If not, then I have two choices: wait for up to 6 months for the cyst to go away by itself OR remove it through surgery. I am so upset… I never had cysts before and don’t even know why the heck I have it NOW, out of nowhere

I am also on medication (Bromocriptine) for my elevated prolactin. My doctor wanted to cancel my IVF before because of it, but then decided to wait and see if meds help…

I am so heart broken…

I am such and emotional piece of nerves right now. This was supposed to be my first IVF and now I realize that all of you girls out there, who had/have fertility problems, had their cycles cancelled or had BFN after IVF – let me tell you, that you are the most remarkable women that have so much patience and strength that all you girls should be put on a pedestal and given a medal for being able to deal with this emotional & physical burden of infertility…

First base b/w & u/s

Well, I went for my base ultrasound today (March 20) and my RE said I have a cyst (2.2cm) on my right ovary and therefore should continue Suprefact (suppression) for another week (3rd week). I was supposed to start stimulation phase with Puregon on March 21. Now everything is pushed back 1 week because of this cyst.I also have 4 follicles on the right and 5 on the left ovary.

Going for a second "base" ultrasound March 27th now to see if the cyst is gone.