Diminished Ovarian Reserve

[image]

I haven’t posted about this yet because there was just too much going on these last few days with all the will-the-embryos-make-it drama. Plus, I didn’t want to drag the embryos down with my negative diagnosis.

Anyway, after my first IVF, my doctor suspected that that I had “some level of diminished ovarian reserve,” but she didn’t sound convinced. Well, let me tell you, she is convinced now. After this riot of an IVF cycle, I have now officially been diagnosed with diminished ovarian reserve (or DOR as it’s commonly known, because the infertility world hearts their acronyms). This basically means that although I am 37, my ovaries are somewhere in their 40s. I’m thinking maybe like 42 or 43? Here’s the weird thing, though. My DOR is a sneaky B. There are three tests they use to determine if your ovarian reserve is low: FSH, AMH and antral follicle count. The first two are hormones. And the last one is how many follicles you have at the beginning of your cycle. My FSH, AMH and antral follicle count are all normal! So my ovarian reserve should be fine as well, right? But I don’t respond well to the IVF medication, I don’t make a lot of eggs and the ones I do make are poor quality. So, boom — secret diminished ovarian reserve.

What does this all mean? Basically, it’s not good. No infertility diagnosis is good, let me be clear, but this one is extra-special fun because the only way to fix it is to turn back time. Will the 23-year-old Tanya please come forward? I’d like some of her eggs. What’s that? It’s not possible, you say? Ok, fine.

Turns out I lost my time machine, so here are our options:

1. My doctor suggested another fresh IVF cycle with a new protocol. She didn’t seem all that hopeful that it would work, though. We are extremely lucky that we have infertility coverage, so this is financially the best option for us. An exercise in futility? Maybe. Even still, this option is not off the table. We could also check out another doctor in our network, but I already feel that mine is the best in the area. It’s for sure worth looking into again, though.

2. Get second opinions. We are definitely pursuing this. We plan on contacting the following:

Dr. Braverman: He’s a reproductive endocrinologist. I already know I have one immune issue because of my elevated anticardiolipins, and I just have a nagging feeling that there are some other immunologic conditions going on here.

Center for Human Reproduction:  DOR is their specialty.

Colorado Center for Reproductive Medicine: All-around bad-asses in the IVF world.

The one problem with this is that these places, awesome as they may be, are out of network, which means that we likely couldn’t afford them anyway. If we’re going to break the bank, it’s going to be for something that’s more of a sure thing. Even still, I think I’d regret it if I didn’t hear what they had to say.

3. Domestic infant adoption. I haven’t talked about this at all here, but we’ve already been researching this one pretty hard-core. I know it’s not an easy road, at all, but I believe that in the end we would have a sweet baby to love.

Neither adoption or fancy fertility doctors are cheap. We could pretty much do one or the other and that’s it, end of story. What will we do? I have no f*cking clue.

Right now I’m going to cry my eyes out and some drink wine.

Lots and lots of wine.

IVF #2: All Embryos Arrested

And that’s all she wrote, folks. The embryos haven’t grown at all in the last 48 hours. Game over. A sad end to a sad cycle.

IVF #2: #GoEmbryos #HopeStreet

You guys, thank you so much to everyone who commented on my post or sent me a message yesterday. I even had one friend drop off some marigolds. It was a rough day, one of the roughest I’ve had in a long time, but you all managed to make me feel so loved. It’s pretty easy to feel isolated and alone on this journey, but you have proven time and again that you walk beside me.

After Lettie went to bed yesterday, Tim and I talked for a long time about what to do. I did end up connecting with my doctor, but she didn’t give us a strong opinion one way or another on whether to go for the day three transfer or hope that the embryo grew to blastocyst. We hashed out every single possibility six times over. We even called a real-life friend who has gone through IVF to bounce ideas off of her. We worried about miscarriages and chemical pregnancies and the possibility of a genetically abnormal embryo implanting. We worried and what-ifed until we were about to pass out from exhaustion.

And then we both just kind of stopped. We simultaneously came to the conclusion that we did not want to make a decision out of fear. Neither one of us wants to live our lives like that. And we certainly don’t want to teach our children to be ruled by fear either. For us, all the reasons to avoid a day three transfer came from a place of fear, not hope. So we decided that if the next day our embryo or embryos looked the same or worse, we would go ahead with the day three transfer. We called the acupuncturist and told her to meet us at the clinic in the morning. Then we went to bed, feeling happy with the decision that we made together. I think we both felt lighter. And dare I say it? Hopeful.

But you know how it is. The best laid plans and all that. This morning the embryologist called bright and early and told us that the decent-looking two-cell guy from yesterday was now a bad-ass, grade-1, 8-cell embryo (these are all good things). And guess what else? One of the two poor-quality embryos from yesterday also looked pretty good! The last one was disintegrating (sorry, buddy. I still love you, though).

Well, eff me. This was not the news we were expecting at all. All of you that told me yesterday not to give up were absolutely right. Your prayers and thoughts and good vibes must have worked because those punks are fighting!

So Tim and I reassessed, and again made a decision from a place of hope. We decided that since the embryos were clearly fighters, we were going to let them fight it out another couple of days. On day five the embryologist will check them again–if any are still going and can be biopsied for testing, they’ll do so at that time. I know there are wildly different theories on this in the infertility world, but both my doctor and the embryologist said that if the embryos were going to make it to day five, they would do so whether in the lab or in my body. I trust them on this one. My clinic has really good labs and that is one of the reasons I chose them. And not only do I trust the professionals, but I have faith in our embryos. I believe they can do it. I’m proud of our scrappy little cells.

And yeah, this means that we might not have a damn thing to transfer in the end, but I think I will ultimately be ok if that happens–very sad, yes, but ok.

Because today, one more time, I choose hope.

IVF #2: One

And that’s what we’re left with: one embryo. The other two are still alive, but she thinks that they will arrest by tomorrow. And that one “good” one? It’s not even that great. It’s two cells at day two, which is the minimum you can have at this point. The embryologist says that if we want to do a transfer of that one it will have to be on day 3. And that means no genetic testing.

I’m trying to get a hold of my doctor to discuss all of this before making a decision about a day 3 transfer, but it’s been over three hours and she hasn’t back called yet. I get that doctors are busy, but SERIOUSLY?

And that’s it. I don’t understand how this could’ve happened. It went from a pretty good cycle the first time to a really bad cycle this time. No minor variations here. Good to total crap. What the HELL, you guys?

I’m so disillusioned with this entire process. I have no idea if I can ever go through this again. It just breaks my heart. I’m so tired of grieving. I’m so tired of picking myself back up.

I am spent.

IVF #2: This is Not Going Well. At All.

We had egg retrieval yesterday. We got eight eggs. That’s two less than last time. Yeah, I was bummed, but I was trying to not be mopey about it and hope for good news this morning.

Well that didn’t happen. Of the eight, six were mature. And only three fertilized with ICSI  (this is where they inject one sperm into one egg instead of letting them do their thing in a petri dish) .

We didn’t do ICSI last time and had a much better fertilization rate. I asked the embryologist if that was the problem and she said that, no, she thinks the outcome would’ve been the same without ICSI. She thinks my egg quality just wasn’t as good this time. I asked her if it’s because I was a few months older this cycle, and she didn’t think so.

I’m not sure if I mentioned this on here, but we did ICSI because we wanted to genetically screen the embryos. ICSI is a requirement for genetic screening. Now I’m not sure if any embryos will make it to day five for screening. I’m going to talk to the embryologist tomorrow and figure out a plan based on how the embryos are doing then.

I am pretty gutted right now. I’ve had a bad feeling about this cycle from the get go, but I thought I was just being a weirdo. I guess it’s good to know I am actually not insane (at least not about this).

WTF? Why would my egg quality have plummeted in five months? I’ve been taking CoQ10 for four of those months, which was supposed to help with egg quality, but now I’m thinking it might have made it worse. Or maybe it was all the root canals I had this cycle or the Tylenol 3 or the stress. I don’t know. It’s really hard not to think that it was something I did.

This sucks, you guys. I know it only takes one and all that, but now I might not even end up with that much.

IVF #2: I Choose Hope

It’s been a rough week. Since my last post I’ve pretty much descended into madness. I’ve been obsessing about follicle growth and root canals and estrogen numbers. My anxiety level has been out of control.

I’m pretty sure it reached its peak this afternoon. My clinic called to say that I would be triggering this evening. A few minutes later I emailed them to find out what my estrogen was at this point during my last cycle so I could compare. For real-life friends: your estrogen number can be indicative of how many mature follicles you have. The higher your number, usually the more mature eggs you’ll produce. You don’t want the number to get too high because then your ovaries can freak out and fill with fluid, earning you a one-way ticket to the hospital. But you don’t want it too low either. For reference, my estrogen today was around 1500.

So this one nurse writes back. I think she’s kind of new, but I’m not sure. She’s young and super sweet, but she just doesn’t seem as with it as the other nurses.

She writes, “Your estrogen at this time last cycle was 258.”

And I’m like, huh? That seems crazy low. So I write he back saying, “Wait, 258? Is there a missing number somewhere? That seems really low.”

And she writes, “Oh, I’m sorry, 258 was your first beta from your last pregnancy. Your estrogen last time was 2578.”

Cue multiple freakouts. Freakout number one: Who wants to be reminded of an unsuccessful pregnancy right before trying to get pregnant again? WTF? Freakout number two: Why is my estrogen so much lower this time? Does that mean I’ll get half the number of eggs? AAAAAAACCCCCKKKK!

So then I wrote, “Whoa, that’s a lot lower than last time. Does the mean I’ll get a lot less eggs at retrieval?”

After that, another nurse wrote me saying sorry for the miscommunication and that I had been given the wrong number ah-gain. The 2587 number was from the day after trigger shot. My number the day of trigger shot was like 1800-ish.

That’s really not that much of a difference than last time. Plus, I had 16 follicles last time and now I have 12, so it makes sense that the estrogen would be a little less. But by the time time I got that last email my anxiety was in super-freak mode, and continued on that way until about an hour ago.

Until I decided enough of this.

I can choose to keep going down this path of fear that I seem so hell bent on walking, or I can choose hope. That’s what has been absent from this cycle so far: hope. I completely lost sight of it. I got so mired in the teeth pain and the baggage from my last IVF that I let the anxiety completely overtake me. I lost sight of what I long for this experience to be: a chance to connect with the soul who will join our family.

Yes, I’m having major teeth pain and root canals. Yes, I’ve been doped up on Tylenol 3. Yes, I’ve been stressed to the max for days on end. Yes, I’m still sad about the loss of my last pregnancy. Ok, fine, these are not 100% perfect circumstances for an IVF cycle. But what in life is ever perfect? Just because it’s not perfect, doesn’t mean it won’t work.

So today, right now, I choose hope. I’m packing my bags and moving my whole family to Hope Street — and that’s where we’ll stay, for as long as we need to. Fear Street is derelict, you guys. And the neighbors are all paranoid assholes.

IVF #2: My Motley Follicle Crew

[image]

I saw my second favorite doctor at the practice this morning.  He looked over my chart when he came in and said, “Ok, so you’re on antagonist protocol, estrogen priming and then atomic bomb. I like it.” Atomic bomb is of course referring to the ridic amount of meds that I’m throwing at my ovaries right now.

He did an ultrasound and said he was pleased with the follicle growth between Thursday and today. There were still a dozen follicles hanging out, so at least I didn’t lose any more. Score! According to him they were “all different sizes,” so they’re definitely not all growing at the same rate. I hope, hope, hope that the tiny ones catch up to the big guys.

I left there feeling pretty good. I was imagining my dozen follicles sitting pretty in a cardboard egg carton. Sure, I’m not going to win the award for the World’s Largest Follicle Collection, but 12 is still pretty damn solid. And besides, quality over quantity and all that business that you wise women always tell me.

But then. Here’s that but again. The nurse called back this afternoon and said that I was to take my regular dose of meds tonight, and tomorrow night I should up my Menopur dose. Whaaaaat? You guys, I’m already taking the Atomic Bomb amount of stims. I thought I was at the max dosage. And now she’s UPPING IT? This can’t be a good sign, right? Something must be wrong for her to do this. I read back through my old posts, and my doctor did up my Menopur around this time last cycle as well. But this cycle I started out on a higher dose of meds than last time, so I assumed that I would be staying at the same dose the whole time. After I increase my dose I’ll be on 450 units of follistim and 225 units of Menopur. So that’s 675 total units of stimulation meds. Gah! Does that seem crazy to any of you IVF vets out there? .

Again, there’s nothing I can do about it, even if it’s a bad sign. All I can do is breathe, take my Atomic Bomb med cocktail, and wait. I have to find a way to get back to my happy place, though. This gloom and doom crap that I’ve been feeling the last couple of days is for the birds.

IVF #2: Why Can’t I Be A Zen Master?

Ok, I tried to stay away from the blog. Tried it. I thought it would help me tone down the crazy. I can’t do it, though.

I CAN’T DO THIS ALONE.

I need you guys like the desert needs the rain. I need you like leaves need the sun. I need you like ____________ (insert cliché of choice).

The truth is, there is likely no way for me to not be crazy. Let’s face facts here. To be fair, I was feeling cool as a cucumber until this morning. I was taking my injections like a champ, listening to my hypnosis MP3 every night and not obsessing about anything (I swear). But then. There’s always a but, right?

This morning I had my first scan since starting stims. At my baseline scan a few days ago, I had 28 follicles. This is a record number of resting follicles for me. I was pumped. I was feeling pretty bad-ass—yeah, don’t mind me, that’s just my ovaries, with like a million follicles. Now, I know that baseline follicle count doesn’t really mean jack, but I was excited just the same. Surely that meant I might end up with more than two blastocysts at the end of this, right? Meh.

So anyway, I go to my appointment this morning after three days of stims and my doctor counts 12 follicles total. Wait, what? Where did the other 16 follicles go? You mean they just turned into dust and disappeared? WTF.

I asked my doctor where they all went and she said that some just don’t respond to the medication at all. So yeah, 12. I’m pretty sure that’s less than I had last time at this point. I asked her if that meant that only 12 would make it through to the end and she said it’s not a definite number, but that’s around what we’re looking at. Well, eff me. Has this ever happened to you guys—after three days of stims you had way less follicles than you started with?

I mean, don’t get me wrong, I’d be psyched to get 12 eggs at retrieval. But last time I had 16 follicles at the end and only got 10 eggs. So this is making me nervous. At my age, a little over half of my embryos will be genetically abnormal. So if I don’t end up with at least two day-five embryos, it’s not looking good for normalcy in these parts.

Another thing that’s upping my crazy factor is that I found out yesterday that I need three more root canals. They’ll have to happen in the next two weeks because I don’t want to put them off until I (please God) get pregnant. You guys, all I do is get root canals. It’s like a part time job. And who wants to get root canals while also injecting yourself every night?

Plus, hormones. HORMONES. This cycle I’m on the highest possible dose of stimulation meds that my clinic will allow. So yeah, I’m like, whoa.

But guess what? I have zero control over any of this crap. It is what it is. So really, what is my crazy accomplishing?

Nada.

But yet. I’M STILL CRAZY.

I need my center back. If you find it, can you send it along to me?

Thanks.