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Posts Tagged ‘implantation’

I have super project management skillz. Luckily, it’s something I also do for a living. I sorted out the miscommunication, waded through the knee deep bullshit, got to the root of the problem, made them get their ducks in a row and at long last, got the call that IVF has been authorized. It’s done. I am less excited…more relieved. I won’t feel ok about it until I get my IVF calendar.

It’s CD1 today…19th failure to get pregnant…and counting. As usual, my period came at the same time it does every month. 14dpo. I’m so regular it seems wrong that I can’t get pregnant. Tomorrow I start taking antibiotics and birth control pills. Next Friday, I have my hysteroscopy and who knows what happens after that. It’s all so unclear, so unorganized and I blame my clinic. They really suck big fat hairy balls. Again, I am making the calls, trying to gather information about what the plan is moving forward.

Life is feeling pretty normal again these days. So much that the whole fertility treatment world seems like a far distant memory. I’m not looking forward to going back there. I’m trying to wrap my head around the idea that maybe I could have a baby soon if this IVF thing works and that seems absolutely crazy to me. My body…pregnant? Life with a baby? It’s infathomable after so many failures. I’m not necessarily looking at IVF as the end to everything. I really see it as another diagnostic test to figure out what the hell is wrong with me. The embryos will give us an idea of whether it’s an embryonic issue or if it might be an implantation issue. My gut says it’s implantation. It’s an eery feeling to know that I might know soon. Knowledge is power.

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I went to my clinic’s IVF info session this evening. Was packed with lots of information but nothing really I didn’t know. I just want to get the show on the road at this point. Before I start with the IVF program, there are a few tests that are mandatory that I need to do. One is the saline sonogram of the uterus. They do this to rule out fibroids, polyps and Ashermans or any other abnormalities in the uterus that may affect implantation. Also I’m probably going to have to do some blood tests for diseases. There are some other hormone level testing that is required but I’m hoping that the ones I did for the IUIs will cover those. I spoke to the IVF pre-cycle coordinator today and she is going to call me to let me know what labs I still need to do.

Assuming I pass all of these tests, I’m wondering how soon they’ll let me start the program.

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I am going to think out aloud here because I want to have this conversation with my RE at our consultation. I’m going to ask him about laparoscopy and he’s going to tell me it’s “elective” and that it’s up to me if I want to have the procedure done. So I want to think this through knowing where I am at right now.

So the whole fertility treatment process for “unexplained” infertility is a basic elimination process. As follows:

Clomid/Femara combined with IUI

The IUI procedure effectively eliminates any issues with sperm not getting through the cervix and allows a larger amount of higher quality sperm to get closer to the egg(s). Multiple eggs obviously increases the chances of conception. But it doesn’t eliminate egg quality problems, sperm/egg interaction problems or implantation problems. This is where I am in the process now and it hasn’t worked out so far.

Injectables combine with IUI

This is plan B for superovulation and IUI. Injectables are more stimulating and I suppose that’s supposed to further increase your chances of conception. But the issues listed above are not eliminated.

IVF

Because the egg and the sperm are brought together on a cute little petri dish, IVF eliminates the need for the sperm to find it’s way to the egg at all. Also visible now and possibly prevented are any sperm/egg interaction issues, i.e. any issues with the sperm not being able to penetrate the egg, too many sperm penetrating the egg etc because the technician makes that magic happen in the lab. It also has the added benefit of giving you some idea of the quality of your eggs. But IVF doesn’t eliminate implantation problems because after transfer, the blastocyte still needs to be able to “hatch” and embed itself in the uterine lining and many other steps for it to become a viable pregnancy.

The thing is…none of these procedures address implantation issues. If you’ve got that, it appears that you are totally fucked. And while Laparoscopy can help diagnose endometriosis and it’s an opportunity to clean up cysts, scar tissue and address inflammation which could interfere with follicle development and a fertilized egg traveling through the fallopian tube, apart from removing fibroids, does it do anything to help with implantation? My thoughts from all this is that, if you’ve made the decision to proceed with IVF, the only thing that I can see a lap helping with is improving follicle/egg development IF you have issues around that. (Of course if you’ve had an ectopic pregnancy then there is a medical need to get in there and do a lap so that’s a separate issue). And when you weigh the benefits of having a lap and then having to do a 2-3 month “break” afterwards, with what issues you can eliminate with the IVF procedure, the pros are not that great for someone who doesn’t feel like they have a whole lot of time on their hands. And I’m thinking that’s why my doctor and so many other doctors don’t require patients to do a laparoscopy, unless there is a visible cyst or a medical reason to do so.

Please someone correct me if there is a flaw in my thinking or if there is something that is missing but based on this, I feel like maybe the right time for me to do a lap is if the first IVF fails to give the IVF elimination plan a chance to eliminate some of the obstacles. But then again IVF is expensive and physically intense and I would love to give the first IVF it’s best shot at working with a cleaned out inside. Maybe even a clean slate for when I get to injectables/IUI! See now I’m faltering again…I wish there were ANSWERS!

I’m not even at IVF yet and I’m jumping the gun but sometimes the act of planning my shit out helps me relax and take back control. Would love to hear others thoughts on this and please point out the flaws in my thinking. I am just pulling this out of my ass and trying to distract myself from the latest failure.

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prometriumi had an appointment with my OB/GYN today. i went in to discuss the tests that she wants me to take before she refers me off to a fertility specialist. here’s what i have to do:

CD 3: blood test for estrogen and FSH levels. FSH levels will give a rough idea of my egg supply. do i have enough that i don’t need to worry too much about time or am i drying up? she also recommended that i have a thyroid analysis done as well.
CD21 or 7dpo: blood test for progesterone levels. if you’re not producing enough progesterone, a fertilized egg has no chance because your uterine lining can’t build up enough for it to implant. progesterone, along with HCG also sustains an implanted egg through the first three months of its life.
ultrasound: get an ultrasound to find out if i have cysts or if there are any signs of endometriosis. my mother has endo so there’s a pretty good chance i have it which is not good.
hysterosalpingogram: that’s a mouthful. this is basically a dye test. they shoot some dye up your hooha through your cervix and xray as the dye come back down through your fallopian tubes. this reveals some information about the shape of your uterus and will show whether you have any cysts or fibroids that are blocking your fallopian tubes.

in addition, she prescribed me some supplemental progesterone (prometrium) to take once i’ve done all my tests. she wants to see if that might help a little bit (just in case i am fertilizing an egg but am unable to sustain an implanted embryo) as my luteal phase is on the shorter side (10-12 days, one time i had an 8 day LP).

currently i’m on day 24 of this cycle and i think its another bust. i have all the typical “pregnancy” symptoms which are also the same as most PMS symptoms and i have the dull cramping that typically precedes my period. these next two days are the roughest days because i’m just anticipating what is inevitable and facing yet another failure.

current mood: depressed, sad and frustrated that i’m now at the point where i am having to take these tests to figure out if something is “wrong” with me. on the bright side of things, if there is something wrong with me, it would be nice to know sooner than later. also, since i’m almost at the end of this cycle, this means i can get started on the tests, probably by the end of the week.

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