IVF 2: Details of Failure

In my last post, I mentioned that I didn’t tell my family about the last IVF. But as you may have noticed, I didn’t tell you, lovely internet, a whole lot of my IVF odyssey either. I want to remedy this omission. You never know, there may be someone stumbling my way, who actually learns something from my shitty experience? And what a shame if I had hold back, right? Plus, for my own records it’ll be good to have a summary of some sorts. Hm, after writing and reading this piece is mostly for my own records.

(0) Protocol
So, let me give you a summary of the ride. IVF 1 followed the “microdose Lupron protocol,” a protocol for the challenged, which left us with four eggs of which only two fertilized (both transferred, both dead). We tried to improve the odds for IVF 2 by 1) draining of endometrioma (to open access to all potential follicles) 2) estrogen pretreatment (I believe to sensitize the follicles to FSH) and 3) highest dose of follistim (about 600 units per day). It was one of those protocols for the truly lost causes; I think it’s called the “estrogen priming protocol”.

(1) Stimming (10 days):
Unfortunately, my ovaries just yawned at all these exercises. The left actually had a good laugh at us and produced nothing at all (my left ovary doesn’t run at full capacity ever since the complete removal of an endometrioma. Full capacity, haha, who am I kidding?). The right tried to put in some effort and came up with about 7-8 follicles, which wouldn’t be so bad had the left not given up so completely.

I have no information about my FSH, for I declined measuring it. I know, that’s quite radical, isn’t it? But seriously, what would that have changed? They already had me on the max. dose of follistim anyway. So, they humored me and let me start anyway. Given that I am not an FSH superstar, I’ll just assume it was a bit on the high side. Actually, after the baseline ultrasound Dr. Soothing took me aside and gave me this uplifting prep talk “we let you start. For you, we’ll lower our guidelines (meaning that they let me trigger with fewer follicles as a normal IVF patient. Sweet, eh? Even for the infertiles, I need extra status). However, if there are only one or two good follicles and/or crappy estrogen, we cancel you.” What an optimistic introduction to my cycle.

I am also not sure about my baseline estrogen. If I remember correctly, the first measure (day 4 on stims) was 130, raising to ~350 (day 6), ~850 (day 8). The final measure on trigger day (10) was around 1400. As far as I know that’s an acceptable rise in estrogen, similar to IVF 1. Apparently even crappy eggs can produce some good stuff. On day 10 of stims, at least some of my follicles were nice and plump (around 18-21mm), and thankfully, I didn’t spontaneously ovulate them before triggering. My lining was a whopping 6.3-6.5mm. Apparently, all that estrogen didn’t really do much for my endometrium. It was trigger day. Nobody had mentioned to me before that my lining was so shitty. Now, I know that some (good) embryos don’t care that much, but would you, lovely internet, feel great about your chances when your lining was only a little over 6mm on trigger day? I sure as something didn’t. After that ultrasound, the one were the words “donor eggs” were mentioned to me while in the stirrups, I went to my acupuncturist to do some last minute emergency intervention. It may have worked. The next day, my lining measured something over 7mm, which sounded more promising, but still didn’t cross the 8mm line. And it was triple-striped.

(2) Retrieval:
To my own amazement, I made it to retrieval day. On retrieval day, 4 eggs were harvested. They all fertilized normally and without the help of ICSI, which was about the best news I received during this entire cycle. I still remember how happy I was when I received theses news. I couldn’t stop smiling. My old, tired, crappy eggs still knew how to couple!

(3) Transfer:
Based on my intuition, I would have preferred doing a blast transfer (assuming one of the embryos would have reached that stage in the lab), but my doctors had decided early on to do a 3-day transfer again. All four embryos happily divided and were available for transfer. I don’t know their actual quality assessment, all I can say is that their pictures looked as if they had all reached 6-10 cells and looked fairly symmetrical. To me they looked like darn nice embryos. Well, anyway, they were all transferred into the desert, formerly known as my uterus, and, well, died. I would have preferred to freeze two of them (you know, to drag out hope, plus I believe we could have addressed my lining issues better during a FET), but the embryos may not have even been eligible for the freezer anyway. I don’t know. All I know is that in the end, they either committed mass-suicide or my uterus committed mass murder. I believe, doctors favor the first choice.

(4) Post Transfer
I went against protocol (I had to fight with a nurse about this. I won) and decided to continue the progesterone shots instead of using the suppositories. During IVF 1, I started bleeding on beta day despite the suppositories. Let me tell you, that was quite the insult. During IVF 2, I used 100mg of progesterone in oil once a day instead (I would have done 50mg twice a day, but the nurse was so afraid that my little ass couldn’t take it. Little Ass, hahaha.) Call me crazy, but I liked that my butt hurt. It distracted me for a while from feeling potential PMS symptoms. Unfortunately my butt got used to the shots and barely hurt after a while. Go figure. Nevertheless, I didn’t start bleeding until after 5 days of the last shot. So, even if there really is no difference in the achieved pregnancy rate between suppositories vs. shots, I would still go for the shots. I just don’t need the extra stress and insult of early menstruation.

The day of transfer I spent on strict bedrest, not so much because I thought it would really help implantation (the embryos weren’t ready for it anyway, they were not blasts yet) but because I liked the time for myself. After that, I tried to give my embryos a darn good time in the hope it would persuade one of them to stick around. I ate lots, and that includes fast food and other nice goodies. This I didn’t do during IVF1, and see where all the healthy food etc had got me? I would have liked to give them the taste of a nice wine but decided against it (not that it’d have mattered). I contemplated the use of crack, for it seems to me that feeling high persuades lots of embryos to stick around. Embryos may like to feel high, too, you know? … I am actually quite proud of myself for not losing it during the waiting period, or just losing it once. I didn’t pee on a stick. The white space just depresses me. I didn’t expect good news on beta day and I didn’t get it. But I sure was much better in holding on to hope for a long time this time around. And you know what, that feels like a tiny victory.

That was it. Some good parts, mostly bad. The worst for me of course is not necessarily the fact that this IVF failed (bad enough) but what this failure implies. I will talk about this some more later.