Sunday, January 31, 2010

Doctor's orders

I find it very unusual that I have been told that I should not exercise. In the winter, I usually exercise a little less, but before Christmas I started going regularly to spin class. I really love group spin. It starts at 6 am, but it is a great way to invigorate and get a work out in early in the day. I like to get my heart rate up and sweat like crazy. For Christmas I even got a new Ga*rmin heart rate monitor and GPS. But alas at my last appointment they actually told me to cut back on the work outs.

I don't really understand it. I mean my body fat content isn't that low and I have always had regular cycles. Of course they did not tell me to go cold turkey. They just told me to cut back on the aerobic work and maybe do yoga and stretching. It is just hard to get into something when the heart rate doesn't get much above 120 bpm. It almost feels as if it isn't worth it to put the workout gear on. To be honest, it is kind of cool to have an excuse not to work out. "Can't go running, honey. Doctor's orders."

It is sad at the same time. Mr. Hoo has been running very avidly and I feel like a slug. I had to miss three of our annual runs because of IVF stuff. I also missed fulfilling my new year's resolution last year, which was to have a personal best for a 5K. Heavy sigh. The worst part is that my clothes are getting a bit tight.

I wonder what they will say if and when I do get preggers. I doubt they will let me run like I was. More likely my dog will be very happy and I will take her for extended walks. I guess I will have to just eat healthy food and do lots of yoga. I need something to reduce my stress level any way.

Thursday, January 28, 2010

Anonymous donor (not any more)

I am going to devote another post to choosing our donor. But I really have to spill the beans regarding something about our donor. I know exactly who she is. I know her name. I know where she goes to school . I know her date of birth. I have even seen her. So you say, big deal lots of people can say this about their donor, but I don't thing they can say this about their ANONYMOUS donor. I am sure this makes me sound like a stalker. Trust me I am not. I have stopped myself short of asking to be her friend on facebook. I know my boundaries and don't want to freak out some innocent and giving individual who took time and effort to provide me with the genetic raw materials to make a baby.

First I'd wondered if I broke some unspoken code. Though shall not ponder any facts about the donor that are beyond the extensive history provided. I looked through the documents that I had to sign, and there was nothing about doing any investigative work on my own. Seriously, I have always wanted to be a private investigator. I love using deductive reasoning. Nancy Drew, Encyclopedia Brown, Bone, Scully. I want to be them. Growing up I wanted to solve tiny neighborhood problems. Figure out that Mr Halifax's alibi about driving back from a two hour trip couldn't be true because his car hood was cold. That is who I wanted to be.

Having an anonymous donor was a mystery for me There were little clues along the way I found out the university where our donor attended because it was provided in her bio. The agency forgot to scratch it off. The agency also told us her father's occupation. Well, sort of. In fact the agency misrepresented the father's occupation, but it was enough information to cross reference as needed. The donor also mentioned that she likes ulimate frisbee. What did I do? I went to facebook and searched groups from that university and that sporting group. Lo and behold there was the donor's picture. One catch there were two people in the picture. I didn't know if the name listed was the donor or a friend. Oh, Mr. Google can you help me? A short image search and there she is with her full name. I looked up the father's last name and it agreed with the agency's information. Found the donor's birth record and it agreed with the donor's age.

For some reason having this information made me feel better. I felt like I was in control. If I ever wanted to I could find this person. It would be easy. She has a very unique name. I haven't done much since then. But I envision I will check up on her status at school occasionally. Thank goodness their is no privacy.

My story doesn't end here. The day we had to drop off Mr Hoo's contribution to our child, we had the choice of an early morning drop off or a later morning drop off. Quickly calculating when the egg retrieval would be, I chose the morning. I wanted the little buggers to be processed and ready the minute the eggs were retrieved and cleaned. I admit in the back of my mind, I thought we could hang out in the parking lot and catch a glimpse of the donor.

It turned out better than expected. We arrived at the office a little late, but they made us sit there for over 45 minutes. I noticed something was up because all of the nurses kept looking out into the waiting room with very nervous faces. And then it happened . The donor walked in with a small woman who I can only assume was her mother. I poked Mr. Hoo. He didn't seem to know why I was poking him. I kept at it and nodded a few times in her direction. Then I think he figured it out. It was hard not staring at them. Not scrutinizing every facial expression. Her body language, but I don't think she had any idea that I was the recipient of her kind gift.
She and her mother were chatting. I couldn't hear them, but it was clear they were close. Like best friends.

She was beautiful. She was tall and fit. She walked with certainty, but she did have the full ovary waddle. She was a college woman who knew she was smart and gorgeous. She was dressed casually in sweats and had her hair pulled up. She wore clunky black Euro glasses. I find it funny that it is so easy to pick out donors in the office. They are always dressed in sweats and tennis shoes. Often donors are frantically typing away on computers. They always seem to have a calm air about them. They don't have anxiety upon their faces. The worry lines suggesting too many visits with negative outcomes. Or the fear-filled look of hope that women who have just had embryos transferred have. Women who have been visiting the RE for over a year rarely walk lightly or energetically. They are more matter of fact. Their lives are filled with routine. Daily injections, weekly blood draws, patches, pills....

Wednesday, January 27, 2010

Endometrial biopsy

My new RE is really into this idea that an endometrial biopsy somehow helps the uterus prepare better for receiving the blastocyst. There really doesn't seem to be much analytical data about why this works. Really it seems mostly anecdotal. I did find a recent article attempting to explain this phenemenon.

Am J Reprod Immunol. 2010 Jan;63(1):17-21.

Inflammation and implantation.

Dekel N, Gnainsky Y, Granot I, Mor G.

Department of Biological Regulation, the Weizmann Institute, Rehovot, Israel.

Approximately half of all human embryo implantations result in failed pregnancy. Multiple factors may contribute to this failure, including genetic or metabolic abnormalities of the embryo. However, many of these spontaneous early abortion cases are attributed to poor uterine receptivity. Furthermore, although many fertility disorders have been overcome by a variety of assisted reproductive techniques, implantation remains the rate-limiting step for the success of the in vitro fertilization (IVF) treatments. It has been demonstrated that endometrial biopsies performed either during the spontaneous, preceding cycle, or during the IVF cycle itself, significantly improve the rate of implantation, clinical pregnancies and live births. These observations suggest that mechanical injury of the endometrium may enhance uterine receptivity by provoking the immune system to generate an inflammatory reaction. In strong support of this idea, we recently found that dendritic cells (DCs), an important cellular component of the innate immune system, play a critical role in successful implantation in a mouse model. In this review, we discuss the hypothesis that the injury-derived inflammation in the biopsy-treated patients generates a focus for uterine DCs accumulation that, in turn, enhances the endometrial expression of essential molecules, which facilitate the interaction between the embryo and the uterine epithelium.

I find it hard to believe that dendritic cells are responsible for the success of this procedure but nonetheless my doctor has decided that this is the best mode of action. Why has the doctor decided this. Well, it turns out that I am incapable of making a thick lining. Only 7.5 mm. In the failed fresh DE cycle, I had implantation but likely lost two embryos 4 days after by 370HCG. Any way, we didn't do a mock cycle because we assumed that the other clinic would have commented or done something special if my lining was thin.

In January we started an FET cycle. Dr. L was not happy with the thickness of my lining using oral, vaginal and transdermal estradiol. Then I went a week doing twice a week injectable estradiol. Still the lining was wimpy so it was converted to a mock cycle with vaginal progesterone and endometrial biopsy.

The biopsy was a little bit of a fiasco. It turns out that I have a tricky cervix. For the fresh embyro transfer Dr. L put a stitch into my cervix so he could tug on it to straighten it out. Dr L was not available for my biopsy so his partner did it. There seemed to be some issues because he kept leaving the room to get additional equipment. Seriously, he left the room three times after his first attempt. There I was, my legs up in the stirrups and speculum in place. The biopsy itself was also somewhat crampy and bloody. Not too bad, and it went away after a few minutes.

So here I am going through the FET cycle for real this time. I have to do injectable estradiol, but it is only twice a week. I go in on Tuesday to find out the lining thickness. Today I found out that my biopsy was completely normal and in phase. Which in my mind kind of sucks because there is nothing that can be done to improve it, but the nurse seemed to think that it was a good thing. We shall see.

Saturday, January 23, 2010

Back in the saddle

I have been lurking around in the IF blogosphere for a while and this cycle I think I need a little support. I have a bit more time and hope that I can be as encouraging and insightful as the regulars. I wanted to come in with a brand new web page that shows my personality, but I have not taken the time to learn word press. Maybe some time in the future. There are many thoughts and events that I have wanted to share. I think I will enumerate them so that I can have subjects for future posts.

1. Changing REs
2. Deciding on a donor
3. Seeing the donor in the REs office
4. Finding out personal information about the donor
5. Endometrial biopsies
6. Being supportive of others

So for now this is just to say, I'm ba ack!


I am not quite sure what ICLW week is, but it looks like one of the requisites is a summary. I am not sure I want to relive all of my stupid mistakes and assumptions but here it is.

I am 42 and P is 36. We got married in July of 2005 and started trying to conceive in November 2006. In December 2007 went to a reproductive endocrinologist. FSH was 8.8 and all of the plumbing looked OK. Doc recommended no major intervention. WTF? Are you kidding me. I was nearing 40 and had been trying for a year and IVF wasn't suggested. Tried 3 clomid cycles in the summer.

Decided it was time to go scientific. Started IVF procedures in Fall of 2008. FSH was 15. First long lupron cycle canceled due to lack of stimulation. Ovulated after lupron was removed and underwent IUI when I went in for antral follicle check. Had to do a clomid IUI cycle because office had a national meeting in November and anesthesiologists didn't want to work over Christmas. IVF attempt 2 in January lupron flare, 6 follicles 1 egg retrieved didn't fertilize. February IVF converted to IUI. BFN. Switched clinics. April ganirelix used for pre cycle suppression. Only 3 antral follicles. RE recommended moving to DE. November DE cycle 19 egg retrieved, 12 fertilized, 2 5 day grade AA blasts transferred . BFP 9dp5dt, HCG 370, two days later HCG 160. Lining declared an issue. January 2010 went through mock cycle with injectible estrogen, had uterine biopsy. Awaiting results. FET planned for Feb 10, 2010