Labor Negotiations

Loopy

Just wanted to mark the day. I had my first depot Lupron (Ginecrin) shot today. Weird, I kept thinking February 20th would be the day, and when I looked at my calendar, I had the 21st marked, so I guess my uterus knew more than my brain, this month. Apparently, I'm regular again. It would have been more convenient, yesterday, since D was in town and off work for President's Day, but I don't need any more holiday IVF reminders, anyway. Now, if I can just narrowly escape a Father's Day beta, I'll be good...I got my friend, M, a vet tech, to administer the IM shot. She asked if it would be in the "haunches." Hardee-har-har...A little early for symptoms, just a numb hip. Plus, I think I was having hot flashes on my own, earlier today, so who knows how I'll feel. Now back to figure skating...

Love That Lovenox!

Had my follow-up "hemadoc" appointment yesterday. It was fairly pointless, I think he just wanted to pad the insurance bill a tad. However, I came away, with a two-month prescription for Lovenox, with two, sixty-day refills, if needed. Enough to get me well past the beta. Yahoo! They are nifty little pre-filled syringes, and couldn't look easier to use. Of course, since I still live in the "bible belt," I had to listen to him wax poetically about adoption. "Have you looked into it? What you really need is to be hooked up with an OBGYN for adoption referrals." I took it as an opportunity to tell him that a good friend of mine, the daughter of the only abortion doctor in the area, got me on her father's "waiting list," should any mothers be "too far along" for his services. That shut him up. I gathered up my script and got the hell out of there, never to see him again...

Have I mentioned that every health care professional I see here, either plays soft Christian rock on their sound systems or just has a big old picture of Jesus hanging on the wall? Even my massage therapist. 31 days until our move to Secular City.

Happy VD...

Ok. Peanuts Valentine's Day special on in the backround. I've armed myself with a double-shot of Bailey's and decaf, with a plate (yes, plate) of warm, home made, chocolate-chip cookies (always ready in the freezer, for needy moments like this), and I'm ready to celebrate the holiday d'amour, by myself, blogging. I cannot wait until D and I actually reside in the same city again! 35 days and counting...

Actually, on the suckiness quotient, today sucked much less than last Valentine's Day. Last year my cousin and I were having our what-nots diddled for our "one-day" work-ups, for what has come to be known as, "Last Shot With My Eggs, 2005, the Collector's Edition." Only one, in a long list of holiday-IVF anniversaries, that I would like to forget. Today, I finished the wedding invitation I've been working on for the last month. Then, just as I was rushing to get to my orthodontist appointment (I'm on the twice a month plan, now) a gorgeous tropical bouquet of flowers arrived at my door. I had told him not to send anything, because I'd be gone all day, running errands, but sweet boy that he is, he ignored me, and they literally came, one minute before I left. They reminded me of Africa. Nice. After orthotorture, I dropped off my job at the printers, and thought what a nice day to order wedding invitations. My train of thought was broken as I tripped over the threshold and crashed into a row of folding metal chairs. Probably not the best wedding omen...Oh well, I had the foresight to book a one hour massage with a new therapist at my chiropractor's office. Lovely, even though I smelled like Ben Gay afterwards. Then I had my chiropractic adjustment, and that was good, too. When I got home, I decided to take a Jacuzzi bath to rinse off the Ben Gay and soak my back. I wanted that tub so much, after living in a house for four years with NO.TUB.AT.ALL. and now I rarely use it, because we run out of hot water, before it fills up, and its a bitch to clean. Not that I let that stop me, I just boil water on the stove in my four largest pots. Its very Laura Ingalls.

I did have IVF business, today. Dr. L sent me my new calendar. It's not the same way my US clinic does things, but I'm letting it go. He says its works really well, and I'm too exhausted to question it anymore. I'm sorry it was so confusing. But first, he forgot to account for the three Lucrin/Lupron shots, then when he did, he had me starting estrogen before my last shot, with an ultrasound only six days later. I asked a friend who is doing DE at my US clinic with the Depot Lupron protocol, what her calendar was. They have her doing her last shot of Lupron then several days later, taking a course of 17 BCP's, then taking 10 IU's of regular lupron, reducing to 5, while simutaneously starting estrogen for the transfer. It was explained to her, that after your first shot of Depot Lupron, your body floods with estrogen, creating a mini-lining (hers was 6 mm). Then, it just sits there while you continue your Lupron, monthly because you don't get a period again, while you're on it. They think its best to bring on a period with BCP's to get that 2 or 3 month old lining out of there, and I have to agree, it makes sense. Dr. L assures me that it shouldn't be a problem, but again, I don't think he's that familiar with this use of Depot Lupron. I'm going into it, thinking it won't work, and I'll be pleasantly surprised if it does. Have to start building my shell of defense.

My meds came on Friday, so it seems very real now. Howard, the UK pharmacist, is a sweetie. He sent me "best wishes for my upcoming cycle." Great service and prices, too. I saved $500 each on the three doses of Depot Lupron over US prices!

We also booked our flights today. So, yeah, that makes it real, too. My first ultrasound is now on May 24th. We fly out on May 20th, with a 14 hour lay over in London, and arrive in Cape Town the morning of the 22nd. So we have a good day and a half to recuperate before getting down to business. We looked into business class and using our miles, but on the longest leg, from London to Cape Town, we couldn't upgrade on British Airways, anyway. Oh well. I flew to Switzerland and back last year in coach, without even getting up to stretch my legs, because of the hassle factor. Won't be doing that again, with this new blood-clotting issue...

Alex came down last week, and we had a great time, watching bad chick flicks, eating my famous crémè brûleé and generally having a good time, bitching about our nearly useless, reproductive systems. Apparently, my prometrium worked for her, and Big Red's in town, over at her place.

No offers on the house. Looks like we're taking the corporate buy-out in March. My realtor still sucks, and I wash my hands of the situation.

I guess that's it. I think I'll top off my very weak Bailey's buzz with a Combunox, left over from my oral surgery. That ought to kick my bad back's ass. Take it while I still can. Do you like the new look? Something different while I decide whether to upgrade when my TypePad account expires in June. (Beta month, we'll see...)

I'll leave you with my famous crémè brûleé recipe to make for your loved one, if you're so inclined. Makes every day Valentine's Day. Cheap and impressive, too. The caramel "crust" is golden and pretty, and doesn't have that burnt taste that comes from the usual blow torches and broiler methods of carmelizing.

Crémè Brûleé

Do not pre-heat oven. Boil a kettle of water, on the stove, for later use. Place 8, 6 oz. ramekins in a large, parchment paper-lined Pyrex baking dish. In a  small saucepan, heat 3 cups of heavy (40% milk fat) whipping cream and 1 whole vanilla bean, (split lengthwise, to expose the seeds) just until very hot. Do not boil. In a medium bowl, preferably one with a pour spout, stir together 8 egg yolks and 1/3 c. of sugar. Remove the vanilla bean from the cream, and with a sharp knife, scrape the seeds into the cream. Gradually, so as not to cook the eggs (tempering), add the hot cream to the egg mixture. Stir in 1 tsp. real vanilla extract. (use a tablespoon or so of a favorite liqueur or a few raspberries, if you like, at this point) Pour the custard into the ramekins, dividing evenly. Carefully pour the boiling water from the kettle half-way up the outside of the ramekins (bain Marie), being careful to not spill the water into the custard. Set the pan in the in the oven and turn it to 250 degrees F. Bake, without opening the oven door for 90 minutes. Remove the ramekins and allow to cool before chilling them for at least two hours.

Spray and set aside, a Pyrex measuring cup with non-stick cooking spray. In a heavy saucepan, stir together 1 cup of sugar and 6 T. of water. Stir constantly, and bring to a boil. Stop stirring and allow the syrup to boil undisturbed until it turns a deep amber. 340-370 degrees F on a candy thermometer. Going by color is easier. Immediately remove from the heat and carefully pour the caramel syrup into the Pyrex cup, to stop the cooking process. Quickly pour a very thin layer of caramel onto each custard. Rotate each ramekin to spread the caramel evenly. If the caramel becomes too thick to pour easily, microwave it for a few seconds to re-liquify. Refrigerate the crémè brûleés for at least 1 hour or up to 8 hours. (The caramel softens and they start to get beads of water on top, after that) Enjoy.

I'm SO confused...

Here is the email exchange that has taken place over the last 4 or 5 days. Dr. l's anwers are in red:

(Off the Protocol sheet)"When to be in Cape Town? You should arrive in Cape Town on 26 April. You can arrive early by a few days if you wish. You should stay a minimum of 12 days. When to take the medication: You period will arrive within a few days of the 17 March. You should take your Lucrin injection on the first day of your period. This can be given subcutaneously. If  you are using daily Lucrin injections or synarel spray you should also start on the first day of your period. (If? He doesn't know?) You should start your Progynova on the 10 April. Take it according to the following schedule: - 1 tablet daily for 3 days, then - 2 tablets daily for 3 days, then - 3 tablets daily for 3 days, then - 4 tablets daily until you see us. Also take: A pregnancy multivitamin formula containing Folic Acid. Take daily, starting now. Additional Comments:  Will need high dose folate and low dose heparin and aspirin. ICSI will be performed If you need any further information, please contact our IVF coordinator, Sr. K."

So, I did, but I didn't get an answer, as fast as I would have liked, so I forwarded the email to Dr. l.

"Dear Sr. K,

I received my meds and protocol from Dr. l, and I would like to proceed, but I have a few questions.

If you'll notice in my "history" I had planned to take three injections of Lupron/Lucrin depot, spaced 30 days apart, due to missing beta-3 integrins, recently diagnosed by endometrial biopsy. In my mind, donor egg is not even worth trying, if I don't do this step, because of prior implantation failures. I would like to take my first injection with my next period, which I expect, on or around, 20 February. Then, do I wait 30 days, whether or not I've had another period, and take the 2nd injection? Lynnette, you can take the first one on the 20 Feb on day 1 of your period. You will not get any more periods once you are on the lucrin. The second one can be taken on the 20 March and the last one (3rd one) on the 20th April. I think that will be enough suppression. What about the 3rd injection? Do you even have periods, after you've been on it so long? I'm sorry if I'm unclear, but I've never done the depot injections before. The protocol with my US clinic was only tentatively drawn up, while I waited to be matched with a donor, there. I think this will push the travel time for my cycle out, to late May, instead? Could you see about re-evaluating my calendar to reflect this? Also, on the current calendar, is 26 April, the day that I would have my first ultrasound and blood draw, or is that only the day that I need to arrive in South Africa? This is the day you must have your first scan in Cape Town. Best to arrive the day before. How many days has my donor stimmed in the past two cycles? Her egg collections are usually on day 13/14

Also, when would Dr. l like me to begin my low dose heparin injections? We usually start the day before the embryo transfer with Clexane(Lovenox) injections.I will prescribe them once you are here and you can get them from a local pharmacy. I would like to begin them before embryo transfer, at the least. My American RE, Dr. S, had suggested 6 weeks prior to conception, throughout pregnancy, and 6 weeks post-partum, with a short break, I think, around the time of delivery. I have a hematologist who would prescribe the medication, but he is not very well-versed in its use for IVF, so I would feel more comfortable having Dr. l prescribe it, with the hematologist monitoring the use (I already have a perinatalogist lined up for monitoring during pregnancy). His dosage suggestion was Lovenox 45 mg, two times daily, for my weight, which is approximately *** pounds (** kg)(yeah, right...like I'm going to post this for you guys...). Does this sound right? Our usual dose is 40mg daily. (Isn't this a little on the lite side? I'm fat people, fat, I tell ya! And it has a short half-life, hence the twice a day injections)

I also had a question about the need for ICSI. Is it being recommended because we have yet to establish a pregnancy? The reason for its use in the past, is because an embryologist had pronounced my zona pellucidas "hard." My husband's semen analyses have always been normal. However, I'm fine with doing it, if the benefits outweigh the risks. Would a 50/50 insemination have any value? ICSI gives the best chance of fertilization and very rarely do we get failed fertilization. You can go with conventional IVF but there is a 5% failure rate. cost of ICSI is 4000 rand.  

Also, has my donor gone to blastocyst in the past? If a day 3 embryo transfer is planned, will assisted hatching be performed? With this donor day 3 transfers have been done, because she has such great embryos it does not make much difference. We do not do assisted hatching unless the zona is hard but there is no evidence that it helps.

I'm no longer concerned about the donor's cystic fibrosis status. I didn't realize that if my husband had tested negative, that any children resulting, would, more than likely, not have the disease. Of course I'll still pay for the test, though!

I will need to order my meds from the international pharmacy. Can you arrange this as soon as possible, so that I can start my lucrin depot on the 20th? The form for the International Pharmacy is attached. you must complete it and fax it to H at the International Pharmacy. Please fill in your address on the form for the courier.

And I would like to pay for my deposit with a credit card. Can you send me a form for that? I have attached a credit card form.

Sincerely,

Lynnette Baduteandeggs"

"Dear Dr. l,

Thank you so much for the answers! I think that only leaves me with a couple of questions. Should I take my first dose of progynova on or around May 10th, instead of April 10th? And what day in May, will my first scan be? May 26th? We will probably arrive a few days earlier. And do my husband and I need to take a course of antibiotics? Do I need Medrol? OK. That's it. I really think I'm done asking questions, now. You've been so helpful. Thank you. Now I must order my meds and get the deposit sent off!

Sincerely,

Lynnette Baduteandeggs"

"Dear Lynnette,

 

I still have your arrival date as 26 April. Do you want to postpone it? I don't think it will make that much difference.

 

We do not usually use antibiotics or steroids (Medrol) as there no evidence that it improves outcome in egg donation.

 

Kind Regards,

 

DR. L"

Ok, so if I'm reading this correctly, I will be starting my estrogen(progynova) tablets before I take my last dose of Lucrin/Lupron? And my first scan will be 6 days after this dose? Does this make sense? I need some advice, but the damn ivfconnections boards are down again. Has anyone out there done a FET or DE transfer with the 2 or 3 injections of Lupron depot? Doesn't it seem kind of rushed, given that his original protocol has the one and only Lupron injection on March 17th? (did I mention that I had a BFN on St. Patrick's Day, 3 years ago? Fucking holidays...) On that, he doesn't even have me starting the estrogen(progynova) until the 10th of April, with a scan 16 days after that! Let alone the embryo transfer...I'm starting to feel like he kind of slapped this together, and I don't want to suffer the consequences. Help...

On the bright side, The Infertile Gourmet is coming down to visit me, in my house(!) for a few days. Girly fun.

Movie spoilers ahead: On a movie note, D and I watched two(!) videos this weekend, where the pregnant woman's baby dies during labor. The Constant Gardener, and Junebug. Like I needed something new to worry about! The odd thing is, neither mother seemed all that devastated. Just sort of worn out, and then moving on. I think I would be suicidal! WTF?

"'cause the rabbit done died..."

BFN. Big fucking surprise. I missed the call (they left a message) because my dogs were busy murdering two baby rabbits in the yard, and we were trying to break it all up. Nothing good about that omen. And here I was thinking rabbits didn't have to die for pregnancy tests nowadays. Too sad. Supposedly, I will get a call from the RE today, but I don't think I'll wait around all day for it. It is the 4th of July and our anniversary, after all. Six years of wedded bliss. At least they can't take that away from us. Yesterday, we drove my dad's convertible around with the radio blaring and stuffed our faces with Cold Stone Creamery. That sounds good, but I think alcohol is in order, today. I guess it's either adoption or DE with a new GC for us. Either choice will be extremely difficut with our move to Europe. P finally offered to do an IUI, but now D is turned off by that idea. My feelings: a day late and $25,000 short. Plus, she wants to be paid half of what we would spend on a DE/GC cycle. Huh? We were going to buy hefty savings bonds for her three kids, for a take home baby (never mentioning this to her, although, we did half-jokingly say we'd buy her a minivan with the money we saved) but now I have sort of a bad taste in my mouth about this offer. I think anonymous DE and agency GC are the way to go. I don't want to be beholden to her or anyone, anymore. Not sure about using this particular "top tier," clinic again, either. We'll have to see. I'll check in later this week after my hangover wears off.

Two negatives do not make a positive.

P took an HPT yesterday and today. Both negative. For a beta of 50+ to show up Monday, she should have had something show up today, at least. The FRED she used, detects 25 IU's of HCG in the urine, and that would need to double by Monday. Fuck. Now what?

WTF?

Well, I hope the whole thing isn't screwed. P's estrogen levels have been out of whack the entire cycle. She had a blood draw Wednesday before transfer. Her E2 had dropped to 140 from the 343 the draw before that. They want it to be around 300. They called her cell phone to tell her to increase her Vivelle patches Wednesday night. She was on bed rest , and didn't have her phone by her side so didn't get the message until Thursday night! I told her to take the older two off, and put 4 fresh ones on. On top of that she was also under the impression that she was only to take 4 Estrace tablets, period. Without getting argumentative, (eggshells here, people, eggshells) I politely insisted that since I picked up her prescription, I was pretty sure she had a 30 day supply, and our nurse never mentioned stopping them. I'm sure she was thinking of the Medrol which was for four nights. It just goes to show that I have to continue to stay on top of her and her meds. Of course, it would help if the friggin' nurses would follow up their voice mails to P with a call to me. I mean I am the IP, right? And it is my money, right? I politely informed the nurse that I expected as much from now on. Fuck.

"It only takes one..."

Well we transferred yesterday. The embryologist came in and wanted to tell us what we had to work with. I said, "Do I need to get a pen?" And she said, "No, it's pretty brief..." I knew right away, we only had one left. The good news is, it was an 8 cell good/excellent (3+ by my clinic's standards). So that, coupled with the fact that we did do assisted hatching, got embryo "glue," and have a fertile uterus, have got my hopes up again. I could tell P was pretty relieved. You know fertiles, 1 embryo=1 baby. So beta is on the 4th of July, our 6th anniversary, but we probably won't have the results until the 5th. Notice how I hit all the holidays, anyway? Please be lucky for a change...

IVF sucks eggs...

Well we retrieved 7 eggs yesterday. Initially, I was kind of excited, thinking that at least 5 of them would be halfway decent, since they were the ones growing evenly during the ultrasounds. But, alas, as per usual, my cycles never go according to plan. We got the fert report and only 2 fertilized normally. 2 fertilized abnormally to the M2 stage, whatever the fuck that means.

Needless to say, I don't hold out much hope for this cycle. P's E2 level is up to 343, so that's good at least. Transfer is tentatively set for Wednesday, if there are any left...

Whoa...trigger!

D, P and I all had appointments this morning. D just for communicables. P had an ultrasound and E2 check. She is holding steady at 14-15mm, but her E2 has stagnated. It is virtually the same as 2 days ago. So they are adding Estrace, orally to raise her systemic E2 level by transfer. My ultrasound wasn't great. I now only have 5 decent sized follicles in the 20mm range, which means I've lost one. I triggered tonight about forty minutes ago and retrieval will be on Sunday at 9:00 a.m. I'm sort of losing hope that this could work...Gotta go, my hotel wireless access is going to run out any minute. Hopefully, I'll have a fertilization report to post Monday.

(did I mention my RE is going on vacation tomorrow, and Dr. Ass, who I dumped a year and a half ago is doing retrieval and transfer? Jeez...)