20w0d: Anomaly scan

This morning we had our 20 week ultrasound. Before the scan, my husband was talking to me, saying that today is the day that we find out whether we're having a son or a daughter. I told him that I didn't want to think about it and made him talk about other things. However, they called us up right on time, and soon got down to business. Everything looked great, and the sonographer couldn't find a single thing for me to worry about. They counted the fingers and the toes, looked at all the internal organs, checked the placement of the placenta and the fluid, and took a bunch of measurements. The baby weighs 377 grams, and we found out today that I am carrying a boy. It is strangely wonderful to be able to say "he" rather than "it". My husband has told me that I now have to start facing up to the fact that we are most probably going to have a son in less than 5 months.

16w1d: Up to speed

I had a great check-up yesterday. The doctor kindly explained that they couldn't do a routine 16 week ultrasound for everyone, but she would do a uterus palpatation, fundal height measurement, and a doppler check. If any of those looked off, then she would send me for a scan.

She said that she could feel my uterus sitting just underneath my belly button, and showed me how to feel it myself. My fundal height was 14 cm (at 16 weeks it should be 16cm +/- 2cm). She had a great deal of difficulty finding the heartbeat, which made me feel better about having trouble with my home doppler. She found the soft wooshing of the ubilical cord pulse quite easily, and some sporadic sloshes of the fetus moving, and finally about 20 seconds of the loud galloping fetal heartbeat at 160 bpm, before the fetus swam away again.

I know that we didn't get an ultrasound, but all in all I felt very reassured. The doctor seemed so calm and confident that I felt like any other pregnant woman in for a routine check-up.

And now only four weeks to go until we reach the half-way point and our big 20 week morphology scan.

The NT scan

This Tuesday last week I was anxiously counting down the hours until my NT test. I was a bundle of nerves, and had to break down the activity into tiny steps so that I could get through it (get dressed, leave house, get to hospital, walk through front doors, etc). My doppler still hasn’t arrived, so I had no idea if the foetus was even alive.

I arrived 30 minutes early and impatiently waited for my husband to arrive, as he left it to the last minute and only arrived 5 minutes early. Twenty minutes after that, they called us in. My first transabdominal ultrasound, I didn’t even have to take off my pants.

The technician pressed down on my belly and a grainy picture appeared. At first glance, it didn’t look that different from the scan three weeks ago, and my heart froze. But she pointed out the heartbeat and I started to relax. I thought that I had been a responsible patient by drinking a litre of water an hour beforehand, but the technician said that all I was doing was forcing my uterus further towards my spine. She sent me to the bathroom to empty my bladder, and then got down to business.

Everything looked great. The foetus was measuring 6.5 cm (12w6d) at 12w0d with a femur length of 0.68 cm and a NT thickness of 1.49mm (photo of the fetus with a hand on its nose here). I was so relieved when I saw that NT measurement. Then the technician went on to check all the organs, pointing them out as she went along: brain, stomach, kidneys, spine, fingers, feet, even the four chambers of the heart. Due to the position of my uterus, she switched to a transvaginal probe for some of the measurements, so I got a visit from my old friend too. All in all, she concluded “it is a good baby”.

The foetus waved its hands in front of its head, occasionally wiggling and kicking. Although the print outs were a bit poor, seeing the live-action movement on the screen was incredible. With my husband by my side, holding my hand and smiling at me, we could have watched that little thing for hours.

After she had finished, the supervising doctor came in to double-check the measurements. I was a little concerned that the heart rate was a little low (151 bpm) – (the mean rate is 159 +/- 3 bpm at 13 weeks). She did something where she did four different types of doppler heartbeat measurements and said that everything looked fine.

My urine, weight, and blood pressure looked good, so they printed out an official certificate of pregnancy that I need for my work and for securing a childcare position. A few days later I heard that my combined trisomy risk is 1:11 600 for T13 and 1:20 000 for the others.

So, there we are. So far, things look good. Now another three weeks until my next check-up, and another seven weeks until the big anomaly scan.

IVF#2: scheduled

Thank-you for all your advice yesterday.

I called the clinic today and spoke with a lovely midwife. She said The Professor had very recently put a big note on my file saying that he must meet with us before we proceed with our next cycle. My husband suspects that The Professor wants to talk to us about my thin endometrium and suggest some further tweaks to our protocol.

However, I managed to convince her to let me start BCPs before the consultation, and schedule me to put me into the system to start injections a few days after the consultation. So this is my tentative calendar:

November 16: Start BCPs
December 23: Consultation with The Professor
December 27: Start suppression with decapeptyl
January 6: Start Gonal-F stimulation
January 24: Tentative transfer
February 4: Tentative beta

I am so happy that I can ring in the New Year while in the midst of an IVF cycle, full of hope and excitement for the year ahead.

FET#1: CD11

Lining: 5.9 mm
Right ovary: 12.1 mm
Left ovary: 9.5 mm

So it looks like I am progressing very similarly to my last IUI, not surprisingly because I am on the same Menopur dose. If things go the same way, I will probably trigger on CD13 (Sunday), ovulate on CD14 (Monday), and transfer on CD17 (Thursday).

We asked the Professor about the chance of multiples, as we are stimulating ovulation as well as transferring an embryo. He said that it is theoretically possible, but they have never seen it in practise. He also said that animal studies have shown that simply the act of intercourse before embryo transfer can increase the rates of pregnancy.

Feeling much better today. I need to remind myself that the best cure, for me, is just to knuckle down and attack all the work that is stressing me out.

The sun is shining over the soft falling leaves. This might be our last autumn as a family of two (plus two furballs). This is a time to celebrate our love for each other, for cherishing all the wonderful joys already in our life together.

FET#1: CD8

I am participating in a clinical trial for this FET, which involves me injecting half a vial of menopur each night, much like I did for my last IUI. This means that they are monitoring my follicles too, even though we have a little embryo that we prepared earlier.

Stats:
Lining 4.7 mm
Right ovary: One large follicle at 9.7 mm
Left ovary: One large follicle at 8.4 mm

Perhaps another week until trigger? Next check-up on Friday.

Things that are currently stressing me out:
* The hours of sunlight are decreasing, so I am waking up in the dark every morning
* More people are catching the metro, so I now have to stand for 30 minutes to get to work
* My boss is off sick, so I am doing the work of two people
* All projects need to be completed by the end of the year, so we are extra busy
* My mother is coming to stay for a whole week
* I am putting on weight
* Blood tests in the morning, waiting for phone call during the day, injections in the evening

Things that I should be doing to decrease this stress:
* Working hard at work
* Cleaning the house
* Going to the gym
* Eating lots of fruit and vegetables

Things that I am actually doing instead:
* Spending hours on the web looking at pictures of cute animals
* Napping
* Eating chocolate and biscuits
* Worrying
* Feeling guilty

Argh.

IVF#1: Post-failure consultation

We had a fabulous consultation yesterday. We left the appointment feeling like our clinic has a great understanding of IVF and is really tweaking out next cycle to give us the best chance of success. These are some of the answers to our questions:

FET cycle
• How fragmented was our 6-cell embryo at freeze?
They gave it a score of 2 (with 0 best and 6 worst). The symmetry was 1 (with 0 best and 2 worst)
• What are the chances that this embryo will survive the thaw?

There is a 60% chance that it will survive the thaw, and then a 10% chance it will result in a live birth. By law, I must use up all my frozen embryos if I want my next fresh cycle to be funded by health insurance. They quickly signed me up for a clinical trial of Menopur-versus-no stimulation for my FET cycle. I am in the Menopur arm, but I can opt-out and just go the no stimulation with monitoring route instead. I am not sure which option I will take.

Next fresh cycle
• Given my poor response, and that no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles?

At my clinic, 9 eggs is not a poor response - they only aim for 10 eggs retrieved. I guess as 6 fresh cycles are funded, they prefer to have fewer patients with OHSS. They said 6-cell and 7-cell is not that far off from 8-cell, and that we have a very good chance of success in future fresh cycles, especially with a change of drug regime (see below).
o Does our history of a chemical pregnancy and miscarriage influence this?

One chemical and one miscarriage, sadly, falls within the 'normal' range and doesn't tell us anything.
• Will I be on a different drug regime next time around?
Absolutely. My LH was too high throughout the whole cycle, indicating that I was not properly suppressed. He even asked me if I had trouble using the nasal spray. So instead of Suprefact nasal spray for suppression, I will be taking an injectable lupron-like drug instead. Then, instead of urine-derived Menopur I will be taking the recombinant Gonal-F. He said that in order to reduce costs, they put first-time IVFers on the cheaper Menopur, but then after that keep them on Gonal-F, which has a better quality control and is easier for the patient to use.

• How many eggs should we transfer next time?

By law I am now permitted to transfer two embryos, but I am leaning towards elective single embryo transfer. The increased risks associated with twins makes me uncomfortable.

• Can we squeeze in another fresh cycle before New Year's?

Probably. I need to ask them if they want me to have a break cycle after my Menopur-FET.

Donor embryos
• Can you tell us about your frozen embryo program?

They were very unwilling to talk with us about this program. They said that they usually suggest it as a last resort, and no on has ever asked so early on in the process. The process is completely closed, even if the child turns 18, and even if the child requires a bone-marrow transfer.
o Does the six month waiting period apply for every frozen donor embryo transfer?

No. It takes six months for the psychological tests, and after that, we are permitted a 'virtually unlimited' number of donor embryos.
o What criteria do you use to match couples with embryos?

I couldn't get much information on this. From the web, it appears that no matching is conducted (I'm not sure about blood-type).
• Can we sign up for donor embryos now while still attempting our own cycles?

Not yet. They suggest we try a few more time with our own gametes first.

• Will they transfer in donor embryos shipped from abroad?

This question really confused the guy. To clarify, I said, if we had a frozen embryo shipped from the Czech Republic (thinking of Reprofit's bank of cheapish embryos), would you conduct the transfer? He then looked really confused, asking me if I wanted a Czech baby? I laughed, and said, no, we just want one good embryo. We don't care where from. My husband said that we'd even be happy to take a baby if they have any of those laying around. The poor guy just looked more confused and I had to tell him that my husband was joking.

So that's that. Most of my questions answered, and a shiny new drug regime waiting for me for our next fresh IVF cycle. I feel hopeful and happy.

Now it's off to the UK for a week!

IVF#1: Day 12 of Stims

Lining: 6.9mm
Right ovary: 6 follicles, largest 13.9mm
Left ovary: 3 follicles, largest 16.3mm
E2: 1218
Drugs: 150u Menopur 1xday, Suprefact 3xday


"Well that's bizarre"

These were the words that the midwife greeted with us this morning before my scan. My husband and I shared a worried look. She said that apparently my plasma hormones seem to be racing ahead of my follicles. i.e., my blood is responding correctly to the medication, but my ovaries are not as active as they should be. She said that this is especially odd considering how quickly I responded to the Menopur during my IUIs.

Also, my lining is still below 7mm. In all my monitored cycles I have never managed to break the 7mm barrier. So this cycle looks like it will feature a thin lining and low egg count, both predictors of failure. I don't think I'll be at the top of the class for this assignment.

We go back on Wednesday for another checkup, with a possible retrieval on Friday.

I calculated that a retrieval on Friday would put my due date near my birthday, and this led to daydreams of joint birthday celebrations in Disneyland with matching mouse ears. I would really like that.

IVF#1: Day 9 of Stims

Lining: 6.4mm
Right ovary: 4 follicles, largest ~8mm
Left ovary: 4 or 5 follicles, largest ~10mm
E2: 461
Drugs: 150u Menopur 1xday, Suprefact 3xday

My midwife seemed fairly happy with my scan today. She said that things were growing "not too fast and not too slow". They are keeping me on the same dose of stims, and they don't want to see me until Monday. She estimates my retrieval will be at the end of next week, maybe Friday.

I am really happy with my lining. One of the great things about a slow cycle is that it is giving my endometrium a lot more time to mature, compared to my premature response during IUIs.

Thank-you so much for all your comments, I am reminding myself that we only want one baby, so we just need one good embryo. It's about quality, not quantity.

And my lovely husband (who came with me to the appointment and held my hand throughout) was even thoughtful enough to ask the midwife for a print-out of my follicles because he knew I would be too shy to ask. So here they are - let's hope they're the beginning of something wonderful.

First infertility appointment

It's a good thing that am very happy about my life, because it turns out the infertility center works out of the gynecological department in the hospital. So we watched many pregnant bellies walk back and forth while we waited.

We were then interviewed by a younger woman about our medical histories. She did raise her eyes at my numerous graphs and statistics. She asked me for how long I had had a "baby wish", and my husband wryly noted that she did not ask him the same question when it was his turn. I thought I had prepared quite well, but when she asked me how often we had sex per month, that was not a ready figure that I had with me. I pulled out Fertility Friend's intercourse analyzer of my fertile periods over the past 12 months, and she asked "and outside of these times, you do not have sex?" I denied this statement, but now I am sure that she thinks we are celibate for 24 days out of the month.

Then suddenly she said to me, "and now we shall do an internal examination", and made some sort of gesture with her hands. Now? Did she want me to take off my skirt this moment? Yes, she did. She did not ask my husband to leave the room. She did not walk out of the room or give me a gown. She merely stood there, waiting for me to undress in front of her. I felt very shy, and removed my skirt without even thinking to remove my undies. It was only when I sat down on the paper that I realised my mistake. I removed my undies, hoisted my legs up on the stirrups, and in a few seconds she was in and out with a cervix spear.

This was all a little shocking for me. Why is it the act of undressing feels more weird than actually being naked? And what is wrong with draping a bit of fabric over the top to pretend otherwise?

Once I was dressed again, she called in the doctor came in. He looked at my temperature charts and told me that these were the best charts that he had ever seen, which was to be expected, he said, as I was a scientist. Usually, he said, they ask women to track two or three cycles, never... fourteen. I replied that you get a much better standard deviation with an increased N.

He said that the plan was to test my blood at CD21 and CD3 and do a basic internal ultrasound. In the meantime, my husband would be tested for "male factor" (he dislikes being reduced to that phrase) and if that came up normal, they would conduct further tests on me. They would also begin genetic tests immediately, as they take two months for the results to come through.

Today was my CD21 blood test, then I have my CD3 blood test, and then I come back for my ultrasound in a month. We meet with the doctor on August 12 to discuss our next strategy. I tried to ask my questions about donor gametes and embryos, but he said it was much too early for those sorts of questions. But now we are moving forward, and I feel accomplished. In 70 days we should have plenty to talk about.