Tests, tests and a few more tests (and some results)

Lots going on as the long prep for cycle 5 continues, but here are the soundbites:

Mrs IVF:

* Completed day 3 blood work and sent it to Denver. Massive deal where everything was finely planned. Mrs IVF read the instructions a million times and we even had roles and responsibilities planned for when the FedEx guy buzzed (I answer door, Mrs I attends to the freezer, check, roger that). Sounds anal, but was just exciting to do stuff and we wanted to get it right.

* Blood work results came back and it looks like we got a whole new protocol we have never heard about. We are hoping this might solve the “4,000 E2 level , 17 follicle but only 5 eggs” issue. It appears that Lupron is used as the trigger in this cycle .

Anyway – here’s the link of what we think we will be doing . Warning – floating foetus on this website , (so guess it works for some) ->http://amiracletocome.blogspot.com/2009/07/protocol-details.html.

Called “EPP – estrogen priming protocol”. Seems to be aimed at poor responders, according to the professional blog surfer herself. Expect slower stim is another tip as is “improved embryo quality”. Well, that’s nice.

* HSG – (injected with dye to see if the “chick bits” leak). Done 4 cycles ago but new clinic wants it done again Mrs IVF fainted in the last one. Mrs IVF did it today returned from this session bubbly and happy, where as last time she was delivered wiped out in a wheelchair. Very painful I believe so we celebrated with a Starbucks vivano and Mr IVF delivered a cupcake later (one off treat and non chocolate!)

* MRI scheduled on Thursday. Bit of blood in the wizz. Had this before so Colorado wanted us to go back and ensure this was clear. Not 100% clear from blood test last week , so Kidney dude wants to do an MRI, may be IGA which is some nasty protein disease that Super Gyno (some super specialist Ob/ gyn) says could be an issue when pregnant. Geez – where does this stuff end?

* diet – big focus on eating well. ALL caffeine eliminated. No coffee, tea or even, to Mrs IVF severe disappointment, chocolate.

Mr IVF

* Blasted though another baby batter session in Colorado and returned fairly crap results again. Count was around 6 million (20 million  is normal), and the fuckers can’t swim well (motility lower than recommended) and look ugly (no  morphology). Found out people still get pregnant with no morphology  – its an IVF term to look for good looking yogurt seeds – but not a knockout punch. So could be worse, but could be a lot better. Is what it is. Need to win this poker hand with some less than great cards, but hey, its been done before.  I blame the porn on Colorado – all these lesbian vids  don’t generate top notch results I think. (my excuse, prove me wrong)

* Send a batch of batter off for DNA fragmentation test as well and came back with borderline results so we will be doing PICSI (which I call “POWER ICSI”, but means the use some form of trap to capture good healthy looking fellas and keeping them away from the clowns.) Will also be doing something called IMSI that will use some super powerful magnification to also find good guys.Fuck knows how any of this works or fits together.

So it looks like we have gone to Maccas and asked to be super sized and turned out we ordered everything on the menu.

No idea where this will end up, but we need 2 more clearance letters (one from the super gyno and one from the Kidney dude) and a clear HSG we are cleared for takeoff. A fair few potential ugly “ifs” lurking in there we haven’t had clearance on, but we’ll see how things plan out.

If all goes to plan we start “the Easter egg hunt” (monitoring for ovulation)  in about 3-4 weeks. Are we excited again? I guess, I don’t know really. I guess the last batch of hurt is far enough behind us that you forget how bad this can be, so that’s about as ready as we’re likely to get.

Hope all is well for you out there in IVF land.

Dr vs Dr

Well, well, well, so much to update you on.

We went and caught up with our existing doctor. We didn’t want to get into a “Denver says / you say” debate, so, after significant discussion (we chatted for 15 seconds as we walked into the dr’s office) we decided to lay low and not talk about Denver and just see what our Dr was thinking. Dr opens with “so – tell me all about it? How was Denver?”. hmm scratch plan A.. plan B was over an hr of very candid and useful discussion. Here’s (some of) the crib notes:

* Dr Current has read Denver’s results and sees they are good but cautions that they sample body was lots of young women, (Mrs IVF still thinks that from what she has read that there are lots of “problem children” like us who are 35+ who appear to have good success in Denver)

* Denver has found some things as per my last post that Dr Current hasn’t even tested for. Maybe means little, but we are strong believers that lots of littles can make an impact on the big. We both just feel that this whole thing is like unlocking a safe. No point getting 9 out of 10 parts of the combination right, that doesn’t get you where you want to be. Maybe Denver has the whole combination? Maybe this whole thing is just a cruel nightmare.

* The cycle. Mrs IVF has done all 3 “stimulant styles”, in summary:

– long lupron. (Cycles 1 and 2) where the eggs are put on a slow cooker. 1st cycle was our best retrieval (15) and 7 up for trf (from memory) and ended in 7 week miscarriage after we lost about half the eggs along the way to quality etc. 2ndcycle our worst (around 12 retrieved none transferred as we PGD all 3 and none passed so no trf) – again lost a lot to quality it seems.

– agressive stim. Double the stim dose, short, bigburst of the egg stim juice. No more eggs that cycle 1 (around 11) and no better maturity, and our prize was a chemical pregnancy

– lupron flare. only 5 eggs (which we still think is a fuck up with an E2 at 4,000 and an average of 10-15 eggs for the last 3 cycles) but, all 5 mature and all 5 fertilized and 4 made it to trf. All 4 trf, none took… landed on ‘bankrupt’ on the wheel of fortune – (can I buy a vowel? oh, and a baby?”)

So – rule out the aggressive stim cycle, as that didn’t do much (apart from deliver a bit of hyperstimulation actually), but its down to approach 1 or 3 in my mind.

Dr current said she would probably go 1. I am thinking 3 delivered the best maturity, but anyway who knows whats best, Dr C said she wouldnt PGD anything ( oh geez  – here come octomum 2009 – yeah right) if we went with her again, So after pushing PGD a bit in the past, she has “gone organic” on us.

* PGDvs CGH – very interesting. She said that PGD (the 9 cromo testing we have done to date) vs the Denver freeze test all chromosomes approach (CGH) is  like trying to play the letter A on a musical instrument. Denver, where the process is computer driven, is like hitting A on a piano. PGD, requires significant skill in the lab, so its like hitting A on a Cello. Not everyone can do it, so the results may not be as great. She is so confident in her labs (which I think basically pioneered PGD) that they don’t see any benefit in switching to the Denver approach as they get the same results either way, (they play a great cello I believe). The trick is that PGD is day 3 and CDH is day 5 (although Dr C said they can do a day 3 CGH if we wanted – hello, where did that come from?)

* Day 5 vs Day 3?  Denver goes day 5 as they want full blasts, take more than one cell to test and take it from placenta cells so you aren’t ripping off any arm or something, but day 5’s are harder to grow (clearly). Dr C goes with Day 3 and at day 3 all cells are stem cells so you haven’t taken an arm vs a placenta cell as they are all the same, you get to test early and get the good puppies back in fast so they are in the environment that they should be in. There is a famous Danish test (I think it was Danish) that biopsied day 3 and did nothing with the results. They just wanted to see if stuffing around with day 3 stunted growth vs ones you didn’t play with. Guess what. Playing on day 3 did impact growth. So…

* Can we get to day 5? We really don’t know – out of our 4 cycles only cycle one had excess eggs we didn’t trf – cycle 1.  Cycle 2 didn’t give us any. and Cycle 3 and 4 we trf back everything. So on the 1st cycle Dr C says the eggs weren’t good enough for freezing but wasn’t clear on if there were good enough to trf. She did add though that by day 6 they were not good. I agree, nothing is good on day 6. I reckon if Denver sees we can’t pull of day 5’s then they’ll trf early. Mrs IVF has read Denveree’s who have never had day 5’s elsewhere but got there in Denver.

So with that, I will leave it with you. Enough for one night. While the Mr IVF blog pole results haven’t quite been up there with American Idol volumes, 80% of you think we should go with Denver. Mrs IVF and I are thinking the same. It’s the fork, we need to go and see what the fork says to us.  We feel they are finding new things we didn’t know (more for a later post) and, well, they test every chromosome so we will know if we can have a bio kid or not.

Meanwhile – in day to day life, more and more of our mates are getting pregnant (good on them) and sadly more of my “out of the know” friends are pinging me on the “hey – where are the kids” question. I have an answer i give them, but again… thats for another post.

 Tonight I am just too tired to be worried about all of this. Work has been brutal, but hey, keeps us busy and this weekendwe are off to the NJ fair (assuming we can work it around MRS’s IVF’s bloodwork), so that should be fun.

Oh, period late again.

Report from the fork

Well, what a very interesting few days. I could write an enormous blog about it, but for now, I’ll try and keep it short, here are the soundbites:

– very nice setup with very friendly and helpful staff. Turning up as a newbie you stand out. We could see that quite clearly after a few hrs when some other shell shocked “deer in the headlight” couple turned up looking completely lost and not knowing whether to start at the nurses reception desk on the left or dr reception desk on the right (give away sign of newbies).

– The place isn’t crowded and you don’t feel like you are part of a herd . Its 3 floors in a dedicated building in the middle of nowhere (well apart from a stonking, gleaming new hospital next door). Top floor is the dedicated world of retrievals and transfers and probably other “in cycle” steps. The ground floor is where we met all the nurses, business staff (aka accountants) , doctors, form signers etc. Basement is the where the boys go to crash the yogurt truck. You’d expect nothing less. Leave the lads to their handy work in the basement.

– Geez – enough on the frikkin building… how’s the treatment? In 3 words, thorough and informative. You really get the feeling they look at things very closely and you just sense that by doing so they may have a few new tricks up their sleeve. Quick run down of the day:

– Met Dr Schoolcraft. Nice guy, straight up, happy to chat and doesn’t seem to be in a rush and answers questions very well and generally quoting studies etc to confirm why he and his team do what they do. You learn things speaking to him and they resonate in your head that they seem reasonable as you speak to him. Its nice to get that feeling even if you know all of this may come to nothing at the end of the day.

– The Business mgnt staff. Talk money up front and spell it out pretty clearly. Bloody expensive, but is what it is. Will dig up the numbers if anyone wants to know.

– Baseline work. One word. Wow. Very thorough and incredibly informative. We asked questions and step by step we knew exactly what was going on without prompting the nurse . We also learnt a few things as the nurse light sabered around my wife’s innards with that ultrasound :

(1) Doppler – this measures blood pumping around the ute. You want it under 3 and nice peaks and troughs. The Mango Princess was hitting 5’s and dropping right back to zero between peaks. Appears acupuncture can help that.

(2) Follice count. Not sure we have had this before but they counted the number of follies Mango has. She scored 15 each side which was great…. we believe (further googling revealed that only 11% of women get this high). This count wasn’t easy, so the nurse did it twice (quality effort or what?)

(3) Spotting a spot. The nurse also spotted a spot about 1cm in size that could be a cyst or endometriosis on one of the ovaries. We  dont know what it is yet, time will tell, but bloody well spotted. Mr IVF , an bit of an avid scan watcher these days, was impressed given he thought he had seen it all when it come to (empty 😦 ) ute scans.

(4) 3D ute shot – no idea what this does for the process but it would make a cool game for the playstation

We also met our nurse, a genetics counselor, did some blood work, took the yogurt truck down to the basement for a spin, signed some papers and generally came out very well informed. We had lots of questions, learnt  a lot and feel as good as we could.

Still, the overwhelming feeling was this for me: this seem seems very well run and they are all 100% focused on trying to get you a healthy child, but behind the nice waterfall and pristine environment there are very blunt clinical facts being shared and hard decisions being made sometimes. If your eggs aren’t good, or your yogurt is crap these guys will hit you right between the eyes with it, (not splattered yogurt – just tough verdicts). There is zero BS in this facility. This is not a complaint, its just part of the ride. Its realistic and the goal is to give you a healthy child through, at the end of the day, a sperm / egg combination that works. Don’t take this that they push donor solutions down your throat, they don’t, but going donor does have an 80% success rate and their goal is to get you pregnant. So no false hopes, lots of great support and thorough analysis, and that’s just great, but for people less hardened by the IVF lifestyle, you could see how people could get expectations up.

This place I think is truly the fork in the IVF road. If we get bad eggs or bad yogurt here, they don’t sugar coat it, and I dont think there is any better place to go and we’d need to make a call – bash on, go donor or give up. Part of that is exciting, as we might finally try a few new tricks that can get us over the hurdle, but also, one way or the other, this place will be our IVF finale and it may end well, or it may be the wildest rollercoaster we have yet to see, and that, my blog world friends, is truly shit scary. Knowing that the IVF world of mirrors will probably end here is daunting, we will leave the maze and I have no one to predict how, when or in what shape.

Oh – next steps? Mango needs to get her HSG (again) next month so we prob wont stim for another 45 days, but that’s ok. We want to get going again, but only once all the test results are back, the dr’s have a plan and we are all on the same page.

One other thing. Denver and surrounding areas are a great place to spend the weekend, although if you are having your ute played with (like for a hysteroscopy) you can rule out white water rafting for a week as your cervix and other chick bits need to bend back into shape. The Princess was not happy about this as the rafting was top of the do list for the weekend, (so much so that she asked the nurse if we can come out a few days early and raft before the stims get too full on. “Ah” came the response “maybe if you sit in the middle of the boat and do nothing?”)

So rafting is off for now (with a lifetime promise in place that we’ll tick that off the list some day), but the rest of Denver looks a go.

Let me know if you have any specific questions, otherwise I’ll prob come back and fill in the gaps in coming weeks.

Denver tomorrow

Just a quick post as have just got in from a work trip out of state and need to complete packing before we heads off to Denver tomorrow night. The Mango Princess is very excited as she is singing. She only sings when she is very happy. The fact that she is singing “disturbia” should not be seen as a negative, in fact its quite hilarious. She is pottering around the house and every now and then sort of yells / sings “DIS-TURB-IA” … which considering its the only word anyone can remember in the song, I guess that counts as singing.

I came home tonight to find hotel, car hire, Dr schedules, scans and all sorts of key documents for the weekend incredibly neatly laid out for inspection on the dining room table. It’s like we are packing for a 6 month trip to Africa rather that a 4 day domestic US trip to see a dr (we aren’t even frikkin cycling, its just a round of tests!)

Wish us luck, we’ll report in next week with results of the test, golf scores and if the whitewater rafting adventure on saturday (the Princess 1st ever attempt) is a success. Its good to feel we are again moving forward trying to get to our goal of some form of offspring that will create havok in out lives, (to replace the havok we have trying to create this child).

Hi Ho Hi Ho … Its off to Denver we go

So we waited with baited breath last week for Bloody Mary (sorry – a blokes version of what is known here in the US as “Aunt Flo” or what non fertility impaired folks call “a period”.) We waited right until the last min – 4am saturday  (boy that was fun getting up for) before we canceled the flights.

Not to waste our packed bag we headed up to the Adirondacks on Saturday (5+ hrs drive but well worth it) for the weekend to get some fresh air, climb a mountain and maybe a spot of golf.  The mountain climb was great, we hit a 2,300ft mountain call Haystack mountain. The weather behaved and we had fantastic views, but we nearly didn’t make it. About 97% of the way up there was a lovely view and we almost settled for “this is good enough” but then I chimed in with “listen – not going to the top is like going through a stim cycle and not wanting to do transfer”. No idea where that verbage appeared from but we finished the last 3% and enjoyed significantly better views. I choose to see this as an omen. Then again I a fairly desperate sub fertile male, so anything I can link to a positive omen is done whenever I think of one.

Driving home last night with a mountain of calm still with us  it hit me that we aren’t going to have some regular child, but instead will we have “a gourmet kid, hand made in the mountains of Colorado”. Makes it sound like something I pick up from Wholefoods rather than McDonalds. Its all BS, but we had a good laugh and realise that our “sub fertile” position gives us the opportunity for a ” hand crafted” child like something that Santa’s elves might knock up as a Christmas present. How nice. Yes, I’ll take fries with that please.

So, now that the period is officially here (and it hit me we failed again naturally), the timetabling of our lives resumes. We fly out to Denver Thursday week, (9th July) for tests on Friday and Monday and back Monday night.

We still need to decide if we do Denver or NJ for the next cycle but let them prod and poke us for a few weeks and then we’ll make our minds up.

Not much humor tonight, I think even if we were pregnant I would have a huge case of skepticism until it came out screaming, but I guess that is life for the moment. Not point arguing with it.

Thanks for the votes – appreciate a bit of interaction.

“Mrs IVF … you are clear to land on runway 1”

A couple of days ago Mrs IVF wakes complaining of lack of sleep. Initially it was blamed upon a new thinner summer comforter (or doona as we Australians call it)  – my wife could easily sleep soundly under a 10 ft thick doona  – but later it came out that she was really a bit stressed about how to get all this pre testing sorted for Colorado. Try this:

– She needs to give a blood sample on day 3  of her period to the Colorado crew

– Colorado cant write a script as we aren’t patients yet

– We need to go out for a 1 day test somewhere between day 5 and 13 (or was it 3 and thirteen – I forget. I am not normally this vague but my third brutal 12+ hr day at work this week starts to do this to me)

– Our existing clinic has kindly offered to take the blood but we still need to get it to Colorado.

… and so it goes on.

Mrs IVF took off a half day today to sort out all sorts of things and is now happy and comfortable that we have a plan of attack. It will go like this:

* Period arrives Thursday (tomorrow), blood sample taken from the old clinic crew on Friday, home for freezing, then we’ll take it with us to Colorado (or we can fedex later)

* Period arrives Friday, we are flying to Colorado sat morning and get in at 9am. Need to pick up car, drive 45 mins and be at lab by 10am or we hang around and do bloody next day (appears day 2 or 4 blood is also ok)

* Saturday period – we are screwed as that seems to blow everything up (I think it clashes with work, or planets are aligned in the wrong order, or the worlds polarity shifts or something) so need to cancel the whole trip.

I think around here I lost track a bit. I said to Mrs IVF when prompted if I have any questions, ” Yes” I said ” You are all over this so what do you need from me?”. “We’re good – don’t need anything, I’ll tell you what to do” came the reply. so, with that we finished dinner and we are done. Now we are just waiting for a period.

Doing and IVF cycle is easier than this. Being and air traffic controller at JFK, or London Heathrow or Sydney would be easier than this. Tricky tricky!!!

VHS or Betamax? HD DVD or Blu-Ray?

Today we achieved a new level in IVF land – we rode the roller coaster without even being on a stim cycle and I think we have some motion sickness.

Mrs IVF reached out to our existing clinic today and told them we are heading to Colorado as we’d really like to play in their sandpit and see if this new CGH toy is better than the PGD one we have been playing with. We’d were also hoping that they wouldn’t mind doing some of the background monitoring for us again while we did this.

They came back and were more that happy to do the monitoring but also offered that we do CGH with them!!! (oh brother). It turns out that these guys have been doing CGH for a few years but didn’t see a benefit over FISH and as it was more expensive, they haven’t been rushing into it. How’s this – they are also thinking of offering fresh and frozen CGH so while that sounds exciting even we have no frikkin idea what is going on.

So we’ve been wandering around this IVF mirror maze and just discovered a whole new area they have been building in the background for people to play in. Its all very new so they are careful who they are chatting to – VIP IVF – how funny. So we googled this to death tonight and have come come away with a mild level of exhaustion, a pile of questions and well… just more questions.

So some brief background for you:

– CGH checks all 46 chromies in any embryo. Sounds good, but takes time, so freezing embryo’s was the only way to do it, but traditional freezing causes Jnr to get icicles sometimes so you can lose up to 30% of your “litter”. Then some bright spark invented vitrification which is some super fast freezing so loss rates are under 10%, so now Mrs IVF’s (of the world) can let the stims flush out of their system, lets the Dr’s play with the kids for a month or so, then you book in (if you have a goodie or 2) and transfer away. Some people say rates are twice as high as normal IVF, but it’s super new, so who knows what it does long term.   Here’s a bit of background -> http://www.newscientist.com/article/mg19325893.900-egg-screening-doubles-ivf-success.html

http://www.haveababy.com/?49bc03dcaa16a

– fresh CGH, Who knows. I think it’s “array CGH” where they check all cells in 48 hrs. Websites praise it as it does “so much more than CGH” but we don’t really understand it and it has to be knew as any google results are all these impossible to read Dr posts.

Try this ->http://www.cs.cmu.edu/~epxing/Class/10810-05/Lecture11.pdf

Right… now that we have those fitness function formulae sorted…..

On top of this I learnt about PICSI this week which is the same sperm jabbing technique as before but this time they let the fellas swim around in a special dish and the good guys get caught in some form of sperm trap. So you have heard of duck season, deer season etc we now have sperm season for hunting good sperm. I have dubbed this “POWER – ICSI!” (copyright Mr IVF 2009)

So after learning and living IVF and its protocols for 18 months in a few weeks all these new toys turned up in the IVF sandpit.

We will see how we go, we are off to Colorado for our 1 day overhaul next week (Tuesday) and will ping the dr’s out there on all manner of questions.

One niggling thought is that I remember reading the current clinics website around PGD being really great just to find out that Colorado thought PGD was flawed. Was one clinic pushing a betamax when the other guy knew we needed a VHS? And now that we are entering a new generation, how do we know we are not choosing HD DVD when we really want a blu-ray?

I think the next development in all of this is the “KFC methodology” (you heard it here first). You drive up to the little voice box, order what you want (with or without fries) and drive around and pick up a your nice happy healthy little kid (ok, and the fries)… yeah – I frikkin wish.