Not looking good

Here's the day one fertilization report:

We ended up with 10 eggs of sufficient quality for ICSI (of 27 follicles harvested) Of those, only 4 made it to the next step (i.e. normally fertilized) but there is concern with their quality. According to the Doctor, they have a "yellow" tint, which normally indicates suboptimal embryo and/or egg quality. We're "still in the game", but just barely ... day 3 report will be received at 8:00 a.m. Saturday. He might opt to transfer on day 3, but I think he wants to wait until day 5 to observe embryo development, if any of them make it that far.

We're pretty bummed, but, nice touch that the Doctor himself calls with this news ... he's a good, empathetic man. Fingers crossed, pessimistically.

Follicle count

27

That's a lot.

At least ten are over 15mm ... not too shabby. But as the Doctor says, "more is not better - better is better"

Fertilization report coming tomorrow. Wife is doing fine - very little pain, hardly any spotting ... a bit teary-eyed after coming off the anesthesia, but all in all, she's doing great.

To my wife, on the eve of a big day

I know that the last two years have been so much harder for you than they have been for me. I've stood by your side month, after month, after month, watching you curse pregnant people, swear at / throw away Pottery Barn Kids magazines, and middle-finger pictures of other people's kids on your iPhone Facebook application. You want to be a mother more than anything in the world, and it kills me that you have yet to become one.

In spite of the fact that it has been harder for you than it has for me, there is one thing of which I have become quite painfully aware: What makes infertility difficult is the uncertainty, and endless cycles of hope destroyed. The "what if", "maybe", "I hope" roller coaster is torture, and I've ridden it with you.

Given that this uncertainty is a part of our lives, and we might never get away from it, I want you to always be certain of one thing: I will always love you, I will always be here for you, and there are no "what ifs", "maybes" or "I hopes" about that - you can always depend on, and hold on to that one, sure thing. I love you.

Now let's go make a (test tube) baby.

There ...

We do our HCG shot tonight at 9:30 p.m. during The Bachelor

No food or drink after midnight tomorrow for my wife, she starts an antibiotic - then, we're at the clinic for a 7:00 a.m. meeting on Wednesday. God, I hope this works ...

... see you on the other side with a fertilization report.

Almost there ...

Another ultrasound this morning - they estimate she'll be ready for retrieval on Wednesday, meaning the HCG shot will be administered tomorrow. One final round of Menopur tonight (300 IUs ... we're out of Bravelle, and have 4 vials of Menopur left, so the nurse said we should be fine using up our stock in lieu of ordering more Bravelle) Needless to say, my wife will be relieved after the barrage of needles that has ruled her life these past two weeks. She is in quite a bit of discomfort, and to make matters worse, she had a mole removed from her back last week, leaving a 1 inch incision (2.5 cm for those in EU) - not fun for her. I really feel for her, and admire her determination to persevere through this.

It's going to be an intense 3 weeks on all fronts - wish us luck - and to anyone else who is in cycle, best of luck to you.

Friday tidbits

• We began Ganirellix this morning - the shots come prepackaged, in nice pre-loaded glass syringes. All you have to do is pop the top off, inject in the leg, squeeze and remove ---- or so I thought --- I completely forgot to remove the small pocket of air from the syringe before injecting my wife - I've become a cocky injector - shame on me. A small amount of fluid trickled out of the injection site after removing the needle, and I believe a small bubble of air made its way in ... I hope this is not too severe an issue (mostly the bubble of air, but also the leaking medication) - we're not too worried


• My wife is getting a bit, how shall we say ... crazy animated? The medications are definitely taking their toll - this morning I attempted to do a P90X video (yes, I'm thinking of taking the plunge and trying the program, only to fall off the wagon in week two just like everyone else who tries it --- try doing a search for P90X blogs - you will find a ton of them that are about two to three weeks long) - anyways, I used my wife's laptop to play the workout video - afterward, all of her desktop icons were moved (from the DVD software I think) - she wasn't happy about it. I think she thinks I spent my morning messing up her computer ... definitely the medication ...


• I start a new, short, intense 3-week project at work that requires visits to some engineering centers in Ohio and Europe - of course the opportune time to do these visits falls dead nuts in the middle of next week - which you all know is when our IVF procedure is scheduled to go down (UPDATE: Based on yesterday's ultrasound, they're predicting our retrieval will take place next Thursday or Friday) So, I've been "on the bench" since mid-December 2008, and now, the one day I actually have to be here, I am needed in faraway places - figures it would work out like that


• We have another ultrasound tomorrow - we're hoping they will see enough evidence to firm up the certainty of their follicle harvest forecast

Summoning magic types

If you are capable of casting magic spells, and you are reading this, I would like to kindly ask you to cast one in our direction so that our IVF procedure next week works. We really, really, really want to become parents ... all you have to do is point your magic wand, or whatever device you use, towards Birmingham, MI anytime between now and two weeks from now (depending on how long your spells last)

In return I can offer you some strategic advice (complete with PowerPoint slides containing upward pointing, green-colored arrows, recommendations to offshore EVERYTHING to China or India, and words like innovatization)

Increased meds

We were told to increase our medication to 150 IUs of Menopur (from 75 IUs) - 150 IUs of Bravelle remains the same.

That is all.

By the numbers

I'm posting actual hard data. Here's the results of my latest semen analysis:

• Volume: 2.8 mL (should be > 2.0 mL)


• Concentration: 161 million/mL (should be > 20 million/mL)


• Total Motility: 45% (should be > 50%)


• Progressive Motility: 23%


• Total Progressive Motile Sperm: 104 million


• Normal Morphology (WHO): NA (should be > 30%)


• Pre-IVF Kruger Strict Morphology: 8% (ICSI recommended if < 6%)


• Round Cells/mL: < 5 million / mL (should be < 5 million/mL)


• pH: 7.2 (should be > 7.2)


• Viscosity: Slight increased viscosity


• Liquefaction: < 50 minutes (should be < 60 minutes)


• Aggregation: Absent (should be absent to slight)


• Agglutination: Absent (should be absent)


• WBC: < 1.0 million/mL (should be < 1.0 million/mL)


• Impression: Abnormal - Normal sperm concentration, mild decrease in total sperm motility, normal progressive sperm motility and normal morphology by strict criteria at 8% which is an improvement into normal rage compared to previous semen analysis at outside laboratory.


• Recommendations: Assisted Reproductive Technologies: I recommend ICSI with IVF therapy due to mild decrease in sperm morphology.

So, as you can see my problem has shifted from morphology to motility. Weird eh? Either way, it's all moot given the diagnosis from our Doctor - and the numbers look good for ICSI, particularly the improvement in morphology.

My wife's ultrasound was uneventful - her follicles are still too small to count. She goes back in on Thursday. Will post an update then - hopefully we'll have a follicle estimate, and a verdict on our meds (i.e. to modify dose, and/or to begin Ganirellix)

More on meds

Okay - wife and I sorted through the gigantic box of medications over lunch. On tap for the next 7 days, or so, we will mix 75 IUs of Menopur and 150 IUs of Bravelle in 1 cc of water. This shot will be administered in my wife's belly with a small needle (thankfully - the nurse noted because of her small size, and her low body fat, she could get by with the small ones - lucky for me too - my wife is HOT!)

She goes in for an ultrasound next Tuesday and was told to bring a syringe preloaded with Ganirelix with her ... depending on how her follicles are developing they will begin Ganirelix, and/or alter the Menopur + Bravelle cocktail. Her HCG shot will be 10,000 ISP units of "Chorionic Gonadotropin" ... and for a chaser she will use "Endometrin vag tabs" progesterone (which will continue well into what we hope is a pregnancy ... and a safe, healthy, prosperous one at that)

I hope my balls are making some nice sperm.

More to come after the first ultrasound ... have a good weekend.

Beginning meds

We start our shots tonight (let me rephrase: I start jabbing my wife with needles containing follicle-stimulating hormones tonight)

It's like climbing the first hill of a roller coaster ... scared shitless, but excited at the same time - either way, it's too late to get out of the car ... we're committed.

In just under two weeks, with luck, we'll have embryos.

Will post detailed med schedule over the weekend (as promised in an earlier post)

Are we hippies?

My wife is going to a new acupuncturist in parallel to our upcoming round of IVF. Our Doctor said he is a proponent of such alternative treatments, but does not enforce it. We figure if it can help, why not? The incremental cost is negligible in comparison to the IVF fees, and my wife derives a sense of calm from the experience (something that she desperately needs)

My wife was referred to a different acupuncturist than the one she saw during our IUIs - her first appointment was yesterday. She enjoyed it.

The acupuncturist recommended a number of organic supplements for my wife, including wheat grass juice, blue green algae, lots of green vegetables, and others. I used to drink wheat grass juice in my early twenties, when I was working out a lot, and had a wildly polarized health regimen (wheat grass juice and workout in the morning, beer and chewing tobacco at night) Those were the days. It's good stuff, and the health benefits seem to be overwhelming (there are skeptics, however)

Any of you drink wheat grass juice? Any of you grow your own? It's expensive at $2.25 per 1 oz. shot - I'm wondering if we should just grow the stuff at home, and get a juicer ... sort of a voodoo / witchraft thing to do, but if it helps ...

Thoughts?

Orientation

We had our "IVF Orientation" session this morning ... our Doctor, and his office did an outstanding job - very nicely done.

I started out the morning just how I always like to: With a sterile cup and a big stack of porn. Yes, they are doing yet another semen analysis. This being the 4th facility in which I've "collected", I'm starting to become a connoisseur of the process. A DVD-equipped TV sat atop a filing cabinet with drawers labeled "DVDs", and on the wall was ~30 Playboy, Hustler and Penthouse magazines. A faux leather couch (blue) was provided and the room was filled with a "whooshing" sound from a sleep noise generator (I'm guessing to minimize any slapping sounds that might leak beyond the door and/or walls) A small metal door covered the opening between the collection room, and the lab - I placed my sample in there post-climax. This eliminated the need to shamefully carry my specimen down the hallway to the nurse at the front desk, saying "here is a cup that contains my semen, which I got by masturbating in the room over there with all the porn in it - my pecker was in this cup just a few minutes ago, and it was also in the hand in which I am handing the cup to you with" Nuff of that ...

The Dr. spent over an hour with us reading through the detailed results of our first failed cycle. He confirmed his theory that we have an embryo development issue. In our first cycle, 19 follicles were collected. 15 of them were mature. Of those 15, 9 fertilized. Only two of the fertilized embryos matured sufficiently to be transferred, and the quality of these two was less than desirable. All remaining follicles degenerated, leaving nothing to freeze. Sounds grim, right? Not so fast - he thinks the cycle-to-cycle variability leaves us cause for optimism. He is hopeful that our next cycle presents a 60 - 65% likelihood of success - not too bad. Depending on egg / embryo quality, he leans towards returning only a single follicle to the womb ... two max, so this is likely the way we will proceed.

The remainder of the morning was spent watching a brief slide show that illustrated the ICSI process with a step-by-step narration from our Doctor. It might not sound like that big of a deal, but we were very impressed. His willingness to spend time with us, and his empathy left a deep impression on us. He could tell my wife was tearing up at certain points of the process, and you could see he genuinely cared ... we have a good amount of faith that we will be getting the best care possible.

Next steps are for my wife to get an ultrasound tomorrow ... then meds begin on February 13th.