The Saga of Becoming Fruitful

Archive for July, 2008

A Crazy Week-End During 2WW

…is very much welcome! Last weekend was one of those jampacked ones!

Attended 2 children’s party with 1 held at home since it was my nephew’s. Lots of children (yes, I am still good around them), food, games and inflatables. Not to be outdone, us, the adults had our own fun too with “guess my drawing” and got an ice, flip-flops, a drowning Causasian and a lot of sombrero-wearing folks. That was fun! The drawings eventually run out, so we settled for Pictionary. (Note to self: Start researching my own “guess my drawing” for the next party!)

Hosted a church subgroup meeting which was very productive and served dinner with food from my part of the world (which thankfully my guests loved! Anyone heard of “lumpia” and “pancit”?). “(Wo)-Manned” the crafts booth on our church’s “Big Party” (in lieu of Vacation Bible School) and avoided the inflatable water slides which I was egged to go try. I refused, of course, and in my mind I was saying to myself, I’ve got some babies inside of me that I need to “protect”!

I noticed that on all these “eating” occassions, I was drawn to the sour types of food. In one of the birthdays, I ate a lot of the grilled pork which I drowned with vinegar and chili - with rice as a neutralizer, of course! In the “Big Party”, I discovered the big dill pickles and they were delish with the grilled chicken. Ayayay!!! All that talk about food is making my mouth taste vinegary.

Could it be that I am really pregnant because of the change in my taste buds??? Could it be true??? Could it be???

I console myself - at least, my mind is fertile!

My First ICLW During 2WW

Signing up to my first IComLeavWe during the 2WW was a great move! Not only was I focused on doing something I committed to (instead on obsessing on the 2WW), but I was also able to discover a lot of great ladies and their blogs!

Thank you for all your comments and emails! It is still my goal to respond to some of the comments that I have not yet responded to, within the week!  Like one lady said, I hope some of these new acquaintances “stick”. Who knows?  Nevertheless, thank you sooo much for visiting my blog and giving me hugs.

Anyhow, I peacefully await my 2WW. I got for BHCG on Aug 5, Tuesday.  I hope and pray I do not freak out as it draws near.  So, to ease up some of my anxiety, I will “cheat”.  I plan to test daily with the cheap dollar store HPTs starting on Thursday which is 10dpiui. I know, I know … I could get a false negative or a false positive. It’s cheap anyway, so I don’t mind. 

So tune in…

My Doctor…

I recently got a forum message regarding my RE, Dr H. The forum poster #1 was not happy with her and went to another doctor instead. I responded that overall, I was happy with her. Later, another poster #2 added her 2 cents not on Dr H but another Dr in the same center. I’ve culled some excerpts here but if you are interested in the whole context and everything, you can read it at SoulCysters.

Poster #1:

Arpee~ That’s interesting that you like Dr H. She was my RE for over a year and I had a different experience than you, unfortunately. I ended up doing 6 cycles of IUI, 5 on clomid with one BFP (ended in m/c). Even though I only ever got pg with a trigger, she constantly pushed for OPKs (though my records clearly showed a history of high LH and unreliable OPK results). We went in knowing we had relatively severe male factor and yet she did not change her normal protocol for us AT ALL. My m/c was horrifying at that office. DH and I went in to see the h/b at 7wk having had an earlier bleeding scare (so we were relatively ready to hear m/c). She just sighed and said, “Looks like you’ll have to try again with another embryo.” And her staff just walked out like rats on a sinking ship. She told me it would be like a heavy AF and to call after it was over and we’ll do another cycle of clomid. Needless to say, she was totally wrong. When we were told the numbers from DH’s post-wash count, we were never told the total motile. After I got the records, the counts were below 5 million for the last 3 cycles. These are well below the 10 mil threshold most clinics use for IUI. We could have just saved the money for the IVF that we now have to do. They never called when they said they would (which is scary early in pg when you’re waiting for beta and progesterone numbers) and you may have to explain your situation multiple times depending on who answers the phone. Needless to say, I’m over at Dr Y’s office and they are 10 billion times more compassionate and informative. I got (correct) statistics for our situation. I really hope you have a much better experience than I did!

My response:

Hey NerdyGirl,
…when I was looking for an RE, I searched the internet for reviews and got 1+ and 0-. Also, I wanted a woman RE and at that point, it was her and the new lady doctor at the same clinic. So I opted for the “older” one.

Just like I mentioned earlier, I like it that she is a straight shooter. Perhaps because I am so myself. They’ve been good at calling my stats to me, so that aspect is not a problem, either.

Your post and some recent experiences though gave me some things to think about:
1. When she saw that my cysts have shrunk already, she said that we were ready for the next Clomid cycle. Wrong…we were ready for our next Follistim cycle. (I realized doctors don’t typically review the charts before they see you.) (My blog details it more.)

2. She told me to use my leftover Follistim (from my 1st cycle) for my 2nd cycle without warning me about the 28-30 days allowed time in the refrigerator once the vial has been used. Good thing I called them today to ask about it. I should have not even used it for the 2nd cycle. The “good news” is that the med seems to be still working (at least until the 3rd Follistim day monitor) even if they have “expired”. Will see tomorrow if that “good news” continued up to the 6th Follistim day - although I use a new vial tonight that my husband will be picking up from her clinic later today.

3. She made a “deal” with me when we cancelled our 1st cycle (due to OHSS symptoms starting to show) that she will shoulder 600IU of my meds. Now that I am following up, her staff got back to me that what she said was that she was going to shoulder half of my meds - 300 IU. $300 worth - not too big of a deal. But that may be an indication that they do not track what they are promising their patients too well.

So you did 5 clomid and 6IUI cycles with her? Anyway, if things do not really work out with her, I may consider going to a male RE. Being of advanced maternal age and 2 miscarriages, it is possible I will be needing a perinatologist. So I like it the idea that they will be the one who will continue to care for you until you give birth - instead of being passed on to a next doctor, the perinatologist.

Thanks for the info! And I wish you health as you and your DH prepare for your next IVF cycle!

Poster #2:

I have to chime in on that center vs Dr. Y issue. I posted this some of this story on the other Austin OB thread, but I think it has relevance on this thread too.

I went to that clinic in February 2005 from a referral from my old GYN at Women Partners in Health (she’s since moved out of state, so no reason to state her name). I saw Dr. V, and neither DH or I were very impressed with him. My GYN had been seeing me for several years, and we had been trying to get pregnant. She ordered an u/s to “check” for PCOS, and I just happened to have the one cycle that I ovulated in about 3 years during that u/s. So, they ruled out PCOS because I was ovulating. She did the standard fertility workup, and found that my progesterone was low and my estrogen was high. So, I had a hormonal imbalance and she sent me to TFC.

Dr. V met with us, and told me that based on my records from WPinH that I had a hormonal imbalance based on me being overweight. That’s it. Nothing else. He didn’t do any tests, didn’t look at other factors like my overall family medical history, my appearance, etc. He said that I needed to go on BCP to regulate my hormones, I needed to lose 40 pounds, and then, and only then, would he start me on Clomid.

I started seeing a new Family Practitioner in April 2005, and she diagnosed me with PCOS right off the bat from medical history and my appearance (where I carry my weight, hair growth/loss, hormone profile from the GYN tests, etc). Her blood tests and putting me on Met confirmed the diagnosis.

I started seeing Dr. Y in November 2005 on my old FP’s recommendation, and at his office we finally saw the string of pearls cysts on my ovaries during an u/s. I talked to him about starting Clomid, and we elected to wait until after the beginning of the year (DH’s benefits started covering infertility then) and for me to try to lose 5% of my weight. I had an appointment on Feb 28, 2006 to talk to him about starting Clomid, and I got my BFP for DD#1 on Feb 24 from Avandamet alone.

The moral of the story is that I went for 3 long years not being properly diagnosed, and I feel Dr. V at TFC was part of that. I don’t know if I would have had a different experience if I had seen a different doctor at TFC, but if nothing else, the attitude I got at TFC and Dr. V regarding my weight put me off of them entirely. My FP who diagnosed me thought that putting me on BCP when I was TRYING to get pregnant and needing infertility treatment was the dumbest thing she had heard of. She was also not happy that a fertility clinic/reproductive endo office missed the PCOS diagnosis when I exhibit pretty much all the clinical symptoms.

In the interest of “balanced” views here, I am adding excerpts from other forum regarding Dr H and the center she has her practice on:

We used Texas Fertility (Dr H) and really liked them. They are really good about making you feel at home & comfortable asking questions. I was sad when we got ‘promoted’ to a regular ob since everything went so good. Dr V (one of the physicians) was on one of the local news channels recently and is very well known. They also have a class (free) once a month that is super informative. Their statistics were very good when we checked although right this minute I can’t recall where we looked but I think it might have been through the Tx center for Disease Control? Anyway, hope this helps and just fyi….we are 18+ weeks w/ twins!!!
- MedHelp

I am currently going there. We had our 2nd IUI today. About half my class from last year was concieved through them. (IUI’s, IVF and donor eggs) Everyone has been really nice and personable. There office staff is great. They try to squeeze you in when they can and are always patient. I am seeing Dr. S but have also seen Dr V and Dr H for ultrasounds.
- Mothering.com (This one has more related posts, so just go there if you are interest in more.)

I think we all have to take these varying inputs like these with a grain of salt. This is where “different strokes for different folks” is very applicable. None is right or wrong. It’s just that there are some things you are looking for and some doctors you just can’t work with. To each her own, just like the many churches one sees around, they cater to different people.

That is why it is so important and proactive to research and do the rounds when looking for an RE (or any health care specialist for that matter). I would really, really, really think twice in setting up a first meeting if my research had shown consistent negative feedback on a particular doctor or center.

In my case, my research on Dr H’s practice’s SART stats vs other centers makes me feel more comfortable with theirs. So from a numbers standpoint, I like them. I know it is more than the numbers…but so far, my actual experience has been well.

I’m pretty happy right now with Dr H. I have no compelling reason for me to transfer to another RE at this point.

How about you? Have you switched REs in the past and what was your breaking point?

The 2-Week Wait

So I had my 2nd IUI for this cycle this morning…we started with the ultrasound to see if the follicles ovulated and if so, how many of them did that. Looks like I ovulated 1 on the right and 2 on the left.

But… I have no sonogram because I forgot to remind Dr H to print one. I was telling the medical assistant later as I was checking out and guess what she said “You don’t want those. You want the “real” ones in the next 2 weeks.” I told her “this is real as well”. Hmmmpph!!!

So “worst” case, triplets? For me, 1 is alright, 2 is better, 3 is a stretch but I think still good. Well, we will know in 2 weeks.

Did anyone notice that I did not mention the SA results yesterday? Well, I intentionally did not mention that so as not to pressure DH (who reads this blog) on it. We however talked about it later, so now I can tell you about it.

My DH’s last SA was done late 2005 with good counts (71M) and motility (53%). What was below normal was the 4% morphology. When we asked Dr H last Sunday, she was not very concerned about the morphology and that she was after the motile concentration instead.

The post-wash SA yesterday for the first IUI was not very good with 4M motile concentration only. Perhaps it was because DH was nervous that he was only going to give a few millions. Perhaps because he was a bit sick. Perhaps because of the lack of lubrication. (I learned later that he did use s teeny weeny bit ) Anyway, Dr H said that maybe if we “stage” it better tomorrow.

So today, we used the recommended lubricant “Pre” from the lab that did the SA. The frontdesk person in the clinic actually said any non-spermicidal lubricant can be used. Here’s the front and backside of Pre containers:

… and we “staged” it. “Stage” - interesting word… let your imagination work. And we got way much better post-wash SA today at 19M motile concentration! (The desired level is 10M.)

Dr H was feeling good about my girls ovulation and my DH boys’ improved motility concentration.

So, the 2-Week Wait starts today and hopefully ends positive on August 5. Meanwhile, I will use Progesterone VS starting on 7/25 Thursday.

The time starts now!!! (tapping fingers…). So how do you “occupy” yourself in the 2WW? Any suggestions are welcome!

COST: $530 (180 ultrasound, $170 IUI, $180 SA/wash)

So That Is What An IUI Is…

I’ve always dreaded the thought of “artificial insemination”. Maybe I guess because it sounded like I was a cow.

Maybe that is why all this time, we have always opted for timed BD.

With the more expensive injectibles, we researched and were adviced that the probability of getting pregnant was higher if intra-uterine insemination (IUI) was done, instead of timing it. Also we have been timing that for 4 years, so we needed something more precise and effective because we’re not getting any younger, you know! It was then more prudent to go the IUI route so that we can maximize our chances with the more expensive injectibles.

Its a good thing that I was adviced by some forum posters that it’s not really a big deal so I did not obsess too much about it.

DH submitted the boys for washing early in the morning and I had the IUI appointment later in the morning.

Truly, it lasted shorter than a normal RE consult - done in less than 5 minutes. The waiting after the procedure was even much longer at 10 minutes.

It was like a pap smear in the sense that a speculum is used to create a passage way. Then a very thin plastic catheter (carrying the post-wash boys) is inserted through the cervix and into the uterus. The boys have avoided the harsh environment they would normally have to journey to get to the uterus, so they should be there either trying to meet the girls now or just hanging out and waiting for the girls to come down. They’re having a party inside of me!

Dr H showed me the catheter labeled with our last name and informed me that the labeling was done to make sure that we get what we submitted :). Just imagine an Asian couple like us suddenly getting a child that looks different from us. Not funny at all.

There’s a bit of discomfort but really, it is very tolerable. What I did to help in the discomfort was to relax my pelvis, breathed deeply and huffed open-mouthed a few times. Before my overactive imagination can take over, it was done!

Dr H set the alarm clock for 10 minutes. I was left laying down on my back with my feet planted on the bed. (I read in a website of one of the fertility clinic that there really is no need for this since the boys are in the uterus, above the cervix already, so they won’t flow down. Anyhow, doesn’t hurt to do it. Maybe it can also aid the boys to swim upstream ) 10 minutes passed by fast, then I was up and ready to go.

Anyway, we go back for another IUI tomorrow. (The same website above mentioned that there’s really no medical study conclusively pointing to 2 inseminations to be better than just 1. The key was more of how well-timed the insemination is done versus when ovulation occurred.)

Meanwhile, I still do not have my ultrasound image of the leading follicle because the sonogram procedure was not done today. Will get that tomorrow, promise!

COST: $350 ($180 for the boy’s wash and $170 for the IUI procedure)

CD13: Follistim Day 9 Response (Cycle #2)

The leading follicle last Thursday really grew and it is ripe for the picking!

I don’t have ultrasound image to show today though because in my excitement, I forgot to remind Dr H to print it for me.

Endometrial Lining = 7.1 -> 10.2 -> 10.5
Right Ovary = 10: 7, 6/3, 5/5, 4 -> 6: 11, 10/3, 8, 7 -> 5: 16, 15, 14/2, 10
Left Ovary = 9: 8, 7, 6/4, 5, 4/2 -> 5: 14, 10, 9, 8/2 -> 5: 20, 15, 13, 11/2
Estradiol = 91 -> 380 -> ?

(For those who are new here - You can go to Follistim response in the top tabs to see the tabulation of all my stats summary from both cycles.)

Dr H said she’ll print an ultrasound image tomorrow. Maybe, it will not show up as big anymore though since I injected Ovidrel this afternoon. She also mentioned that the other 3 next biggest would be candidates too. So potentially I will ovulate 1-4 eggs. Yaiikkks -potentially, quadrups?

So… we will be going in for our very first IUI tomorrow !!!

When I asked Dr H about the probability of conception for IUI, I initially got the “it depends on the quality of the egg”. I eventually got some quantity: 20-25%. This is about the same as the IVF success rates (live birth) they have for my age range.

We then asked about what the effect of SA low morphology to this probability and she said that post-count wash count was more important that morphology. The desired level is 10million count. I better go take care of the boys now.

Meanwhile, say a prayer for us!

I’d Really Like to See 2 Lines…

I’m talking about the OPK right now.

Since I have been annovulatory for more than a decade now and have just been TTC in the last 4 years, I really have not seen double lines on my OPK.

I’m excited to see my own double lines - perhaps tomorrow since I had Ovidrel today…

CD10: Follistim Day 6 Response (Cycle #2)

Murphy threw a couple of curveballs today - I woke up late because of tossing and turning last night thinking of the “expired” Follistim (will post about this separately) and then I had to get some gas because DH did not replenish the car’s gas. So there I was late for a 7:30am ultrasound appointment, so I detoured for the blood draw because I didn’t want to be late for both. It was already 8:45 when I came in for my ultrasound appointment. Dr Hansard graciously squeezed me into her schedule - but not without asking me why I was late.

I have 1 “leading” follicle - yehey!!!

Read more »

Comparing Follistim Cycle 1 vs 2

I just added a new page called “Follistim Response” - you can find it on the top tabs (near Home, Costs, Jargon, etc).

It contains the Follistim dosages per day and the corresponding response on the monitor days - ultrasound measurements of the follicles on the right ovary, left ovary and endometrial lining and the estradiol levels.

It’s a good summary for me since I can see everything in one page and can easily compare my responses based on the dosage variations between the 1st and 2nd cycles of Folllistim.

If you find it useful for comparison, drop me a note!

Check it out!

CD7: Follistim Day 3 Response (Cycle #2)

The effect of the lower Follistim dosage on my left ovary is shown in the ultrasound image below: (It was Cindy the sonologist who did the ultrasound.)

Other stats are as follows:
Endometrial Lining = 7.1
Right Ovary = 10: 7, 6/3, 5/5, 4
Left Ovary = 9: 8, 7, 6/4, 5, 4/2
Estradiol = 91
Read more »