Fasten your seatbelts

We're about to take off! My period started last night, which means that the next phase of IVF will be starting on Monday. Many of you have emailed me asking for more details on how the whole process works. I'll try to give a bit of an overview, and if you still want more, there is a video you can watch that explains it all in great detail.

(OK, i admit, i copy/pasted this from my clinic's website)
Step One - Ovulation Induction
Hormone injections are given to stimulate multiple egg production rather than the single egg normally produced by the body each month. This stimulation process usually requires the initial use of Lupron to suppress the ovary to prevent ovulation until the desired time. Daily gonadotropin injections are then added to stimulate the development of the eggs. These are usually given subcutaneously (under the skin) and are much less uncomfortable than the previous generations of medication. We then monitor the progress of ovulation induction with ultrasounds and blood estrogen levels over several days.
In English? I've been taking these Lupron shots for a week now. Those are basically shutting everything down in order to be able to stimulate the ovaries to produces multiple follicles (which eventually mature into eggs). Starting on Monday, i will go in for monitoring appointments every other day. At this appointment they take blood so they can measure hormone levels and do a transvaginal ultrasound (lovingly referred to by a friend of mine as the Dildo Cam) to see how many follies and what size. On Monday i will also find out about when to start the next round of injections, the gonadotropins, which do the actual stimulation. So my injections may go up to 3 a day, fun fun! I will keep going for monitoring every other day, and then eventually every day, as they continue to check on the growth of the follies getting closer to ovulation. When everything is looking right, I will do one massive injection that triggers the ovulation and 36 hours will be in for step 2.

Step Two - Egg Retrieval
An egg retrieval is performed by placing a special needle into the ovarian follicle and removing the fluid that contains the egg. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, strong, short acting intravenous sedation is provided.
Basically, i get to take the day off and go in to have all the follicles sucked out of me. This is also the day that M gets involved with his "sample". I get to be poked, prodded and drugged...he gets to calmly and pleasurefully (is that a word? doubt it) deliver it into a cup.
This will probably be in about 2 weeks (around 11/13) but it will all depend on how i respond to the stimulation drugs.

Step Three - Fertilization and Embryo Culture
Once the follicular fluid is removed from the follicle, the eggs are identified by the embryologist and placed into an incubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI).
During conventional insemination approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle.
The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. They are now called embryos and are placed in a solution called media to promote growth. Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryopreserved (frozen). We now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples these blastocysts may have a greater chance of implantation, allowing us to transfer fewer embryos, in some cases only one, and lower the risk of multiple birth while increasing the chance of pregnancy.
On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days.
Believe it or not, there are people with greater infertility problems than me! We do not have to do the ICSI procedure. M's swimmies get to meet up with my eggies in a dish and have their own fun without being chaperoned by an embryologist. I'll get a phone call to find out how many eggs were retrieved, and then a daily phone call with an update on how many are growing and to what size.

Step Four - Embryo Transfer
Embryos may be transferred on day 3, 5, or 6 after egg retrieval. Transfers on day 5 or 6 are called Blastocyst Transfers. They are placed through the cervix into the uterine cavity using a small, soft catheter.
This is when the doctor and embryologists decide which of the embryos look the strongest and have the greatest chance of survival. There is a ton of science and statistics behind the decision of when to transfer and how many to transfer. I'll get more into this at another time as i begin to understand it better.

Step 5 - Testing for Pregnancy
Two weeks after the embryo transfer you will return to our office for a pregnancy test. If you are pregnant, we will follow your progress with blood work and ultrasounds for four weeks before referring you back your to obstetrician for continued care. You should expect a normal pregnancy, unless advised otherwise.
Do you love that last sentence or what? I expect nothing at this point. The two weeks between the transfer and the pregnancy test are going to be brutal. Fortunately Thanksgiving will fall in that time, and scarily enough, we will be testing for pregnancy right around M's and my bdays.

If you are still reading, you must really care about me. :)
If you want to learn all this with audio and visual support, go to this link http://www.shadygrovefertility.com/webcast and choose the IVF Overview.

Needle Count: 1

Step one has officially begun. This morning I gave myself the first injection of the first medicine. It wasn't too bad but i was shaking and M ended up doing the actual injection. It was really just a tiny little prick in the tummy. Hopefully I can start doing them by myself tomorrow!

I'm Very Fortunate

Before i get into my post about today, let me just add that my real-life support network has been amazing too. My husband is absolutely wonderful, magnificent, fantastic, you name the synonym and he is it! He loves me even when i am being difficult, and finds ways to make me smile through the tears. My parents and sisters love and support me even when they have no clue what they are supporting! Does that make any sense? They just want me to be happy and I feel that through every interaction with them.

And now onto the official coming out...we are pursuing IVF.

When we switched to our awesome new RE, she said that we could try another IUI or get more aggressive and move on to IVF. Since the two IUIs hadn't produced anything, we decided to move on. It wasn't an easy decision, but the bottom line is that we are tired of trying to get pregnant. We have been at this for far too long. We're not getting any younger, and we want a family so badly. We want to be parents to someone other than the most spoiled cat in America! Not that Halley doesn't fill our hearts with love, of course, just that if we can do something that can improve our chances of achieving this dream, then we are all for it.

Tomorrow, I'll try to explain what this IVF journey may look like. For now, let me just say that I'm Very Fortunate to have found a new doctor who "gets it" and to have my hubby, family and friends.

How I came to love message boards

Last year at this time was pretty miserable for me. I had just lost my second baby and girlfriends both near and far were a) starting to show for their pregnancy that would be due close to my first due date and b) announcing their pregnancies that would be due close to my second due date. It seemed everywhere I turned I was being reminded of what I had lost.

A friend of mine suggested the message boards at babycenter.com. She had had a pretty complicated pregnancy and said she had received good advice and support from the women on there. Hesitantly, i decided to check it out. I have to admit I was skeptical at first. There seemed to be a code they spoke in, a foreign language I had never heard. Acronyms and abbreviations abounded, and I was confused.

Underneath all this lingo, however, I found some amazing women. They helped me to feel less alone in my struggles. They put aside their own issues to offer their condolences and give advice from the other side. Other women who struggled to either get pregnant or stay pregnant or both. They understood what it felt like to watch every one else get what they wanted while they got left behind. I gradually came to rely on my "fix" of babycenter every night...updates from RE appointments, the latest news from a friend, new diagnoses, and the hope that came with every success story BFP. There have been times when babycenter has not been good for me because i was getting too consumed, and i've needed to back off and gain perspective by living in the real world. But overall, I will forever be grateful to the amazing and strong women who have been by my side throughout this whole ordeal.

more alphabet soup

Today's abbrevation is MTHFR. It is nothing fun or cutesy like the ones listed below. This is a genetic mutation that my new RE decided to test for. In fact, she was surprised that my old RE had not included it in the mega-round of testing last year when I had 13 (yes 13) vials of blood taken out of me to test for everything under the sun. Well, apparently it was everything minus one. It turns out that I tested positive for this mutation last week. I am still gathering information but apparently it means that my body does not absorb folic acid because of elevated levels of something called homocysteine. Starting today, I have to begin taking a medication called Folgard twice a day. This med will apparently help fix the problem. Why, oh why, couldn't I have known about this before???

Here is a link to an article that i found interesting. http://miscarriage.about.com/od/thrombophiliadisorders/i/mthfr.htm
But in general, i need to stay away from Dr. Google because I end up going crazy reading about worst-case scenarios!

In a nutshell

This is a recap of the journey thus far. (along with some explanations of abbreviations I may be using on this blog)

May 2008 We were thrilled beyond belief when we found out I was pregnant after just a few months of trying! My first BFP (Big Fat Positive)!!!
June 2008 Crushed when I lost the first pregnancy at 6 weeks
Summer 2008 Took OB's advice to wait 2 cycles before trying again. Enjoyed a fun summer and bought our house at the end of August.
September 2008 Cautiously thrilled about another BFP
October 2008 Another loss at 6 weeks
November 2008 Began seeing a specialist (reproductive endocrinologist or RE) and underwent extensive blood tests and other exams to find out what was going on. All results were normal, which was good news.
January 2009 New Year, New Hope. Cleared to start trying to conceive (TTC) again and we approached it with optimism that the 3rd time would be the charm!
January-June 2009 6 straight months of BFNs (Big Fat Negatives). RE suggested we try a more aggressive approach and try an IUI (intrauterine insemination).
mid July 2009 enjoyed an amazing trip to Ireland
late July 2009 first IUI...no success
August 2009 second IUI...no success
September 2009 Decided to seek a second opinion with a new RE who we are so far thrilled with! I also started a Yoga for Fertility class which has been really wonderful.
And now here we are in October, 1 year after my second miscarriage. When I went through it last year, it never crossed my mind that a year later i would still not be pregnant. More to come on what we are currently doing!

What am I doing?

I recently started thinking about keeping a blog of everything that's going on. I know many of you want to know but don't know how to ask. So here goes!

This blogging thing is scary new territory to me, but nothing compared to the unknown territory of infertility that we've traveled over the last 18 months.