Hail Mary Pass

So I had my Day 3 (on Day 2) scan this morning. My FS gave me some bad news. My AMH is 0.4….which can be expected as I am 38, so you would expect to see it dropping. I had a 1.3 last year, so was surprised it went down so fast. but not unexpected. My Antral Follicle Count (AFC) was 5, which is also quite low. The conversation was rather positive than negative. We have decided to go ahead with the cycle as both AMH and AFC are indicators of ovarian reserve, but not absolutes. We need to see how my follicles stimulate and the quality of the eggs I produce. My FS is optimistic as I have always been a good responder to stimulation. We have never had more than three embryos so I am used to low numbers. The FS also said that as I have been pregnant with my own eggs (although baba only stuck around until week 7), this is also an indicator that we should keep moving forward.

We are going to stimulate hard with a mix of Menopur and Fostimon, which is a first for me. In older ladies (like me and my gray hairs) the lower acidity of the added Fostimon is supposed to work a bit better. We shall see. However, the FS and I spoke a lot about what this means. It basically means this will be my last shot with my own eggs. DH and I were ready to do donor eggs last year, so not too much of a surprise or adjustment for us. So I am moving forward and hoping for the best. I just want to get to retrieval, which says I can produce eggs. That will be step one, then I will worry about getting to transfer. If we do get to transfer, we will do Intralipids immediately after transfer, which is also a first. I only did them before once I was pregnant. We are also going to do Clexhane at transfer as well, so hopefully that will also assist.

All guns in. Last attempt with my own. Hoping for the best…but not the end of the road. DE is definitely on the cards. Feeling optimistic….but don’t really have a choice now, do I ? Ladies please send me all your happy-love-juju-positive-light-energy-peace-hope-vibe….praying that this is my ‘Hail Mary’ pass.


Fog on the road…

DH and I sat waiting so patiently to see the FS today.  We hadn’t been back to see him since our last cycle ended with a very short lived BFP in August.  We had prepared ourselves for the possibility of DE, we had also prepared ourselves for the possibility of walking away without a clear plan.  IF is not a simple recipe, or easy intervention.  It is a gamble in so many ways.

So we went through out entire history with our FS.  We spoke about my eggs and although I have never produced very many, our FS is happy with the quality.   DH has very few good sperm, but because we do ICSI that removes the male factor.  Also we have always had a fairly high fertilisation rate, which again supports the fact that my eggs are decent and DH’s sperm are as well.  Our FS then explained that because we have achieved implantation twice, although unsuccessful, the fact that we had some BFP’s is a good sign….however it makes offering another option a little more difficult.  There are many reasons for miscarriage, and we have already ruled out chromosomal challenges through genetic testing as well as clotting abnormalities.  My uterus is in good shape, and my endometriosis is not interfering.  The only other factor that could be playing a role is an immunological challenge, that Intralipid could take care of….partially.    We spoke about DE and if we had never had a positive result, or our embies were poor, then that would be the obvious next step.  Because our embies are good and we have had implantation…..DE may not be the solution right now.  If there is an immunological problem, I may never carry, I may continue to miscarry….but we don’t know that for sure.  We could go with DE, and that would improve our embies, but if the problem is not the embies, we are not really any better off.

So my dear IVF friends…..what to do?  Our FS said that he wished he had an easy answer for us, but it is not an easy situation.  He did suggest Clexhane to thin my blood and do Intralipids a week before transfer, so there are some minor changes we can make.  Although our FS was clear, there is little scientific evidence for this and he is going on his gut feeling based on other cases he has had that are similar to us.  This is a big shift for our FS, because he doesn’t usually go with his gut, he goes with science.  This tells me he is really grasping for options for us.  I can’t decide if that is good or bad.

DH and I have had a long chat and feel we need to give our embies another shot.  I am still 37 and as long as my embies are holding up….we think we should keep trying.  I just don’t know how long I will hold up.  So we are back on our same path…..long protocol IVF ICSI with Intralipids and maybe Clexhane this time around.  Maybe December, maybe January….we’ll see.  I wish it were all more definite and easier…..but it is not.  So we have a few months to get ourselves into the best shape we can to give the next round every chance for success.  I can’t believe we are headed for round number six!  It blows my mind (and my bank account) that we are where we are.  It will happen…it will just take more time unfortunately.

But as of now…I am on holiday. One last hurrah before we start focusing on getting ready for our next cycle.

Day 10 – Little baby follies

I just came back from my Day 10 scan and was happy to see that there were lots of good sized follies, but they are still quite small on Day 10.  The FS tried to see my left ovary again, but I have long given up on that hidden ovary and have resigned myself to a ‘one-ovary’ gal.  So I have about 5 leading follies and a few followers, so they may catch up and I might have a few more.  We will see on the Day 12 scan to determine if retrieval will be on Monday or Tuesday.  I will be so happy to have retrival done and hopefully I get at least three nice embies for transfer.  I have rarely had more than three to transfer and always have done a Day 3 transfer, so I am assuming that my pattern will remain.

I didn’t sleep well last night at all, was awake since 2:30am and am now really wishing I could have a coffee.  Not sure if it is the hormones causing the insomnia, or the anxiety. I gave up coffee a little over a year ago.  I am a rooibos feen now.  I still have the occaisional cappuchino now and again, but rarely.  I am hoping that this one little sacrifice is helping my fertility a little extra….maybe my egg quality!  That would be nice!

So on to Day 12!

Day 3 – A good start

This morning was my Day 3 scan.  Normally a pretty uneventful scan, but today my FS discussed AMH and antral follicle count with me.  I must say…my Day 3 scan will never be the same.  For some reason, probably because I never asked, I always thought that Day 3 was about ensuring there were no cysts, looking at your hormone levels from Day 2 blood tests and deciding the way forward.  I asked my FS to explain to me in more detail my AMH, as I had ‘google-fever’ and had convinced myself that 1.29 was a crap result.  The problem with google is that you start comparing yourself to everyone else…what a ‘beginner’ mistake…I should know better, but I think it is human nature to compare yourself to everyone else.  So my FS explained to me that AMH had no correlation with egg quality, it is an indicator of egg reserve and reduces with age.  AMH levels are also impacted by endometriosis.  So  I am 37, with endo 3, so you would expect my AMH to be on the lower side.  However, when we look back at my previous cycles I always produced around 7 eggs per ovary (remembering that I have a hidden ovary, which they can never retrieve from), so on average I am actually producing around 14 eggs per cycle, which is a good outcome.  The more important point is that AMH is never looked at in isolation, it is also important to look at the antral follicle count which will tell you a lot more about the potential outcome of your cycle.  FSH is not a good indicator of a potentially good cycle.  My antral follicle count this morning was good….so all is good in the world of my ovaries!  Yeah!  So now Day 3 has a whole new meaning to me….antral follicle count.

We also discussed Intralipids and my FS will give me Intralipids the day of embryo transfer.  If I get a BFP (crossing everything….please, please, please) then he wants to give me Intralipids weekly until my first scan!  Wowzers, I thought that was a little OTT (over the top), but he explained that with my history of miscarriage and that this is now my 5th IVF cycle, he wants to give us every chance possible.  As it can do no harm to increase Intralipids, I say why not!  I am just so pleased that my FS is doing all he can to help me…it makes such a difference to have a FS who is always available, realistic and practical, and is truly committed to the outcome…a baby!  By the way…he is also very affordable compared to others.  I am so happy and I love his team!  They were always great, but since the miscarriage, they really have been so amazing and it is the little extras, like all the staff knowing my name (although that is probably because I have been in the office almost every month for the last three years), asking about DH and treating me with so much kindness.  It makes the process a little bit easier.

I really hope this is my last cycle….please.  I start Menopur tonight.  The FS said 3 amps each night, but when I was speaking to the sister we spoke of my last cycle and how we did 4 amps for the first three days.  So we decided to change it to 4 amps for the first three days and she would just tell him we changed it.  Now I really know I am a Veteran IVF’er!  I could probably rent an ultrasound machine and do my own cycle!  I am happy to do some harder stimming the first three days, I have gotten more good quality eggs using this process.

Back in for Day 10 scan on 28 July, so just need to keep on keepin on until then.

AMH results…finally

After many years, I finally asked about my AMH results. I have no idea why I didn’t ask sooner, I guess I just had so many other questions. So my result is 1.29, which is above normal, but not high enough to be of concern. The range is between 1.0 and 3.0 being normal and anything around 3.0 or above suspect of PCOS. At 37, I am really happy with my result and it make me feel relieved that I still have the option of additional IVF cycles if I choose. I feel the clock ticking and the window slowly closing on my IVF success rate based on my age. We would love to have a successful cycle again…and a successful full term pregnancy. Now that I have been around the block (now on my 5th IVF ICSI) I feel I know so much more about the tests, the drugs, the whole process. I wish I never had to be here, but the positives of being here is 1) knowledge and 2) I am much more relaxed throughout the cycle. My first 2 cycles I was a mess. However, all my anxiety has now transferred to when I do get a BFP and all that can go wrong. So I will need to work on that. For now, I am just happy that my AMH is good and I am starting my new IVF cycle with lots of hope.