DONE!

So.. I may have forgotten to take my last BCP (birth control pill- ironic, right) last night.

Birth control is used in many IVF cycles to "calm" the ovaries prior to the beginning of your cycle, as well as to time your IVF if your clinic batches women, or if you have commitments and need to start your cycle at a certain time.  In a natural cycle, the ovaries mature 1 or 2 leading follicles out of all of the resting follicles. That's not what you want in IVF, so the birth control can suppress those leading follicles, resulting in 8, 10, or even in some cases 20-30 follicles maturing at the same rate so that you have a better selection of eggs to fertilize. 

Our clinic is hoping that I make around 15 mature eggs this cycle. In a healthy couple (without male infertility) approximately 75% of eggs will fertilize. Since DH has poor sperm quality, we will be using ICSI, where they inject 1 sperm into each egg. Most clinics agree that fertilization rates are lower for ICSI, so we are hoping for somewhere near a 60% fertilization rate.  If all goes perfectly according to plan, we will hopefully have somewhere between 3 and 5 viable embryos by the time we get to our transfer.

But things might not go according to plan. And I've just come to accept that it's out of my hands. 

So we start our stims on Saturday. I'll be sure to get a good picture of my med haul... because it's quite impressive! We are supposed to do our injects between 6 and 8 PM every night. We have a football game on Saturday... so my first round is probably going to be a bit early. 

My husband, the realist

A conversation over dinner

Me: Hon, we're gonna get pregnant!
Husband: No, you're going to get pregnant. I'm going to get yelled at...

I've got a feeling....

Seriously though. I cannot even begin to count the number of people who have said "Naria, I just KNOW that this is your month." 

And I can't shake that feeling either. Sure there are nerves and fear and anxiety... but there's also a deep peace. The calm before the storm. When I'm talking with DH, I refer to "the babies" already. It no longer feels like a way far off remote possibility, but rather it feels like this cycle will be the manifestation of the plans that the Lord has laid for us.

Anyone who knows me knows that I've been struggling with my faith in a big way since 2012 when I lost my father.

And yet, I have a deep sense of peace about this cycle. And one bible verse (I'm Catholic, so verses on their own are often meaningless to me) just keeps popping into my mind

This is it. Final  BCP tonight and then stims on Saturday. And in 28 days we will SEE these plans come to fruition. It's not an if- it's a when.

And I'm so excited for that when! 

And now, a rant about obesity and IVF

Last week my RE and I got into it over a new "study" that shows that women with high BMI's have a lower chance of conceiving via IVF.

The following is the long version of the BS that the RE and I went through:

So my RE called and left me a message 3 minutes before the office closed last night. I had the phone in my hand when I got the voicemail notification... but I don't remember the phone ever ringing. I may just be paranoid, but I'm starting to think he used a 3rd party service to bypass my phone ringing and go straight to voicemail so he could avoid talking to me last night. But I digress. 

 The voicemail was about a "new study" with donor oocytes showing there's a significant decrease in the success of IVF rates in patients with BMI >40. The message rambled for several minutes but the gist was "your BMI is 42-44, and puts you in a group that 's significantly less likely to achieve a live birth regarding this new study". He ended with "I'm sure you've got lots of questions, I'll be in the office all day tomorrow, give me a call." 

So of course at 4:29 I call the office back and the phone is already off. FUCKERS. You know he was making those calls at the end of the day to hopefully avoid talking to me. What he forgot was several months ago he called me from his personal cell phone with a blocked number to leave a message for me on his day off. I have software on my phone that automatically forces a redial for blocked numbers and unmasks the block... so I knew I had his personal cell number. I figured it would come in handy one of these days. Yesterday was that day. 

So I called him back... probably around 4:35 or so. Not obnoxiously late. He was BEEEEEEEEYOOOOOOOOOND pissed that I was calling for a non-emergency. But frankly if he wants to play dirty pool, so will I. 

The conversation lasted about 10 minutes. It was a lot of "this new study just came out, it was with donor oocytes from "average weight" individuals so we know the egg quality wasn't compromised by a high BMI" and talks about how women with a BMI >40 had "something like a 60% lower chance of having a take-home baby at the end". And then he mentioned that he knew I had had "problems" with my weight, and highly encouraged me to think about cancelling my cycle until I lose some weight. He went into the details (that he remembered) of the study and went on and on about how women with a BMI >30 really aren't good candidates for IVF, and moving forward he will be refusing them as clients. 

I told him we're not cancelling our cycle and that I'd see him next week. 

So I got home, panicked, cried for about an hour straight, took my meds, and then sat down to research. Turns out the ASRM annual meeting was this week (Monday) and this "study" was presented by its authors. It's not been peer-reviewed, and it hasn't been published or replicated. And yet he decided it would be a good idea to call a bunch of patients and fat shame them over preliminary data. 

I don't have the links to the full studies with me right now ( you can pull them from the ASRM website) but here is an excerpt from the press release from the conference: 

"Often eggs from one donor are provided to different patients. Using records of fresh, shared donor cycles performed between 2004 and 2012 investigators from the National Institutes of Health (NIH) were able to examine cases where one donor’s eggs went to different patients and those women had different BMIs.  Of the nearly 4,000 cycles examined, 63% of the recipient patients had a BMI of less than 25, 24% had a BMI of between 25-30, 8% were between 30-35 and 5% reported a BMI of greater than 35. A higher BMI was associated with a lower live birth rate. This difference persisted even when controlling for other factors such as age and number of embryos transferred. The impact was strongest in recipient patients with a BMI greater than 35, who showed a 21% lower live birth rate."
SOURCE

The part that really bothers me about the above is the bolded. The VAST MAJORITY of the sample was skewed toward an average/normal/healthy BMI, and only 5% of the sample (so roughly 200 women) had BMI's "greater than 35". So if we're talking a 5'6 woman, that minuscule part of the data subset could have ranged anywhere from 217lbs-300+lbs. 


So of course, I've spent a bit of time researching studies that have actually been PUBLISHED regarding obesity and IVF in the year 2014 alone. Here are some of the highlights:

The Impact of Maternal Body mass Index on In Vitro Fertilization Outcomes
Alexandra Legge, Renda Bouzayen, Linda Hamilton, David Young

Objective: To examine the effect of body mass index on gonadotropin dose requirements for ovarian stimulation, as well as other clinical outcomes in women undergoing in vitro fertilization.


Results: There were no significant differences between the three BMI  groups for any of the IVF cycle outcomes measured, including the total FSH dose required for ovarian stimulation. The likelihood of cycle cancellation, clinical pregnancy, and live birth were not significantly different between normal weight, overweight, and obese women.

SOURCE


Obesity is not associated with the poor pregnancy outcome following intracytoplasmic sperm injection in women with polycystic ovary syndrome
Funda Akpinar, et al

Objective

To determine if body mass index has an effect on the outcome of in vitro fertilization in patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation.

Results

Total gonadotropin consumption increased, and the number of retrieved oocytes decreased as the body mass index increased. The implantation rate and clinical pregnancy rate were similar in all 3 groups. In response to the mid-luteal long protocol, the cycle cancellation rate was lower and the number of retrieved oocytes was higher in the overweight and obese groups, as compared to the antagonist protocol.

SOURCE

So honestly, I'm not that concerned. I'm more concerned that my doctor is apparently an idiot for basing this rash decision on an unpublished study. 

We've got our schedule!

We finally have our schedule.

Stopping BCPs on Wednesday
Starting 100IU of Follistim + 75 of menopur on Saturday (PM shots)
Monitoring appointments set for M/W/F (11/3, 11/5, 11/7)

If I respond well to the starting dose (which is equivalent to 175 IU of follistim-only) the plan is set to tentatively trigger (lupron + novarel)  on 11/11 and then retrieve on 11/13. The doctor would prefer a 2 day transfer (it's the most common transfer day at their clinic). So potentially transferring on 11/15.

Which would put us at beta-or-bust on Thanksgiving day. I'll probably cave and test at 10dp2DT (11/25).


Either way, unless my body decides not to play ball at all, we will know by THIS TIME NEXT MONTH if we are pregnant or not.

Holy shit. Triggering on 11/11. Time to make a wish :) I won't share what that wish is, but I'm pretty sure y'all can figure it out!

6 days!

Six days until my baseline scan.

I can't even begin to describe the anxiety that I'm dealing with. So much is riding on this cycle, and I'll admit blogging has been the furthest thing from my mind. I feel like there is still so much to deal with (including fixing an error with our FSA account we are using to partially fund this cycle) and I'm running out of time.

I have a conference this weekend that I'm not at all prepared for, and then BAM, Monday morning it all begins.

But by this time next month we should know if we're going to have a very Merry Christmas or a rather subdued holiday.

Self-Care Friday

I wanted to focus today on Self-care at the place we all spend the most time- our offices. 

You see this is the busiest time of the year for me- it's not uncommon for me to work 15-18 hour days between now and mid-December. It's just one of those things that happen.

So in addition to my hourly walking around the department/stretch break, and ensuring that I'm guzzling water like it's my job, I'm also making sure to take time to relax and read. We're encouraged to keep up with growth in our field, so I have a book case of professional development books just waiting for me! Every 3 hours during the day, I take a 15 minute reading break. I've got a reading nook (which is also where I conduct my video conference calls) as well as my tea nook.

I grew up "doing tea". It's a huge tradition in my family. So when I got the closed door office, one of the first things I did was set up a proper place to have tea. I've made a TON of friends from other departments when they discovered my delicious tea stash and I often have visitors stop to have a cup of tea. I don't mind it. I tend to be a "keep to myself" person at work so it gives me an opportunity to met people from other departments.

Sorry about some of the mess and cropping. I tried to make sure I hid anything that alluded to my employer!

The Reading/Conversating Nook: 

I have a new spider plant I need to bring in and hang, and my succulent and orchid both need repotting

My Tea Nook

I'm slightly obsessed with Disney.

The stuffies were gifts from my nieces and nephews

Close up of the Tea Nook

I have 5 flavors of Harney and Sons teas to suit my mood

I also keep both sugar and artificial sweeteners in the office

The little yellow duck is my loose leaf tea infuser- isn't he sweet!

I've failed at self-care the past few years, so these were just two steps I knew I could take with my new office to ensure I treat myself better at work. It is the responsibility of the employee to pay for any decor that you don't "inherit" from the last occupant. Since I'm broke as a joke, I wanted to keep it thrifty. 

1) The fabric "runner" on the chair, side table and the tea nook was a total of 1 yard of fabric from Hobby Lobby. With my coupon it cost a total of $1.59. I used mailing tape to affix it to the cabinet.

2) That gorgeous chair? $15 on craigslist. 

3) The side table- free from the curb. I have no shame. It's got some scuffs up top, but could easily be sanded and repainted at a later time

4) Floor lamp- $10 at Target

5) The framed art was all inherited from the last occupant except for the Disney poster. The poster was free (Travel agent perk) and the frame was $8 at Wal-mart

I also have a desk lamp ($5 thrift find with $10 shade), a book case ($15 craigslist) and some other frames from  home (probably $30 total)

So I was able to make my office one of the most inviting and comfortable at this organization for less than $100. And I'll be taking most of it with me when I move to my next job. 

I highly recommend doing whatever you can to make your space yours within what is culturally acceptable at your organization. 

It's like I can't focus

I'm worse than a kid on Christmas eve
Or someone in a room of puppies

I've got the period poops (and my customary yeast infection) that signals the onset of my period... and yet AF won't show up.

My IVF meds are all ordered (or donated- THANK YOU!) and the hubby is putting the finishing touches on a couple of remodeling projects.

13 days


13... freaking days.... until we start stims

This time next month I could very well have my BFP. This time next month I could very well be PUPO (That's pregnant unless proven otherwise).

Next month.

NEXT MONTH

Next month is the month that I WILL become a mother. Next month is when the last 36 months of tears, heartbreak, loss, and frustration will all be worth it.

And I can't wait.

I can't wait for this time next year. Optimistic me may have bought a few things at Disney for Future Fetus Dreamer. I may have spent our trip dreaming about taking the baby(ies) to Disney for their first time next fall- in the magical time between Halloween and Christmas at Disney. It would be the very end of my Maternity leave, and it would be perfect!

The cart at this point is about 10 miles up the road from the horse. Shit, at this point we haven't even BOUGHT the horse yet, but the cart is there. That's how optimistic I'm remaining.


This is the single most stressful time at work. I'm combating it by making sure I take long walks around the office every 45 minutes, scheduling time on my breaks to meditate, and I have an AWESOME tea nook set up in my office. I'll have to snag a picture of it. It's fantastic.