Friday, February 15, 2008

Au Naturale

We've gotten the go ahead from Dr. S to move forward with this cycle. Our nurse sent us a copy of a sample schedule and it is possible we could get to transfer as early as March 2nd. Of course, I have absolutely no idea what my body will do this cycle. The first step is to go in a week from today for an ultrasound so they can check for a dominant follicle. Assuming there is one, the size will give us some idea of how close I am to ovulating. I'm hoping that they'll be able to tell something about my lining at that point as well, but it may be too early.

If they see a dominant follicle, we will begin watching for LH surge. I can either do this with home OPK's (ovulation predictor kits) or I can go in for daily blood draws. I used OPK's in the past along with my CBEFM and they always SEEMED to work, but how do I know for sure? We were never successful with timed intercourse or with IUI's, so I just don't know for sure. This makes me lean towards daily blood draws. Except that driving to my clinic every day is somewhat inconvenient during the week because it is in almost the opposite direction of my work and will either require me to get up quite a bit earlier in the morning or show up to work late. Factor in the fact that it's winter and a couple inches of snow could make this even more inconvenient. I'm just not sure at this point which option will cause less stress. What would you do?

My comment the other day about a shot-free cycle was not completely true because they do like to do a trigger shot for natural cycles. Once we detect a surge, we will do an HCG trigger shot to ensure ovulation (even if I'm ovulating on my own). I think this is meant to ensure that my body will start producing progesterone on its own. The day after trigger I would go in for a blood draw to check progesterone level and the day after that begin progesterone and estrogen support. The schedule shows a standard "natural" FET protocol of using 2 Viv.elle patches in addition to 3 progesterone suppositories a day. I'm a little confused because Dr. S didn't mention anything about estrogen support.

Assuming we detect LH surge on February 26th (which is a complete guess at this point), my schedule would look like this:

February 26th: Trigger shot
February 27th: Blood draw (progesterone level)
February 28th: Begin progesterone and estrogen support
February 29th: Begin Tetra.cycline & Med.rol; Blood draw (estrogen and progesterone level)
March 2nd: Transfer; Blood draw (estrogen and progesterone level)
March 2nd & 3rd: Bed rest

Of course the above schedule will move depending on when I surge.

The nurse said she still needed to talk to Dr. S about timing for when they would thaw the embryos. And Dr. S is recommending we thaw ALL 14 of them to grow the to blasts. They said they have no reason to believe a lot of them won't survive to the blast stage, but I don't know. The only one we've had a chance to try that with didn't make it, so I don't have a lot of confidence.

Overall, I'm a little excited because we are already moving into another cycle already. But I'm a bit apprehensive about all the variables that could go wrong. I'm trying to keep my expectations low for this cycle and expect my cycle to be all screwy, my lining to be anorexic, to miss ovulation, etc. I guess I am going into this expecting to get cancelled and if we do make it to transfer, it will be icing on the cake. I'm not sure anymore what the right attitude is to have towards cycling. I'm tired of being disappointed. So I'm going to tell my old friend Hope to go hide in the closet for awhile and not show her face. I know she's there, but I don't want to look at her.

How do you balance hope with managing your expectations?


Maria said...

This is pretty cool. You're doing your very own science experiment! I'm kind of jealous that you get to start again so soon! ;)

I'll be praying really hard for you this cycle.

M said...

Maybe you could do a combination to watch for the LH surge -- do the daily blood draws, but on any days that it snows a lot you could substitute with the home OPK.... And maybe even do the home OPK on all days to see if it shows the same as the daily blood draw. Or maybe that is just too much?

shinejil said...

You know, I think denial has an important role to play in maintaining our sanity sometimes. I think it's fine to shove Hope in the junk drawer for a while. It's so much easier to tolerate IF when I keep that neutrality and don't let myself walk down the primrose path of "what if, what if."

I guess with the opk vs. blood draw question, it would be good to understand what will actually cause less stress: not knowing for absolute sure what's up in your body, or facing all kinds of inconvenience to get to the clinic.

That said, I've never been quite where you are. I really, really hope this cycle goes well.

Jen said...

I'm so jealous that you get to start so soon! I hope this goes well for you. I need someone to have a good story at CCRM.

Lori said...

The balancing act happens in adoption, too.

My technique is simply to breathe. Whenever I start to think about the future with either a "yay" or "bummer," I try to move back to the present and just breathe.

It's the hardest thing.

Melanie said...

A woman with a plan. Doesn't it just comfort your soul to know that you're doing something, anything, to get this moving. My "thaw embryo transfer cycle" sheet from the RE's office is like a security blanket for me. Sad. But you're on the move (and you sound good, at least as much as you can "sound" in print).

Duck said...

Hope and expectations is a bitch. I expect the absolute best to happen and hope it will happen and picture it happening and then when it doesn't happen I have to accept that it wasn't meant to be, again.
This can only take anyone, me, so far.
Very exciting to see how this natural cycle works. I have a feeling it will be the charm for you.
I don't know what's up with my uterus, there should be some sort of "your uterus is a bitch club".

Anonymous said...

I'll be sending UP a shout out!

nancy said...

That's wonderful that you get to move forward if that's what you want to do. Having to be forced to wait sucks.

I have some comments, so I'm just going to go in the order of your post itself ...

I know how hard it is when you don't ~know~ what's going on by just using opks or monitor. I can tell you though that I used a monitor or opks for most of my 35 cycles and whever I had u/s to back it up, it always "worked". At least it was detecting the ovulation right. Timed sex and IUIs didn't work for me either but it eventually did. I don't understand how in the world perfect circumstances and perfect timing didn't work, but I'm proof. BUT ... if I was doing FET, I wouldn't want to leave anything to chance and I would go for the daily draws too.

I'm excited for the possibilities for you. You'll already have ET before I start Lupron. Not that I'm complaining that you are ahead of me or anything, just that I feel that it's SO close for me and you'll already have some embies in you!

Bah. Hope sucks. Expectations suck too. Even when I try to keep the latter low, miss hope mucks it all up.

This is getting long. We'll talk tomorrow!

My clinic likes to do hcg shots for natural cycles too. Not only does it ensure O like you said, but it helps support the LP - which can't hurt, right?

Duck said...

hey I don't know how to email you so I will send a comment.
Have you heard anything about viagra and lining?? Just doing some investigating on my screwed up uterus and thought that you may know something.

Wishing you the best for the au natural cycle

Anonymous said...

Take the time you need to get your body ready for your natural cycle. Even though waiting may be the last thing you want to do emotionally, see if your body needs time to recover from your last cycle. If you're going to do this naturally, you want to be in the best shape of your life. I think the therapy will also be very helpful for your process.

I was forced to wait 3 full cycles before trying my next IVF cycle. Even though I hated it emotionally, physically, it was the right thing to do. And in hindsight, I grew emotionally too. I was able to handle this cycle much better.

~Carrie said...

I'm glad you have the go-ahead for this month and that Dr. S. is allowing you to try a natural cycle.

If you're getting consistent results with OPKs, then they are probably working, though I would go with the blood draws *IF* it weren't such a hassle getting to your clinic during the week. I honestly don't know which would be less stressful... could you use OOKs and when the line starts getting darker, meaning you are heading towards ovulation, go get blood drawn to double check? That way you don't have to go all the time, but you'll have the peace of mind knowing that ovulation was confirmed with a blood draw.

As far as your 14 little frosties... I can understand your concern in thawing all of them at once. While there's a good chance that some out of the 14 will make it, I would feel the exact same way about taking a chance with all 14 at one time. Could they take maybe 7-10 and try and thaw them? If none of those make it to blasts, then that could be an indication that the others may not either (unless they just happen to pick the 7-10 embies that were not quite as strong). Then you would have some embies left and they wouldn't take the chance on letting them grow to blasts - maybe? I don't know, I'm certainly not a fertility expert so I hope I'm not suggesting something totally stupid.

I hope this cycle is as stress-free as possible for you.