MrsGoldie's IVF Journal** Updated 8/19/13**

I think I have it all covered, but just in case I forgot something...

Any important questions I should be asking today at my NP consult?

UPDATE: (please excuse the long post, but I know some other posters have asked for information)

Feeling so much better!!!! Love Susan the NP at RSoNY!!! She took so much time with us and was soooo patient and answered all of our questions. I'm not afraid anymore . Of course I'm scared of the will it/won't it work, but that's normal.

Things I learned today...

SART data is self reported and pretty much works on the honor system. REs don't "have to" report everything. The data is also 2-3yrs old. It is also dependent on patients reporting their birth information, and some patients don't report back to the RE after birth. Also, some REs reject patients or turn them away. For example...REs can turn you away if they feel you are too old or they feel like they can't help you. Lesson learned...stick to where you feel comfortable and have the most confidence. I love the office I am with and I am very confident in the office and the staff. I am sticking with RSoNY for my IVF.


1. How does monitoring work? How often will I need to come back for ultrasounds and bloodwork? What are the office hours, etc? I go in CD3 but they monitor a little more closely. Could be every 2-3 days but closer to retrieval they monitor every day. Luckily for me I can go in at 7am right before work.
2. How will I find out my test results? RN calls with results and levels every time if you are a Dr Lydic patient. Some REs only call with abnormal results or if something needs to be changed.
3. Can you give me information on what protocol you'd recommend in my case? RE gave me the protocol he would last month when we ordered meds, but I will find out more exactly when I go in for CD3 on Friday. In the IVF packet I was given was a list of every possible med that could be ordered, what it's for, and it's side effects.
4. Fees not covered by infertility coverage. There was a list of all possible fees in the IVF folder given to me.
5. Do you require/recommend ICSI? The cost was included in my packet, and she said they determine that in the lab after retrieval. They put a pool of sperm in the dish, introduce the egg and watch under the microscope; if fertilization is not occurring naturally for some reason wether it be because of a thick egg or a sperm problem, then they will do ICSI.
6. Would you recommend assisted hatching with the IVF/ICSI to help? Again, depends on what they see under the microscope. If the wall of the egg is thick or if the patient requests it, they will do it.
7. How many embryos would you recommend that I transfer at my age? Before 36 they recommend 1 unless the patient requests 2. After 36 they recommend 2 unless patient requests other. I am 35 1/2 so I requested 2.
8. What are your current success rates for the treatment that you have recommended? (Remember, there is a difference between pregnancy rates and live birth rates) I have to ask Dr Stelling bc he is really good with statistics, but in women in a similar situation, if the fertilization is good and the embryos are good, the success rate is around 45%-65% and in some cases higher.
9. Do you recommend any testing for either me or my partner? DH and I have had all the testing necessary. They include...HSG, hysterosono, trial transfer, SA, blood work up, genetic testing, endometrial biopsy...
10. How will I be able to communicate with you during my treatment process? Phone. I can speak with a RN or my RE.
11. Will you be the only Dr. I see? Since I am a pt of Dr Lydic, I will only see him, his partner Dr Bronson, or Dr Stelling.
12. What protocol would I be on? What is a typical schedule for this protocol? She went over in detail every medication I will be using. Since I was already on injectables and the endometrin, I already know what to expect...just different dosages.
13. What medications will I be taking? What are any side effects of the protocol? Went over in detail meds and side effects...nothing terrible and nothing I haven't already experienced.
14. Does your clinic normally do a 3day or 5day transfer?
They try to go for the 5d since they can monitor the embryos closer while they are developing and be very selective. But if the embryo isn't thriving in a laboratory environment as well as they like they will do a 3dt. She said not to stress if that is the case, just has mostly to do with monitoring the development and being selective.

15. Some REs require bed rest 48hr after transfer. RSoNY does not, but if my job is stressful or if I prefer, they will give me a note for work to take off. I decided I will take off they day of transfer and the day after.

16. They schedule retrievable and transfers 7d a week. They usually do the retrievals earliest in the morning, and the transfers are scheduled mid morning to early afternoon.

17. They will make every attempt humanly possible to have Dr Lydic do the transfer bc I requested it. They are able to make schedule changes and honor special requests.

18. Retrieval is done under sedation transvaginally. Side effects can be spotting, cramping, bloating...but they monitor very closely.

19. Transfer is done similar to IUI. With the exception that they make you relax for 45mins to an hour after.

20. All normal activities and diet until the transfer. She said a glass of wine here and there is ok. After the transfer they treat you as if you we're pregnant.

I am going on vaca in Aug, so I will be taking the BCP for a little longer and my retrieval and transfer will be somewhere in the 2nd/3rd week in Aug.

Allllllllllmost there!!!!!!!!!!!!!!

Background
Me: Unexplained
2005 Rt fallopian tube removed. Both ovaries functioning.
TTC one year on our own with OPK
Started with Dr Lydic of RSoNY in Aug 2012.
HSG: Lt tube open
Endometrial Bx: Normal
Saline Sono: ? Polyps, schedled for polypectomy & Hysteroscopy
Stony Brook ambulatory surg: Had D&C, no polyps seen on hysteroscopy, just the lining was thickened and folded in on itself.
Skipped a cycle or 2 bc of cysts.
8 IUIs all bfn. 3 clomid, 1 with Follistim, and the rest with Gonal F. All cycles but one i used the hCG trigger shot. Ovidrel twice, Pregnyl once (got a terrible reaction at the injection site that lasted for a week, RE said that med is nototious for that) the rest just generic hCG.
Next step...IVF

DH: Normal
Normal SA. Great counts, notmal morphology and motility.

Found this:
3 Day and 5 Day Transfers
For those who are on their TWW and want to know what is going on in there here is a list for 3 and 5 day transfers.

This is what happens in a 5dt:

-1dpt ..embryo is growing and developing
0dpt... Embryo is now a blastocyst
1dpt....Blastocyst hatches out of shell on this day
2dpt.. Blastocyst attaches to a site on the uterine lining
3dpt.. Implantation begins,as the blastocyst begins to bury in the lining
4dpt.. Implantation process continues and morula buries deeper in the lining
5dpt.. Morula is completely implanted in the lining and has placenta cells & fetal cells
6dpt...Placenta cells begin to secret HCG in the blood
7dpt...More HCG is produced as fetus develops
8dpt...More HCG is produced as fetus develops
9dpt...HCG levels are now high enough to be immediately detected on HPT

this is what happens in a 3dt :

1dpt ..embryo is growing and developing
2dpt... Embryo is now a blastocyst
3dpt....Blastocyst hatches out of shell on this day
4dpt.. Blastocyst attaches to a site on the uterine lining
5dpt.. Implantation begins as the blastocyst begins to bury in the lining
6dpt.. Implantation process continues and morula buries deeper in the lining
7dpt.. Morula is completely implanted in the lining and has placenta cells &
fetal cells
8dpt...Placenta cells begin to secret HCG in the blood
9dpt...More HCG is produced as fetus develops
10dpt...More HCG is produced as fetus develops
11dpt...HCG levels are now high enough to be immediately detected on
HPT


7/12/2013 Went in for CD3. I have one large cyst on each ovary. That and bc I am going away in August...I have to wait this cycle out and start next cycle So annoying but it's for the best. RE said looking like retrieval the last week of August and Transfer first week of Sept. I start BCP next period for 7 days then go back for monitoring and start the meds.
7/12/13 Nevermind...STARTING TODAY!!! HOLY CRAP!!
(BCP)Desogen 28d daily. Back in 1 week for monitoring. They said the bcp will take care of the cysts
7/19/13 Sono & Bloodwork today. Cyst on right is gone. Cyst on left is still there and a lil bigger RE said depending on bloodwork I may be on BCP for a week longer. If bloodwork is ok, then we start the stims today. for normal bloodwork!!!!!
7/19/2013 Bloodwork is in. I'm staying on BCP for 4 more days. Back on Tuesday for sono and bloodwork.
7/23/2013 THE CYST IS FINALLY GONE!!!! No more BCP. I go back on Thurs for sono and more blood to check E2, if all levels are ok I START STIMMING ON THURSDAY with Gonal F and Menopur
7/25/2013 STARTING TODAY YEAAAAAA BUDDY!!!!!
Gonal F 450 & Menopur 2 vials powder 1 vial solution.
Started spotting today but that's ok. Dr Stelling said I may spot or I could get a full period. Either way, it doesn't matter. He said...average stim for 10 days. That would put ER on Aug 5th and ET on Aug 10th. But that's just a guesstimate!! I'm trying not to get too excited bc I'm terrified of the outcome. Trying to stay optimistic
7/26/2013 First injection went well last night. Mixed my 450 Gonal F and my 2 Menopur powders into one injection so I didn't stick myself twice. AF came for a visit today. Hopefully this will be the last time I see her for a while!!
7/29/2013 Right ovary is "quiet" Left ovary has 4 or 5 follicles developing. Staying on same dose, back again on Wed.
7/31/2013 Right ovary has 1 alomst 10mm one. Left ovary has 4 or 5 ranging from 14mm-17mm. Added the ganirelix today, and since I'm pretty much maxed out on meds the dosage stays the same. So, Ganirelix in the am, and Gonal F 450 & 2 Menopur in the evening. RE said he is not hopeful anything else will pop up, but it is possible. He also said not every follicle will have an egg, and not every egg will be viable...GREAT But then I saw Susan and she said as long as there are more than 3 she feels good about it, and she reminded me that I still have a few more stimming days. Looking to trigger Sat or Sun, ER Mon or Tues, ET next Sat or Sun. Don't know if it's the Ganirelix, the low # of follicles, the stress of it all, or everything combined but I'm sooooooo emotional today. I think it's time for a mani/pedi
8/1/2013 2 17s, 1 15, 1 12, and 1 11. RE wants the 17s around 22 and he said maybe the little ones will get to 15 which would be good. He said "hopefully" we can get a good egg from one of them. Oh boy Well I sure hope so!!!!! Same doseage of everything, back in the morning.
I let DH give me the shot last night not sure I'll do that again lol He bruised me and injection site still hurts...amateur
8/2/2013 Phew! Susan said this morning that since I have 3 ready to go we may trigger tonight and ER on Sunday but Sunday is my niece and nephews baptism...I really did not want to miss that! Luckily, I just got the call...back in the office in the morning for more bw and sono, trigger tomorrow night, ER on Monday!!!! I think I'm getting a little excited
8/3/2013 I PULLED THE TRIGGER!! It's all out of my hands now. Triggered at 9:30. I go back tomorrow for bloodwork at 8 to make sure the levels are good. I have to be in Mineola at 7:30 and ER is scheduled for 8:30. 3 +20 ready to go 1 14 he is not hopeful will catch up and then 1 13 RE said they aspirate all of them anyway.
8/5/2013 On our way to retrieval! Not sure if I'm excited, nervous, or terrified ol. I'm not afraid of the procedure, just the results. Trying to remain positive. I will feel better once I hear the results.
THEY RETRIEVED 8 EGGS!!!!!!! That's the best news I've had in 2 years!!!! I feel much better. They will call tomorrow with fertilization report. Come onnnnnnnnn little eggs!!!!!
I had a weird reaction to the anesthesia, and have had a super stuffy, runny nose and Ive been sneezing ever since...annoying. I was feeling really good before, just a little cramping; I guess I should have rested a bit more. Now I am feeling really crampy, bloated, and my ankles are swelling So I'm drinking tea with my feetsies up, watching some tv. I have to start my endometrin tonight. One in the AM and TWO in the PM. Waiting patiently for the fertilization report in the morning.
8/6/2013 8 were retrieved. Out of the 8, 5 were mature. Out of the 5 mature, 3 fertilized.
Now, how many to put back if the quality is not great I would put back all 3. Still trying to convince dh to put back 3 even if they are all great quality bc this is our only chance.
8/8/2013 got the call this morning. My transfer has been pushed to Saturday for a 5dt. My little embies are doing well....come onnnnnnnnnn embies!!!!!!!!
8/10/2013 TRANSFER DAY!!!!!! Took my Xanax, drank my 8-16oz of water, and headed to the office. I was soooooooo nervous!!!!!! Dr Trixax is fantastic! I can see why everyone loves him!!! too bad he never goes to stony brook. We transferred one blastocyst and one morula, the third one didn't make it sadly. Thank goodness we waited til 5d. Unfortunately that means there is nothing to freeze they bury themselves deep in there!!!!!! Started taking estradiol 2mg twice a day and still taking endometrin 1 in the morning and 2 at night. I was a little crampy all day.

8/15/2013
Monday (7dpER/2dp5dt) E2 was 857 and P was >40
Today (10dpER/5dp5dt)E2 is 252 and P is 6
Increased endometrin to 2 in the morning and 2 at night
Found this:
http://www.nyufertilitycenter.org/ivf/embryo_transfer
8/19/2013 BFN The End.

Message edited 8/19/2013 7:54:28 PM.

What should I ask @ IVF consult?

These are the questions I asked:

IVF Consult Questions
1. How does monitoring work? How often will I need to come back for ultrasounds and bloodwork? What are the office hours, etc.
2. How will I find out my test results?
3. Can you give me information on what protocol you'd recommend in my case?
4. Fees not covered by infertility coverage
5. Do you require/recommend ICSI?
6. Would you recommend assisted hatching with the IVF/ICSI to help?
7. How many embryos would you recommend that I transfer at my age?
8. What are your current success rates for the treatment that you have recommended? (Remember, there is a difference between pregnancy rates and live birth rates)
9. Do you recommend any testing for either me or my partner?
10. How will I be able to communicate with you during my treatment process?
11. Will you be the only Dr. I see?
12. What protocol would I be on? What is a typical schedule for this protocol?
13. What medications will I be taking? What are any side effects of the protocol?
14. Does your clinic normally do a 3day or 5day transfer? For my age, how many embies would you recommend transferring back?

Re: What should I ask @ IVF consult?

That is so incredibly helpful! Thank you very much

Re: IVF consult ** Updated with IVF info**

Updated with IVF info at the top

Re: IVF consult ** Updated with IVF info**

Nevermind the fm to you
Lol


Sounds great
Good luck

Re: IVF consult ** Updated with IVF info**

So excited for you! Told you Susan is great! !

IVF consult ** Updated with IVF info**

Very exciting that you are almost there! WOW, that was very helpful. I am totally stealing all of your questions and responses for future. How much is ICSI? Is that the same as PGD? I think taking off the day after transfer is a good idea. You will feel better knowing you relaxed. Interesting about the info about transferring 1 or 2. I think thats good you are transferring 2 since you will be close to 36. Did they talk about grading the embryos at all? I would think that would also determine how many you transfer. I have no idea how that works. Keep us updated and lots of luck!

Re: IVF consult ** Updated with IVF info**

best of luck to you!

Re: IVF consult ** Updated with IVF info**

Thank you ladies I am excited that this will triple my chances from 15%-25% with IUI to 45%-70% or more with the IVF.

ICSI is Intra-cytoplasmic sperm injection where they take the head of the sperm and inject it directly into the egg.

PGD is Pre-implantation genetic diagnosis which is essentially a biopsy of the embryo. I forgot to include that above...I asked Susan about that and she said she would only recommend that if there was a personal or family history of genetic disorders. Unless of course the patient requested to have it done. We have no family history and all of our genetics testing was normal, so we are not going to do it.

Both of them are around $2500.00

Re: IVF consult ** Updated with IVF info**

Posted by MrsGoldie

Thank you ladies I am excited that this will triple my chances from 15%-25% with IUI to 45%-70% or more with the IVF.

ICSI is Intra-cytoplasmic sperm injection where they take the head of the sperm and inject it directly into the egg.

PGD is Pre-implantation genetic diagnosis which is essentially a biopsy of the embryo. I forgot to include that above...I asked Susan about that and she said she would only recommend that if there was a personal or family history of genetic disorders. Unless of course the patient requested to have it done. We have no family history and all of our genetics testing was normal, so we are not going to do it.

Both of them are around $2500.00

IVF consult ** Updated with IVF info**

I had less than a 50% fert. rate but they did not do ICSI since I made enough embryos. If I do IVF again they recommend ICSI.

Good luck!!!!!!!!!!!!!

IVF consult ** Updated with IVF info**

This post should be a sticky. You girls are so thorough!

Re: MrsGoldie's IVF Journal** Updated 7/19/13**

Thank you. I start IVF in the next week or so.

MrsGoldie's IVF Journal** Updated 7/19/13**

Best of luck to you! I should be a few days behind you.

Re: MrsGoldie's IVF Journal** Updated 7/19/13**

Good Luck!!! Once you start the stims its basically over. It goes by really fast!!! Had my ER on July 5th and now I am four weeks along!!! Lots of and

Re: MrsGoldie's IVF Journal** Updated 7/19/13**

Good luck, Goldie!!!!

MrsGoldie's IVF Journal** Updated 7/19/13**

Good luck. I'm totally going to be following this post since we will probably be starting the IVF journey after this cycle (on CD 6 of natural IUI). I have no idea what I'm doing so please post lots of details! Thanks and best of luck.

Re: MrsGoldie's IVF Journal** Updated 7/19/13**

Good luck to you too!!

MrsGoldie's IVF Journal** Updated 7/19/13**

Thank you everyone Good luck to everyone too!!!!

Message edited 7/26/2013 10:23:16 AM.

Re: MrsGoldie's IVF Journal** Updated 7/26/13**

updated

MrsGoldie's IVF Journal** Updated 7/26/13**

Glad you made it through the first shot.

MrsGoldie's IVF Journal** Updated 7/31/13**

Update up top. Almost time, next week will be all the action.

MrsGoldie's IVF Journal** Updated 7/31/13**

My first IVF cycle, we only got 6 eggs, 5 mature and still had 2 to transfer. You are doing great! Although I'm surprised with only 5 or 6 follicles they are looking at a 5 day transfer - usually when the number is lower, they go for a 3 day :) don't be surprised if that happens! DS was a 3dt, so don't stress!!!

Re: MrsGoldie's IVF Journal** Updated 7/31/13**

Re: MrsGoldie's IVF Journal** Updated 7/31/13**

Posted by MrsGoldie

Posted by ShhhTTCin11

My first IVF cycle, we only got 6 eggs, 5 mature and still had 2 to transfer. You are doing great! Although I'm surprised with only 5 or 6 follicles they are looking at a 5 day transfer - usually when the number is lower, they go for a 3 day :) don't be surprised if that happens! DS was a 3dt, so don't stress!!!

Thank you