Wednesday, April 23, 2014

Club shopping (part 2)

I didn't realise changing clubs would be so hard. The journey started about 5 weeks ago, and as I discovered from the very start - it wasn't easy.

When I started this blog post, I was going to fill in all the eensy details, the drama that engulfed my volleyball career as I see-sawed from one club to another.

But, it isn't easy blogging under my real name. You can't really be honest when writing about things that may affect people.

So the short edited version is: I changed clubs from UWA to ECU Chequers. Still playing at Division 1, we had our first game last Sunday and lost a very close 5-set game against my old club:   
3-2 : 26-28,  25-22,  25-23,  25-27,  16-14.

I played libero, and didn't really notice how close the scores were until a few days after the game. But it was an early 8am game, 2.5 hours 5-setter game which drained me for the rest of the day.

After the ups-and-downs of changing clubs,I'm going to give this season with the new club a go. But, with a mix of oldies and young uns, I am also prepared for the personalities and conflict that come with the game.

Monday, April 21, 2014

13th IVF cycle - crash and burn (part 3)

Day 13
Egg collection and we arrive at Hollywood Hospital at 7.45am. The procedure isn't till 9.30am, so another long wait. At 9.25am I walk into theatre, hop on to the bed. Everything starts and at 9.30am I am out.

9.45am and I open my eyes - already! That is really fast. Nothing written on the back of my hand, no numbers. I ask how many eggs were collected, with not an ounce of inkling of bad news.

But now I know, when there's bad news, it isn't written on your hand. Only ONE egg collected.

I am in disbelief. That is simply not possible, I had at least 6 follicles at the last scan ..... shock. Disbelief. That's it, game over.

I collect Crinone and instructions. I am in tears and can hardly get the words out to the embryologist, and all they can tell me is what they've been given. No mistakes. No oversight. I've heard enough about the "all it takes is one good embryo" spiel. I really have.

As I sit and wait for Rob to pick me up, I treat myself - coffee and a chocolate biscuit. I really really need it to cheer myself up just that little bit.

Despondent, I have nothing left in me. I make an appointment to speak to Dr B, to discuss the protocol and meds. So not happy with the results of the last 2 IVF and Menopur.

I also consider revisiting my old doctor, Dr P who was at Hollywood and did my previous IVFs. He's now at Fertility Specialists WA. The "crazy lady" in me starts the ball rolling to get a referral to see him.

This is it. This last cycle, I've been telling myself - this one and one more. That's it. 2 more IVF cycles. To go from no embryo transfer in the last cycle, to a single egg collection - it's a sign. Is my body telling me it's time to give up?

As I shower that night, I do a practice run of the call from the embryologist the next morning -
"As you know, you only had 1 egg collected yesterday. I'm sorry to tell you that it didn't fertilize."
It's so much better to be prepared, and being mentally prepared this way for me doesn't hurt me at all.

I then start googling. First I start with "empty follicle". Apparently it's called "empty follicle syndrome" (EFS). Studies state that

"... EFS is a misnomer since the follicles are not actually empty, but rather that the oocytes are not aspirated or identified utilizing standard ART methods. EFS may represent a syndrome of impaired granulosa cell function, in which oocyte meiotic maturation is not resumed, cumulus expansion does not ensue and the immature oocyte–cumulus complexes are resistant to follicular aspiration."

or, perhaps to put it in layman's terms (from the Sher Fertility website):
Discussion: In cases where eggs fail to be captured at follicle aspiration, the patient is sometimes told that this was due to her follicles being “empty” thereby implying that the follicles did not contain eggs in the first place. This in my opinion, is a misstatement! All follicles contain eggs. The most likely reason for follicles fail to yield an eggs at aspiration is that the eggs were severely chromosomally irregular (complex aneuploid). Such “complex aneuploid eggs” often will remain densely adherent to the inner lining of the follicle, such that they will not come free with attempted aspiration.

The above website is a really good source of information and I wish I had read it prior to starting this cycle. I've never really grasped the whole agonist, antagonist protocols and feel like my doctor should be the one reviewing my results and changing my medication!

There's been no communication from the doctor since my egg pickup, and you would have thought that - ok, if you had a decent number of eggs then that's fine. But when you have such a poor result, and the poor patient in tears, surely some form of communication would be necessary? Some explanation? Some empathy? No ....?

I feel like the money that we pay towards "planning and management" of an IVF cycle which goes to the individual doctor should at least cover a session of feedback at the end of a negative cycle. Instead, you have to make a consult, pay the fees, and wait for an available appointment to see your fertility specialist. Not good enough.

Needing to understand how such a bad result can be obtained in my last 2 successive IVF cycles with Menopur, I have to read about the effect of LH and the role of testosterones:

How LH and FSH promote follicle growth and egg development: LH causes the connective tissue (theca/stroma) that surrounds the ovarian follicles to produce and release androgens (male hormones)…mainly testosterone. These androgens are then transported to the (granulosa) cells that line the inner ovarian follicles, where FSH then causes the conversion of (predominantly) testosterone to estradiol. As a result, the follicles grow, blood estrogen levels rise, and eggs undergo the developmental change (ovogenesis) necessary to allow proper preovulatory maturation triggered by the LH surge or by the administration of human chorionic gonadotropins (hCG).

My brain hurts so much, but these key phrases jump out at me:

..... it is important to maintain body’s own LH at a low level prior to and throughout the stimulation cycle. 

.... injectable gonadotropin fertility drugs such as Menopur and Repronex contain about as much LH-like activity as they do FSH.

"by avoiding protocols of ovarian stimulation that increase availability of LH, because it is excessive LH that leads to over-production of androgens by the ovary. Since women with DOR already over-produce LH, this is best achieved by:
  • Avoiding “flare agonist protocols” that cause increased LH to reach the ovaries exactly at the time that gonadotropin stimulation is initiated.
  • Avoiding over-administration of LH or hCG (which works in the same way). In my opinion therefore, the use of menotropins such as Menopur should be limited in women with DOR.
  • Avoiding the deliberate supplementation of ovarian stimulation with hCG or testosterone.
  • Avoiding the use of 250mcg doses of Ovidrel to “trigger”. In my opinion, if Ovidrel is used, the dosage should be doubled to 500mcg. Alternatively, 10,000U of hCG can be used.
the use of protocols where anantagonist (Cetrotide, Ganirelix, Orgalutron) that blocks LH release is first administered 6-7 days after ovarian stimulation has been initiated, should in my opinion also be used with caution (especially in women with stromal overgrowth). The reason is that by the time LH release is controlled through their use, some degree of irreversible egg damage for that cycle might have already occurred.

Antagonist protocols: There is another group of drugs that rapidly blocks the release of gonadotropins (FSH/LH) by the pituitary gland. These so called antagonists (e.g., Ganirelix, Cetrotide, Orgalutron) are traditionally administered starting 6-8 days after the initiation of controlled ovarian stimulation (COS).  I believe that this might be all well and good with COS in younger women that have normal ovarian reserve and in whom LH activity is not excessive. However, the initiation of an antagonist LH blockade starting as late as 6-8 days after COS is started fails to protect early developing follicles and eggs from the potentially ravaging effects of over exposure to LH-induced ovarian androgens. Thus, in my opinion, it is preferable to commence antagonist therapy at the point that COS with gonadotropins is initiated, rather than starting a week or so thereafter.

LH-containing menotropins: For the same reasons , the use of gonadotropins such as Menopur, that have a considerable amount of LH activity should  in my opinion   be limited in IVF, especially when it comes to older women, those with DOR and women who have PCOS. I submit that it is at all times preferable to predominantly use FSH-dominant, recombinant DNA-derived Follistim, Puregon and Gonal-F than to use LH-containing menotropins.

I am convinced that the drugs have had a big influence on this extremely bad result, and feel so mad that my time, effort and money has been wasted on a protocol that was wrong for me.

I feel like there should have been a better procedure to cater for this outcome, as apparently it isn't very common. There have been suggestions on how to deal with EFS and get a better outcome.

I wait for the dreaded phone call the next morning, it's late. As I lay in recovery yesterday, I overhear someone from the bed next door, they are providing donor eggs and 16 eggs were collected. "That's what the embryologist is busy doing - checking on her 16 eggs.", I think bitterly to myself.

and keep replaying this in my mind:

"I'm sorry but it didn't fertilize".

Prepared for the worst, and also from experience, prepared that one egg will not travel far in this IVF journey.

The call comes and the worst outcome is what I expected. Total bummer.

I chat to my husband on the internet as I continue googling. I find this bit of info, and wonder - did I trigger properly?

The question continues to haunt me. I fish out my Ovidrel pen which I was supposed to trigger with, and I also take out the unused Ovidrel pen which I was given after egg collection to use for support. I look at both of them.

DARN IT! The levels on both of them are the same!!!

Grimace. One more test. I dial the pen to 250 and push, liquid spurts out and the level goes down from 250.

Oh.My.God. I didn't trigger properly. 

The stuff up of losing our carkeys on Saturday night and triggering in the car - I mustn't have pressed the knob all the way in.

I am a total fool. I torture and beat myself up over this for the next few days. How could I have been so stupid????!!!!

All I can think of is - wasted money, time and effort on this cycle. Anything could have happened, the possibility of more than one egg, fertilization and ... a good embie.

Sigh. I am devastated.

My follow-up appointment with the FS at Hollywood is another disappointment. I confess to not triggering properly, but he shrugs and says it's also my age/eggs.

I ask him about the reasons for using Menopur, about the LH component contributing to poorer quality eggs, about what he would expect to see if I did an IVF with a high FSH, about my stimulation response, and finally about whether a change in drugs might be possible.

Dr B answers the questions but not in a very helpful manner and finally says in undisguised frustration that I need to stop questioning and just trust that they know what they are doing. I can continue doing IVF but he won't change the protocol and gives me a 2% chance of conceiving.

After my experience with Dr P, I am disillusioned and disappointed. Maybe I needed the reality check, that all the problems are due to my age. It's been 3 years since I last did IVF and had good results and embryo transfers.

I am resigned and disappointed. At 44, I haven't even got as far as an embryo transfer.

Wednesday, April 16, 2014

Broken blog links

I'm pretty particular when it comes to websites. Accuracy of information is important, and having worked in online content management for a while, a badly-designed website is one of my pet-hates.

If I find a broken link, I will usually try and send an email to technical support.

So I was browsing the internet not so long ago, and decided to plug in my blog URL into a free website-link-checker. And .... I had over 100 "broken links"! Guess I won't be emailing myself to complain about these links! And I probably won't ever get to fixing them anyway.

Broken link (you can scroll this field left-right)
Page where found
Server response
1url src404
2url src500
3>>url src404
4url src404
5url srcbad host
6url src404
7url src404
8url src404
9url src404
10>>url src404
11>>url src404
12>>url src404
13>>url src404
14>>url src404
15url srcbad host
16url srcbad host
17>>url src404
18>>url src404
19url src404
20url src404
21>>url srcbad host
22url src404
23>>url src404
24url src404
25url src500
26url src404
27url src404
28url src404
29>>url src404
30>>url src404
31url src500
32>>url src404
33>>url src404
34url src404
35url src404
36>>url src404
37url src404
38>>url src404
39url src404
40url src404
41url src500
42url src404
43>>url src404
44url src404
45url src404
46>>url src404
47>>url src404
48url src404
49url src415
50url src404
51>>url srcbad host
52url src404
53url src404
54url src404
55url src404
56url srcbad host
57url src404
58url src404
59>>url src404
60>>url src404
61>>url src404
62url src404
63url src404
64url src404
65url src404
66>>url src404
67url src404
68url srcbad host
69url srcbad host
70url src500
71url srcbad host
72>>url src404
73>>url src404
74url src404
75url src404
76>>url src404
77url src404
78url src404
79>>url src404
80url srcbad host
81url srcbad host
82url src404
83url src404
84url src404
85url src404
86>>url src404
87url src404
88>>url src404
89url src404
90url src404
91url src404
92url src404
93url src404
94url srcbad host
95url src404
96url srcbad host
97url src404
98>>url src404
99url srcbad host
100url src404
101>>url src404
102url src404


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