3rd Time's The Charm...

3rd time is the charm...so they say?!  So it's only been a few days since I've stopped taking all my medications and boom the mother of all mother periods have already began!  I thought I'd have at least a week before this next round...and by the reaction from the clinic, I think they did too🤭.

So the process so far has been cycle day 1 notify the fertility center, cycle day 2, start taking estrogen, and cycle day 4-5, take a baseline ultrasound to ensure my lining is basically gone.

Even though everything on my ERA testing said it should have the results completed with a week or two...the fertility center said they did not have the results back yet and would need to reach out to my sister to find out if she wants to proceed without the results or wait until my next cycle.

(Internally I'm thinking...aren't there additional options?? Like what about calling to check on the results with the lab, or starting the cycle as normal and then if the test results come back as oops we needed to change something early on, then skip to next cycle.  Why waste an entire cycle if it isn't necessary??)

I reach out to my sister and share a few of my thoughts...she's also been a reaching out to the fertility center separately on a different chain....so I wait.

Day 2 I hear nothing back.  But being a little hard headed and not wanting to have the cycle delayed by not have starting estrogen day 2...I start the estrogen day 2.  (Luckily I still have plenty from my last round and am good to go, at least until they have an update for me 🤞🏼)

Day 3 I get an update from the fertility center saying that they received my results, they wanted me to start taking estrogen and then make an appointment for a baseline ultrasound and bloodwork! I was shocked they felt they could still start it on day 3? 

So no one really explained the results of my ERA to me, I just saw on the new calendar they provided, that it had literal hours on it.  (See below)

So what I read and began to interpret myself is that "stimulation" happens when I begin to administer the PIO shots.  Progesterone stimulates my uterine lining to begin to be susceptible to carry a baby.  So in my prior cycles they just said 5 days before transfer begin taking the progesterone at 9pm...this one was oddly specific in saying to take the progesterone at 10:20pm, 5 days prior to transfer.

My wall of past and present calendars and shot instructions 

I'm still not exactly sure how they know all of this or what specifically they found during my test.  I'm curious as to whether anything had to change from the first cycle to now or not?  So many questions!  But for now...I will follow my protocol and update if anything changes 😊

ERA Day

Okay so it's arrived...today I was scheduled for my ERA, which was described to me a few different ways.  I was told it would be similar to a transfer (so far, one was difficult and one was easy) so I had an idea of how that part would go...then instead of a release of eggs...it would be a quick pin prick feeling inside my uterus while they capture the lining to see what stage my uterus was in and if it would have been receptive to a blastocyst implanting or whether my timing is not like the average girl (shocking) and need to move.

The second way it was described was that it would be very similar to a pap smear.  Hmm okay..both things not extremely joyful, I would describe them as uncomfortable.  I've never had my husband or anyone around for those...so I let him know I'm done to go by myself to this appointment.

Okay so let me start by saying the nurse practitioner who performed it was very nice and did a wonderful job explaining what she was doing and even showed me the biopsy she got after she was done, which made the ordeal a little easier.

But this was NOTHING like a pap smear or a small pin prick!  They use a small vacuum tube with a blunt end and ram it into your uterine lining over and over to agitate it, suck it into the tube and continue doing so until they have what I can only describe as like a pencil sized tube with the eraser sized tissue crammed into it.

It was very uncomfortable and now that it's done am very thankful that I don't have to go through with it again.  Let's hope we truly get the results we need out of this! 🤞🏻🤞🏻

Next steps?

Tonight I no longer take the progesterone shots and instead begin taking a medication that's supposed to regulate your cycle and continue the estrogen together, for five days.  After those 5 days I stop taking both and within a week I should start my next period....which means round 3!  

Stay tuned ...

You're late...

 So this morning around 8:45am, I'm at work and I get a text saying, "Hi Summer, you've missed your appointment this morning for lab work, are you on your way?"

Uh, what?  I quickly look over the appointment paper that they gave me...no appointment.  Then I look over the string of messages they send on this app called Klara...nothing about an appointment. So now armed with this information, I feel confident that they are reaching out to the wrong Summer.

After a few exchanges back and forth...I guess it is me they want.  Although my last labs from Monday came back as negative for progesterone they want to check again to ensure that before I begin taking PIO shots tonight...that my levels are still very low.  (Having progesterone in my system early would mean by body could ovulate on its own, instead of allowing them to hijack it on their timeline, which is what IVF does)

Okay sure I'll let work know that there was an appointment scheduled that they forgot to notify me about and I have to go to Gilbert to complete lab work.  Ugh.  Oh well...it is what it is and luckily my job is very flexible. Whew.

My biggest concern at this point is I've been wearing long sleeve shirts because my left arm still has a major bruise from the phlebotomist royally sucking it up.  

...a few hours later I roll up, quickly get called back and low and behold it's the same phlebotomist!  Oy vey...she asks to see my right arm because it's closest today.  (I think to myself...there's no way she's gonna screw this one up too.  I'm sure it was a one off.  The funny thing is...I've been going here for months...and I don't think I've ever had the same person draw my blood.  Yet I have some how won the bad phlebotomist lottery and lucky me get her twice when my other arm still looks like a junkie 💉😬)

After a less painful draw...I leave bandaged up and scurry back to work.  After about an hour I remember I have this darn bandage on my arm!  So I pulled it off and boom...looks like she screwed up this arm too😞.  

In 100+ degree weather...I will now be wearing long sleeves for the foreseeable future thanks to Ms. Jabby Jabberson the horrible phlebotomist.

For your viewing pleasure...here's my lovely arm pokes after about two hours on both arms.  (Monday and Wednesday)

Monday (8/7) two hours post jab left arm

Wednesday (8/9) two hours post jab right arm

I didn't end up getting a photo of them both a few days after...but trust me, the people who saw them were like holy canoli keep those covered up 🥲.

Wish me luck...PIO shots start tonight.💉😲

Lining Check Pre ERA

This morning I went in for another ultrasound, to check my lining.  The doctor quickly looked at my left side and I saw him take at least one measurement of what appeared to be a cyst.  He said it was approximately 3-4cms, but so far wasn't producing any hormones, which is great, and wasn't cause for concern.  (Okay...I guess this is kinda normal...I read that they can get large up to 10cms before they become a concern.  Usually these cysts rupture on their own and become a non issue.  Their cause?? Hormones.  Increased levels of Estrogen can be a cause. Haha sooo, shouldn't be surprised.)

 Other than the measurements nothing really of note to share.  He mentioned that he wanted me to have blood work done to measure my hormones again, specifically progesterone to see if the cyst is still not producing anything, and mentioned he would talk to my sister and let her know that either ERA test would be fine.  He said they should get the results within a week or two and it should be perfectly timed for my next cycle.

After a quick "goo" cleanup on aisle thigh...I got dressed and stopped over at the lab to get a quick jab.  (Ouch!  I'm not sure the gal knew what she was doing...a little rough and I have easy veins!)

Okay...next appointment will be Monday, August 14th for the ERA.  I'm a little nervous, but the doctor assured me that as long as I take some ibuprofen it will feel just like a little pin prick 📍.  So here's to hoping it's simple and fairly pain free.🤞🏻 

P.s. Progesterone shots 💉 start again on Wednesday 👀not sure if Phil has mentally recovered from the last round so I better make sure he's prepared 😜!

CD5 Baseline Check

On Friday morning (7/28) I notified the clinic that it was my CD1.  Shortly thereafter I received my new ERA schedule from them along with a question about which ERA testing group I'd like to go through with.  (They must have sent the same information to my sister, because she sent me a screen shot of her response to them asking which test company the doctor recommended shortly afterwards.)  

I still had Estrace left over from my last go around in June, so that was easier to start this time (last go around was like racing against a clock)!  The progesterone will need to be refilled, but according to this calendar...I've got some time.  

As you can see, my appointments for the month had also been scheduled, so I quickly made some arrangements to be available for my Tuesday, 8/1 ultrasound check.

**Flashback**When I went through this in June, it was rather unpleasant.  I was on CD4 then and was still having a regular flow.  (As I have gotten older my periods only last about 5 days.  Heavy CD2-3 but light until about CD5 and by 6, I'm golden.) They assured me they were expecting a flow and this would ensure my lining was at its thinnest.  

**Present**Okay so this time around my CD4 is like CD5... because today was CD5 and guess what? No flow.  Like none.  I was ecstatic about not having to deal with flow and an ultra sound "wand" again. Everything else about the period was pretty normal, other than the flow just lightened up pretty quickly, so I wasn't really worried or questioning anything at this point.  

I arrive at my appointment, get called back rather quickly and then am told the doctor is busy doing "retrievals" all day so he would be in when he could.  First I thought, wow this is like the second time I've had to wait longer than 5 minutes...why didn't they just schedule me with a nurse like they always do? (Last go around I didn't see the doctor once!  Not once.)  Anyhoo for now, I'm not going to question it! Haha they had me scheduled with the doctor for both my appointments this cycle so far, which is a welcomed change, so I'm not questioning or complaining.

After waiting for about 20 minutes, a knock came to the door and the doctor was greeting me with a friendly hello.

Okay so these visits are never the greatest, I mean...it's awkward.  You're laying on a table, legs spread, covered in a cheap napkin, with a wand being moved around inside of you, making small talk, all while trying to decipher what the heck is what on the screen 🤪?!  However, having been to several dozen of these types of visits over the course of my pregnancies, I will say that he made it a little smoother.  

In a quick few minutes he was able to spot my ovaries, follicles, and two cysts growing on my left side.  He noted that my lining was growing quicker than expected, even said it was close to being thick enough for an ERA now, technically.  He wasn't worried about the cysts, since that's how we ovulate, however he was concerned that they might be producing hormones.  So he requested blood work, to check my thyroid, progesterone, and leutenizing hormones and told me that once the blood work returned the results, he would ensure his team followed up with me on any updates to my current treatment calendar.

**Next Day Update** My thyroid levels were a 3.2, which are within normal range; however, aren't optimal for what the doctor is looking for.  So he's increasing my dose by an extra 100mcgs a week. (Adding pills to my normal daily dose, a few times a week)

My progesterone levels were >.01 (which means my cysts aren't producing hormones... yay!) and my LH levels were normal and showing that I am not about to ovulate.

They would like me to continue Estrace as prescribed and would see me back on Monday for my second lining check on Monday.

He Exaggerated The Length?!

I received a call last night around 5pm asking if I was available to come into the office today for the faux tranfer with the doctor.  (Talk about last minute notice). Luckily, I was able to swing it and scheduled the appointment.

I walked into an empty office (maybe it was lunch time?) and took a seat.  I was feeling a little nervous, which always makes me feel like I need to pee...so as I'm quietly contemplating whether to run really quickly to the bathroom (they didn't tell me to come with a full bladder) a door opens and they call my name.

Welp, I decide I really don't think I have to go (probably nerves) and follow her back. 

She's super sweet and tells me to undress from the waste down.  Luckily, I was prepared and wore a dress👏👍.  So within a minute I'm wrapped in paper with my bare bum on the napkin covered reclining bench thing that are in every OB/GYN office ever.

A moment or so later the doctor knocks and pops his head in asking if I had a full bladder.  After a quick internal status check I let him know that I do. Which was the answer he was looking for!  Apparently they forgot to instruct me to come with one.  (Okay so my bladder wasn't really full or at least didn't feel full...but again I was nervous and I don't think it was empty...so they were getting what they were getting)

Another moment or two passed and the doctor and a team of two other ladies joined me in the room.  We had one nurse with the over the top ultrasound, just like the original transfer and the other was assisting the doctor with the speculum thing.

As they were adjusting everything I made sure to say, I hope that's the longest speculum you have?  Because I was told that my vagina needed the longest one, because my canal was sooo long apparently 🫣.  I wanted to make light of it but also prepare them so I'm not being poked and prodded anymore than necessary...right?

The doctor looked up and said wow, I'm sure that's something nice to hear when you're lying on your back and shook his head looking at the nurses.  (I could tell he wasn't pleased with the comment that had been made).  I just said hey...I've had six children, I can understand things aren't exactly in tip top shape...but I have never heard that I have a long vagina before....ever.🤣 I will own it if I do...just wasn't expecting it😕.  

He was so kind and said that he has done thousands of transfers and he has had some difficult transfers, but none were due to a long vagina. Haha.  He said some ladies develop fibroids which can cause the canal to seem like it's longer...but the canal can only go so far.  He then promised to give me the good, bad, and the ugly truth during the procedure and was ready to begin!

So first of all let me start off by saying, the ultrasound wasn't uncomfortable at all this time (my bladder wasn't about to explode)...she guided him with the ultrasound and within a minute he said okay I'm in, transfer would take place here!

I looked up shocked and said, you're already in?  So what's going on in there?  He said there was absolutely no abnormalities, my vaginal canal was within average length (never thought I'd be relieved to hear I'm average 😉) and he was trying to figure out why the previous doctor had such a difficult time.

Once he was complete he suddenly asked me if my bladder was overly full on the day of transfer. (Um yes!)  It definitely was!  He said that when bladders are overly full, it can push out the catheter, which can make holding it steady difficult, but you either ask for your nurse to hold it or you get creative and hold it in with your knee...it's not using extra length though 🤷‍♀️😜!

I appreciated the update and oddly felt relieved that I don't have a long vagina.  I also am sooo happy because I will make sure that the next time I'm having this procedure performed...I'm underfilling my bladder!!  It was so quick and I didn't experience any discomfort (well any more than you'd expect with a speculum and catheter being put into your hoohaw)!

So first test done!  Next step... Mock Cycle.🥳

Testing, Testing...1...2...3

So last month (June) we left off with a negative pregnancy result and no update on whether we would be proceeding with another round.  It was nice to enjoy 4th of July without the pressure of running back home to receive a shot or being on my period (small wins)!  

My cycle began the day after the 4th, so just a few days shy of where they said it would begin and because I hadn't received an update from the clinic or my sister - I didn't have any pills to take or things to track.  It was a HEAVY few days, but luckily working from home, made it a little more bearable.  

On July10th the clinic scheduled a follow up appointment to go over the results and possible reasons that the transfer did not end with a positive result.  The doctor that has been overseeing my care, was out of town for the actual transfer, but did have the scans, lab results, and notes from the doctor who performed the transfer and felt that there should have been no reason that the embryos didn't implant. 

After looking over the results, he felt that it might be that my cycle isn't like the average woman...so perhaps my uterus was ready prior to the transfer...there is only a 24 hour window for the "magic" to happen.  Since this isn't really anything I've tracked or paid attention to, like um ever...I have no input here. 

My sister mentioned that the transfer was really uncomfortable for me...and that the doctor mentioned that he had a difficult time with the transfer (remember the comment about the "long vagina" LOL).  She asked if this had something to do with it not working.  He said nothing was said in my file or showed in the scans how my anatomy could have made the transfer difficult, so he asked if I would be willing to do a faux transfer, where he would perform the same procedure, but without an embryo inside.  This would allow him to get to know my "anatomy" and prepare for any adjustments that might need to be made when a transfer takes place.

After further discussion, the doctor recommended that instead of a transfer next month, we proceed with an endometrial receptivity analysis (ERA).  Which basically consists of doing the same things as a transfer cycle (taking estrogen and PIO shots five days before "transfer") but instead of a transfer, they take a biopsy of my uterus (similar to a pin prick and send it to an outside lab for review) so they can see if my uterus would be susceptible to a transfer during that same time frame or if they need to move it before or after.  Once they can determine timing, they will proceed with another transfer of two embryos in September.  According to the testing websites, 30% of women have different windows of implantation (WOI) so if I fall in that category, this will help to remove that as an obstacle for implantation.

I've opted to go through with both the faux tranfer this month and the mock cycle and the ERA next month...so wish me luck and let's hope we get some answers with the additional testing and the two month transfer delay is worth the wait 🤞❤️!

Coopergenomics ERA Testing Brochure

ERA Video