Begin life at forty

Tag: canceled IVF

  • Canceled IVF Cycle 5, July 2023

    ​​​Two weeks before my baseline ultrasound and blood tests, I was nervous and anxious about my upcoming cycle. It was the first time I found myself emotionally and physically unavailable for the treatment, feeling negative and doubtful. I wasn’t certain if I could proceed with the treatment.

    My immune system was badly affected by allergies, despite it not being an allergy month. While helping S build two flower beds in the backyard, I might have exposed to allergens or fungi when touching the old soil and decayed leaves. I ended up with constant runny nose and relentless sneezing, which forced me to take Clarins even though I didn’t want to. Additionally, I experienced swelling in one spot of my gum for unknown reasons, slow healing of a scratch on my hand caused by Sam, and sudden pain in my left knee joint. My muscles were stiff and my entire body tensed up.

    S took me to a spa for a massage, which provided temporary relief. However, I still felt exhausted, and deep down, I sensed that my body wasn’t fully prepared for the treatment. I hesitated to order stimulation drugs, unsure if the baseline ultrasound and blood tests would provide the green light to proceed. It was the first time I mentally prepared myself for the possibility of failure right from the start.

    The test results revealed active cysts in both ovaries and a high estradiol level of 128 pg/mL, surpassing the expected 50 pg/mL. Therefore, the doctor decided to cancel my cycle and put me on birth control pills, Norethindrone Acetate and Ethinyl Estradiol (1.5 mg). I started taking these pills on 6/26 and will discontinue them on 8/7. However, I am not fond of being on birth control pills, especially for an extended period. I had expressed my concerns regarding the risk of ovary over suppression multiple times to the doctor, and while she understood, it seemed she didn’t weigh that risk as heavily, considering the benefits it provides in preventing cysts and facilitating the clinic’s scheduling.

    I felt trapped, unsure of how to strike a balance between resolving the cysts and ensuring that my ovaries respond well to the medications. Given my age and the past negative experience with prolonged use of birth control pills in the second round, I worried that I would encounter the same outcome in the future. When I asked about an alternative to birth control pills, the nurse mentioned the possibility of using long Lupron, but she added without an explanation that the doctor might not want that option for me. I was advised to talk with the doctor to understand possible solutions she could offer. This means I would have to book an appointment with her and wait for at least a month for the appointment. I hesitated to do this because though we previously discussed how to avoid the development of cysts during the stimulation phase, we have never talked about how to resolve cysts that occurred before stimulation injections. This is the first time I’m experiencing active cysts before stimulation, so I persuaded myself to try not to overthink or overanalyze the situation and to follow the professional instructions without questioning, believing that the medical team is providing the best care they can.

  • Fantasy and post IVF visit

    ​Fri, 5/26: I had lived in my fantasy world when my period was almost a week late. In that magical realm, all the long-standing infertility struggles we had endured were magically resolved. A miracle had occurred, washing away all the exhaustion, fear, and pressure. We were on the verge of experiencing the joy of parenthood, which would bring a sense of fulfillment to our marriage and lead me down an exciting and challenging path. The presence of our little one filled me with excitement, instilling in me the determination and motivation to overcome any obstacles that might come my way. However, this fantasy ended abruptly today with the arrival of my period. Though it was late morning, I still lay in bed, closing my eyes and holding onto the fading remnants of that illusion before it vanished completely and I had to face the harsh reality of continuing this foggy journey.

    Once my dream world had been shattered, I became worried about my period. It was bleeding but not fully. It was sparse and infrequent. I had no idea what’s going on with my body. I felt lost and clueless about what steps to take next in order to make the treatment work. Every time I dwelled on this journey, a wave of darkness, heaviness and disorientation washed over me. My once unwavering determination and desire for success were wearing thin…

    Sun, 5/28, I was feeling down. When I thought about my unusually light, dark brown period, I was wondering if it had actually started. I started to question about the benefits of my diligent indulgence in various supplements (Ovasitol, fish oil, NeoQ10, prenatal vitamins, True Niagen, DHEA, and Vitamin D3) for over a year, hoping for a positive change in my IVF treatment. I have restricted myself not to do this or only do that to maintain a healthy lifestyle. Yet, regardless of my efforts, the result hasn’t changed. It seems the more treatments I have, the worse the results turn out. When I was hit by my period, I gave myself a day to temporarily forget that I’m an IVF patient. I skipped taking supplements which made me relieved, and ate whatever I wanted to pamper myself.

    Tue, 5/30: I was nervous before the consultation with the doctor. I wasn’t confident that the doctor would be able to provide me with a definitive answer regarding the reasons behind the continuous failures or give me an effective solution for the next cycle. There were numerous questions I wanted to ask, but at the same time, I had a feeling that the doctor’s responses might not be new to me.

    Anyway, below were basically my concerns and her explanations:

    1. Baseline hormones: Estrogen of the 4th cycle was 32.8 pmol/L, compared to 19 pmol/L of the first one – it changed but the difference wasn’t much as both levels remained in the low range.

    2. Baseline scan of AFC: It was good with 24 follicles (the 4th cycle) compared to 19 (the 1st).

    3. AMH: 2.3 (the 4th cycle) compared to 2.7 (the 1st measured in March, 2022). Slightly decreased but is still a good number of egg reserves.

    4. Dominant follicles during stimulation: It’s not unusual as long as the blood tests show normal results. Sometimes, doctors may consider sacrificing dominant follicles and prioritize the growth of smaller ones. However, in my case, it was likely that the giant follicle sucked up most of the medication, leaving little for the smaller ones, leading to their slow growth despite the normal blood tests. The doctor advised against prolonging the stimulation phase beyond 13 days as doing so could potentially lead to poor quality eggs. I’ve experienced the issue of dominant follicles in 3 cycles and each time the cycle was either canceled or only few eggs were retrieved. It’s still unclear what she can do to prevent it for the next cycle apart from prescribing birth control pills that I have taken in each previous cycle.

    5. Decreased Estrogen during stimulation: During the recent stimulation, my estrogen decreased but then bounced back up the following day. Again, there was no single clear reason for this fluctuation. It could be attributed to factors such as Letrozole or Cetrotide or age or an unknown reason. There’s only certainty is that my body has responded extremely poorly to the drugs.

    5. Light menstruation: Despite having a short, brown, and extremely light period, the doctor assured that it should not be a concern. She added that a heavy menstruation is more concerning to her.

    6. High FSH: A year ago, my FSH was high, 15.9. When I consulted a Vietnamese IVF doctor, he told me to wait at least 3 months before proceeding with IVF; if I insisted on immediate treatment, “you would never be successful”, he emphasized. However, my IVF doctor and the embryologist didn’t take into account this marker when I first questioned them. I brought this up again today and she reaffirmed that FSH isn’t a determining factor in the pregnancy rate. According to her, AMH is more important. At my age, when the successful pregnancy rate is significantly reduced due to the higher rates of embryo abnormalities, the more eggs I have, the better the successful rate will be.

    7. Protocol for next cycle: The doctor suggested two protocols for me to consider: the Cetrotide protocol and the microdose protocol. She mentioned these would be the only ones available for me, which contradicted what she said earlier about their being no limits to how many times I wanted to try; they always had treatments as long as we could afford them. (Maybe I misunderstood?!?) Anyway, I’m not dwelling much on it. I still stick with my plan to continue the treatment in Vietnam if my attempts here fail. My next cycle was scheduled for July 8, 2023 and the protocol will be microdose using Birth Control pills, Lupron, Gonal F and Menopur.

    In general, the doctor couldn’t really pinpoint the causes of the issues, why it happened that way or give me an effective solution. All she has done and is going to is trying different protocols and hoping one of them will work for me.

  • ​Canceled IVF Cycle 4 (Round 3), May 2023

    Paid $4,494.45 for medications.

    Sun, 4/9: period (disappointingly light flow)

    Wed, 4/12: start BCPs 

    Tue, 4/18: specimen collection 

    Tue, 4/25: stop BCPs (taken total 14 days)

    4/28: baseline ultrasound and blood tests

    Worried that if there was a cyst, I would lose the chance to do the treatment. Luckily, the results turned out normal with 13 follicles on the left and 11 on the right.

    Sat, 4/29 (day 1 of stim): 300 unit Gonal F (PM), 150 unit Menopur (PM), 100 mg Clomid 

    Sun, 4/30 (day 2 of stim): same doses, same time

    Mon, 5/1 (day 3 of stim): same doses, same time

    Tue, 5/2 (day 4 of stim): same doses, same time

    Wed, 5/3 (day 5 of stim): Same doses, same time. Added 5 mg Letrozole (2 tablets).

    – ultrasound and blood tests: one 12.5 mm on the left and one 13.3 mm on the right with many tiny follicles. It was good that there were no dominant ones.

    Thur, 5/4 (day 6 of stim): Same doses, same time as on Wed, 5/3.

    Fri, 5/5 (day 7 of stim): Same doses as Thur, 5/4, different time: AM: 300 unit Gonal F, 0.25 Cetrotide, and 5 mg Letrozole (2 tablets); PM: 150 unit Menopur

    Ultrasound and blood tests: Not good. A dominant follicle appeared (19.7 mm on the right). The second biggest one on the left was 13.6, showing minimal growth compared to its size of 12.5 mm two days earlier. Additionally, Estrogen decreased from 331 to 281, indicating that follicles didn’t grow as expected, increasing the risk of the lack of ovulation. Was instructed to continue stimulation injections and go back to the clinic for ultrasound and blood tests the next day. If Estrogen didn’t turn around, the treatment would be canceled.

    Sat, 5/6 (day 8 of stim): 300 unit Gonal F (AM), 0.25 Cetrotide (AM) and 150 unit Menopur (PM)

    Ultrasound and blood tests: The dominant follicle jumped to 22.7 mm and the biggest second one was 15.7 mm. Other follicles were less than 10 mm and the scan showed they didn’t grow. However, Estrogen slightly increased to 336. Was told to continue stimulation injections and went back to the clinic for ultrasound and blood tests the next day; the possibility of cancelation was also mentioned. If I proceeded with the retrieval, the maximum number of eggs expected would be only 2.

    Sun, 5/7 (day 9 of stim): 300 unit Gonal F (AM) and 0.25 Cetrotide (AM)

    Ultrasound and blood tests: One 18.4 mm follicle on the left and one 25.5 mm follicle on the right.

    Canceled the cycle following the doctor’s recommendation.

    Going to have a consultation visit with the doctor on Tue, 5/30/2023 regarding an overview of the recent failed cycle and a protocol to be considered for the next cycle.

    I still have 3 boxes of 300 unit Gonal F and 2 boxes of Cetrotide in the fridge. Need to remind myself to check the fridge’s temperature first thing in the morning to make sure it stays within the safe range. For the next cycle, I plan to buy enough medications around the ultrasound and blood test time, instead of buying all at once as my treatment can be stopped any time if the tests don’t show normal results. I actually tried this way last time because I wanted to avoid wasting medications, but ordering them was incredibly nerve-wracking. I spent hours anxiously on the phone, finally being able to talk to the pharmacy’s representative and place the order. I had been so worried that I wouldn’t have medications when I needed them. I then asked for the representative’s email in case I can’t reach anyone by phone next time. But I’m not sure if avoiding potential waste of money is worth the stress I experience. I can’t afford the risk of not having medications, especially on weekends and Monday mornings. The pharmacy doesn’t ship on Sunday but ships overnight during week days but the delivery usually arrives around 9 am the next day while I may need medications earlier in the morning – I typically take morning injections at 5 am so that S can leave for work after giving me shots.

    I was utterly defeated each time our IVF failed but this time I’m not feeling as devastated. It’s probably because I still hold onto the hope and have chances to try again. And deep inside, my emotions have been crushed so profoundly that I told myself, “Enough is enough!” I can’t continue living a life feeling incomplete due to this any more. I need to live life to the fullest though it’s incomplete. Also, what truly helps me stay strong after the stressful experiences is that I no longer hate or get disappointed about myself. This is so meaningful as it allows me to enjoy life with all the blessings I have been given. In previous failures, I was struck by the double blow of the bitter disappointment from unsuccessful IVF attempts and the self-hatred.