Nose surgery, skin cancer?

Wed 4.02.15 - Appt with my plastic surgeon re my nose surgery for my possible skin cancer. It was early! 8.15am appt, DH and I went early just incase but got there before him so had a while to wait while he got himself sorted. 

The consult was quick, we talked about my previous scar (cyst removal from my chest) and then talked about the upcoming IVF and how important it was to deal with this now and not after. He had a quick look at my nose and said "right lets do it". DH waited for me in the waiting room and I went into his surgery room and lay down.

He prepared my face to start, I had no makeup on so was a simple case of sterilising with wipes and then he began. The worst part was the local anaesthetic that he injected into just below my eye, all the way down both my cheek and nose and right in the tip. He apologised for the discomfort and then left me for 10 mins while the local did its thing.
It was the strangest feeling as it felt like it was spreading through my face so ended up numb from the eyebrow right down to my top jaw and teeth. He came back in, checked I couldnt feel anything, told me to close my eye to protect it from the blood and he began.

I could not feel a thing other than a big of tugging. The worst part was hearing my skin tear when he cut me with the scalpel and the smell of burning flesh when he used the laser afterwards. The actual procedure was quick and he had completed my stitches (all 7 of them) within about 30 mins. He patched me up then left me with the nurse to explain wound care and I was back the following Mon 9.02.15 to have my stitches removed.

I was then she told me it was not a Basal Cell Carcinoma. It was in fact a Seborrhoeic Keratoses. A very common and harmless skin lesion that appear during adult life. Otherwise known as a basal cell papilloma or senile wart (but not part of the wart family). Despite the name, they do not have the sebaceous origin. They begin as slightly raised, skin coloured or light brown spot (this is what mine looked like) but can thicken and take on a rough warty surface and darken and turn black, taking on the appearance of a melanoma. I am SO glad we removed it when we did. I was incredibly angry when first finding out they had told me I had skin cancer when I didn't and that it could have waited till AFTER our IVF as I now have to wear tape on my face right through our cycle but hey, its done now and it is what it is.

ICSI - so how does it work?

So this post is for those who want to know a bit more about what we will be doing this coming month.

What is ICSI?

1. Intracytoplasmic Sperm Injection (ICSI) is a specialised form of In Vitro Fertilisation (IVF) that is used for the treatment of severe cases of male factor infertility. ICSI involves the injection of a single sperm directly into a mature egg.

ICSI is very similar to conventional IVF in that gametes (eggs and sperm) are collected from each partner. The difference between the two procedures is the method of achieving fertilisation. In conventional IVF, the eggs and sperm are mixed together in a dish and the sperm fertilises the egg ‘naturally’. However to have a chance that this will occur, large numbers of actively swimming normal sperm are required. For many couples, the number of suitable sperm available may be very limited or there may be other factors preventing fertilisation, so conventional IVF is not an option. ICSI has provided a hope for these couples. ICSI refers to the laboratory procedure where a single sperm is picked up with a fine glass needle and is injected directly into each egg. This is carried out in the laboratory by experienced embryologists using specialist equipment. Very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this has been assisted by the ICSI technique. ICSI does not guarantee that fertilisation will occur as the normal cellular events of fertilisation still need to occur once the sperm has been placed in the egg.

Here are some videos:
http://youtu.be/vGbIL9QWSsM - 3D animation of ICSI procedure
http://youtu.be/gRqI3XThGrw - actual footage of ICSI procedure under microscope
IVF Patient Info - full info on IVF procedures

So what have we been up to?

27.01.15 - We had drug training at the Fertility Clinic. We went through what each of the drugs were, what they would do, how to assemble and dissemble the needles/pens and a schedule or days/times to administer them. Thought I was actually going to be able to practise jab myself with a needle today however I simulated it, that was good enough. Will be a different story when I do it for real in sure, i'm all "I got this" haha DH is not afraid to take over if necessary..

We were given our coolie bag along with a few other bits and pieces like progesterone pessaries (for after procedure), sharps/needle bin, alcohol swabs and of course the meds. They are now living in the fridge for the next 3 weeks while we wait to start our cycle.

 I will be doing what they call a Short Protocol IVF cycle, as I have previously responded well to previous Clomiphene cycles they are confident I should respond well to these.

I will be taking daily Puregon (FSH) injections from CD2-8, 175iu. This comes in a pen form and is super easy to administer. This will be taken in the evening. Same time every night.

On CD6 I start my daily Orgalutran injections. These come in preloaded syringes with the right dosage 0.25mg. Must be taken between 9-10pm. I'll continue those until clinic day.

CD8 - Blood Test and Scan day. We will find out what those pesky follicles are up to and find out if those drugs are working. Its apparently a low dosage but shes confident I will respond well.. shall wait and see! Ovarian stimulation is monitored by blood tests and ultrasound scans. Once the follicles have grown to the right size, a trigger injection of the hormone hCG causes the follicles and their eggs to undergo the final step in maturation.

Ovidrel or Buserelin which will be my Trigger injections (HSG). These will be given to me by the clinic when I go back to see them. Egg collection is then scheduled 36 hours after the trigger injection.

 So, in a nutshell, that is it. I will continue to chuck in some links so things make sense... and for me, its great having all the links in one place. I'm planning on DH videoing some injections so will post with my update when we start. Approx second week of Feb 2015 at this stage.

Eeek! Countdown is on. Better get reading, lots of information to absorb. 

Drug Training booked, countdown on!

Well xmas was meant to be a relaxed week with family. NOT! Haha we tried, our Xmas day took 3 looong days. Then my poor Dad got an infection in his surgery site and was in hospital for 5 days so i think i had one semi relaxing day river swimming and hill climbing. Ive realised I dont relax very well. Then back to work i went. I made it through a busy week covering for my workmate and decided that week to have a meeting with my boss and tell him finally. He took it really well and is really supportive so will look after me and help me reduce my workplace stress.

Drug training is booked! Tuesday 27.01 @ 3.30pm. Arghhh! That makes it real now. I will be sent home with my "pack" all ready to start once my Feb cycle arrives. Appt should take an hour. This months cycle was pretty light and short so i need to talk to my RE or nurse about that as I never know which day to call Day 1.

Ive been trying to up my exercise with stair climbing at work. I am aiming for 544 steps a day which is 7 flights 4 times a day. I need to get fit and also maintain my BMI which is sitting just over 20. It needs to stay 20-22. I ordered a prenatal/postnatal yoga DVD today so will crack into that when it arrives and plan is to bike also. Im not going overboard with the exercise as they also told me to relax.

Im also not going overboard with the prep. No acupuncture, no special herbs, no wives tails. Im going to ask my RE next week when i should stop drinking coffee, how much sleep do i need and is my diet ok? Apart from that im not stressing my self out about what i read online, ill just get tied up in knots over it. I have been watching IVF You Tube videos which a helpful, ive learned i might need a big arse bin to put all my empty needles in, wear loose clothes, drink heaps of water and think positive haha.

Soooo. Its nearly time! Im excited and nervous, trying really hard not to be anxious and stressed. Oh, forgot to say in 2 weeks time im having skin cancer removed from my nose, so once thats over ill be feeling alot less stressed hopefully. Just taking it one day at a time... Trying hard not to plan ahead.

Ill update after my appt next week...

  

Consent Appointment, Test Results...all booked for Feb 2015!

Tue 25.11.14 - IVF Cycle #1 Consent Appt, 1.50pm. The day had finally arrived.

DH and I decided to take afternoon off this day. 1) because I was soo anxious I could hardly concentrate that morning and 2) my Dad had surgery. We arrived early as we do for all our appts. Waiting room was full of couples today, avoiding eye contact as per usual, nervous looks on faces. 

Our RE called us in, it was DH's first time meeting her. Think he was relieved to finally see a woman as my last two OB/GYNs have been men. We got straight onto Blood and Semen Analysis. My Day 3 Bloods look fine apart from my Prolactin levels shooting up again. If you head back to start of blog this has been an issue before. Turns out stress is a likely factor, she asked how much stress ive been under and i laughed out loud! "Everyday" i said. DH's bloods had nothing to report, so far so good until we got to the Semen Analysis. Turns out this whole time DH has had sperm antibodies at levels of 100%. What does that mean you ask? Simplified it means there wasnt much possibility of us conceiving naturally and did 6 clomiphene cycles for nothing. Sighh. More info below...

It is possible to develop antibodies to sperm.  Almost always, sperm antibodies are generated by the man producing the sperm.  Most commonly, sperm antibodies are generated after vasectomy.  The areas of the testicles where sperm are formed, and the entire tract that delivers the sperm as ejaculate is immunologically isolated from the rest of the body.  Proteins on the surface of sperm are never in contact with the body to either be recognized as part of “self” or, under normal conditions, be deemed as foreign material.  Performing a vasectomy interrupts the normal barrier between the portion of the body which produces sperm and conducts them to the exterior at the time of ejaculation.  Once the barrier is breached, the body’s immune system discovers a new set of proteins, and believes them to be foreign invaders.  Therefore, the immune system begins to make antibodies.  Antibodies are large proteins which attach to sperm, and can interfere with motility or cover the head of the sperm, so as to interfere with the acrosome reaction.  To explain the last term, the sperm head is covered by a packet of enzymes called the acrosomal cap.  As part of the process the sperm undergoes to be able to fertilize an egg, the outer membrane of the acrosomal cap breaks down, releasing the enzymes.  Enzymes of the acrosomal capchange the membrane covering the sperm head behind the acrosomal cap allowing the sperm head membrane to fuse with an egg cell membrane.  Once fusion of these 2 membranes occurs, the boundary between sperm head and egg disappears, and chromosomes of the sperm enter the egg to fertilize it.  If the sperm head is covered by antibodies, none of these processes can occur.

Trauma to the male reproductive tract can also cause a defect in the barrier between the sperm production area and the immune system. 

So what that now means is we need a specialised form of IVF called ICSI. Its quite common actually, RE said the use it for at least 50% of most cycles performed. It is where they select one of the best sperm and inject it straight into the egg.

After talking about all that we had a quick run through of the timeline of the cycle, how the drugs worked, when retrieval willhappen and answered any questions DH had, she then checked her calendar.

"February, around the 23rd, how does that sound?" Marvelous! My grin was ear to ear. Even tho we were desperate to get started there was alot going on and DH and I needed to be ready. So we're all booked in.

I start my drug training as soon as my cycle starts in January so hoping thats when my workmate is back from leave, otherwise im going to be one busy girl trying not to wigg out. Then the countdown is on! Im really hoping my New Year resolution of early nights, healthy eating and no stress comes to fruition. I neeeeed this to work.

This year has been tough! I cant wait to start a fresh one. Update you when I know more.

It's happening!!

Good things really do come to those who wait! After nearly 24 months of waiting very patiently for public funding we made the top of the waiting list for IVF! Looks like 2015 will be our year. Surgery, recovery, everything couldn't have been timed better. Finally a win! 

Letter received 31 Oct advising we had reached the top of the list. Conveniently my cycle was only due this week so had a week or two to chill and wait. Cycle started 4 days early so caught me by surprise, must have been the long cycle last month, Clomiphene really screws with things.

So called clinic yesterday (CD2) and booked in for my Pre-IVF ovary scan and BMI weigh in. They booked me in for Friday but I advised the new patient Coordinator that I also need a trial Egg retrieval as RE keen to confirm that entry into my Uterus through my slightly left deviated cervix wouldnt comprimise the delicate procedure. My new nurse called me back and asked if I could shift appt to tomorrow as my RE wanted to do both. So this morning after DH and I went for our PreIVF bloods I went next door (they have blood lab next to my Fertility Clinic), they took me early which was great as i had prepared a very full bladder (maybe oversculled slightly in waiting room) i was ready! Thats for sure.

Nurse took me through to the procedure room and I got all gowned up. Small room! Esp with 3 of us in there. Had a quick chat about my previous scans and straight into it. Its pretty much like having a smear done, they use the long contraption to simulate harvesting my eggs while using a doppler to check where it entered my Uterus. no problems there she said and we all took a sigh of relief. Got dressed and headed to her office/medical room in the clinic part of the building (interesting setup!) for my internal ovary scan. That all went smoothly, we could see at least 15+ small follicles doing their thing so she is confident we should have enough on the left ovary. The right? Well we are leaving that one till stimulation to decide what we are doing there. Only option would be laprascopic retrieval and lord knows I dont have that kinda money. Its a wait and see. After that all that was left to do is call to book consent meeting to 'lock it all in' as DHs sample would be with the clinic Friday.

Confirmed.. Consent appt next Tuesday 25.11. We will be sitting down to go through the whole IVF cycle timeline with the RE. Looks like egg retrieval will be February 2015 due to avail appts. arghhhhh! Its really happening!

Called the hospital to let them know we wont be booking on for our 6th Clomiphene cycle, my nurse as Womens Hospital was super excited for us!!! Aww bless xx I said id keep her posted and no doubt if we are successful, she will see me pass through Fetal Medicine anyhoo, they cant get rid of me just yet.

So there you have it. Things moving quickly. Will certainly update again when we know more next week.

TTC - Clomiphene Cycle #5 - Oct 14

Tuesday 21.10 - Finally AF arrived, CD34 which means the Clomiphene is definitely causing me a few issues as almost always on time. I had my new 50mg prescription from the hospital all ready to go, so much easier not having to get my tablets cut in half. CD3 arrived and started taking meds, decided to try 7.30pm this time just incase of side effects with the increased dose, we'd soon know by the morning.  Weekend was super busy but was great, didnt seem to be having any issues apart from being thirsty. Was a long weekend and meds finished up on the Monday night. I had a thai curry for tea which I ate in a hurry and took my meds straight after. Lets just say not the greatest idea as was up all night with extreme nausea and vomiting, spent Tuesday working from my couch with a bucket. Im slowly starting to come right by CD12. 

Day 10 bloods showed my Estradoil levels were in the 1900s! Wow thats my highest yet, last month only in 300s and highest ive been is 700s so dosage increase definitely working. I'll post results when I get them from GP. Waited to get the call to come for scan.

Scan was 1pm Friday 31.10, Halloween. I had a new lady today, she had studied up on my notes which is great, however didnt realise id had surgery and my diagnoses was back to UU. I quickly filled her in on Streak Ovary and we started with a Doppler Scan to have a look at that one first as told her I had been getting pain in that location. She couldnt find a good shot of it so we moved onto internal scan for Endometrium and Lefty.  My lining was really thick this month, even I could see the difference so be interesting to see what it is incomparison to my normal 7mm. Cervix looked good, she had a quick hunt for the second cervix and tube they thought that had found last time. No sign. Left ovary had ALOT of follicles but we couldnt see and dominant ones. GREAT! At that stge I knew it was Streaky so we went back over and this time started scaning bit lower. Boom! There it was, so its right on my waist stretching from my right hip bone 4-6 cms across. It looked huge, so we came at it from all angles until we came across two sizeable follicles that stuck right out. Great stuff she said, I said not really as the are not going to be scooped up, ie no Right Fallopian tube. Oh well, thems the breaks, i had known it was that side as I could feel it, just was secretly hoping it wasn't. So we decided to wrap up the scan so I could get back to work. 

One of my Nurses from the hospital rang my cell at 5.30 to give me the good news re my follicles and I also had to explain to her that it was now a dud cycle and said id talk to her in another 20 days when we start Cycle 6 hoping Lefty will cooperate this time. That will be last cycle before Xmas, not sure if we can do one around Xmas, id rather keep going while we wait for New Year IVF news.

In the meantime I think ill pay visit to my GP and try and figure out why Im feeling tired, itchy and nauseous. 

Update when I know more.

TTC - Clomiphene Cycle #4 - Sep 14

First cycle back after a couple of months off and it was terrible! My cycle arrived right on top of a nasty virus, I had just started to feel better by the Saturday (CD3) and meds began. Still on 25 mg, not long till the mood swings, temp spikes and the nausea kicked in. I had mostlyrecovered by the time i went for my CD10 bloods which i did on CD9 as hospital had to check them being a Friday. I went before work and phoned hospital when i hadnt heard by 3pm. It turns out my Estradiol was only in the 400s. It should be in the 600s for them to book a scan. So we decided i should go for a retest on Saturday which I did. Hospital phoned Monday and my levels had dropped to the 300s so cycle therefore cycle void. Strange! Was it the op? Was it the virus? Was it the 2 month break? None of us really know. All I know is that I havent felt well for the rest of the month so hoping that improves before next cycle.

OB/GYN has decided to bump up my meds to 50 mg for next cycle (October) so watch this space!