Tuesday, December 27, 2011


My nurse asked me to get my HCG checked before starting estrace.  I did and it came back 17.  I was 7 weeks post D & C at the blood draw.  It should be zero by now. 

I  am going in tomorrow  (8 weeks post) to have my HCG checked again and it needs to be below 5.  If it does not go down, my nurse said that I could have retained tissue.  If I have retained tissue I think it means another D & C...  I have read a few cases online where woman have slow falling HCG numbers and they did not have to have another D&C.  I'm really hoping I'm in that camp. 

Also, I can't start estrace/my cycle unless HCG is below 5.  I'm already playing out worse case scenario.  I want to think positive thoughts, but it's been really hard. 

I wish the IVF crystal ball would appear and tell me what to do.  I still wonder if we are just wasting our time with me.  I'm making normals, but are they healthy eggs able to get the job done?  I'm worried about another failed pregnancy and another D & C.  The one thing I've have going for me is my lining.  I do not want to screw that up.

I guess I will have an answer on Thursday. 

Monday, December 19, 2011

A little Sad

I found my sadness.   

As the Christmas cards come in I am reminded of how I wanted to announce our pregnancy via a holiday card.  I think about how I would be showing by now and feeling our baby kick. 


Newbie - protocol 3 or the Shoyer protocol worked to combat my dominant follicle issue several years ago.  I had my best two cycles as far as follicle numbers and no dominant.  You take ganirelix  and estrace before your period starts.  As you know, the protocol can work different on you.    
When I cycled with the progesterone protocol we saw better quality eggs, but I had a dominant.

I've chosen to go with the protocol 3 hoping we can get more eggs.  I'm hoping half the reason we saw better eggs was because of CCRM's lab.  My estrogen toward the end of my cycle was only slightly higher.  Was this because I was younger?   

I'm an ongoing science experiment.  Come read what my body does next!        

Sunday, December 11, 2011

3s a charm

Wednesday was Day 1 (5 weeks from D & C) I had a normal period with no crazy bleeding, cramps or issues.  I have my calendar from CCRM.  I've decided to go with protocol 3.  The protocol that first gave me hope two years ago.  If everything goes well with my HSG and baseline, I will be in CO in early January for our 3rd CCRM IVF.

Friday, November 25, 2011

I'm back

I had the D & C and everything has been ok.  I had spotting for two weeks then everything stopped.  I had my two week follow-up appointment and everything seemed ok.  My OB did not do an ultrasound just an examination.  I haven't had the crazy emotional experience I had with a previous early miscarriage.  I've been teary off and on and a little in disbelief.  

Mostly, I feel thankful for having an opportunity to carry a baby even if only for a short period of time.  It was amazing seeing a heartbeat, even if it wasn't perfect.  I loved that my breasts were swollen, that I had horrible heartburn and was sleepy.

There is not a day that goes by where I don't think about how lucky I am.  I have a husband that supports my journey, an egg, and the resources to pursue IVF. 

I had my follow-up with Dr. S.  He thought the miscarriage was a fluke.  He encouraged me to talk to someone in their DE program.  I told him about RBA and he looked them up while I was on the phone with him.  He thinks I would have better success with CCRM. 

We are leaning toward another ER with CCRM.  I was at peace moving forward with DE until this cycle.  Now I am giving myself one more shot.  I really need closure before moving forward.  I am preparing for both.  I am busy testing and filling out paperwork.  We are going to pay the DE deposit.  I'm hoping to have the ER and begin gearing up for an ET with OE or DE.  Working with two out of town agencies should be fun.  You should see my kitchen table.  It is stacked with paperwork and multiple to do lists. 

I'm wondering how I will endure the holidays?  Last year I was fine.  I'm hoping the same for this year.           

Because I cannot leave comments for some weird reason -
Just a girl - Don't forget to bring your camera.  We took a picture of our little one and it was so cool to look at.  After the transfer I would just stare at it in disbelief.  I wish you all the best!

Saturday, October 29, 2011

D & C vs Natural

Caution - this is a debbie downer and I hate to be the sad one.  I want to be happy.

I have a D & C scheduled for next week, but I think natural might be the better route for my body.  On the other hand, I'm ready to move on.  I have to redo all testing again before we can proceed with another ET.  I hope I pass the mammogram.  Last year was scary and I always wonder if everything is ok.  There are so many obstacles.

I still feel pregnant.  My breasts are sore, fatigue and a crazy sense of smell.  My body is hanging on to this pregnancy.  I am ready to let go.

I've been in treatment for over 3 years.  I really thought CCRM would be our answer and I would be pregnant before the holidays arrived.  I know I need to change my way of thinking and just hope that sometime between now and the next three years we will have a child.  I know that if you try long enough you will have a baby.    

Sunday, October 23, 2011

Same place

I had another ultrasound on Friday and our little one is still hanging on - 68 beats and no growth.  My gestational sac is growing appropriately.  I still have the same pregnancy symptoms. 

Everything is looking very bad, but they still want me to stay on meds.  They are releasing me to my OB so they can decide what to do with me.  Apparently, I have a unique pregnancy.  I want to stop pumping myself up with drugs.  I've thought about stopping.  I'm hoping to see my OB tomorrow to end all of this.  I think it's an ethical thing - I think the ultimate choice is up to me.  The Doc doesn't want to be responsible.  My CCRM nurse isn't sure now if I will have a natural miscarriage or a D & C.  Again, it will now be up to my OB.

I'm a little disappointed that we haven't heard from Dr. S.  I feel like he is leaving the tough choices up to me and my OB.  I hope I'll have a chance to talk to him at some point. 

Most of the time I'm ok.  8:00 pm is the bewitching hour.  I get very weepy and start going over all the things that I may have done to cause this...  I have a new empathy for anyone who has had a miscarriage.  I wonder if you are young woman have a different kind of experience?  Who knows?


Monday, October 17, 2011


We have to wait until next week to have another ultrasound.  They want me to stay on all meds because we have a heartbeat.  My nurse does not believe the baby will survive.  I'm also showing venus legs (bleed).  I'm still not bleeding or cramping. 

I want to stop the meds and move past the bad news, but I don't want to be the reason our baby's heart stops beating. 


Stopped growing

Just returned from our ultrasound.  Our little baby stopped growing and it's heartbeat has slowed down to 80 beats.   We both thought the heartbeat looked like it was beating faster.  She had me hold my breath.  Honestly, I don't think it matters because the baby isn't growing.  I'm not spotting and no cramps.  I am a little nervous about the miscarriage.

We have a few questions for Dr. S.  We put back a normal - what happened?  What are the suptations in my gestational sac.  I guess I'm in for more testing or should I have a D & C so they can maybe find out what is wrong with my sac?

I'm tired of bad news.  We want to live.  Time to go back to work... 

Monday, October 10, 2011

7 weeks 1 day or 6 weeks 1 day?

I had my ultrasound today and they found our baby with a heart rate of 95 and measuring 6 weeks 1 day - a week behind.  Surprisingly, my nurse was not worried.  We will have our next ultrasound next Monday to see if the baby is growing.  I did not think we would see anything.  I was already planning next steps.

Our nurse is worried that we have these suptations in the gestational sac.  I had the ultrasound tech point them out to me and my dh and they look like bright light streaks.  Dr. S doesn't know what causes them or what they mean? 

I feel pregnant.  My breasts woke me up the other night from soreness.  I'm tired and hungry.  It is amazing to think that I have a little life growing in my belly.  I hope our baby grows strong this week.

Thank you for following me and all your sweet thoughts.

Saturday, October 8, 2011

Blighted Ovum???

Tuesday we went in for our ultrasound to SEE a heartbeat.  30 minutes before our appointment I passed a clot and started bleeding.  I called my CCRM nurse and she said it happens often, not to worry.  I called my friend who had the same thing happen to her and she calmed me down.

During the ultrasound we found the source of my bleeding - subchronic hematoma.  We asked several times if everything looked ok and the tech said development could swing forward and backward 3/4 days.  She did not see a heartbeat, but it could arrive later in the day.  She said everything was fine. 

We walked up to pay and the receptionist had tears in her eyes and said how sorry she was for us.  Jeff and I looked at each other like what the hell just happened?  My monitoring clinic wanted to take a blood draw.  I called my CCRM nurse to see if she wanted me to do anything else before we left and she was not available.  The person who answered the phone said we needed to get a Rhogam shot because I am O-.  My heart is now racing and I feel like people are not being straight with us about the state of the pregnancy.

Later, I get a call from one of the CCRM nurses.  She explained the purpose of the Rhogam shot.  She recalculated my days and let me know that today I'm actually 6w 1 day pregnant and that it could be too early to see a heartbeat.  My other CCRM nurse thought we were 6w 3 days pregnant.  

Later, I get another call and the CCRM nurse and I learned that my gestational sac was a little irregular.  This is not a good sign. 

The next day I called my regular CCRM nurse to find out that the tech said she could not clearly make out a yolk sac or fetal pole and that I had irregular subtations inside the gestational sac and the outside of the sac is usually smoother.  They have me going back on Monday, but all of this is not good. 

My nurse let me know that if my ultrasound is bad then I will stop all meds and get a period.  We will wait until my HCG drops to 0 and then we can begin again.   

I did some googling and learned that I have a blighted ovum.  Most attribute it to genetics or bad egg or sperm.  Our embryo was tested.  I blame myself because I think it might have happened when my progesterone became really low and we did not get to it for several days.

I don't know what to think and feel.  I have moments of tears.  We are both so tired of all of this.            

Sunday, October 2, 2011

Trouble commenting

I'm having trouble commenting, but following you and continue to wish you well!

Week 6

I woke up with a little surprise this morning on the 1st day of week 6 - blood.  Bright red blood the size of a quarter on my undies.  I put myself on bedrest and it stopped.  I'm now having light brown spotting.  I'm also having the same kind of cramping I felt around implantation.    I talked to the nurse and it can really go one of two ways.  I'm hoping my little guy is setting up his home.

Tuesday is the big ultrasound to see our little golden nugget and detect a heartbeat.  Tomorrow we will check my progesterone and estrogen.  It was all over the place last week.

The extra progesterone I'm taking makes me feel a little drugged like when I'm taking cold medicine. 

Overall, boobs are very sore, I'm extra tired and my sense of smell has increased. 

I'm trying to stay positive.  Wish me luck.

Sunday, September 25, 2011

Week 5

I am 5 weeks today.  It's still hard to believe at moments that I am pregnant.  I guess it will feel more real when I begin telling friends and family.  I had a little fluttering feeling early this week, I don't think it was the embryo - I think my uterus was just changing, growing...something?  I'm a little more tired at night and my boobs are sore in the morning.  Oh and I can be a little snappy toward DH.  He has been great. 

I didn't get my P or E numbers.  Quest never sent them in.  I may have to drive there tomorrow to make sure they send them to CCRM.  I haven't had much spotting so I think I must be OK? 

I'm kinda bummed I didn't document my CCRM FET experience.  I guess the highlight was coming in the day of my FET and all the nurses were so excited and kept saying I was coming in to pick up my baby.  I smiled in front of them, but went into the bathroom and tears just ran down my face.  I also loved seeing my embryo on the screen. 

I can hardly wait to see this little one again next week! 

Wednesday, September 21, 2011


Blame it on our DSL service for keeping me from you...

I woke up Saturday morning,  held my first pee, and drove to Walgreens to pick up a pee test.  It came back "pregnant" again. 

My heart was beating so fast.  My DH drove me to my blood draw and I was out of it.  

I kept busy in the am and got the call at 11:00 that my beta was 72.  Yea.

Monday I went in and my beta came back 198.  Yea.  I'm pregnant.  I go through a range of emotions throughout the day.  I am really trying to just enjoy the moment.

I go back in Friday to test Progesterone and Estrogen.  I think about checking the Beta line to have them run it again for confirmation, but then I think I need to just enjoy the moment.  After everything I've been through it's hard to believe I can now relax and just live.

My ultrasound is on October 4 - can't wait.  Yea! 


Friday, September 16, 2011

Positive for the moment

I got my first positive pregnant test in the most unexpected way tonight.  I had some spotting late in the afternoon with some crampiness so I called the nurse to find out if I should add some additional progesterone.  The first time I was pregnant I had low progesterone. 

I came home from work and announced to my husband that I was taking a pregnancy test.  I peed on the stick and noticed I had started bleeding a little red and I immediately gave up.  I got up and opened the bathroom door and my DH walked in and looked at the test and asked how the test works because it says PREGNANT.  I used Clearblue digital.  I really really did not think I was pregnant because I saw the bleeding. 

I've stopped bleeding, but of course I'm very nervous about tomorrow.  I go in for the beta.  I know I need to enjoy the moment and hope for the best.  

I might go out and buy another test.  

Thursday, September 1, 2011

Come to Momma

woowe -- I'm feeling the meds.  I'm very dingy - I think I'm playing it off at work.  Not good to have colleagues thinking your clueless... 

I'm tired, breasts feel weird, and I'm still having some GI issues.  Did anyone else have GI issues?  I asked my nurse and she didn't think it was the meds.  I'm glad work will lightened up next week before my actual FET.

I know I have to appreciate where I am today.  I have to remind myself daily that I am lucky that I was able to cycle.  I'm lucky that I have eggs, that I had enough to fertilize and that I have a normal.  There is so much talk over Day 3 testing and Day 5 testing.  I don't think it really matters.  It's all just totally up to GOD. 

I hope GOD sees that I'm tired and that I don't have much steam to go forward.  I'm ready baby - come to momma! 

I hope all of you enjoy my random rants!

Monday, August 29, 2011

building a home

I'm trying to build a home for my little embryo.  My estrogen needs to be at 50 or above today and mine was 44.  I usually have a lining that is too thick.  My nurse wants me to up my patches from 1 to 4 every other day.  I'm tired from starting a new job and I just don't have the energy to do yoga in the morning and walking for 30 minutes at night.  I did 15 minutes of yoga tonight and I'm up way past bedtime.  I've also been having headaches and GI issues.

I'm going to do better tomorrow!!!   

Friday, August 26, 2011

almost time

I have my first monitoring appointment on Monday to check my estrogen.  If everything looks good, we continue on and fly out on Sunday in time for my first monitoring in Denver on Monday.  They will check my lining to make sure its creating a good home for our little one. 
The whole FET has been pretty ok.  I spotted a little on birth control.  The nurse said its ok to spot.  The Lupron and patches are fine.  I might have had a few minor Lupron headaches and I've been very tired at night.  I've been a little weepy the last two nights.  Watching Juno tonight did not help.  Only IFers really understand the pain the Jen Gardner character feels in that movie. 

Last night I had a dream that I was breastfeeding.  I love having baby dreams.  I haven't really had many the past couple years.  I might have had too much anger in my heart.

I feel like I should give our little guy a name.  I see so many people give them a name and I think they like it.  I'll have to ask my DH to help me create one.  I'm not very creative.   

I've been following all of you and it really sucks not to be able to comment.  I have no idea what is going on with my access.  I most likely hit something that keeps me from posting?  

Thursday, August 11, 2011


Lots of change is on the horizon for me.  I'm starting a new job.  I disclosed my situation before I accepted the position because I'm in the thick of IF and I don't really need to change my job.  I hope I made the right choice! 

I begin Lupron this weekend.  I feel like I'm an expert at IVF and a total newbie at FET.  If you have any suggestions throw them my way.  I'm staying away from caffeine and alcohol.  I'll stop my melatonin when I begin Lupron.  I love melatonin so this will be hard...

Tuesday, July 19, 2011


We have one normal - two total.  One Day 3 - 7 cell grade 4 Polar Body tested and one Day 6 - blastocyst graded 2AB.  We have our consult with Dr. S to discuss what to do next.  The nurse said they would have liked to have seen a 8 cell, but mine was fine and I should transfer. 

I don't know if I have it in me to do another retrieval.  I wonder sometimes if we should just go the DE route for the first baby and save my stuff for second baby.  Is this weird?  I'm just so tired and want to be a mom and start a family.   

I never thought I would think or feel this way.  The genetic link is starting to become less important which I guess is a good thing.  Maybe I just need a vacation from all of this.  When will the decisions end... 

Monday, July 18, 2011

Any moment now...

I will be getting the call with my results any minute now.  I called to get my husbands blood results for plan B and learned that the results came in.  She said a nurse would be calling me back in a few minutes with the results.  I wonder what I will feel like?  My heart was racing on the phone, but now I'm calm. 

I went on the Plan B website this morning and they posted a new girl.  I haven't completed all our paperwork so I don't have access to all the information. 

If my results are bad I will immediately pay the deposit and try to get access.  I really want to cycle as soon as possible. 

At this moment I feel like I would be fine with things going either way.  Plan B offers a 70% chance of being a mom soon.  The CCRM plan offers my genetic link, but not a lot of certainty.     

Thursday, July 7, 2011


I'm beginning to feel anxious and emotional about our impending results.  We could get the call any day now.  We have next steps in place for moving forward with DE and I'm at peace with this course of action.  However, I would love to have a baby with my husband. 

Tuesday, June 28, 2011


Time away from supplements, charting my calendar, watching my eating, exercise, limiting my beverages is awesome!  I still do not want to know the results.   

Although, I do find myself thinking about our 4 in Colorado often.  I wonder if they are boys are girls, if they look like me or my DH, their personality...  I want them to be healthy and normal so I can take all of them home with me.  I know this is not possible.  I had a dream we had normals - I hope my dream comes true!    

Tuesday, June 21, 2011


I haven't posted on my journey in a while.  Everything was touch and go with this last cycle.  I had a dominant again, but we were able to get it under control and we ended up retrieving 7.  Ann called the next day to let me know that 5 fertilized.  We did the CCS testing on Day 1.  Today is Day 3 and I called the embryology lab and talked to Terry and he let me know that 4 continued to grow and look beautiful.

This was not a good cycle, but we ended up with way better results. 

My best cycle over a year ago we had 12 follicles, 7 were retrieved, 4 fertilized and we tranferred two - HCG 22 - one frozen

I am so relieved and I'm happy that I have 3/4 weeks.

Wednesday, June 8, 2011


I passed go last night.  I had my monitoring and everthing looks ok.  I didn't see a ton of follicles.  The tech said my largest was 9 mm and my CCRM nurse said it was 7mm.  I don't really care this time I just want to go from begining to end.  I was so nervous about having a cycst.  I slept like a baby last night after the stress of starting. 

My next monitoring appointment is on Saturday.  If all looks good, I'll be on a plane to CO.  I'm really going to take it easy this time and try to rest and sleep.  I'm already very tired. 

Thursday, June 2, 2011

Almost Here

Today is my last day of meds.  I will go in for my suppresion check on Monday.  I am hoping for no dominant follicles and for no cysts. 

I've been so emotional on these medications.  My dreams have been out of this world vivid and emotional.  I've been woken up around 2:30 am several morning unable to go back to sleep because of bad dreams or emotionally charged family/friend dreams - so weird. 

I feel like everyone around me is pregnant.  I can normally handle it ok, but not this month.  I feel life is just passing me by and I'm not living. 


Wednesday, May 18, 2011


I wonder if God sends me signs?  I have a second round interview on Monday.  I am considering another job to remove me from a stressful work environment with my current boss.  They are trying to remove her, but these things take time.  The new job would likely be a better title and more money.  There are so many people out of work right now who would love a second round interview.  All I really care about is being a mom.  I wish I could embrace my situation and just accept the good things that have come my way.  I wish I didn't care so much about raising a family.  I wish I cared about how much money I make. 

I'm also wondering if the new job will bring a different type of stress to my day.  I'm nervous about having to prove myself to a whole new group of people.  I don't want to look like a slacker when I take off for a week to pursue a baby.   

Monday, May 16, 2011

Week 1 - Day 11

Today marks a week on the Testosterone gel and estrace.  The Tgel smells like cheap perfume - after several days of smelling it, I've grown accustomed to it and it doesn't bother me.  I've noticed my legs feel like they are pulsating and I have a tiny bit of breast tenderness when I wake up. 

My acupuncturist felt my pulse pick up and the needles were zingery.  My pulse is usually sluggish.
I am watching what I eat, but I'm not being crazy careful.  No caffeine or alcohol.  I'm watching my sugar, wheat and dairy. 

I'm walking for 30 minutes in the morning and I'm going practicing yoga in the evening.  I've heard that you need at least 60 minutes of yoga 3x a week to see any results.    

I may start using an ovulation kit tonight to be sure I ovulated.  I want to know in advance if I might have a cyst issue. 

Sunday, May 8, 2011

Gray Hair

All of this IVF stuff is causing my hair to turn gray (actually white).  I found my first three strands.  They are about two inches long so I'm guessing my last CCRM experience cleared the way for their arrival. 

I started estrace on Friday.  I start testosterone on Monday.  It is better to apply it on in the morning after you shower.  If you apply it at night it can get on your sheets and some could transfer onto my hubby.  He does not need testosterone.  I'll keep you posted. 

Tuesday, May 3, 2011

Blood - Take 1

I received my results today from my first blood test.  They ran a chem panel, checked my CBC and testosterone.  Everything came back normal.  My testosterone is 18.  They want it above 10 and under 25. 

Chem Panel - Chemistry panels are groups of tests that are routinely ordered to determine a person's general health status. They help evaluate the body's electrolyte balance and/or the status of several major body organs.

CBC - A complete blood count (CBC) is a calculation of the cellular makeup of blood. A CBC measures the concentration of white blood cells, red blood cells, and platelets in the blood and aids in diagnosing conditions and disease such as malignancy, anemia, or blood clotting problems.

I begin taking prometrium and start applying the gel this weekend.  My expectations for this cycle are low based on my last cycle with CCRM.  Some may wonder why we are returning after the fiasco from the last IVF.  I still believe CCRM is the best and we have put so much time and effort going down this path.  I have to make it to ER.     

Monday, April 25, 2011

Meds are ordered

I've ordered my meds for Protocol 3 with testosterone.  I'm still not 100% sure this is the path I should take.  Some women are reporting cysts so I'm going to check-in again with my nurse to find out what she thinks.  It always takes me awhile to obtain my meds so I went ahead and ordered them.  I can donate them if I choose not to use them for this cycle. 

I attended a Resolve event and met several nice people.  It is so wonderful to be a part of a community!  Thank you to all of you who share, attend meetings, talk about IF.  I think all of this helps our outcome. 


Sunday, April 10, 2011

I'm still here

Not much is going on in my world.  I didn't follow POAS to see if I ovulated this month or anything really related to IF.  I was surprised to have a normal cycle this month after our IVF.  I've been walking almost everyday and I wonder if that helped?   

I'm still trying to decide which protocol to use?   

I'm also applying for a new job within my company.  I have a really mean boss and I thought they were going to relocate her to another department because she did some unethical things, but they haven't and I don't think anyone wants to deal with her.  I'm sure she knows I went to HR about the things she said and did so she is extra mean to me.  The others that went to HR found new jobs and left the company.  I've remained because of the IVF benefits they provide.  We have saved over $100,000 so I think its worth it! 

Monday, April 4, 2011

Fresh or Frozen

I've been educating myself on all egg donor related things just in case my own egg IVF fails in June.

I came across a few places where you can choose a frozen donor egg.  I like this idea because the donor has already gone through the process and their little eggs are just waiting for me and my hubby.  I've read where fresh IVF donors forget to take their meds or decide at the last minute not to cycle.  I'm so ready to be a mom yesterday so this option looks interesting.  There was a woman on one of the boards who chose frozen and was pregnant within a month of entering the program.  The price is half the price of a fresh donor cycle and the selection isn't too bad.  One place boasts a 65% success rate! 

I'm wondering why more people don't choose this path?  I think CCRM boasts a fresh donor cycle 80% success rate - I guess that would be one reason to go with them over frozen.  However, the cost is less and you could get two for the price of one and that would increase your chances.

For those of you who chose DE - did you go fresh or frozen and why?

Friday, March 25, 2011


We have decided to cycle in June.  I hope this is our lucky month!  I want to go into this believing again that I did everything I could to make a healthy baby.  I just believe my older body needs three months to gear up for IVF. 

I talked to my nurse yesterday and we are moving forward with Protocol 3 with testoterone.  The protocol is very new and people have just started stimming so we will see if it is the "magic" we need to make more eggs.  If truth be told I am leaning toward the protocol with ganirelx at the start because it was our best protocol that addresses the dominant protocol issue.  I have a month to see what happens with other patients - always keeping in mind that everybody is different.  I just feel good that I have a date. 

Please note that CCRM's lab will be closed the first week of July.  Double check with your nurse.  

Tuesday, March 15, 2011

Decisions! Decisions!

I received Protocol 3 from my nurse on Friday.  The prep time begins on Day 1 the cycle before you start stimming which would mean starting my meds in three weeks for an April cycle.  I think its better to wait three months, but I would be pushing up against the June/July CCRM lab closure. 

Here is a link to protocol 3 http://humrep.oxfordjournals.org/content/21/7/1884.full It looks promising for women like me.  Low responders with normal FSH numbers.  Mine is inching toward higher than normal.
I have a few concerns - will I develop a dominant follicle with this treatment and will I be oversuppressed? 

I could play it safe and go with the protocol that worked with my last RE?  I didn't get a ton of eggs, but at least I had a few to work with.  They retrieved 7 and 4 fertilized. 

I wish I knew what to do? 

Thursday, March 10, 2011

The waiting is over

I feel a bit a relief that I took a pregnancy test this morning and it was a BFN and that my period has started.  The progesterone had major effects on me this time.  I had heart burn, orgasms in sleep, sleepiness and weird twitching.  

I can see how people can give up after a few cycles.  I had so much endurance in the beginning.  I thought I could go through a million cycles if it would just bring me our baby.  I don't know how some woman do it.  In the end, I did everything I could to make this cycle a good one.  I took a lot of daily supplements, ate foods that would nourish my follicles, exercised to increase blood flow, listened to meditation CDs, and went to acupuncture. 

I'm really tired and yet life hasn't stopped.  I still have to get up and try to be a good wife, sister, daughter - friend.  I'm not ready to commit to next steps.  I'm sure they will involve CCRM, but I'm not excited or looking forward to tackling the next roller coaster ride.   

I am looking forward to having sex with my husband.  I am going to finish my painting project and drink champagne at a St. Pat's party I'm planning to attend.  I'm going to try to be the fun person I knew before IF. 

Friday, March 4, 2011

My 2WW

I'm in a weird 2WW.  I'm not obessesing about POAS to find out if I have two lines.  I really think our chances that this IUI worked are 1%. 

I want to go home and paint.  My family does not think its a good idea because I could be pregnant.  We are going out tomorrow and I can't drink because I could be pregnant.  I wish we would have retrieved then I would have had at least 4 weeks to not think about the possibilty of two lines.

All of this "maybe pregnant talk" now has me paying closer attention to my uterus.  I had a a little piching feeling yesterday.   - hmmm might that be our blastocyst attaching to my uterus?  This is not my first time, I know these are the effects of progesterone.   

I haven't scheduled the beta test.  I guess I'll just see how it goes next week.

Thursday, March 3, 2011


We had record attendance last night at my Resolve group because of anchor, Alisyn Camerota's courage to talk about her struggle on the Today show Feb 24.  She encourages woment to seek support.  If you do not have a support group in your area, I encourage you to contact Resolve and see if they will allow you to start one.  So many of our members come away with resources, unused medication, and reading material.          

Wednesday, March 2, 2011

Back to Work

I really thought this day would be horrible.  I thought people would think bad things of me because I was out of the office for two weeks, but I don't think anyone really noticed too much.  The people who did notice I was out seemed happy to see me back.

I'm so glad I took the chance and went to CO.  Traveling for treatment is teaching me that its ok to be away from work and take care of yourself.  I would have never dreamed of taking two weeks of sick time just one year ago because I would have worried about my work reputation.   

I suggest getting flowers for your first day back.  I received a beautiful bouquet of gerber daises.  They have really brightened my day!  

Tuesday, March 1, 2011

We regrouped

It sorta went as expected.  The reason for the failure is my poor response to the drugs which extended our treatment and my age.  There was nothing we can do to prevent it.

I believe I will ask for an ultrasound before ER if my LH ever climbs over 15 and inches toward 20.  An LH surge above 20 is in danger of initiating a surge.  I always asked for my estrogen, but never my LH.  I never understood its importance. Lucky me - I now know one more thing about human reproduction! 

We talked about putting me on a microdose lupron protocol.  In the past, this one just didn't work.  I had 4 eggs retrieved and only one fertilized.  Because my eggs suck, I need quantity so I pushed for another go at the antagonist protocol.  He suggested adding testosterone.  I've never had much, so maybe this will help?  I'm just hoping for one good embryo - two when all is said and done.  I don't think that is too much to ask for.   

I think Dr. S does not give any help to those who are getting help through insurance.  We really have been blessed in that arena.  I also wonder sometimes if we had to pay out of pocket, would we have looked at success rates more closely and found CCRM sooner.  There is good and bad sides to every story!

Thank you to all who stop by and give me support.  I came on here as an outlet and to help document everything that went on.  All of you are a nice bonus! 


We have our regroup in a few hours and I really don't know what to say or what to question? 

Monday, February 28, 2011

Where we are

I hadn't cried since Christmas until this IVF went south.  I hate being sad and depressed.  I try really hard not to be sad.  We have stayed busy since returning home from CO and that helped.  Today, I'm at home trying to work, but mostly I'm just thinking about what happened and how to proceed.  I've thought about calling it quits and going the DE route so I can begin the life I always wanted with my husband.  I emailed the DE, Adoption Resolve group so that I can gather resources.  I've also thought about missing out on the opportunity to have a child genetically linked to me and my husband.  I always hoped our child would have his curly hair, my brown eyes, his smarts and my temperament.

I do love going through IVF with my husband.  He is so helpful and we work together as a team.  Outside of IVF, we migrate toward the things we are most interested in.  I'm a girly girl and he is all boy so our interests don't usually include each other.  Our big main shared interest is our home.   

I'm kinda scared of our regroup with Dr. S.  I'm mad that we had a shitty cycle and he wanted to proceed and that we got nothing in the end.  It doesn't matter where you go, you must stay on top of your cycle and ask many questions.  I was never worried about ovulating, so I didn't think much when I say a little blood, my breasts were tender and my ovaries where achy.  Combined with my high LH I should have been concerned.  This will never happen to me again because If I see the signs, I will ask for a ultrasound before ER.  My husband is hopeful they will help us out financially with our next cycle, I don't think they will.  We signed the consents!  This is all really just a crap shoot - a gamble.  We gambled at the best and lost.

I hope I am not making anyone less excited about going to CCRM.  I still believe they are the best and people should go to them immediately.    

Sunday, February 27, 2011

Ovulation before ER

I never got my regroup.  My dh and I sent questions through to the nurse and Dr. S answered them.  He assured us that we would get at least 4 fertilized eggs.  We made plans to do the polar body testing if we got 3 or more.  I was haoping for 6...

My LH began to rise on Tuesday and the nurse instructed me to take another Cetrotide, I did.  Cetrotide prevents ovulation.  We triggered with HCG at 12:15 pm and again with Lupron at 1:15 and again the next day with Lupron. 

We arrived on Thursday at CCRM for ER.  My ovaries were achy, but I was feeling hopeful.  Dr. M was was our ER Doc.  After waking up from anesthesia, I learned that I ovulated before they could get to my eggs.  We had nothing!  I couldn't believe what I was hearing - nothing...  Dr. S came up and just explained that these things happen and that he could perform an IUI.  I am at a small risk for an ectopic because my left fallopian tube opens a little slower than my right.  All the eggs were on the left.  I think I ovulated on Tuesday so the IUI just isn't going to work - no hope there.   

I am disappointed that we did not receive a call the next day from the surgery center, nurse or doctor to check on us.  I decided to call my nurse at 4:00 pm to see if she had any additional answers and to see if we could schedule a regroup.  As I was calling, CCRM calls and asks us why we were not at our 1:00 Dr. S regroup?!  My DH and I did not know we were signed up for a regroup?  We bought our ticket to fly home the day after the ER on trigger day. 

We are scheduled for a regroup on Tuesday.  I called my nurse just to see if we could get some answers and she said that this just happens.  They were never concerned over my LH levels.  She said that this situation is talked about in the CCRM consents we signed.  We later found it.  I've just never had this problem.  I asked her if this counted as an ER and against my insurance and it does. 

We are still processing everything.  I wonder if this is GOD just telling me to hang it up and stop trying. 

Friday, February 18, 2011

in Limbo

I tried to schedule a regroup, but Dr. S isn't available until Monday afternoon.  I go in tomorrow for bw/us and I could very well cancel myself.  It so hard to know what to do?  My dh arrives tomorrow. 

My disappointment is knowing my body can do better than this, not being able to do the genetic testing and if we cancel I will want to give my body a 3 month break and that prolongs our journey.  My dh is fine moving forward and paying out of pocket for another try in 3/4 months. 

I've attacked my fertility with such gusto over the last several years and I guess I'm winding down.  I'm tired.  More than ever I want to put this all in God's hands and hope.  Problem is, I've never been further away from my faith. 

On Again

Schoolcraft does not want to cancel my cycle.  He feels like he can get 4 fertilized eggs.  I've had a larger quantity of eggs and ended up with 4 ferts so that would be the same.  I was hoping to get more eggs, better quality here.  I just don't know what to do.  I went ahead and took my shots last night.  I think I'm going to try and get a regroup with Dr. S today. 

Never a dull moment. 

Thursday, February 17, 2011


I had my monitoring at CCRM today and they found a 15mm dominant follicle.. They also discovered 3 small paraovarian cysts on my left ovary.  I have a paraovarian cyst on my left ovary that I've known about.  I have 5 other follicles ranging from 6 to 8mm.  Things are not looking good and I think we are going to cancel the cycle.  This is our last IVF cycle covered by insurance so we want to make it a good one.  Plus, I really think my body can do better than this.

I need to flush out all these drugs and give my body a rest and then we try again.  I'm wondering what protocol Dr. Schoolcraft will put me on.  Will he prescribe the estrogen priming using the vivelle dots and ganirelex - at least with that protocol I had 7/9 follicles and no dominant.

I don't know if I'm still processing all this or what?  I haven't cried and I'm not angry about my situation.  I just hope this isn't God's way of telling me to move on because your body will not make a baby.  I feel like you have to have so much patience.  My husband and I are ready to be a mom and a dad.  I hope our baby finds us soon.

On a positive note, CCRM is really amazing.  The ultrasound machines and nursing staff is just great.  You feel like you are in good hands with them.

Tuesday, February 15, 2011

I'm going to CO

The nurse called and my estrogen is 180.  She said it most likely dipped and now my Estrogen is on its way back up.  I look forward to what they see on Thursday.  They are keeping my medication the same.   

I wondered in the beginning if they would even take me on as a patient.  People scared me into thinking maybe I shouldn't even try because CCRM cherry picks their patients.  I am a bad responder with a low AMH and they are letting me have a chance.

In so many ways I've put CO on a pedestal and I just wonder how I'll feel after all is done?  Most people are happy with their experience even if it hasn't led them to their baby.   

I went home at lunch and finally started packing.  I had things loosely ready, and now must of my stuff is packed.  I still need to pack work stuff and my medication. 

I should have started earlier - I've been very scatter brained.  I walked out of the house with a see through silk undershirt.  I only got as far as the driveway when I remembered...  I tried to warm up food in the toaster oven with the door left open...   

I'm kinda excited!!!!

1st Monitoring

I went in this morning and they placed me in a room with very old ultrasound equipment...  The tech found 7 follicles and (2) 7s being the largest...

I don't know what to make of it because I was on the old machine and I'm on this new protocol.  The tech thought I was at baseline because my endo was 3.67 and the small follicles she found.

I really need to try to go to bed earlier.  I was sooo emotional last night and feel fine this morning.  I feel myself getting snappy around 8:30 pm.  I asked the nurse if I could continue taking melatonin and she said no.  I love the sleep I get from melatonin.

I'm still not sure if I'm leaving with such small everything?    

Monday, February 14, 2011

Going on an IVF vacation

I'm getting ready for my IVF vacation.  I haven't packed yet, because I've been too frightened it will jinx me and I'll be postponed a month.  I'm trying to tie up loose ends around work, but I don't know if I'll be here for that meeting on Friday or at a monitoring appointment in CO. 

I'm not stressed really, I find humor in my situation.  And, as always, feeling very fortunate that I have this opportunity to cycle with the best.

My next monitoring appointment is scheduled for tomorrow am.  I'm going to listen to my circle and bloom mediation CDs and do a little yoga tonight to keep anxiety at bay.  I'm definitely climbing the coaster!  Weeeeeeee     

Friday, February 11, 2011

I'm Day 1 / 2

I'm not really sure where I am in my cycle, but my nurse went ahead and had me go in for my baseline bloodwork and ultrasound.  I felt very hormonal and tired yesterday afternoon.  I finally had "full flow" at 4:30 pm    

I arrived this morning without orders from my nurse so luckily because I'm a fixture in their office, they let me move forward without the paperwork. 

For those of you having your initial bw/us at another clinic, don't make the same mistake I did and not ask for your orders to be sent to you via email the day before your appointment. 

Baseline Ultrasound
Endometrium 6.97

Measured follicles on both ovaries: 7

The largest follicle they read was a 9.  I had 3 follicles reading at 12mm during my baseline ultrasound from a previous IVF.

The good news is I didn't have a dominant follicle or a cyst.  The bad news is I had 9 resting follicles last time and this time I only had 7. 

My Estrogen was high at 177.  You want it at 60 or below.  Mine is high because I've been taking 2mg of estrogen daily.  I will stop taking estrogen today and will get my body ready to begin stimming tomorrow.

Thursday, February 10, 2011

not yet

Well - I'm still waiting.  I'm having heavy spotting, but again, not what I would consider "full flow".  I HOPE things get started today before 5pm.  I went ahead and scheduled a bw/us appointment for tomorrow.

My Bs are no longer sore.  The soreness must have been cause from the progesterone my body already makes.  I slept really well last night.  These usually occur after my . has started.  Although, I am having some lower back aches which happens before my .


Always waiting...     

Wednesday, February 9, 2011

Game on - I think

I think things are starting...  I started spotting a little last night and this morning a little heavier, but still not full flow yet.  Full flow is what most clinics consider Day 1.  Spotting doesn't count.  This is Day 28 for me.  My nurse informed me that I might start my period early while taking estrace.  If today is indeed Day 1, this will be just one day earlier than my normal period start date.   

I'm really hoping this is the beginning.  The timing would be really great.  Its amazing how on hold your life is when going through this.  I've been able to get most of my work obligations taken care of.  Food is ordered for DH while I'm out of town.  I ordered Dinner by Design meals.  All the shopping and chopping are taken care of and he just has to take the food from the freezer to the stove - wha - la!  He has a habit of consuming too much pizza when I'm away so I am hoping this is helpful.  I've started collecting the clothing and toiletries I'll need while I'm there.  I hope my body cooperates with my readiness!


Monday, February 7, 2011

DE meeting and Pregnancy news

Sunday was eventful.

We had our meeting with the counselor to make sure we were OK to be DE parents.  I think we passed!  It was a very basic meeting.  The one thing we touched on and have not made a decision about is whether or not to tell.  Everyone has their reasons for telling or not telling.  I'm leaning towards not telling anyone in our family before the baby is born.  I want them to fall in love with their family member and then if, and when the time is right, tell the child first and then tell family.  I think a decision on when to tell will be hugely based on the child's personality and when the time feels right. 

I come into this situation with baggage.  I'm adopted and I would often over hear family members talk about how I wasn't "really a family member" because my Dad adopted me.  Kids have radar ears...  I survived, but it did make me feel less like a "real" part of the family.  I always felt like I was an outsider.  I never felt like I had "real parents".  I should disclose that my mother was my "real" mother and she is not in anyway nurturing or loving.  I never felt this way with my half-siblings who I consider my siblings.  I don't look anything like them, but we are very close.  Our family situation is messy.

On the family front, my sister announced she is expecting.  This will be her second child.  She is a wonderful mom.  Getting pregnant and staying pregnant in our family is not easy so I consider this a blessing.    

Friday, February 4, 2011

One more week before suppresion

I've got one more week to go until my expected suppression check. 

I take the 2 estrogen tablets at night before bed.  The last three days my Bs have been very sore and I'm very tired at night.  I'm guessing its estrogen related. 

I'm still going to acupuncture.  I'm trying to get in 2/3 more sessions in before I go.  My acupuncturist hooks me up to machine that sends electricity to needles in my back.  It does not hurt.  It feels like a thumping sensation.  We hope after 5/6 sessions my blood flow will increase.

I'm also trying to exercise every day.  I walk for at least 30 minutes or I'll do a little yoga.  Its very cold outside so I sit at my desk all day.  I need the exercises.       

Tuesday, February 1, 2011


I'm sitting in my home during a blizzard.  Its nice because everything gets quiet including my mind and I begin thinking - Oh my God - my life is going to change...

In one month time I will be closer to knowing if I can bear a genetically linked child.  There is so much riding on the eggs I've been cooking for the last three months.  Did you know it takes three months for your little eggs to get ready to surface to the top and grow for an IVF cycle?  This is so huge!  I can only hope for a maximum of 9.  I can hope 4 will fertilize with CCRM labs.  They say usually half are normal - 2.  This is a perfect scenario.  We all know there is nothing perfect about IVF.   

I wonder if I'm a little crazy some days because all I think about is infertility.  I think about my upcoming cycle.  I think about all the woman out there who do not have insurance.  Most of the treatments we receive are experimental because everybody reacts differently to the drugs they prescribe.  I think most doctors do their best to find the right cocktail for your situation and hope it works.  I think about the women who suffer in silence.  I was one of them and I'm so glad I'm climbing slowly out of my cave.

I don't think I know how much change is in store for me?      

Thursday, January 27, 2011


I talked to one of my best friends last night.  I'm so thankful for her because she is the one friend who understands me best when it comes to the small intricate details of my life.  We are both the oldest of three siblings in our family.  Our life has been anything but perfect, and we can be open and honest with each other about anything.  When we are on the phone she doesn't try to change the subject when I talk about IF or get a glazed look on her face.  She is a strong Christian and my faith meter is on empty right now so I need her prayers!   

I also now have the women I've met at Resolve meetings.  If your not already attending local support group meetings, I recommend going.  You meet women who you can talk to about your journey and they understand IF, plus you come away with great resources and usually a new perspective on your journey.  I've met two women who I now see outside the group.  They are both newly pregnant - I'm not sure how our friendship will develop as their bellies grow, but as of now I'm glad I have their support. 

Wednesday, January 26, 2011

I surged!

I surged right on time, so on the 28th I will begin taking Estrace (2) mg tablets at bedtime.  Dr. S prescribed the estrogen to prevent me from developing a dominant follicle.  My last protocol we used vivelle patches and estrogen tablets and I did not develop a dominant so I am hoping this process is even better.   

I really recommend buying the smiley face digital ovulation predictor pee sticks.  They are expensive at $49.00, but you get 20 individually wrapped sticks.  If we are so lucky, I can use the remaining sticks during my next cycle. 

I started out with the ovulation predictor kit that has you look for two lines and then I got scared that I would mess up the lines.  A few days before I surge I get two lines.  You have to wait until the test line is as dark or darker than the baseline.  I just do not want to make a single mistake. 


Monday, January 24, 2011

My Drugs Arrived

I'm so glad my drugs arrived on Friday.  It took a little waiting and patience, but they are here with little stress.  My Centrotide will arrive on Tuesday and we will pick up Lupron in CO. 

I feel so good right now.  I want to continue feeling this good.  I'm so scared this feeling of normalcy is going to go away if we fail this cycle.  I'm thinking I need to work on our next steps now and have everything in place to move forward with DE so that I can keep this feeling.

I'm going to make the call this week to get the Attain paperwork to fill out.  I want to see if we qualify for a price break on multiple DE cycles.  I don't have a history of lining issues so I'm hoping we will qualify.  I'm not 100% sure where we would cycle?  local or CCRM?           

Thursday, January 20, 2011

Trying to get my drugs

I'm less stressed over getting my drugs this time. 

Drugs were to arrive this past Tuesday - didn't happen because they are now dispensing the drugs locally instead of through a specialty pharmacy

Drugs were to arrive today - didn't happen because Follistim and Centrotide are difficult to get. 

Drugs will arrive tomorrow - who knows what I will get?  I'm going to wait to call my nurse after I see what I've received and order the drugs that didn't come with another pharm. 

My last IVF cycles were more stressful because I was traveling for work and often I wouldn't get the drugs until the day before I left for business.  I was shooting up in Starbucks between meetings.  I went through a lot of ganirelex- under pressure it spews.  You must slowly remove the lid. 

My drugs for this IVF cycle:
Estrogen Priming:
I'm taking Estrogen

Stimming Phase:
2 AMPs of Menopur - shot

300 Follistim u - shot
100mg Clomid - tablets
Saizen - shot
Dexamethasone - tablet

Follicle release control:

Double trigger with Ovidril and Lupron 

One question, for those of you who stop by.  Did you continue to take supplements throughout your cycle?  If so, which ones?

Sunday, January 16, 2011

Where I'm at

Its weird, I really haven't been sad since Christmas Eve.  I had one moment of sadness driving home from my co-workers baby shower.  Why?  Is it because I've been unmedicated?  Have I mourned the child I may never have?  Is it the acupuncture?  I wish I knew because I hate being sad.  I hate the kind of sadness that sits in your throat and in your belly.

I wonder too, if I'm not beginning to feel a little optimistic?  Maybe I'm climbing up the roller coaster, only this time at a slower pace because of past disappointments.   If it is because of the ride, I hope we plateau, I hate the ride down.  I guess only time will tell?

Thank you to all those who stop by and read my thoughts.  I've never been the best writer, but I think blogging has been helpful. 

Friday, January 14, 2011

Wow what a week!

This week was a little crazy and I am so glad it is almost the end of the day!  It was a good week in the end.  I was so nervous about my job and getting clearance to go to CCRM.  I decided to request the time off now instead of waiting and letting her know last minute and not telling her how long I would be out.  She didn't say no!   

It's so hard to request time off for fertility related events - you don't know exactly when you are leaving or how long you will need to stay.  I have insurance that allows me to have these procedures so it shouldn't be a big deal, but it is a little. 

I'm Day 2 of my cycle and I've started the Dox.  I can't believe after all this time we are starting the process.  I will be on Dox for the next 10 days.  On Day 8,  I will begin looking for my surge on pee sticks and once I detect it I will begin the estrace. 

CCRM has been great so far.  My nurse called in my drugs and they will be arriving on Tuesday.  I did not have to call my nurse to remind her to call in my drugs!  Previously, I had to fight between my insurance co- my nurse - and the pharmacy to get my drugs ordered and delivered.  I had an HMO.  It would take me up to two weeks of constant contact to make it happen.  It was a mess!  So far, I'm liking the PPO - I will keep you posted.  I will say there is not a day that goes by that I don't appreciate how lucky I am to have fertility insurance.  We will pay around $400 for all our drugs.  It's not fair for you ladies who don't have insurance to pay for more.    

Tuesday, January 11, 2011

the ramblings of a stressed person

I am supposed to be free of stress, and for a long time my job was one thing I could count on to bring me an identity outside of being infertile and it was stress free.  I loved everything about it and considered myself to be lucky!

For the last year, my job has brought me nothing but stress.  I eliminated the travel and that made it less stressful, but then my direct report began exhibiting some very unprofessional behavior that I could not tolerate and it shows.  I distanced myself from her and that strained our relationship.  Now she is very unpleasant to me.    

We have new leaders and I'm not sure how they feel about women trying to start a family and taking off work to run across the US for fertility treatments and that is what is making me feel very insecure.  I'm not sure if I should say something about my upcoming treatment or keep it to myself.  I have a ridiculous amount of sick days and vacation so I just shouldn't worry.  I am a worrier... 

Monday, January 10, 2011

The weekend

I went to a work baby shower - and I will not do that again.  No more personal or work baby showers.  I thought this might be different than a personal baby shower and it was worse.  My colleague often talked about how she never wanted children.  I'm happy for her, the situation just reminds me of my long unsuccessful journey.  I've been in such a good place lately and the baby shower put me in a bad place.  I'm so sick and tired of being sad.  The only tears I want to cry are tears of happiness over a healthy pregnancy.

I went to dinner with family and friends and it was so nice.  Everyone knows my situation.  Everyone expected me not to drink and asked questions about CO.  It was just so nice!

I enrolled in a 6 week yoga program.  It will end just as I am gearing up to leave for CO.  There are six women in the class.  Everyone comes from a different place.  There is one woman who is the same age as me and the same egg numbers.  She just recently had her eggs genetically tested and all were abnormal.  I feel like I'm prepared for my results.  I know I have less than a 50% chance - you just never know? 


Thursday, January 6, 2011

Protocol 5

I received my calendar and I will be cycling in February.  Dr. S ordered me to follow protocol 5 - Midluteal/Estrace/Clomid/Antagonist

We asked for a phone chat and he went over the protocol and described how he felt each of the drugs would address my issues - dominant follicle/s at the beginning of each cycle, egg quantity and the maturity of the eggs.  I'm going to be on a lot of drugs.  I am a little nervous about Clomid.  Clomid is the only drug that really affects me and maybe that's a good thing?  From here on out I just need to give into the ride and be happy that I have an opportunity to go to CCRM.

I attended a Resolve meeting last night and one of the members isn't able to cycle with her husbands sperm.  I was reminded of just how lucky I am that I get to cycle.  She would love to be in my shoes cycling with her husband.   I look at my numbers and my past response and I get down and depressed, but not everyone gets to try IVF or go to CCRM because of the cost, egg quantity, or their husband may not be open to advanced fertility treatment.