Wednesday, June 24, 2015

One is the loneliest number.

We went in for my ultrasound at 11am to see all the follicles I am growing after sticking myself with a needle... And there was one. Only ONE. I am on the highest dose of Menopur and I get one freaking follicle. He said there is another really small one that might grow over the next few days but it is unlikely. The doctor is going to have me stay on the stim meds until Friday and then I will go in for another ultrasound. From there he will decide when he will retrieve my one lonely egg - if it is even worth it (the cycle might be canceled) - but likely Monday for the egg retrieval. Good news is that I won't have to go under anesthesia for ONE follicle. I am crushed to say the least. So, we decided to go to our local farmers market and get a chocolate filled donut and a glass of wine from our favorite vinoteka. I wasn't expecting 26 follicles or even 12 follicles.... but one.........!

Thursday, June 18, 2015

Cycle date 1

***warning I am going to talk some more about my vagina***

On Tuesday Jason and I met with the doctor at Iscare for our appointment prior to the start of my period and the start the stimulation injections.  After rushing to get there after my yoga class, we ended up waiting for a hour to see the doctor (not very different from the US). I wasn't expecting another vaginal ultrasound but it made sense once I thought about it. He wanted gain information for the future cycles and needed to see my endometrial lining to make sure that it was normal and that it was adequate for embryo implantation. This time there was a room for me remove my bottoms and a cloth to drape around myself. Jason and Jarslov were still still sitting at the desk when I came out (which happens to be at the foot of the examination table) and while the doctor got up to perform the vaginal ultrasound, Jason continued to sit in the chair. I told him that he might want to move to a different view point - just for now - he'll have plenty of time once I am pregnant and giving birth to see my vagina in all its glory. Jarslov was pleased with my endometrial lining and showed me the corpus luteum on the ultrasound. After he was done, I went and changed and then we discussed the stimulation plan... oh boy!

So the plan is to start the injections on Day 2 of my cycle. Jarslov said that I should start my period on the 18th or the 19th (he knew this by looking at my lining and knowing approximately when I ovulated). His stimulation plan for me is 6 ampules of Menopur once a day on days 2-4 and then 5 ampules on days 5-7. In addition, I have another injection of Orgalutran on days 6-7. He said the nurse would explain how to administer the injections and the dosing -- (that was an interesting conversation because her English was a little lacking and my Czech is nonexistent. But after 10 minutes of struggling to understand, another nurse came over and explained it and her English was great while my Czech is still nonexistent...) Then the doctor discussed what he thought the best plan was for the rest of the cycle. As a side note, Jason and I have been educating ourselves on various success rates for different protocols as well as trusting the original plan of the doctor we saw at the Colorado Center for Reproductive Management (CCRM). That plan was to "bank" the embryos for 3 cycles and then test them all after 3 cycles to find the best embryo(s) to implant. This plan was crafted by CCRM to help save their patients money (One full cycle with all medications runs around 30K but 3 cycles of banking and one implantation is discounted to 50K). The other factor is that frozen embryo transfers (FETs) show a higher success rate. Jarslov explained that this is skewed by the fact that only the best ones are frozen and then only those that survive the unfreezing process are transferred. He is suggesting a fresh transfer for this first cycle. He doesn't think I will have many follicles to collect - from there it is like a pyramid  - fewer will start dividing, and fewer will divide normally. Depending on how many I have to start with that doesn't leave very many viable embryos to freeze and not all survive freezing and thawing.

So here is how it will all go down. Stimulation meds as outlined above on days 2-7.  Day 7 or 8 -ultrasound to see how the follicles are developing and the doctor will determine if any additional medications are needed at that point. The egg retrieval will occur somewhere between days 10-12. At that point, I will start taking progesterone. Jason will donate his swimmers on that day and the eggs will be fertilized. From there the lab will watch them divide (24hrs/day for 3-5 days). They will decide after 3 days of embryo growth if they want to let the continue to grow to day 5. The embryo transfer will occur either after they have grown for 3 days or 5 days which will be somewhere around day 13-17 of my cycle. I will continue on progesterone and then from there I am not sure when we will test to see if I am pregnant but I am sure I will find out more after the embryo transfer.

Today is day one of my cycle so that means that tomorrow I start the injections. Oh boy! I wasn't given much guidance on the do's and don't regarding my IVF cycle. I assume part of that is because the US is so hyper-sensitive to possible complications so they give you all the warnings - don't run, don't drink coffee, don't drink any alcohol, don't stress, don't stress about stressing and so on. When I asked the doctor his answer was - there are no special restrictions (of course please avoid higher amounts of alcohol and very heavy exercise). It is advised not to change your lifestyle significantly during the stimulation period. So there you have it. That is what we know so far. Tomorrow I might be a hormonal crazy person... we were planing to go to Vienna for the weekend but we have decided to postpone the trip until we know how I react to the injections. The plan for tomorrow is to give myself the injection and then go to the Vietnamese market. If you know me you know I LOVE Asian food so this makes me very happy!

Here are a few random pictures from around Prague for your viewing pleasure!

Mmm...bread.


The is a tiny glimpse of the market that is near our flat.

Riegrovy Sady park  - one block from our house. 

One of the old entrances to the city.

More pretty buildings.

The views don't get old.



Wenceslas Square.

 Stromovka park - with an area of 235 acres


Stromovka park.

 Stromovka park.

Prague streets in the evening.

A view of Prague from near the beer garden in Riegrovy Sady.


xo -katherine

Monday, June 15, 2015

Adjusting to life in Prague - 12 days in

"Don't be satisfied with stories, how things have gone with others. Unfold your own myth." -Rumi


Since my wife has updated everyone in great detail the "scientific" side of our story, I thought I could fill in some gaps of the rest of the experience thus far in Prague.  We spent the first week in an AirBNB rental while we searched for a flat to rent longer term.  That search was exhausting; communication barriers and the extreme differences in how you go about renting a flat was a learning process.  All while adjusting from jet lag and learning the local transit.  When we found our place there were three other people "helping us", one representing us (for a hefty commission paid by us), the flat owner's representative and a building manager.  We tried to save ourselves some money and go around the system but it can't be done (maybe if your a local with connections). We moved into our flat last Thursday June 11th.  This meant it was time to go to IKEA.  Wife says "hooray" and I just shake my head.  IKEA without a car is.... interesting.  Our first trip (yes, more than one so far and we need to go back) we left IKEA and got onto the bus at 9:30 P.M (thankfully IKEA closes at 9) with large bags stuffed to the gills for our 45 minute bus/metro trip back to our flat.

Coming from small town Colorado to big city Europe has a few minor changes to adapt to.  Big city life is fascinating.  The public transportation system here in Prague is amazing, but after selling three vehicles in the U.S. we still had to acclimatize.  There are 3 major metros (subway) covering 62 km and 500 km of tram lines. Stops are typically 4-12 minutes apart means your waiting very short time periods and seldom do we need to walk more than 3-4 blocks to get to a stop.  From our flat it is 2 minutes to a tram and 7 to a metro by foot. Another big city note, since there are endless buildings it is not uncommon to find dog excrement/urine on the sidewalks, probably part of the reason you don't where shoes in the apartment. Thankfully Prague gets plenty of rain at over 20" annually to help wash it away.  That being said there seems to also be an abundance of parks/open space, from our flat it is 1 block to a park that has two pubs within it and is about a mile to walk the perimeter.  Czechs love beer, therefore I love Prague.  There are 27 places within a 10 minute walk where I can order two 1/2 litre (17 oz) beers and pay less than $3.  What a way to enjoy my first retirement.

The endless sea of available restaurants is overwhelming.  Katherine and I love food!  Leaving our small town with limited delicious options we have enjoyed all that the big city has to offer.  Due to travels, jet lag, lack of functioning kitchen, and our love of eating out we have enjoyed meals at many different restaurants.  Just trying to find our staple Thai, Mexican, Indian,Italian, Pho, coffee/pastry/dessert/wine cafe, burger, and sushi restaurants plus some of the local fair (it's a meat and potato kind of country). We were slightly worried about finding good food in eastern Europe but have been pleasantly surprised.  Some locals, Dan and Jana (new friends from a common old friend, thanks Trish) started us off right at an amazing Indian restaurant.  Almost every dining experience has been a pleasure.  We have enjoyed all the types of food listed above except sushi. Our background with sushi requires us to find something excellent, anything less would ruin our stellar experience in Prague thus far.
In old town square is the world's oldest functioning astronomical clock installed in 1410.
While Prague can be modern it has a strong retro element.  The first song I consciously heard here was by Genesis (jet lag is helping me forget which song).
Katherine on an escalator to the metro (subway). At Namesti Miru, our closest metro stop and the deepest, it is 171 feet underground or about 15 stories.
The Prague castle across the Vltava river at dusk.
Jana and Kat chatting after dinner.
A common sight.  Two 1/2 litre mugs of beer for about $2 total.  A good way to enjoy the afternoon.
Cobblestone hand laid roads with some cool local art.
Our first Mexican experience was delicious and long overdue.
A Michelin rated Italian restaurant just down from our flat had Katherine say "that's the best thing I've ever tasted"
Fresh made crepes with many options, Katherine chose chocolate and strawberries.
Cheesecake, wine and an ashtray. While smoking is not permitted in most restaurants, most allow it on there patios.  An adjustment for sure.
Thai food in old town.  Happy belly!
Prague is all about recycling.  These are street side collection containers found around town.
A local market three days a week with different offerings each day.
Bacon baked around cheese, need I say more?
Lots of gnocchi and beef options.
Delicious soups and carpaccio
The Church at Namesti Miru (peace square) a couple blocks from home.
The Vinohrady theatre with winged statues of comedy and tragedy
Stain glass windows in the Church of St. Ludmila at Namesti Miru.
Hanging out in Riegrovy Sady our neighborhood park.
Latte, americano, eggs with prosciutto and a croissant.  The coffee and croissants here are amazing.



The Powder Gate found in old town. A historic entrance through the original city walls.  It's construction began in 1475.  It's current name derived from it's use for gun powder storage in the 18th century.  

















Sunday, June 7, 2015

It was a no go.

On Saturday we arrived at the main Iscare clinic. The building is a new, fancy, shiny building. As we sat in the waiting room, we were joined by a few other women. Each time someone walked through or into the waiting room, every single person said, "Dobry den". The literal translation is good day. They were all so very polite. I was the first called and Jason started to get up with me but Dr. Marika Jaržembovská instructed Jason to wait there. She explained quickly that we were going to do a vaginal ultrasound to see if there was still a follicle to extract. There was a room for me to remove my bottoms and a paper sheet for me to wrap around my waist. I exited the changing room and hopped up on the table. Marika checked out my ovaries and said there was nothing there. I had already ovulated. That was it. Now we wait until June 16 for my appointment and from there we will come up with a stimulation plan.

We have had a lovely 2 days since then. We've been exploring Prague and my feet and legs hurt from all the walking. I felt like an active person before coming here but I have never walked this much. Good shoes are a must! More to come on our adventures around Prague the last few days.

xo -katherine

Friday, June 5, 2015

The word from the Doc

*Alert*  This post talks in detail about my lady bits. I am posting it on the web for all to read but if you are uncomfortable with the biology of the human body then read no further.

The doctor I am seeing at Iscare is named Jaroslav Hulvert. He is the director of the clinic. His son, Jan (pronounced Yan - and the most popular boy name in Czech), also works for Iscare and he picked us up yesterday for our first appointment. Normally we would see Jaroslav at the main clinic (first name basis - Jan explained that you don't call your doctor Dr. So and so because you are already at the doctors office so why would you need to call the doctor Dr. So and so as you already know that he is a doctor - interesting!) but instead we saw him at his private office. Jan explained that there was construction to his office building so they moved him to an older building. As we walk down the dimly lit yellow hallway, we arrive at a door and Jan knocks. Jaroslav (which I have no idea how to pronounce) answers the door and smiles big and says, "Sorry I am not in white!" He is wearing a lime green polo shirt and black pants. The room has a desk and a table with an ultrasound machine that appears ready for me to hop up and put my legs in the stirrups (they are a bit different than the ones in the US).

We all sit at the table and talked for a bit. Jaroslav speaks english but his son is there to help when Jaroslav couldn't think of the english translation. After he looks over my chart again he says that he wants to see the anatomy of my uterus and cervix for himself. Jan leaves and Jaroslav says I can remove my bottoms behind the folding divider. I awkwardly remove my bottoms and hop up on the table. As you ladies know, we usually have something to cover ourselves in order to hold on to our modest notions. This was not the case. Naked from the waist down the doctor proceeds to start his examination - I have to say his bedside manor was superb and I totally felt comfortable. He examined my cervix and exclaimed with joy how beautiful it was  and discussed the consistency of my cervical mucous. He was very pleased. Then he performed a vaginal ultrasound. He was also ecstatic with the endometrial lining of my uterus. He then examined my ovaries and asked me what I saw on the monitor. And to his delight, I say that I see a follicle. I had one 19mm follicle on my right ovary that was in prime condition and he said I should ovulate soon (18-24mm is the ideal size for a healthy follicle). After, the exam was over and he said I could go clean up and then we would talk about our plan. As different as it was to an examination in the US, I felt pleased as he was pleased with his findings and had hope. Throughout the whole process he was very professional.

We all gathered around his desk and after a bit of conversation he suggested that we try a natural cycle this month as I am in the perfect spot in my cycle for it. He said that if it worked it would save us a lot of money. A natural cycle in IVF terms means that I allow my follicles to grow normally (versus stimulation medications) and then they extract the follicle and fertilize it and then implant it back into my uterus. Last night I gave myself a trigger shot to induce ovulation and the extraction happens 36 hours after the shot. That means that tomorrow morning at 7:30 am (12:30 am Colorado time) I will undergo the egg retrieval. Here is the process:

  • A needle is passed through the top of the vagina under ultrasound guidance to get to the ovary and follicles.
  • The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary.
  • The oocyte-cumulus complex is pulled from the follicle wall when we aspirate the fluid through the needle.
Usually this happens under anesthesia, but as I only have one follicle it should be fast so I will be awake for the whole process. (OUCH!) A variety of situations could happen. First, they could discover I have already ovulated and there is no follicle to extract. In that case, we go home and start a medicated cycle on day 2 of my next cycle. Or they could extract the follicle and fertilize it, only to discover that it is not a viable egg. But if it is viable, then they will implant the egg and either I will be pregnant or it will not implant. If it does not implant then we go onto the medicated cycle. 

Our sleep has been all over the place and I am a bit nervous that I will not fall asleep again tonight until 4 am. Send us good thoughts for a restful night of sleep and a successful egg retrieval in the morning.  Off to bed we go (it is almost 10 pm here)


The trigger shot. Not many other photos I could take regarding this post!!!

Thursday, June 4, 2015

We're really doing it!

I am so confused on my days right now... I am pretty sure we left Grand Junction on the 22 of May. We spent a few days in Durango with Laura, Kevin and Lucy and then we took a road trip up to Bend, OR with Jay, Jeanie, Kim and the twins. We crashed Jeff and Elaine's home and had a family filled week. Jason ran his half marathon and we camped at Timothy Lake the night before the race with Jeff, Elaine, Grey Gladden (3.5 years old) and Silas (10 months old). Grey gave her best rendition of Let It Go from Frozen at 4am for the whole campground to hear - it was quite funny. We also camped with Jerry (Jay's brother) and his wife Francine and her daughter Ashley and her husband Peter. Jeff drove us to Portland on Monday and we flew out at 6 am from Portland to JFK. When I purchased our tickets 3 months ago, the only way I could find affordable ones was to book 2 separate tickets. So, I booked Delta from Portland to JFK and then Norwegian Air from JFK to Prague via Oslo - which meant we would have to collect our bags and recheck them in New York. The flight from Portland to JFK went smoothly but we found out that the flight to Prague had been cancelled and rescheduled for the following day. While we would have normally enjoyed a layover day in NYC our doctor appointment was scheduled for June 4 and could not be rescheduled for the following day because the doctor will be on holiday fishing in Norway for 2 weeks. Long story short, our tickets we refunded and we booked a flight with Lot Airlines that day. We flew to Prague via Warsaw, Poland and arrived earlier than was originally planned.

Exhausted and delirious we arrived at the airport and collected collected our 3 checked bags and our 2 carry on wheelies (I really really tried not to over pack - but I can't say I did that great of a job) So we and made it out and got a new SIM card at the airport for our phones so that we would have cell service. Then we proceeded to purchase our passes for the city public transportation and hop on a bus. We took the bus to the metro station and then in no time we were at our stop. We arrived at the flat where Daniel met us and explained the in's and out's of the place and recommended a place to eat. We ate at a little place around the corner and went to bed around 8:30pm. I managed to get a full night of sleep but tossed and turned most of the night. I kept waking up and seeing Jason reading on his Kindle (he got a lot less sleep than I did).

Today consisted of venturing out to find breakfast, working online for a bit, a meeting with someone to help us find another flat (we like the one we are in but there is quite a bit of construction going on in the 2 apartments next door - not the best thing when you are trying to sleep in the morning) and meeting with the doctor. Yes, the whole reason we are here!!!

I am too tired to go into the whole appointment details - and they really deserve their own post. I will update the blog again tomorrow.

After the appointment, we had a wonderful dinner at a restaurant that was recommended to us  and then took the metro to old town to walk across the Karlův most (Charles Bridge) - which is one of the most touristy spots in Prague. It is now 11:30pm and I am headed to bed. More to come...

Snowy drive to Durango

Sweet Lucy!!

Jeff making Grey's hair all pretty.

Three of the Hammitt fellas before the half-marathon

Seriously, the most chubby, fluffy, happy baby.

Woohoo Jason!!

Fun rolling down hills.

Jeff, the pixie stick dealer.

The family the day before we left for Prague.

First meal. Yum.

The Metro.

Sunset over the Prague Castle.

Charles Bridge.

Streets of Prague.