The In Vitro Journey - The Longest Overdue Update of All Time(Sorry!)

I am officially the worst blogger ever. I left you all hanging with no answers after our embryo transfer and 2 week wait. I'd like to think I have a pretty good excuse but in all reality I've just been lazy. Alas, I promise to give you the whole update and not skimp out on any details.

My last update ended at 4 days past our embryo transfer. Well 2 days later at 6dpt (days past transfer) we got this result:

See that super faint, almost invisible line? Well so did we. That was the start of some very happy news. I then continued to take at home pregnancy tests daily and we watched the line get darker and darker.

Our first blood test at the fertility doctor was on 10dpt. The doctors consider anything over 50 to be a positive pregnancy test.. Ours was WAY above 50:

The doctors were very happy with this number and considered us totally pregnant. They even said with a number that high they expect there could be multiples! We were pretty confident there were two babies in there as well. We had our second beta test on 12dpt. A normal result would be around 1,500-2,500. Ours, again, was WAY above that:

We were over the moon! We both cried and decided we were in the clear to start telling our friends and family. Since people were already so involved in our IVF process there wasn't much room for surprises. My parents were asking about the blood test results before I even had the blood drawn. Luckily, I was able to hide it from my two best friends and revealed it to them like this:

So all was well, everyone was happy and excited and we started to really celebrate our IVF success. We've come so far! We deserve this and we are so happy to see the fruits of our labor paying off. Then came the scariest moment of our lives when I began bleeding. We're not talking a little bit of blood that could be considered spotting; we're talking a LOT of blood with blood clots and abdominal cramps. We expected the worst. The doctors put me on bed rest until they could see me the next day. I was seen at 5w3d and they told me it was too early to see anything and they were right. They also told us that bleeding is common in IVF pregnancies and that I could bleed again. They told me not to stress and when it happens to lay down and put my feet up. It happened again at 5w5d. I was seen again at 5w6d. This is when the doctor confirmed there were TWO gestational sacks! Twins! 

She was also able to find the sub-chronic hematoma which was the bleeding area. She said it was fairly small compared to those she's seen before and she was not worried about it at all. She also said there was a good chance I would bleed through my whole pregnancy but it would not affect the babies. We left there feeling really relieved and so happy that it was confirmed that we were having twins! We started telling pretty much everyone, "we're having twins!" We started to really wrap our heads around what that meant for us.. Double diapers, double feedings, double EVERYTHING! We're gonna need a bigger house, bigger cars, two babies?! What!? We started talking twin names, looking at twin products. We got to see our twins and their tiny little heartbeat flickers @ 6w5d:

Baby B on the left was right on track, measuring at 6w5d. Baby A was a little behind measuring at 6w1d. The doctors weren't worried at this point and said as long as they are measuring plus or minus 5 days it is nothing to worry about. Today we went in for our 7w5d ultrasound. This is when we got the news that Baby A hasn't grown much in the past week and they didn't see a heartbeat. Baby A measured at 6w2d while Baby B measured at 7w2d. The doctor informed us that this is common in twin pregnancies and it is likely that Baby A will either miscarry or absorb into the uterus. Yes we we're sad. The loss of one of the lives inside me is not something you just shrug off. But at the same time we have SO much to be happy about! We got to hear Baby B's heartbeat and it was the most amazing sound I've ever heard. Here's he is in all his glory; our alpha fetus:

We mourned the loss of Baby A for however we knew this was a possibility and we are just as happy to have one healthy baby as we would have been to have two. We also graduated from the fertility clinic today. Que another onset of emotions. What a journey this has been! To be leaving the comfort of this clinic we know so well; the doctors and nurses and even the receptionists we have grown to love and trust; to be discharged out into the world as a regular ol' pregnant couple. We have accomplished what we set foot in there to accomplish and now it's time for my body and nature to run its course. We are so grateful for this experience and all the wonderful people it has lead us to. All the trials and tribulations, every monumental step in the right direction; it was all worth it for this outcome. We are pregnant with a child that is equally me and equally him. We will raise it together in love and unity; teach it right from wrong and love it unconditionally. 

Next week we go to Kaiser for our first OB appointment. A new set of doctors, a new facility, new rules and protocol. We are beyond excited for the continuation of this journey. Thank you to every single one of you who have tuned in to read the updates, supported us through kind words or prayers, and held my hand as I cried and rejoiced through this journey. 

This is truly a Christmas Miracle we will never forget.

The In Vitro Journey - Round 1 - Transfer and 2ww!

Readers, I am so sorry to keep you waiting on this post. By now everyone who reads this probably already knows we had our transfer but I thought I owed to you all to sit down and right out a detailed description of bringing our embryos home and what has gone on since then.

Here they are in all their glory! 

2 perfect embryos after they had been thawed out 

(one was 5 days old before it was frozen and one was 6 days old). 

On Tuesday we arrived at the clinic at 11:30am to check in for our 12:00pm transfer. Due to my clinic's over booking, we sat in the waiting room until 1:00pm. This was probably the most torturous hour of my life. We were annoyed but we were confident our embryos were in good hands and were thawing out and getting ready for us. Finally around 1:30pm we saw our doctor who apologized for the wait and promised us the transfer itself would be quick and easy and we'd be out of there in now time. 

We met with the embryologist who gave us the above picture of our embryos and also let us know that one of our embryos was lost during the thaw. Though we were saddened by this, we knew it was a possibility and it made us even more thankful that we did another round of IVF before attempting to transfer the one frozen embie from our first batch.

The doctor came in and inserted a ultrasound so they could see my lining and know exactly where to place the embryos. The doctor then inserted a catheter which we could see on the ultrasound. We watched on a TV screen as the embryologist in the lab sucked the two embryos up into a tiny catheter and then walked them to our room. The doctor then inserted the small catheter into the catheter that was inside of me. You can see on the ultrasound the exact spot in my lining where the embryos were placed (the little white dot).

After the transfer was complete we were told to take it easy for a little while but ultimately to return to live as normal. No bed rest, no baths, and no heavy lifting. I have been taking part in all the IVF "old wives' tales" such as eating one piece of pineapple core a day, one 8 oz glass of pomegranate juice and 5 Brazil nuts. I've also been eating healthy and drinking lots of water and most importantly staying positive. It's hard not to over analyze every little cramp and movement you feel in your body and I've turned to Dr. Google more times than once.

1dp5&6dt

(1 day past 5 & 6 day transfer)

I kind of laid around the house a lot this day. I didn't feel much of anything all day.

2dp5&6dt

Back to work! Felt little tiny pulls and twinges in my lower abdomen but nothing to think twice about.

3dp5&6dt

Felt some cramping and sore lower back on and off all day.

4dp5&6dt

Today I woke up feeling crampy and sore. The cramps have been pretty steady all day which I want to think is a good thing but at times I worry it's the beginning of my period. What a cruel joke of the world that pregnancy symptoms so closely mimic period symptoms! I bought @ home pregnancy tests today but my other half is making me hold off until at least 6dp.

The 2ww (2 week wait) continues!

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The In Vitro Journey - Cycle #2 - Final Embryo Update

My favorite thing about this process so far has been the lab's daily embryo update calls. I usually let them go to voicemail so David and I can listen together. Also sometimes I need to listen to them a couple of times to really take in all the information. Today was day 6, our final day for the embyros to be viable for freeze. Yesterday we got that call that 3 of our embryos had reached blastocyst stage and were frozen. 2 were good quality and 1 was fair quality. (Embryos are rated on a good, fair, poor scale) Today they were able to freeze 2 more. 1 good quality and 1 fair quality. That leaves us with a total of 6 frozen embryos (with the 1 from last time). So we have 4 good quality embies and 2 fair quality. 

We are so happy with these results and so glad we went through with this second round of stims like the doctor suggested. Although it is tough to wait another couple of months to have these embryos transferred back in me where they belong I know it is in our best interest.

I will be starting a 21 day all natural cleanse called Standard Process in the upcoming weeks to flush out all the toxins and prepare my body to the best of my ability for a successful and healthy pregnancy.

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The In Vitro Journey - Cycle #2 - Day 2 Embryo Update

This morning we got some interesting news. One of our 12 embryos split and became two embryos. That means 2 of our now 13 embryos are identical twins!

Embryos should be doubling in size every day. 1 little guy is lagging behind and is still only 1 cell. 6 have doubled into 2 cells and 6 have already doubled again and become 4 cells.

2 Cell Embryo

4 Cell Embryo

For more information or to compare our embryo grown to Cycle #1, click here!

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The In Vitro Journey - Cycle #2 - Emotions n' Stuff

As we find ourselves embracing cycle #2 I think a less factual and more emotional post is in order. So far most of my posts have been to the point. The doctor said this, this is our plan of action, this is what happened, this is what's going to happen. Instead I'll venture off that track and into the depths of my mind for a little.  

Infertility can be a dark place. We have not yet faced some of the hardest, darkest things that many couples on this journey experience but it certainly hasn't been rainbows and butterflies. IVF is such a big, scientific thing. There are so many unknowns and so many possibilities. It is a constant roller coaster. Even when you finally see those two pink lines, even when the doctor confirms you are pregnant; you are not out of the woods until months into the pregnancy.

Infertility can put constraints on every relationship in your life, negatively impact your mental health and cause bitterness, jealousy, heartache, hopelessness and so many other negative emotions. It is a daily choice to bathe in positivity and not succumb to the negative thoughts and emotions taking over your brain. As hard as I try to rise above these thoughts and feelings there are days when it all weighs down on my heart. Days when it all just seems so unfair. I read stories in the news ALL THE TIME about people who do not, in any way, deserve to be a parent. Mothers that inject sanitizer into their babies feeding tubes, fathers that leave their children locked in a hot car for 6 hours. Here we are, wanting absolutely nothing more than to have a child of our own; Stretching our finances, our minds, and our hearts to a near breaking point; Doing unnatural, over the top things to accomplish what so, so many people take for granted.

Through this journey I have stumbled into the most supportive, helpful and accepting community I've ever witnessed. I have met some of the strongest woman that have been completely broken with hearts shattered on the floor. From cancelled cycles due to poor response, to chemical pregnancies, or multiple miscarriages, these women allow themselves to grieve and then pick themselves up and start again. We share in each other's joy and sorrow, we share our deepest, darkest fears, endless questions and our own kind of humor. It has helped me beyond words to have these women to relate to and confide in.

It has also been a huge blessing to have my family so supportive and on my side through all of this. It cannot be easy for a mother to watch her daughter go through something so drastic to accomplish something that many women do on accident. I'm sure there is the constant question of why does it have to be this difficult when she's perfectly healthy. They do not pressure me directly to give them grandchildren but I know in their hearts they are ready. I know they are among the last of their friends who's babies are having babies and I know they are ready for that to change. 

Infertility affects so many aspects of so many lives. It is currently affecting mine in more ways than I can count. The things we go through over the next year will always be a part of me and my experiences will shape the rest of my life. All I can hope is that the good outweighs the bad and we get our happily ever after.

 1 in 6 couples are infertile. We are 1 in 6.

The In Vitro Journey - Cycle #2 - Calendar

Starting over is kind of exciting. This time we know exactly what to expect and how all the medicines will affect me. We know how often we will have to go in to the clinic and how quickly it will be egg retrieval time. We'll get a fresh set of eggs and those daily phone calls updating us on our growing embryos.

Calendar

August 24th                            Cycle #2 Starts

August 25th - September 13th  Birth Control

September 18th 8:45am           Baseline Ultrasound & Bloodwork

September 18th 6:00pm           Start 300iu Follistim & 150iu Menopur

(Continue everyday for 9-12 days per doctors recommendation)     

September 23rd 10:45am         Ultrasound & Bloodwork

September 24th 6:00pm           Start .25mg Cetrotide

(Possible increase of Menopur. Continue for 4 days per doctors recommendation)   

September 25th ????am            Ultrasound & Bloodwork       

September 28th ????am            Ultrasound & Bloodwork

September 28th - October 1st    Egg Retrieval one of these days, 

                                               trigger shot 32 hours prior.  

If you're wondering what the different meds do, click here to read my post from the first cycle of stimulants. We are currently shopping around and trying to find the best deal for all these meds. Some places are quoting as much as $7,000 but we think we can do better.

Bring on round 2!

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In Vitro Journey - Cycle #1 - Change of Plans

Yes, another change of plans in the mix. 

That's the nature of this process and we're learning to not expect anything to stay the same from day to day.

On Monday we went in to meet with the doctor for what we expected was our Frozen Embryo Transfer Consultation. We ended up being presented with two options and a strong recommendation from our fertility specialist. 

Option #1 - go forward with our frozen embryo transfer. Transfer the one and only little embryo that made it through the freezing process and cross our fingers and hope for the best. The doctor told us only about 80% of embryos survive the thawing process and when transferring one single embryo there is only about a 25% chance of pregnancy. 

Option #2 - start from the beginning. Do another round of hormones, a new egg retrieval, watch our embryos grow and hope and pray that we have more than one make it to the end.

Now, at first I was devastated. We had spent the last week trying to be positive about our 1 little embryo. Reading all these "it only takes one" success stories and thinking one is all we need. Yes, I cried in the doctors office when he strongly suggested we go with option #2. But then I got to thinking, WE got to thinking, and talking and realized option #2 is really, truly in our best interest. The clinic is not going to charge us to do another cycle since we are doing the success guarantee program. (You can read more about that here) We were told we could start the second round right away if we want.

The  main reason the doctors want us to do a new cycle is so they have more than one embryo to work with. They ideally want to implant two at a time to increase the chance of pregnancy to 50%. Also, embryos that are frozen can be stored forever. That means, in two or three or five years from now if we want to have another baby, we can come back and do a simple frozen transfer and not worry about all the injections, monitoring appointments, major surgery all with a child on our hip. Egg quality decreases the older a woman gets so it is ideal to get as many out now as possible. 

We've had a few days now to reflect on our decision to do another cycle and I'm actually quite excited. The injections are really no big deal and the only time I was affected by them was at the very end when it felt like I was carrying around bowling balls inside me. The doctors have started me on different vitamins meant to help improve my egg quality in hopes that this time we'll get not only more eggs but more mature eggs. Another big factor of this cycle will be closely monitoring my estrogen levels. The hope is that we will be able to do a fresh transfer right after the retrieval. 

We are both confident that round 2 will yield more healthy embryos and have positive results all around. Thanks in advanced for your prayers, well wishes, and good vibes.

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In Vitro Journey - Cycle #1 - "It Only Takes One"

More "It Only Takes One" Success Stories

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In Vitro Journey - Cycle #1 - Egg Retrieval and Embryo Update

Lots of exciting news to share with everyone! 

On Tuesday 8/18 at 11:00am we had our surgical egg retrieval. We arrived at the surgery center, which is just next door to the fertility clinic, at 10am and got checked in and into pre-op. Stylish surgery gowns, my lucky troll socks, and a high end massage chair had me pretending to feel pretty relaxed. In reality I was freaking out.  

David stayed with me until it was time to go into the operating room. As soon as he left, I broke down. Cried all the way onto the operating table until I fell asleep from the anesthesia.
Took a quick little nap and woke up hyperventilating about 30 minutes later. The nurses brought David back to my recovery room and gave me a narcotic to ease the pain. Eventually I calmed down enough to talk to our Dr. about how the procedure went. 

We were told they got a total of 16 eggs from my ovaries!

The rest of Tuesday was spent in a blur of groggy, pain filled complaints and not being able to stand up or walk unassisted. David was the most amazing caretaker; administering my meds, going to the store for things I needed, and continuously telling me how great I did and how proud of me he was. Wednesday was Day 1 of conception for our embryos. We got a call first thing in the morning that of the 16 eggs, 9 of them were mature. Of those 9 mature eggs 6 were successfully fertilized. 

Today is Thursday or Day 2 for our little embabies. They are being closely monitored and documented and are expected to have divided from single cell organisms to 2-4 cells. 1 embryo is ahead of the game and has already divided into 7 cells! 4 of them are in the normal 2-4 range and 1 was still a single cell organism. Our embryos are rated on a "poor, fair, good" scale and they all fall in the fair - good range.

We will get a call every day to update us on our embryos progress. We hope that they make it to 5 day blastocysts and then they will be frozen right before hatching. We will meet with our Reproductive Expert in 2 weeks to have some more blood tests done and see how my estrogen levels are doing. From there we will have a better idea of when we will start preparing for the Frozen Embryo Transfer.

This has been such a crazy, intense journey so far and I am so so thankful that I have David by my side through it all. He is just as involved in this process as I am, attending every doctors appointment and is constantly by my side encouraging and helping me in anyway possible. He has put up with my extreme mood swings, constant complaints about side effects, has given me over 30 shots and so much more. I couldn't imagine doing this without him. We are both so amazed and happy that we have 6 little embryos made up of 50% of his DNA and 50% of mine. We are so excited for everything the future holds.

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The In Vitro Journey - Cycle #1 - The Final Check Up

We officially have a date and time for Egg Retrieval! Tuesday 8/18 @ 11:00am.

I will not miss these shots!

Our last ultrasound was today and my follicles are HUGE!! Some are measuring at 28 and 29 mm! 

I'm still in a good amount of pain and not sure what my estrogen levels are at today. We were instructed to take our trigger shot tonight @ 11pm. This is the final step in making my eggs mature before surgery.

We're taking guesses on how many eggs we will get.. I say 18, David says 21.

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The In Vitro Journey - Cycle #1 - Complications

Yesterday we got some news, which at the time of the call I considered bad news. Now that I've had some time to process, research and talk about this news I realize it's in my best interest and am ready to accept it for what it is.

Friday morning we had another ultrasound to check on the growth of my follicles. The doctor was happy with what she saw and called me a super-star egg producer. My uterus lining is 8mm and shaped perfectly. She counted 19 follicles on the left side and 12 on the right. There is no way to see if each follicle contains an egg however they are looking for follicles bigger than 14mm and assume that those follicles have grown to the point of containing a mature egg. My follicles measured as follows..

After the ultrasound I got my blood drawn and scheduled an appointment to come back for monitoring on Sunday morning. I was told we were probably looking at a Tuesday (8/18) egg retrieval. 

Now you're probably asking yourself, where's the bad news? Where's the complication? This all sounds good and normal. Well, as soon as we left the clinic I got really bad lower back pain.. I couldn't stand up straight and struggled to get in and out of the car. When we got home I laid down and tossed and turned trying to get comfortable. I figured the pain was due to how large my ovaries are and the probing of the ultrasound pushing them around and causing some soreness. A couple hours later we got a call from the doctor who said my estrogen level is 3,360 when it should be no higher than 2,000. They said we will most likely have to do a freeze all after egg retrieval. This means that after the eggs are collected they will be fertilized, monitored, and then frozen. We will then have to wait a couple months for my body to reset itself, clear itself of all the hormone drugs, and then have a frozen embryo transfer. Now, at first when the doctor told me this I rushed off the phone before I started to cry. After waiting this long the last thing you want to hear is that you have to wait longer. When I turned to my awesome Facebook IVF support group to complain about the news, the response I got really helped to ease my mind and calm me down. It seems that this is a very common thing that happens and is really in the best interest of my health and my future pregnancy.

The back pain and the high estrogen level is a sign of Ovarian Hyper Stimulation Syndrome (OHSS) which is a side effect of the hormone injections. Getting pregnant while having OHSS can cause many complications and be extremely painful for the mother. 

As it turns out, frozen embryo transfers are typically more successful than fresh transfers. Allowing your body to detox and rid itself of all the drugs puts you in the best physical state to achieve a healthy and successful pregnancy. We're not quite sure how long we will have to wait to do the transfer, it could be a month, it could be three. Obviously the doctors are looking to do what is in everybody's best interest and all we can do is trust them. We've waited this long, what's a couple more months?

Will update again after our appointment tomorrow.

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The In Vitro Journey: Cycle #1 - Day 1 & 2

The "shooting up" has officially started! Yesterday was our first injection night and we were more nervous than was necessary. It ended up to be a breeze; no pain, no side effects. I gave myself the first shot and David gave me the second one. At first he was timid and didn't want to hurt me but once he realized it didn't hurt he was excited to do it again today.

The Follistim pen is so easy and convenient. The Menopur injection stung a little bit today but nothing I can't handle. 

Don't mind my crazy beach hair... Spent the day riding jet skis at the bay :)

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In Vitro Fertilization Fact of the Day

Normally a woman's ovaries are the size of a walnut.

After a cycle of hormone stimulants, a woman's ovaries are the size of a grapefruit.

I think I'm gonna need to get some bigger pants!

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The In Vitro Journey: Cycle #1 - Stimulants

Yesterday we went into the clinic for our baseline ultrasound and blood tests. The purpose of the ultrasound was to confirm there were no cysts on my ovaries, check the position of my uterus, and count how many follicles are present in each ovary. We counted 9 on my right ovary, and 10 or 11 on my left ovary. These are great numbers and everything looks perfect & normal in my uterus.

Tomorrow is the day that makes this whole thing even more real than ever before... We start injections! Some people have been asking me why I have to take stimulants when I'm not the one with the fertility problem. But here's the thing... Infertility is a medical diagnosis. We, as a couple, are infertile. These stimulants are part of the process. Our clinic does not give the option for a "natural" IVF cycle.

In a woman's natural cycle the body releases one single egg. The hormone stimulants I will be taking will force my body to create multiple eggs in the follicles that will be retrieved when they are matured. Multiple eggs means maximum opportunity to create healthy embryos. If we were to do this without the stimulants, we would be working with one egg at a time, significantly decreasing our chances of creating any embryos let alone healthy, growing, multi-cell embryos.

Let's also keep in mind that not all eggs retrieved will be mature and not all mature eggs will be successfully fertilized. The doctors could retrieve as many as 30 eggs but maybe only 20 of them will be mature and only 10 will fertilize. Of those 10 maybe only 5 will grow to 5 day blastocysts. These hormones stimulants are absolute imperatives to the success of our IVF cycle. 

Now lets talk about what exactly I'll be injecting. For the first week I will be doing nightly injections of Follistim & Menopur. Follistim is a man-made form of the hormone FSH which occurs naturally in the body. The injection is administered through a 
pre-filled, pre-mixed pen which allows the user to dial a specific dose and inject by pushing in on the plunger. 



Menopur is a highly purified preparation of naturally derived gonadotropins. It comes in powder form and is mixed with sodium chloride to be injected daily. Both medicines help to stimulate egg production in the follicles and assist in ovulation.

After a week I will stop taking the Follistim and will begin taking Cetrotide and decrease my dosage of Menopur. Cetrotide prevents eggs from being released too early by blocking the hormone that causes woman to ovulate. 

I will have monitoring appointments 3x a week during all this and the doctors will closely monitor the size and count of my follicles. My meds will be adjusted if necessary and when everything looks right I will be scheduled for egg retrieval. I will be instructed to take my trigger shot 36 hours prior to the ER.  

We are so excited for the next step in our journey. As always, it may not be easy but it will always be worth it. More soon...

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The In Vitro Journey: Cycle #1 - Calendar

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
July
			1	2	3	4
5	6	7	8	9	10	11
12	13 Cycle start	14	15	16 Start Birth Control	17 BC	18 BC
19	20	21	22	23	24	25
BC	BC	BC	BC	BC	BC	BC
26	27	28	29	30	31	1
BC	BC	BC	BC	BC	BC	BC
August
2	3	4	5	6	7	8
Last BC Pill			Baseline Ultrasound & Bloodwork		Start 225 units of Follistim Start 75 units of Menopur	6pm - Injection
9	10	11	12	13	14	15
6pm - Injection	6pm - Injection	Start taking Centrotide Increase dose of Menopur TBD        6pm - Injection	Ultrasound & Bloodwork 6pm - Injection	6pm - Injection	Ultrasound & Bloodwork 6pm - Injection	Start taking 1 tab Azithromycin 6pm - Injection
16	17	18	19	20	21	22
6pm - Injection, 1 tab Azithromycin	Ultrasound & Bloodwork 6pm - Injection, 1 tab Azithromycin	Egg retrieval? (12 hrs prior - inject Ovidrel, take 1 tab Zofran)	Egg retrieval?	Egg retrieval?	Egg retrieval?	Embryo Growth/Watch
23	24	25	26	27	28	29
Embryo Growth/Watch	Embryo Transfer?      (Start 1 tab Prednisone, start 1 tab Prometrium, start 100mg Endometrin)	Embryo Transfer?      AM - Prednisone, Prometrium, Endometrin	Embryo Transfer?      AM - Prednisone, Prometrium, Endomtrin	Embryo Transfer?     AM - Prednisone, Prometrium, Endomtrin	AM - Prednisone, Prometrium, Endomtrin	AM - Prednisone, Prometrium, Endomtrin
30	31	1	2	3	4	5
AM - Prednisone, Prometrium, Endomtrin	AM - Prednisone, Prometrium, Endomtrin	AM - Prednisone, Prometrium, Endomtrin	PREGNANCY TEST! AM - Prednisone, Prometrium, Endomtrin

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