Wedding

The best day ever.

Our AppyCouple wedding website

Our Wedding Pinterest Board

Our Honeyfund


Our Wedding Day
0052kris_ross
Bridal Veil: Mia Bella Couture
Bridesmaids: Vow to Be Chic
Cake: VG Donuts
DJ: Elite British DJ (Mick)
Rings: Brilliant Diamonds – Tacori (Ariel)
Wedding Planner: I do weddings (Melissa)
First Dance choreography:  Wedding Dance San Diego (Liz O’Grady)
Photo: True Photography (Billy)
Video: Campbellicious (KC)
0001kris_ross

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Screen Shot 2017-07-09 at 11.28.12 AM

You’ve lost that loving feeling…

  
One of the best times and best nights captured on vid (thank you so much @zeekachu !). When @calfanz put in a special request to congratulate me and my 🐻 on our engagement. The timing, crew, and love was incredible! Special thanks to @zeekachu @calfanz @ross.c.77 ❤️ #lovingfeeling #topgun #duelingpianos 

Engagement Weekend

Saturday, February 13, 2016

Ross set the alarm early (5:30a) and was really eager to get the day started.  He told me to sleep in a little bit so he could get the car packed (what a sweetheart!).  So, I snoozed until 6am when I got up and got ready and went downstairs for an already hot cup of coffee waiting for me (with Stevia and cinnamon of course!).

We jumped into the car and started our drive up to Santa Barbara.  Ross had this Saturday all planned out.  We luckily had a 3day weekend and were absolutely going to take full advantage of our time off!  Earlier in the week, I had told him no funny business for Valentine’s Day.  It’s one of the “holidays” I dread… for 2 reasons: 1) it’s incredibly over-commercialized and beats fear into men to woo their significant others.  Boo Hallmark holiday! 2) It makes me sad bc my dad used to give me a single stem rose from our rose bush in front of our Abilene house and tell me I was beautiful and his lil girl.

IMG_0101.JPG

So, we’re driving along and we’re listening to the radio and there was a Bruno Mars song that came on.  Ross wondered how he came up with that name Bruno Mars.  And then he joked and said we were going to name our first born Biff Jupiter.  We both busted out laughing! (That man brings a smile and laughter to me always!).  Well, around 10am, we get to our first destination in Santa Barbara… the botanical garden.  But first, we had a little snack from the cooler that Ross packed — guac (my fave!), chips, and an ice cold Cali Creamin’ (fave!).  Say no more, this man knows me to a T!  After a snack, we enter the grounds and tour the garden.  They have a beautiful redwoods section (did he know that?).  We had talked about going up to Nor Cal to do some hiking amongst the redwoods in the Redwood National Park — but this would do bc it was so close to home!  What a creative and wonderful idea!  They also had a Japanese tea ceremony that we watched.  Even though we were in Japan for two weeks, we didn’t get a chance to see one!

IMG_0008.JPG

After the hike, we headed to the Mission in Santa Barbara to check out some history.  It was a gorgeous area with a beautiful vast lawn area to layout and enjoy the Cali sun.  After our own walking tour of the mission, we picked out a spot on the lawn and laid out a yummy picnic that Ross had gathered up and packed into the cooler.  Some bbq chicken, roasted beets, humus, veggies, and guac and an ice cold Allagash Curieux was heaven!

After lunch, we packed up and headed out to a winery that came highly recommended from his friend Jason, who is a sommalier.  In fact, he was showing us his awesome skills down at some wineries in Valle de Guadalupe (Mexico).  We did a tasting and quite honestly, I loved almost every single one we tried (and that’s rare for me!).

IMG_0142.JPG

Now we were starting to get a lil hungry again..so we decided to hit up the famous La Super-Rica Taqueria.  It was a delightful treat of amazing and authentic Mexican food.  We overstuffed ourselves, but it was worth it. 🙂

IMG_0144.JPG

So after being ridiculously full, we needed to walk. And where better to walk than to a brewery?  In fact, Ross researched and found out that Telegraph Brewing Co. specializes in Belgians – one of our fave types of beers!  We opted for the tasters and definitely realized we had to take some growlers home!

IMG_0020.JPG

Then we headed down to the wharf area.  It was starting to get late (4:30p) and I wanted to get checked in so we could walk out to the pier and watch the sunset.  So, we did just that.  It was a beautiful evening — people were out and having a great time.  The surf was big and we watched the surfers for awhile…Ross was teaching me all kinds of things about that surf spot and the waves.  (I love this man!). While we were watching the surfers, Ross got his foot pooped on by a big ol fat albatross sitting on top of a light post.  He was at least 3 feet away, but the splat from his poo was so massive that it sprayed Ross’ foot and flip flop.  🙂  We walked a bit along the boardwalk/sidewalk.  Santa Barbara is an incredibly stunning place!!

IMG_0061.JPG

Lastly, it was time for dinner.  We loved The Stonehouse when we went there the first time [After only 1 month of dating, we took a road trip to Santa Barbara and Ross booked this restaurant.  We had such a great time and dining experience…and after we ate, we walked around the grounds and came upon an archway that was beautiful. We both had a bit of an emotional and just really magical feeling there!].  I was ecstatic that we could get reservations for  dinner on Valentine’s weekend (I figured it would all be booked out!).  We purposefully got there an hour early (although our Uber driver really had a tough time finding the place, despite Google Maps) and wanted to walk around the grounds.  I suggest some champagne since we could walk around the gardens with alcohol.  So, we ordered up our bevies and then took a beautiful walk along the property.  It was beautifully lit with tasteful dim lights, tree lights, and little pops of red denoting V Day.  A powerful Santa Ana was raging that day — despite it being chilly in the mountains, the wind was warm and forceful.  We finally get to a lil garden terrace area with small wooden seating benches with a pergola-type overhead decor.  We were looking out into the night with the lights and the garden itself…. when Ross starts talking to me about our relationship.  The rest is history — as much as I want to say I remember what he said initially… all I can remember is that he started to tear up and get emotional.  I started to wipe his joyful tears.  His love was so strong and it engulfed me completely.  I was surprised, but I knew this day was coming.  He is the only man I can imagine spending the rest of my life with in complete happiness, honesty, love, and friendship.  He got down on one knee…and asked me the question every girl wants to be asked.  Will you marry me?  My answer: Yes, yes, yes, a million times over.  I would’ve waited an entire lifetime for you.  We kissed and held each other for a quick minute before he slipped a beautiful ring on my finger.  It was beautiful.  Ginormous!!  Classy, elegant.  He was the man I had dreamed of and he was offering his heart, love, and devotion.  I am a freakin’ lucky girl!

After our ooooo’s and aaaaaaaah’s with the ring (the sparkle was crazy brilliant even in the dark night!), I asked him a million questions on how he hid it from me and where and how my mom and aunt were in on it. Sneaky lil devil!  We headed off to dinner and when we got seated, there were a dozen red roses in a vase at our table.  Initially, I thought it was part of the VDay dinner decor, but then I looked around and our table was the only one.  He is such a thoughtful man!

IMG_0092.JPG

IMG_0026

IMG_0049

Slideshow from engagement weekend

Engagement

Saturday, February 13, 2016

Ross set the alarm early (5:30a) and was really eager to get the day started.  He told me to sleep in a little bit so he could get the car packed (what a sweetheart!).  So, I snoozed until 6am when I got up and got ready and went downstairs for an already hot cup of coffee waiting for me (with Stevia and cinnamon of course!).

We jumped into the car and started our drive up to Santa Barbara.  Ross had this Saturday all planned out.  We luckily had a 3day weekend and were absolutely going to take full advantage of our time off!  Earlier in the week, I had told him no funny business for Valentine’s Day.  It’s one of the “holidays” I dread… for 2 reasons: 1) it’s incredibly over-commercialized and beats fear into men to woo their significant others.  Boo Hallmark holiday! 2) It makes me sad bc my dad used to give me a single stem rose from our rose bush in front of our Abilene house and tell me I was beautiful and his lil girl.

IMG_0101.JPG

So, we’re driving along and we’re listening to the radio and there was a Bruno Mars song that came on.  Ross wondered how he came up with that name Bruno Mars.  And then he joked and said we were going to name our first born Biff Jupiter.  We both busted out laughing! (That man brings a smile and laughter to me always!).  Well, around 10am, we get to our first destination in Santa Barbara… the botanical garden.  But first, we had a little snack from the cooler that Ross packed — guac (my fave!), chips, and an ice cold Cali Creamin’ (fave!).  Say no more, this man knows me to a T!  After a snack, we enter the grounds and tour the garden.  They have a beautiful redwoods section (did he know that?).  We had talked about going up to Nor Cal to do some hiking amongst the redwoods in the Redwood National Park — but this would do bc it was so close to home!  What a creative and wonderful idea!  They also had a Japanese tea ceremony that we watched.  Even though we were in Japan for two weeks, we didn’t get a chance to see one!

IMG_0008.JPG

After the hike, we headed to the Mission in Santa Barbara to check out some history.  It was a gorgeous area with a beautiful vast lawn area to layout and enjoy the Cali sun.  After our own walking tour of the mission, we picked out a spot on the lawn and laid out a yummy picnic that Ross had gathered up and packed into the cooler.  Some bbq chicken, roasted beets, humus, veggies, and guac and an ice cold Allagash Curieux was heaven!

After lunch, we packed up and headed out to a winery that came highly recommended from his friend Jason, who is a sommalier.  In fact, he was showing us his awesome skills down at some wineries in Valle de Guadalupe (Mexico).  We did a tasting and quite honestly, I loved almost every single one we tried (and that’s rare for me!).

IMG_0142.JPG

Now we were starting to get a lil hungry again..so we decided to hit up the famous La Super-Rica Taqueria.  It was a delightful treat of amazing and authentic Mexican food.  We overstuffed ourselves, but it was worth it. 🙂

IMG_0144.JPG

So after being ridiculously full, we needed to walk. And where better to walk than to a brewery?  In fact, Ross researched and found out that Telegraph Brewing Co. specializes in Belgians – one of our fave types of beers!  We opted for the tasters and definitely realized we had to take some growlers home!

IMG_0020.JPG

Then we headed down to the wharf area.  It was starting to get late (4:30p) and I wanted to get checked in so we could walk out to the pier and watch the sunset.  So, we did just that.  It was a beautiful evening — people were out and having a great time.  The surf was big and we watched the surfers for awhile…Ross was teaching me all kinds of things about that surf spot and the waves.  (I love this man!). While we were watching the surfers, Ross got his foot pooped on by a big ol fat albatross sitting on top of a light post.  He was at least 3 feet away, but the splat from his poo was so massive that it sprayed Ross’ foot and flip flop.  🙂  We walked a bit along the boardwalk/sidewalk.  Santa Barbara is an incredibly stunning place!!

IMG_0061.JPG

Lastly, it was time for dinner.  We loved The Stonehouse when we went there the first time [After only 1 month of dating, we took a road trip to Santa Barbara and Ross booked this restaurant.  We had such a great time and dining experience…and after we ate, we walked around the grounds and came upon an archway that was beautiful. We both had a bit of an emotional and just really magical feeling there!].  I was ecstatic that we could get reservations for  dinner on Valentine’s weekend (I figured it would all be booked out!).  We purposefully got there an hour early (although our Uber driver really had a tough time finding the place, despite Google Maps) and wanted to walk around the grounds.  I suggest some champagne since we could walk around the gardens with alcohol.  So, we ordered up our bevies and then took a beautiful walk along the property.  It was beautifully lit with tasteful dim lights, tree lights, and little pops of red denoting V Day.  A powerful Santa Ana was raging that day — despite it being chilly in the mountains, the wind was warm and forceful.  We finally get to a lil garden terrace area with small wooden seating benches with a pergola-type overhead decor.  We were looking out into the night with the lights and the garden itself…. when Ross starts talking to me about our relationship.  The rest is history — as much as I want to say I remember what he said initially… all I can remember is that he started to tear up and get emotional.  I started to wipe his joyful tears.  His love was so strong and it engulfed me completely.  I was surprised, but I knew this day was coming.  He is the only man I can imagine spending the rest of my life with in complete happiness, honesty, love, and friendship.  He got down on one knee…and asked me the question every girl wants to be asked.  Will you marry me?  My answer: Yes, yes, yes, a million times over.  I would’ve waited an entire lifetime for you.  We kissed and held each other for a quick minute before he slipped a beautiful ring on my finger.  It was beautiful.  Ginormous!!  Classy, elegant.  He was the man I had dreamed of and he was offering his heart, love, and devotion.  I am a freakin’ lucky girl!

After our ooooo’s and aaaaaaaah’s with the ring (the sparkle was crazy brilliant even in the dark night!), I asked him a million questions on how he hid it from me and where and how my mom and aunt were in on it. Sneaky lil devil!  We headed off to dinner and when we got seated, there were a dozen red roses in a vase at our table.  Initially, I thought it was part of the VDay dinner decor, but then I looked around and our table was the only one.  He is such a thoughtful man!

IMG_0092.JPG

IMG_0026

IMG_0049

Slideshow from engagement weekend

Learning to Surf: My newbie thoughts

I have been in southern California for about 5 years. In that time, I’ve only been surfing once. Luckily, I had checked out a Groupon for Surf Diva that offered two afternoons of surfing on a weekend!

Taken from the Surf Diva website.

It was a great introduction to surfing, and I felt it was a safe environment. There were 5 other girls that came out and the surf school outfitted us with foam boards and rashguards. There was one instructor for all of us and they did a great job going through all the details of how to hold and handle the board, popping up, surf stance, surf etiquette, just the basics.

I believe I took that class back in 2012. According to this article, you’re never too old to learn to surf! Fast forward to August 20, 2015, when my bf was eager to help teach me how to surf. We headed out to Swami’s with a longboard, and he helped me catch three waves! I was so excited… as was he! In fact, he may have been more stoked! Because I had such a great time, I’m on a mission to learn as much as I can so we can surf together!

After reading several sites, I think the funboard is the way for me to go. It seems pretty versatile for a beginner board with some room for more maneuverability as I improve. YouTube vid: 4 tips for picking a surfboard (for beginners).

Learn how to read a surf forecast so you can actually go catch some waves!

Websites I found useful:

So you want to get a board…

Getting into surf shape:

Blogs for motivation:

My Equipment:

surfbags

My favorite surf places

May 7

Happy bday Dada. 🙂

i had my first date with Ross –> http://www.coastlawgroup.com/ross-campbell/

Our first date he planned and made reservations for at Cucina Enoteca.  I met him at the restie — it was a bear to find parking.  He arrived slightly late.  He was nicely dressed in a button down fitted shirt and nice jeans. You could see his nice muscle tone.  He had a very nice friendly vibe to him.  We got seated.  The conversation immediately flowed.  He was a gentleman.  Very mature.  Happy to serve me first.  He was genuine.  And he communicated very well.  Time got away from us.  Before you knew it, it was 10:45pm at the restaurant and we had to go!  He walked me to my car.  Gave me a kiss.  I enjoyed it.  Sweet soft warm lips.

Hormone stimulation for oocyte retrieval #eggs #fertility #hormones #professional #women

I’m a professional.  

On call in the hospital
On call in the hospital

What does that even mean?  My best guess is that it means I went to school for a long time and entered a career where I get to behave professionally and interact with people.  Fast forward 18 years after graduating high school and I have a successful career in medicine doing anesthesia.  I have met some fantastic people along my journey and I’ve traveled and experienced life to the fullest.

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So why this post?

Because I’m 35 and according to the OB/GYNs…I’m AMA (advanced maternal age).  In a nutshell, it means that after the age of 35, there are significant (possibly exponential?) risks of chromosomal abnormalities with my eggs or there could be serious problems with my baby at my age.  The older I get, the more I’d like the option of having a family… and that’s whether I meet the right guy or not.

From Wikipedia (James Heilman, MD): The risk of having a Down syndrome pregnancy in relation to a mothers age.

What’s it like to undergo hormone stimulation?

Tues, March 3:  I’m currently on day #5 of injections and I still feel normal (i.e. no crazy hormonal emotions or anything; no bloating; no weird experiences, etc.). I don’t have any emotional drama; no crazy hormonal thoughts or outbursts. I actually feel pretty normal.  No bloating, no PMS, etc. I don’t know what I’m supposed to feel bc I feel just normal… like a normal day without the injections.  Now, the injections –> I’m starting to dread the 7pm hour bc these injections are starting to hurt!  I’m a pretty tough cookie… don’t be fooled by the smiling youngish face.

The meds and my mini sharps container
The meds and my mini sharps container

Fri, March 6: I’m bloated.  Cravings are starting to kick in, but maybe it’s just stress at work?  No crazy emotional stuff.

Sat, March 7: The bloating continues.  In fact, my ovaries are pretty sensitive — any big bounces in the car or if I sit down hard is painfully noticeable.  The Ganirelix stings a little bit more than the others on injection.  No big hikes or active things: no trail running, no running (period!), no elliptical, no jumping.  I’m starting my couch potato life and getting stir-crazy!  But, I did do a 7 mile flat hike today — I couldn’t help it!

Sun, March 8: The bloating continues.  I definitely feel the pull/sensitivity of both my ovaries.  Even when I empty my bladder, the pressure/tug release is definitely present.  Huge mishap today: I underestimated how much Follistim I had!  Today, I was supposed to go up on Menopur, but I didn’t have any extra, so I was told to take my standard 150 dose.  Yet, they told me to go up to 300 on Follistim today and I barely had any when I stuck the needle in! I remembered I had an extra vial with just a small amount left and injected that.  it was only 150.  3 injections in one night is no fun.

Mon, March 9: Gave myself an additional 150 follistim this morning once the pharmacy opened.  15mm follicles are looking good!  My left ovary has a ton!  The right ovary is doing alright as well.  Just waiting to get the estrogen level up.  Same bloated feeling.  No physical activity or heavy lifting.

Tues, March 10: Estrogen is finally above 1,000! Apparently after many years of birth control pills, it suppresses estrogen… on track!

Thurs, March 12: All systems go for Friday retrieval. 🙂  My last injection was this morning.  I’m incredibly happy to be done with those!  The indomethacin makes my head cloudy — not sure I like the feeling.

Fri, March 13: yes it’s Friday the 13th. But I’m not superstitious. Showed up at 6 am and proceeded with paperwork. Estrogen and progesterone levels were fantastic. Went back to the OR around 7am. A little propofol and fentanyl for my MAC case. I requested no versed. Some Toradol in the pacu to help with cramping. Had a fine relaxing day after. Took some tylenol for cramps. They retrieved 13 eggs. 6 mature ones and 5 not quite mature ones.  Wonder what we do from here. I’m still super bloated and my doc said no physical activity for 2 weeks.

Tues, March 17: The bloating is getting better.  There wasn’t much cramping or pain or spotting after the retrieval.  Maybe I am lucky?  I only took Tylenol twice since Friday.  The bloating was extremely intense Saturday, Sunday, and Monday.  I feel that it is better today.

Wed, March 18: I was thinking more about the numbers of eggs retrieved and came upon a couple of different articles and resources.  I haven’t chatted with my doc yet.

Taken from Wikipedia
Taken from Wikipedia

Here’s the replay of my series of events:

  • Wed, Jan 28: Ultrasound to assess # of follicles.  Start antibiotics (5 day z-pak).  Start taking prenatal vitamins, vitamin D, and baby aspirin daily.
  • Sun, Feb 22: Stopped birth control pills per Fertility Doc who had me start and stop these a couple of times.
  • Thursday, Feb 26: Morning blood draw and afternoon ultrasound.
  • Fri, Feb 27: Start Menopur 150IU SQ and Follistim 150 SQ @ 7-9pm
  • Sat, Feb 28: Menopur 150 IU, Follistim 150
  • Sun, Mar 1: Morning blood draw. Menopur 150, Follistim 150
  • Mon, Mar 2: Morning blood draw. Menopur 150, Follistim 200
  • Tues, Mar 3: Morning blood draw. Afternoon ultrasound. Menopur 150, Follistim 250
  • Wed, Mar 4: Morning blood draw. Menopur 150, Follistim 250
  • Thurs, Mar 5: Morning blood draw. Afternoon ultrasound. Menopur 150, Follistim 250.
  • Fri, Mar 6: Morning blood draw. Menopur 150, follistim 250.
  • Sat, Mar 7: Morning blood draw and ultrasound. AM Ganirelix start. PM Menopur 150, Follistim 275.
  • Sun, Mar 8: Morning blood draw.  Ganirelix. Menopur 150, Follistim 300 (but I only injected 150 bc I ran out!).
  • Mon, Mar 9: Morning blood draw and ultrasound.  Ganirelix, Follistim 150.  Menopur 150, Follistim 300.
  • Tues, Mar 10: Morning blood draw and ultrasound. Ganirelix. Menopur 150, Follistim 275 (ugh! i ran out again!).
  • Wed, Mar 11: Morning blood draw and ultrasound.  Ganirelix. Indomethacin 50 tid. Lupron 0.8ml @19:30. Pregnyl 1000U IM.
  • Thurs, Mar 12: Lupron @ 7:30a. Morning blood draw. Indomethacin tid. NPO after 10pm.
  • Fri, Mar 13: Oocyte retrieval @ 7:00a. Doxycycline 100 bid.  No heavy lifting (>10 lbs for a couple of days — better yet I was told two weeks!).
  • Sat, Mar 14:  Doxycycline 100 bid.  Restart baby aspirin, prenatal vitamins.
  • Sun, Mar 15:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Mon, Mar 16:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Tues, Mar 17:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Wed, Mar 18:  Doxycycline 100 bid.  Baby aspirin, prenatal vitamins.
  • Thurs, Mar 19: Could this be my first normal day??? Holy cow!
  • Fri, Mar 27:  They said they got 13 eggs… but they didn’t tell me 6 were mature and 3 were intermediate. When i had my initial consultation… i told her i wanted 2-4 kids possible.  If i assume wcs (worst case scenario), which i should in this case… that would mean at best only 1 or 2 kids.  I was completely deflated. so i am going to do a second round.  it’s not what i want to do, but it’s my best chance.  She thinks it’s bc i’ve been on bc pill for so long, so i can’t take those from now until my next go.  She’s aiming for July 2015.  She saw plenty of follicles (which is good)…. but my hormones had been suppressed so long bc of the bc pill.  I’m sad bc i have to do this again…. and it was hard enough the first time.
  • In this whole process, I met a wonderful man. We are looking at doing embryos for a higher success rate.
  • Mon, July 13: Prolactin level is 38 on re-draw from fri. 😀 that is normally where I hang out. We decided no repeat MRI (I had been getting them annually for 5 years after surgery to assess growth — I think last was 2010). No growth with drawing prolactin at those times as well as checking for visual field defects annually still. All points to good signs. She’s going to reach out to my endocrinologist and I’m going to get back on bromocriptine (to make my prolactin normal). I wanted to normalize prolactin first before getting on an estrogen stimulating med (that can grow the old prolactinoma). So… I also told her about you and that we’re looking at a possibility of embryos instead of just eggs. She felt very positive about that bc she said I had plenty of follicles and that would ultimately a higher success rate. And she also knows about my prior long use of birth control pills for regulating periods (bc of prolactinoma). All of this points to a good sign that things are normalizing and we have a plan. She said she’d like to see me on bromocriptine for about 3months and would be getting another prolactin draw 6mo after starting that med.

When I was a kid and had to get immunized, my dad used to tell me “don’t be a chicken shit.”  And I wasn’t.  When I was 4, I vividly remember putting my arm out voluntarily when I had to get a shot.  What’s more odd, is that at the tender age of 4, I would watch the needle placement into my arm and not look away.  It was single-handedly one of the best lessons my dad ever taught me.  Face your fears directly.  So, my present-day self is perhaps a bit more squeamish giving my own shots into my abdomen.  The injections are given subcutaneously, which means that it goes into the fat layer below the skin but above the muscle.

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Why Am I Doing This?

I wanted to preserve my fertility and not feel so rushed to find “Mr. Right For Me.”  To be honest, I never thought I would be taking this journey… let alone by myself.  I always envisioned being with the love of my life and starting a family once I achieved my career.  But nature and the biological clock don’t stop.  That’s life.  So I’m making the best of my situation and hoping to preserve my future and share it with someone who will explore and share this journey of life with me.

Because in the end, happiness deserves to be shared.

Another gal’s journey and exploration


Updated Nov 1, 2015 from the NEJM

Teaching Topic
Cryopreservation of Oocytes
CLINICAL PRACTICE

G.L. Schattman

CME Exam   Full Text Audio  Comments

In the United States, more than 100,000 women of reproductive age receive a diagnosis of cancer each year, and they are at risk for diminished reproductive potential or infertility as a result of treatment. The freezing of oocytes has become a clinically viable option for women who wish to have a child in the future but are facing either an age-related or iatrogenic decrease in the quality and quantity of oocytes.

Clinical Pearls
Clinical Pearl  What is currently the preferred method for cryopreservation of oocytes?

The large size and high water content of oocytes make the formation of ice crystals and subsequent cell injury or death difficult to avoid during the cooling process. Vitrification has replaced the slow-freeze method as the method of choice for cryopreserving oocytes, since it minimizes ice-crystal formation and results in higher rates of cell survival, fertilization, embryo development, and pregnancy. As compared with the slow-freeze method, vitrification involves exposure of oocytes to relatively higher concentrations of cryoprotectants for a shorter duration, followed by ultrarapid cooling either through direct immersion into liquid nitrogen (in so-called open systems) or with the use of small, volume-sealed straws (in closed systems). Once vitrified, the cells can be stored indefinitely in liquid nitrogen.

Clinical Pearl  Is there an association between cryopreservation of oocytes and subsequent congenital abnormalities?

Oocyte cryopreservation by means of slow freezing or vitrification has not been shown to increase the incidence of aneuploidy or congenital abnormalities in children, although long-term studies involving large numbers of births resulting from thawed oocytes are still lacking. Collection of data on long-term outcomes by the Society for Assisted Reproductive Technology is under way.

Morning Report Questions
Q. What factors are central to the likelihood of achieving a live birth using cryopreserved oocytes?

A. In determining the probability of achieving a live birth with the use of cryopreserved oocytes, the two most critical factors are the woman’s age at oocyte collection and the total number of oocytes available. Rates of embryo implantation decline as women age, owing to increased embryo aneuploidy; this risk applies also to cryopreserved oocytes obtained from older women. Whether cryopreservation further damages the oocyte beyond the normal age-related decrease in oocyte quality is unknown. In a prospective study evaluating the efficiency of oocyte vitrification, the proportion of vitrified oocytes that resulted in a live birth was 8.2% (12.1 oocytes per live birth) in women 30 to 36 years of age and 3.3% (29.6 oocytes per live birth) in women 36 to 39 years of age. In a multicenter observational study that assessed predictors of outcome when oocytes were vitrified, the live-birth rate decreased by 7% for every year of increase in the age of the woman. For every additional mature oocyte, the delivery rate increased by 8%.

Q. What are the guidelines of the relevant professional societies concerning oocyte cryopreservation?

A. The American Society for Reproductive Medicine suggests that oocyte vitrification and warming should be recommended to women facing infertility due to chemotherapy or other gonadotoxic therapies. The American Society of Clinical Oncology recommends that “even if women are ambivalent” about having children, they should be referred to a reproductive endocrinologist. However, the guidelines of the American Society for Reproductive Medicine also recommend caution regarding the use of oocyte vitrification to circumvent the effects of age on the reproductive potential of healthy women. These guidelines specifically state that “ . . . there are no data to support the safety, efficacy, ethics, emotional risks and cost-effectiveness of oocyte cryopreservation for this indication.”

Table 1. Reasons to Consider Cryopreservation of Oocytes.


ROUND 2

Cycle day 1- Call doc to schedule a BASE US and blood draw for cycle day 3.
Begin checking for ovulation surge with ovulation predictor kit on cycle day 8.

Call me when the surge is positive.

o Doc will make me a calendar when I surge that maps out the rest of my cycle

6 days post surge you will begin taking Estrace for about 2-3 weeks

After Estrace course you will begin stimulation with Menopur and Follistim again or Menopur and Clomid

Stimulation takes approx 10 days

Retrieval two days later