Tequila Rose

Life is what happens when you are making other plans.

We decided to take a short break from medications and procedures and go on vacation.   I was kind of annoyed because my period was due the last day of our vacation. Well, it didn't start that day, or the next day, or the next day.  Two days after we got back from vacation (this past Monday) I took a pregnancy test and it was positive. So I took 3 more, all positive including a digital.

 

We were excited and scared and freaked out. It was amazing that his had happened. After all of these procedures and medications and time and money, this had happened naturally, out of the blue.  It was a holiday but I called the doctor anyway and he ordered a blood test. I joked that we'd name our daughter Tequila since she was likely conceived on our vacation in Mexico. 

I went and had the test but didn't hear back until Tuesday morning. Tuesday morning I took another test and it was lighter, which indicated to me that something was wrong, it should have been getting darker.  I got the call later that morning, the numbers came back low. My HCG was 25 and my progesterone 10.9.  They put me on Progesterone in Oil shots and scheduled more blood work for Wednesday (today).  

I had the test today and got the call, HCG has dropped to 9 and progesterone was up to 18.8 from the supplements.  

I'm in the process of miscarrying the pregnancy.  I barely even knew it existed and now its going to be gone.  I'm trying to look on the bright side that we went from completely infertile to a natural pregnancy.  That is really amazing.

Digital tests require an HCG of 50 to register pregnant but later that same day a blood test showed 25 and 48 hours later 9, that is a pretty fast drop.
Based on my last period I am 4 weeks and 4 days pregnant today.

I was taking 200mg oral progesterone from 10dpo. Yesterday added 50mg progesterone in oil injection and 2 100mg endometrium suppositories. I'm supposed to stop all progesterone and wait for my period to start.

It's been a rollercoaster ride of emotions this week.

IUI Cost

So far, IUI #1 cost about $640 and IUI#2 cost $670.   So far my insurance has been paying for my ultrasounds all but $30 which is great this cost is for medications, ultrasounds and procedure.

IUI #2

Had IUI #2 today.

My ovulation predictor was positive on Sunday.   I went in yesterday for an ultrasound and had a follicle on my left.  Since he is trying to lengthen my leuetal phase he had me do an injection of 2,500 iu of HCG yesterday. I'll do another on Wednesday, a third on Friday and the last on Sunday.   On Friday I will also start Endometrium, a progesterone suppository.

The sperm was not nearly as good today.  There were very few motile, he let me look in the microscope.  He made sure I knew how small the chances of success were before he did the IUI.

Since I'm on the HCG a home pregnancy test won't work (would be false positive) until 5 days at least after my last injection.

I'm not going to get my hopes up this cycle like I did  last time.

This month's cycle

When I went in for my last ultrasound he found a cyst, which is basically when a follicle does not collapse after a cycle. They usually continue to grow and can become painful until they are either reabsorbed or in my case usually burst.

When you have a cyst they can't put you on Clomid because the cyst can become dangerously large. So I was instructed to get a blood draw on CD10 (yesterday) to check my estrogen level. It came back at 134. That's about the same level it as last time I had a cyst.  I had some sharp pains yesterday and figured the cyst had burst. He had me come in for an ultrasound today and confirmed that there was free fluid, indicating the cyst had burst.

I have 3 follicles now, 2 on the right and one of the left.  We will not be doing Clomid this cycle because of it being so late in the cycle. We might be able to do an IUI anyway though, depending on if the follicles mature properly.  I go back on Monday morning for another ultrasound.

Oh and there were 3 people in the room today staring at my crotch during my ultrasound. Doctor, intern and nurse. It's a good thing I'm not modest.

The Fat Lady Sang

This IUI cycle is over, the fat lady sang yesterday.

I go into the doctor for an ultrasound on Friday to make sure all of the follies from this cycle emptied before starting meds for a new cycle.  We also will be discussing timing this cycle a little more closely as it may have been about 12-24 hours too late this time.

Some lessons and the signs

So a couple of biology/anatomy/physiology lessons before today's update.

More about the IUI process
During an IUI the washed semen is placed, using a catheter directly into the uterus, bypassing the cervix.  The timing of this is critical.  The sperm needs to be waiting for the egg when its ovulated from the ovary but washed sperm has a much shorter life than raw sperm, 12-24 hours as opposed to the 3-5 days of raw sperm.   The woman has an ultrasound which measures the size of the follicles in the ovaries and determines if they are large enough to induce ovulation.  Typically doctors want the follicles to be around 20mm before triggering.  The trigger is a 10,000iu shot of HCG which quickly finishes the egg maturation process and incites a "forceful" ovulation.   The HCG shot is normally given 24-36 hours before the IUI procedure.

Basal Body Temperature Tracking
Basal body temperature (BBT) is the lowest body temperature attained while at rest (usually sleep).  A woman's basal body temperature fluctuates in a predictable pattern throughout the course of her menstrual cycle.  Many women track BBT as a way to pinpoint ovulation and predict the onset of their period.   At the beginning of a cycle the temperature is typically low, usually rising slowly up to the point of ovulation where it drops down usually for one or two days before making a quick rise.  These changes are triggered by hormones, the surge of luteinizing hormone (LH) at ovulation causes the drop and then the rise of progesterone after ovulation keeps the temperature high.  The body temperature usually starts to drop a couple of days before the onset of the period.  If pregnancy occurs the temperature remains high.

The Two Week Wait (2WW  or TWW)
Trying to conceive (TTC) is all about the 2 week wait. Its called a 2 weeks wait even though it can be slightly less or slightly more.  Each woman cycle varies slightly in length and can vary from cycle to cycle.  The cycle is broken down into 4 parts, the follicular phase where the ovaries are maturing an egg (or multiple eggs if on fertility drugs), ovulation where the ovaries release the egg, the leuetal phase where if an egg is fertilized it will start to become an embryo and implant into the uterus and menstruation.   The IUI procedure starts the two week wait and marks the beginning of the leuetal phase.  In most women the leuetal phase is about 14 days.  During that two weeks if the egg is fertilized then a lot is going on.  HCG, which is what is measured by a home pregnancy test is not produced by the body until after implantation.  Once implantation occurs then HCG is produced and the amount doubles approximately every 48 hours.   It typically takes about 4-5 days after implantation for the amount of HCG to reach a level it can be measured on a home pregnancy test.

The update

So now that you've had your lesson of the day here is what's going on with me.  My leuetal phase is typically 12 days long.  Today is day 12 for me.  I took a home pregnancy test yesterday and it was negative and my body temperature had dropped for the past two days.  Both of these things indicate that we are likely out (not pregnant) this cycle. It is of course not over until the fat lady sings but all biological signs point to that being the case.

The wait

Just a quick update to say no news!  Just waiting.

I tested out my trigger shot and as of last night the hcg tests were almost completely blank so that is out of my system now meaning that any pregnancy test I take will have accurate results.

 I went and got progesterone blood work done yesterday and it came back this morning with a level of 27.8 which is great!  Anything over 10 is good. That was a relief because I'd been worried that the supplement dosage I was on was not enough.

I had a temp drop yesterday on my basal body temperature testing and then it spiked back up today, that is a good sign (and making me obsess more).

Inseminated!

We are inseminated!!!  

I was SUPER nervous waiting this morning for them to process the sample, then we waited what seemed like forever but was about 40 minutes and at that point we had decided they didn't find any sperm and were waiting on the doctor to tell us. Then they called us back and the embryologist said "come look at the microscope" and my heart fell to my knees.  Then she's like, There are good swimmers in there!  

They said they don't do an actual count but  '2.5 mil after wash" was written on the thing beside the microscope with our name on it, so I'm guessing that is their estimate which is WAY better than we ever had before.  So I'm hopeful. The doctor seemed very happy so I'm happy now too. 

I'm a little annoyed though because they don't schedule a beta, just said to do home pregnancy test.

What's next?  If an egg gets fertilized then it takes 5-7 days for it to implant in the uterus and start growing. Another 3-5 days after that HCG levels ( HCG is secreted by the growing embryo) should rise to a point a pregnancy test would showt positive.  On Saturday I start a progesterone supplement to help sustain an embryo.

Between now and then I mostly wait. I can test out my trigger.  The trigger is a shot of HCG given before IUI to help mature the eggs and ensure strong ovulation.     testing out the triggrt means taking pregnancy test now until it's negative so that I'll know the result on the one in 3 weeks is a true result and not leftover HCG from the trigger shot. 

IUI Eve

Went for my follicle check today and had 3 mature ones, doctors office went ahead and gave me HCG trigger shot and I go in at 7:45 tomorrow for a date with the turkey baster. Hubby has to do his collection at home and we bring it in, hopefully there are lots of swimmers.

IUI

On Sunday I started Clomid, 100mg once a day.  Today was the final dose,  I go in Tuesday for an ultrasound and then should trigger and do the IUI late next week.

While the Clomid is MUCH easier than the IVF drugs it triggered the worst migraine of my life today with tingling hands, dizziness and excruciating headache.

What's next

It's been about a month since my last post.  We have been taking a break while we figure out what we wanted to do.  Earlier this week we talked with our doctor and have decided to do an IUI with hubby's sperm only, no backup.  We know this has a quite low chance of success but we want to give it a try before moving on to donor.   So at the start of my cycle I will go on Clomid then will have ultrasounds to confirm ovulation and then we'll do the IUI.

Speaking of next cycle, I am still not back to normal after IVF. My cycles are usually 27-29 days and I'm on day 36 now and no sign of AF.

IUI= Inter Uterine Insemination.  The ejaculate is washed of all seminal fluid until only sperm is left and then its placed directly into the uterus that the time of ovulation.

Options

Saw our RE today to talk over what happened with the IVF and discuss options.

He is afraid, based on our IVF that the issue does not lie with just one of us, but both of us.

Our REALISTIC options are as follows

1. Donor IUI (low cost, 20% chance of success each cycle)

2. Donor egg with combo of hubby's sperm and donor sperm (high cost, 40% chance)

3. Adoption (high cost, success rate unknown)

4. Embryo adoption (mid cost, 40% chance)

He think embryo adoption is the best way to go and gave us some literature on it..

He does not think that we have any realistic chance doing an IUI with hubby's sperm.

So now we will research and talk and come to a decision about how we want to proceed.

IVF Cost

Since I did many searches for IVF cost before we began I thought I'd share what we ended up paying.

Total spent: $24,355.10 (Testing, Procedures, Medications for 2 cycles and another complete cycle)

Breakdown:

Medications: $7,012.69
Cycle 1: $3,711.76
Cycle 2: $3,300.93

IVF Cycle Cost with Clinic: $12,355

Testes biopsy and storage:  $2,300

TESE: $2,002

Miscellaneous Doctor Appointments/Services:  $438.94 (Urologist co-pay, Reproductive Endocrinologist co-pay, ultrasound for cyst not covered in cycle cost, surgery center co-pay )

Lab/Blood Work: $152.35

A little more info on the medications. I did a LOT of research and calling around before ordering my medications. The pharmacy that the IVF clinic usually uses that they recommended quoted me $4500 for my set of meds for the first cycle.   For the medications I needed it turned out that Walgreens Specialty was going to be cheapest using several discount programs.   I ended up saving over $800 for the first cycle by going with Walgreens and using discount programs.

The discount programs I used were: 

Heart + (https://www.ferringfertility.com/savings/heart/)

Fertility Pharmacy Care Card (http://www.newlifeagency.com/surrogate_maternity/fertility_pharmacy_care_card.cfm)

Follistim Manufacture Coupon (I got mine on eBay,shhh, don't tell anyone)

Here is the breakdown cost of all of my medications for both cycles

Medication	Quantity	Cost
Azithromycin	6	$10.00
Clindamycin Suppositories	3	$10.00
Dexamethasone	30	$10.00
Dexamethasone	30	$13.92
Dexamethasone	30	$10.00
Estradiol Suppository	14	$42.00
Estridol Valerate	5	$144.31
Folic Acid	30	$2.36
Folic Acid	30	$8.86
Follistim 300 IU	7	$1,834.00
Follistim 300 IU	7	$1,834.00
Follistim 600 IU	2	$748.00
Follistim 600 IU	1	$524.00
Ganirelex	7	$738.50
Ganirelex	7	$738.50
Ganirelex	1	$115.34
Ganirelex	5	$0.00*
Lupron	1	$199.00
Menopur	4	$300.00
Menopur	5	$150.00*
Novarell (HCG)	1	$79.90
Progesterone IM	20	$10.00
Progesterone/Estridol Suppositories	30	$45.00
Provera	5	$10.00

*I was lucky enough to have someone give me some leftover Ganirelex and was able to buy some Menopur at a reduced cost

Here is the simplified version

Medication	Cost
Azithromycin	$10.00
Clindamycin Suppositories	$10.00
Dexamethasone	$33.92
Estradiol Suppository	$42.00
Estridol Valerate	$144.31
Folic Acid	$11.22
Follistim	$4,940.00
Ganirelex	$1,592.34
Lupron	$199.00
Menopur	$450.00
Novarell (HCG)	$79.90
Progesterone IM	$10.00
Progesterone/Estridol Suppositories	$45.00
Provera	$10.00

Savings: 

Follistim Manufacture Coupon: $300

Fertility Pharmacy Care Card: $600

Improved count!!!!

For those of you following along at home the reason we were doing IVF is because hubby had basically zero sperm, highest count ever was 14 (not million, just 14). He had varicocele repair surgery just over a year ago but the only improvement was going from zero to the 14 or so.  When we started going down the IVF path he stopped the soy based protein shakes he was drinking twice daily, started taking Fertility Blend and CoQ10 and increased his caloric intake (he'd lost a LOT of weight in the past 2 years).

We have an appointment next week to talk to our RE about our options post IVF.  Hubby did a semen analysis yesterday in prep for that meeting. So nurse calls me today with results of yesterday's test. Get this 1 MILLION!!!!!  I know that most people would be devastated at a sperm count of one million but we are elated!  That opens up the possibility of IUI for us, maybe, hopefully.

This is the best news we've gotten in awhile!

Post Egg Retreival Recovery

I wanted to write a bit about my recovery from the Egg Retrieval. As you might have read a couple months ago from my cancellation I don't like not knowing what to expect. I did quite a bit of research and most women said they felt okay in 2-3 days unless they got Ovarian HyperStimulation Syndrome (OHSS). Since I was at low risk for that I didn't worry to much about that.

My egg retrieval was on a Saturday morning, and I'm going to call that day 0.   On Wednesday before my retrieval I had 17 follicles, 14 of which were larger than 10mm.  That is a pretty average number, and my E2 was around 1300 (high E2 makes OHSS more likely).

Day 0 (Saturday)- Returned home around 9:00 am and I went straight to bed and slept about 2.5 hours.  Pain was moderate all day but I slept off  and on.  I stayed in bed all day/night. Bleeding was moderate, quite a few clots, about like a period flow.

Day 1 (Sunday)- Felt pretty good in the morning. Got up, made breakfast, read the paper.  Up about 2 hours before pain started to escalate and went back to bed. Got up a couple more times but stayed in bed lying down or reclining most of the day with the heating pad on my abdomen. Bleeding was still present with some clots but less than previous day.

Day 2 (Monday)- Got up around 7, showered and dressed and worked in my office for a couple hours, went into work around 12:00p.  Still bleeding some. Severe diarrhea in the AM, slight nausea. Pain was moderate, got severe with bowel movement.

Day 3 & 4 (Tuesday and Wednesday)- Worked full days both days, pain mild for the most part, moderate if I got jarred or had to bend at the waist. Bleeding stopped.

Day 5 (Thursday)- Pain was moderate, worse than the previous days and diarrhea was back

Day 6 (Friday)- Pain moderate to severe.  Left work at 2:30 and came home and rested lying down until 5, went to a birthday party. By 9 pain was getting bad, got home around 10 took 3 advil and immediately went to bed and less than 5 minutes later I was writhing on the bed in pain.  Dinner had given me gas and there was no room inside my abdomen for both my swollen ovaries and gas. The pain was so bad I thought I was going to pass out. After about 15 minutes I was finally able to pass some gas and started feeling better.  Hubby brought me the heating pad and I was able to fall asleep after about an hour.

Day 7 (Saturday)- Full week since ER.  Pain is mild to moderate today, tending towards more soreness than actual pain, potholes hurt and I feel bloated today.

I attribute Friday's pain to a few factors, the clinic recommends intercourse the night before a embryo transfer and since we first thought it would be Thursday and then Friday we did it two nights in a row, I think that caused irritation of my swollen ovaries. Second factor is that I wore too tight jeans to work on Friday and I think that irritated my abdomen all day. Thirdly was the gas.

So once again, I am in a place where what I expected was not what happened. So if you find this blog I hope some of this info can help you!

Nothing to transfer

I just got the call from my RE that none of our embryos made, they all stopped growing (arrested).   I'm doing okay right now, I had my breakdown last night and pretty much got it out of my system.  I'll post more later.

Day 5

I didn't sleep well and woke up early. I'm not a good waiter.  The nurse usually calls about 9:30a, so once I got to work I tried to concentrate but had a really hard time because I kept glancing at my phone, stomach churning

Right at 9:30a the call came and it was not good news. The embryos have not really changed much since day 3. Today if they were growing properly they should be blastocytes with hundreds of cells and they are still in the cleaved embryos' with only a few cells.  I talked to my doctor and he confirmed what I thought that things are looking pretty grim at this stage.    I asked him if he ever transferred embryos that had not made it to the blastocyst stage and he said yes but they have to be growing.  So right now I am trying so hard to hang on to my very fragile hopes upon at least one of these growing in the next 18 hours.  The doctors said he would call me around 9 or 9:30 in the morning with the news.

 I'm a person who hangs on to hope when all seems lost but this past year as beat me down, I'm feeling very fragile and despondent.

Day 3 Report

So the day 3 report was not as good as we were hoping for but not as bad as we were dreading.

We have:
2 grade 2's one is 6 cell and 1 is 8 cell
1 grade 3 with 3 cells

Grading Key:
Grade 1- No cell fragmentation
Grade 2- Some cell fragmentation
Grade 3- A lot of cell fragmentation

The nurse said there is very little difference in pregnancy rates between grade 1's and 2's.  

Based on this we have decided proceed with Plan B which is to do a fresh transfer on day 5 (Thursday) of the two grade 1 embryos. They will call me on Thursday morning and let me know how the little ones are doing, if they are slow to grow then we could be pushed to a day 6 transfer (Friday).  If we do it on Thursday my transfer time is at 12:30pm. 

I'm feeling slightly overwhelmed at the moment.  

Oh, and I've nicknamed our two grade 2's Will and Hester and our grade 3 is Chester.   The names are from the children's book McBroom's Ghost which I loved as a kid. 

Waiting and recovering

I emailed the nurse today because I'm still having some bleeding and quite a bit of pain.  She told me to rest, hydrate and take over the counter pain meds.  I worked for half a day today and am now sitting in the recliner with the heating pad.  Tomorrow morning we should get our day 3 status report, to say I'm anxious for the results would be a bit of an understatement.

Fertilization Report

I got the call from the clinic this morning while I was in the shower, I figured that is what would happen so I'd taken my phone in with me. So I jump out and take the call dripping and naked.

Of the 9 eggs they retrieved 7 were mature and 4 fertilized, one is still questionable and may still fertilize.   There was more details about the 4 that fertilized but they went over my head. I've emailed my nurse to ask if they used the fresh sperm or the frozen vials because I forgot to ask on the phone and asked for the details of the fertilization report too.

I'm still incredibly sore this morning, I have to move slowly but the pain is not as bad as yesterday. I'm still bleeding a little but less than yesterday. The nurse said I could take ibuprofen.

Update:
Found out that they were able to use sperm from the fresh samples, that is HUGE news for us!  18 months ago hubby was diagnosed as azoospermic (zero sperm) so to be able to use fresh sperm for IVF was something we didn't think could happen.

Here is the actual fertilization report from the clinic. m2 indicates a mature egg, "gv" or germinal vesicle indicates immature egg, "2pn" is 2 polar nuclei and indicates normal fertilization, "nef" is non efficient fertilization.

Also it appears from reading the report that we have 2 that are on the fence, not one. So let's hope those little buggers decide to get with the game!  Maybe I should name them to encourage them?

Update and PIO Shots

Just wanted to post an update; I've spent the day in bed, that's really all I've felt like doing. I took some advice from other ladies and started using the heating pad after lunch and that helped a lot.  I've played around online, watched some tv, read, slept. The pain has lessened a lot as has the bleeding.   Bending and jarring still hurt so I haven't moved much other than to go to the bathroom and walk to the kitchen. Probably won't do much tomorrow either.

I enjoyed one day without a shot, tonight we start the Progesterone in Oil (PIO shots). Now we're in a little bit of a unique situation because we still have not yet decided if we are doing a staggered or fresh cycle. We are going to wait until our day 3 report (Tuesday) to decide based on our embryos.  So in case we decide to do a fresh cycle (transfer embryos next week) we have to take the medicines. Progesterone supports the utereus and fetal development so I will take 50mg per day in an intramuscular injection until either we decide to do the staggered cycle or until 12 weeks of pregnancy.   This is a shot that goes in my butt so hubby does this one.  He's been doing the E2V shots so he's not as freaked out as he was when he first did a shot for me.   

I'm trying not to think too much about the fertilization report but I do hope the call comes early in the day. 

Egg Retrieval Day

I woke up at 5:30, more than an hour before I needed to, so I laid in bed for awhile before my buzzing brain made me get up. Long shower and still had time to kill before we could leave so I painted my toenails

Finally time to go, we got there and were taken straight back, we were the first ones of the day.  I was told to undress completely and put on a gown. I did that then they took hubby  away for him to do his business for his sample.  A nurse came in to put in my IV and I was so surprised when shot got it in on the first try! 

Next they gave me a Valium, which means I got a drink of water, that made me happy, I was thirsty already! She gave me my medicine instructions for the next few days and my discharge instructions.     My doctor came in and talked with me, I shared my concerns with him and he put them to rest, he's a great doctor and a good person, I even got a hug!

Hubby came back and we waited a few minutes then they took me to the bathroom then back to the surgery room.

I sat down on the table and draped my legs across these huge stirrup thing, different than the regular stirrup beds these go from your knees down.  The anesthesiologist then started putting something in my IV and I started getting fuzzy.  However, while I stayed fuzzy I was not under well enough and I started feeling pain when they were working on me. I remember them asking me if I hurt a few times and I must have said yes because I don't recall anything after that.  As a side note,  this is not the first time this has happened to me, when I had a gastroendoscopy some years ago I also woke up during it, must be something about the light anesthesia for me.   I woke up back in the recovery room with hubby  and the nurse telling me to breathe because the monitors were going nuts because my oxygen level dropped.  Again, not unusual for me, this happens every time I have surgery.  I was still very woozy and dizzy and only vaguely recall them coming in the say that they had found sperm in hubby sample (yay) and they wanted him to do another one. 

They also came in and told me the got 9 eggs which I was happy with, it was the number I had in mind for a few days now for some reason. 

Not sure how long I stayed in recovery but they came in and told me I could get dressed.  I managed that but needed help walking out.

We came home and hubby made me a breakfast sandwich and some coffee which I ate and then promptly feel asleep while he went to pickup my refill of dexamethasone 

I slept very soundly for a couple hours and woke up with pretty bad cramps/pain.  My discharge instructions didn't say anything about pain meds so I called the nurse line and she told me to take extra strength Tylenol.

So here I am now, laying in bed, eating a few potato chips and drinking some powerade.   Tomorrow they will call with fertilization report. 

Oh, and here is a photo my my ovaries ultrasound they gave me, not sure why. 

Egg Retrieval Eve

I've been a big ball of crazy all day.  I woke up at 5am thinking about my left ovary.  My left ovary hides behind my uterus and the doctor who does my ultrasound monitoring throughout the cycle always has to hunt around to find it, but she is good at doing so. She is not the doctor that will be doing my egg retrieval though,  I like my doctor and trust my doctor but this is where my anxiety has focused. I worry that he won't be able to see the left ovary well enough to get the eggs out and that is half of the follicles we have for this cycle in there! I made sure that I'll be able to talk to him before I go under tomorrow and will express my concerns to him.  One of the reasons I like him so much is that he does not discount my concerns or fears, he talks me through them and reassures me with facts.  

Other worries include but are not limited to:  fertilization rate using our frozen vials,egg maturity, premature ovulation from the HCG, attrition rate, genetic issues, freezing issues, thawing issues... the list goes on, I won't bore you. Just suffice it to say that my name is obsession and my internet history is filled with too many searches to count on most of these subjects.

I'm hydrating now since I can't have anything to eat or drink after midnight until after the surgery.    My husband will be giving a fresh sample tomorrow too in in hopes that the changes he's made to meds and diet over the past 3 months will have made a difference in his count.

I had a nap when I got home but I'm still sleepy. As soon as my favorite stretchy pants I want to wear tomorrow come out of the dryer I'm going to bed.

Trigger day!

Today is trigger day!  I got the call from the clinic this afternoon to do my trigger shot at 9pm tonight and come in at 7:45 on Saturday morning for an 8:30 am retrieval.

Update: HCG Trigger shot hurts! Not the shot itself but almost immediately afterwards I feel like I've been punched in the shoulder! No one told me this, I was not prepared!

A lot of people not familiar with IVF have asked me, "so what's next"? So here is it is

Today (2/20): 

• Trigger with HCG shot at 9pm exactly
•  HCG is the hormone produced when you are pregnant, in this case you get 10,000 units in one shot in the arm to cue the eggs to finish maturing and to prepare for retrieval. This trigger shot is done approximately 35-36 hours before egg retrieval
• Start antibiotic (Clyndomicin) vaginal suppository as a secondary prophylactic measure to prevent infection (already on z-pack)

Friday (2/21):

• No meds except antibiotics, folic acid and dexamethsone.  This will be my first day without an injections since January 22nd. 
• No food or drink after midnight

Saturday (2/22):

• Egg retrieval
• Be at the clinic at 7:45
• Meet with anesthesiologist
• Get put under
• Doctor uses ultrasound and inserts a needle through my vaginal wall into my ovaries to remove the fluid and egg from each follicle (so a dozen times or more)
• I wake up
• Husband gives fresh sperm sample but expect to be using frozen vials, Embryologist will examine and make this call
• Embryologist examines eggs and determines how many eggs were retrieved (not all follicles have eggs) are mature (not all eggs retrieved are mature)
• Embryologist fertilizes each mature egg using a procedure called Intra-cytoplasmic sperm injection (ICSI).  Pronounced Ick-see and its where one sperm is injected directly into each egg

Sunday (2/23);

• Fertilization report from clinic 

Monday (2/24): 

• Nothing

Tuesday (2/25):

• Day 3 growth report 
• How many are continuing to grow
• What are their grades, cell sizes, etc

Wednesday (2/26):

• Nothing

Thursday (2/27):

• Day 5 growth report
• Biopsy for PGD (Pre-Implantation Genetic Diagnosis)
• This could also be moved to day 6 depending on growth
• If we have only a couple of embryos/blastocytes at this point we may decide to forgo genetic testing and go straight to implantation but the plan is to do the PGD
• Biopsies are sent to genetics lab to make sure they are chromosomal normal
• Embryos are frozen

Depending on how long it takes to get the results of the genetic tests and how long it takes my normal cycle to return we will do what is called a Frozen Embryo Transfer (FET) in either March or April, more on that later but it involves much less drugs!

Follicle Update

14 measurable follicles as of this morning. The doctor said they are growing just as they are supposed to! So happy to be normal for once! I don't have my E2 number back yet, I'll update when I get it. My lining was at 12.7

	2/17/2014			2/19/2014
	Right	Left		Right	Left
>23
22
21
20
19					1
18					1
17				1
16				3	2
15		1
14	1	1		1
13	2	2		2
12	1	1
11	3				3
10
<9				3

So the plan, regular meds tonight and in the morning then I'll do my HCG trigger shot tomorrow night. That is the shot that tells the ovaries they can start letting go of the eggs in preparation for retrieval on Saturday.  I will get a call tomorrow to let me know what time to do the trigger shot and what time my egg retrieval will be on Saturday. The trigger shot is done 35 hours before retrieval.  

I'm excited but still nervous about all the possible outcomes.

Update: E2 is at 1,293 today. I expressed concern that it was down from Monday but the nurse said when you are doing estrogen priming that it can be all over the place and is not a good indicator of follicles.  I'll be doing my last estrogen shot tonight. 

Follicles!

Went in for ultrasound and blood work yet, I don't know my E2 number but will update when I hear back on that. Follicle count was much better this time than it was last cycle at this time.   I had a total of 12, the sizes are shown below.  The doctor was pleased and said she thinks we'll be able to do retrieval on Friday or Saturday. My left ovary was again hard to see and I asked her if this would be a problem for retrieval, she said not really as they are able to do more when I'm asleep than they can when I'm awake!

	2/17/2014
	Right	Left
>23
22
21
20
19
18
17
16
15		1
14	1	1
13	2	2
12	1	1
11	3
10
<9

Update: My E2 is 1401! Nurse said that is right on track. My lining was at 12.5.

And here is a current side effect listing, in no particular order

• Headache
• Nausea
• Exhaustion
• Leg Cramps
• Sleep Disturbances
• Bloating
• Discharge
• Sore Breasts
• Forgetfulness
• Irritability 
• Emotional

Shooting up in the bathroom

Sometimes you have to do your meds in the bathroom of a church reception hall while shooting a sweet 16 party.  The follistim case is the perfect size for a small ice pack.

Bruising

The left side of my lower abdomen looks like I've been beaten. I'd post a picture but no one wants to see my fat belly. I'm bruising MUCH more this time that I did last time but ONLY one my left side. I barely have one mark on my right side even though I rotate sides daily for all shots. The left side bleeds more too.  Last night after I did my Menopur injection I had a large knot under the skin, I rubbed it for awhile and it went away but it is so sore today!

Update

I went to see my RE this morning for an ultrasound and he is very please with how I am coming along for being 4 days into my stims (today is day 5).  He said he saw at least 5 or 6 follicles mostly on my right side as my left ovary  likes to be sleepy and hide. He said he was very encouraged.

Last night I went out with friends and did my shots away from home the first time. I just put in ice pack in my Follistim case and put my Follistim vial and my Menopur that was ready in a syringe in it, then when it was time I just went in the bathroom at the restaurant and did the shots. Didn't try to do it in a stall since there is no where to set things down, I just did it at the counter. I figured if anyone walked in I would explain, but they didn't so it was no issue.

Tomorrow night I have a photography job so my nurse said it was okay to do my EV2 shot earlier in the evening than I usually do.

The nurse at the clinic had to call Walgreens to get me some more needles. Since I got some meds from other ladies who had been through IVF I didn't get enough meds in my shipment from Walgreens to begin with. I got those and should be good for the rest of the cycle unless I need more meds

Today is Valentine's day, we are going out to dinner tonight, yay!

Stims started and lessons learned

I started Follistim tonight so its now officially stim time again!

Last night I started the second part of the estrogen. This one is a vaginal suppository, what fun!  You get an applicator to insert it but since they have to be kept refrigerated it still feels odd. And as I found out the hard way they make you leaky! Which leads me to some lessons learned so far.

1. Panty liners- just go ahead and wear them as soon as you start to cycle. All the meds affect bodily fluids.

2.Reminders- some/all of these meds destroy short term memory. I have turned into a goldfish.  alarm clock+on my phone is my new favorite app. I have separate alarms for each med that won't stop going off until I dismiss it. I have notes EVERYWHERE! 

3. Falling pills- you are probably going to do your meds in the bathroom and chances are something is going to fall in the sink. Place a paper towel or clean hand towel in the sink before doing meds.
4.Organization-  see previous post for more on how I do this but with the memory issues keeping track of up to 7 meds a day can be a challenge. 

5.  Aim- clean a bigger area with alcohol than you think you need.  I have big boobs and can't see my belly. Its hard to aim in the mirror so give yourself a bigger area to work with.

6. Cold- cold meds burn more. Cold oil based meds burn a lot more. Even a couple minutes out of the fridge makes a difference.

That's all I remember for now. I'll try to add to this.

Freak out!

I totally freaked out tonight! I forgot to do my Ganirelex shot this morning. I didn't remember until 6pm!!!  I quickly called the on call nurse and she said to go ahead and take the shot now and again in the morning. She said this was the best possible timing for forgetting one. The Ganirelex keeps me from ovulating and since I'm still on my period and didn't miss the shot all together it will be fine.  I have now setup multiple alarms on my phone and my husband is putting up a big sign in the kitchen that says "DID YOU DO YOUR SHOT?" Ugh, my heart is still beating fast!

So he did a really good job with the E2V shot on Sunday night.  He said it felt too easy so he was afraid he didn't get it in the muscle, the sore spot I had the next day proved that he had!  Speaking of sore spots I seem to be bruising a bit more this time around, I already have several small spots on my belly and still have about 3 weeks of shots left.

Estrogen

I went Saturday morning to have my Esterogen level re-checked, it went from 162 on Thursday to 26 on Saturday!  But since I hadn't gotten my period yet they wanted me to wait on starting the E2V shots.  Well now I got my period so tonight will be my first intramuscular injection. My husband has watched the video on how to do it several times and says he is ready but still nervous.

As a side note, the clinic has been great, I was on phone and email with them off and on all day yesterday (Saturday) and they were super responsive and very nice.

Ovarian Cyst Aspiration

I'm home from having the cyst on my left ovary aspirated.  It was highly unpleasant but not horrible, it was on of those things that was bearable because it only lasted a minute. So here are the gritty details. They clean off your cervix then put a shot of Novocaine in your vaginal wall, next they insert the ultrasound probe and the needle catheter.  The needle then goes through the vaginal wall into the ovary and they suck out the fluid and remove the needle (assuming there is only one, I had 2 but she got them both). Then they hold pressure on the spot where the needle went in for a few moments to stop the bleeding.  That's it, you are done. Its hard to describe what it feels like, the Novocaine shot feels like any other Novocaine shots, just in your hooha instead of your mouth. The needle hurts, its a deep pain and then you start what feels like a continuous hard cramp that lasts until they take it out. I've been cramping ever since, which they said I would and have been bleeding some, which they also said I would. They gave me a prescription for antibiotics as a safety measure.

I go get followup blood work tomorrow to make sure my E2 level is dropping, I have to get that done before 9am.  They will then call and tell me what to do about meds, I was supposed to start the E2V shots tonight but have to wait now. They said my calender will probably just be pushed for a few days.  I need to get my period before I start the stimulation medications and the cyst producing estrogen was preventing that so hopefully that starts soon.

 The doctor said that I have a good number of follicles on both sides which is a good indicator of response at this point, I hope she is right.

I'll update once I hear from them tomorrow.

cyst

I went in for my baseline ultrasound and bloodwork today and found out I have a 1.5mm cyst on my left ovary that is producing estrogen. My E2 level is 162 so they are going to aspirate the cyst tomorrow afternoon. I will not be put under for this, it will be done using a local anesthetic. This will likely push the start of my estrogen injections to next week so that they can make sure my E2 levels go down. The nurse said I'll probably get more blood work on Monday to check. I'll update again tomorrow, I'm feeling kind of down in the dumps about this, it seems like the deck is stacked against us.

In other news the steroids are causing me extreme insomnia this cycle and I am SO exhausted!