Tuesday, May 31, 2016

IVF: My Egg Retrieval Story!

I couldn't believe today was actually the day! I woke up multiple times in the early morning, checking the clock, worried I would over sleep. Even though that was pretty unlikely, since I wasn't due at the center until 9:15 AM. But still, I kept worrying I'd miss my appointment!


Once both my husband and I were awake, we spent awhile just laying in bed cuddling. It was such a relaxing, comforting morning. I felt surrounded by love! I had already laid out a comfortable outfit the night before. I chose a loose fitting long skirt and a t shirt. It was much too warm for sweat pants and none of my shorts would have felt comfortable on my belly. I didn't have too much to do to get ready. I took a shower and used some fragrance free soap. No makeup was allowed for egg retrieval or anything at all scented. So I simply straightened by hair and put on my glasses (no contacts allowed either), and I was all ready to go! No eating or drinking since midnight, so I couldn't have any breakfast. I was really thirsty!

We got to the center 10 minutes early and got checked in. I soon had to leave my husband in the waiting room as I went back to get changed and prepped. I was able to take my phone with me though, so I was texting him from my hospital bed! I found out that the doctor scheduled to do retrievals that day was on vacation, and it just so happened that my doctor was filling in! That made me incredibly happy because he is the most gentle doctor I've ever met.

After they brought me to my private room, I went over our plans with one of the IVF nurses, such as our plans for ICSI, how many to transfer, and our freezing preferences. We also went over everything I needed to know for the anesthesia. After I got changed and emptied my bladder and the nurse drew a circle on each butt cheek for my PIO shots. Then they wrapped me in a pre-warmed blanket. I waited for about 20 minutes for the current retrieval taking place to be over, so the anesthesiologist could come in and start my IV.

It's a bit funny actually. Even though I've had so much bloodwork and so many shots throughout this process, IVs really gross me out. Believe it or not, it was the only thing I was truly dreading. Which does seem silly, because I've had IVs in the past and I've never ever had a problem. Other than that they gross me out. The anesthesiologist was incredibly warm and friendly. First, he numbed my vein with an injection, which I didn't even feel. Right as he was about to start the IV, my RE came into the room and was able to distract me. Before I knew it, the IV was in!

Once it was all set, they gave me some antibiotics through the IV. The anesthesiologist observed me for a few minutes then left me to rest. That's when things went downhill a bit. I started to get nervous... about the IV of all things. Then started to feel "funny". Then dizzy. So I called them back into the room. It turned out I was having a vasovagal reaction, which apparently is a common thing. They immediately reclined the table to lower my head, started fanning me, put a cool pack behind my neck, and my doctor rushed in to hold my hand. In just a couple of minutes, I felt totally fine! Apparently I was white as a ghost, but then my cheeks started to pink back up again. Crisis averted!


After they were sure I was fine and my vitals were back to normal, they wheeled my bed into the procedure room! They normally have you walk, but after my near fainting spell, they wanted to be cautious. Before I knew it, I was set up in the procedure room for monitoring. The ceiling had a nice decal on it that said "breathe". Everyone was really nice and calming. I had an oxygen mask put on and the medication was given to me through the IV. The anesthesiologist distracted me by talking about my families lake house and boat. That's the last thing I remember. I was totally out after that!!

The next thing I remember, I was waking up back in my room and the nurse was asking me how I was feeling. I was wrapped up in a blanket, with a heating pad on my lower belly. They give everyone some mild pain relief through the IV after the procedure. I had absolutely zero pain thankfully and no cramping or even spotting. I know I asked the nurse at least twice how many eggs were retrieved. I felt groggy for the first 20 minutes or so, and I was apparently quite "chatty" with the nurses! I don't remember any of that of course. My husband was brought in shortly after I woke up, who got me my phone from my locker. I relaxed for about 20 more minutes, and then my IV was removed and I was allowed to get dressed. I was in my room for about 45 minutes total after the retrieval.

We ended up having 9 eggs retrieved!! Which is such a wonderful number to hear. For some reason, the number my husband and I really were hoping for was at least 6. So getting 9 is way more than we were hoping for! I'm not sure exactly how many of them are mature but I will find out when I get the fertilization report tomorrow.

They will use ICSI to fertilize our eggs. ICSI stands for intracytoplasmic sperm injection, which is basically a fancy way of saying a single sperm is injected directly into each egg. They will only perform ICSI on mature eggs (immature eggs cannot be fertilized anyway), so we aren't sure how many of the eggs were mature yet. We will find this out when we get the fertilization report!

Once I got home, I relaxed for the rest of the day. I did take a single tylenol just in case, but I don't believe I needed it. I had zero cramping, zero bleeding, zero bloating. Mainly I've just felt extra tired, mostly from all of the stress. I spent the day laying in bed, with our furbabies. My husband was so sweet.. he picked me a bouquet of flowers that you can see above!

Now we just wait! The rest of this process is really just waiting. Waiting to hear how many fertilized, waiting for the embryo transfer, waiting for the pregnancy test... lots of waiting! I will update when we hear from the center, hopefully with good news!


Poke Count
Arms: 9     Belly: 38     Ultrasounds: 5

Sunday, May 29, 2016

IVF: Trigger Time!!

Today would have been stim day 9, but instead of shots of Gonal F & Menopur, I'll be doing my trigger shot! In my last update, I had written that we were hoping to trigger tomorrow. Based on the sizes of my follicles at my last ultrasound, they had estimated Monday would be trigger day, but had me come in today for another ultrasound check. It's a good thing they did!


My follicles exploded since my last ultrasound! Just take a look at the above picture. Last time, most of them were in the 11-14mm range. but now they are much larger! I was pretty uncomfortable during the ultrasound. Normally they don't bother me, but today there was a lot of pressure. They measured 8 big ones on my right ovary. I'm not sure how many they did not measure this time. On my left side (still next to that big blood vessel), there were two bigger follicles, but still on the smaller side. They will probably grow enough from the trigger to possibly contain mature eggs, but I'm still not sure if they will be able to retrieve any from that side. My lining was 9.9 mm. Hopefully it's nice and cozy in there for my future embaby!

Here's a few more shots from my ultrasound:



After the ultrasound, one of the doctors needed to review my scans to give the okay to trigger. Once that was done, we had our trigger appointment! Basically where we got all of the information we needed for our trigger, retrieval and transfer. I was given instructions for both the full strength and half strength trigger (10,000 units vs 5,000 units), because my E2 was getting a bit on the high side. So depending how my labs come back today, they will make a recommendation on which to use. I'll update this post once I find out! Update: My E2 wasn't too high, so I was able to do the full 10,000 unit trigger. My E2 on the day of trigger ended up being 2933 and my progesterone was still low at 0.7, meaning that we don't have to do a freeze all cycle! I was instructed to do the trigger shot subcutaneously at precisely 11:00 PM Sunday night, for a 10:00 AM retrieval on Tuesday morning!

I have a lot of meds left over, because they had to keep lowering my dosages. So I am planning on holding onto them in case we need to do another cycle. But if this works out, I'm hoping to be able to gift my meds to someone else who needs them.

As of right now, we are scheduled to do a 5 day transfer.. and I'm really hoping we are able to!! If we do a 3 day transfer, it will most likely be transferring 2. That would be on June 3rd. If we do the 5 day transfer as scheduled, that would be on June 5th. Our beta test is scheduled for 14 days past retrieval, which is on June 14th. Right before Father's Day! I'm hoping we get some really wonderful news and are able to celebrate Father's Day, thinking of our future little one!

Poke Count
Arms: 7     Belly: 38     Ultrasounds: 4

Saturday, May 28, 2016

Stim Days 7 & 8: How Many Follicles?

On stim day 7 of my IVF cycle, I went in for another follicle count ultrasound! At my last check, on stim day 5, I had 4 measurable follicles plus other smaller ones. I was told that the micro dose lupron flare protocol that I am on tends to move a bit slower than the antagonist protocol, so at that point they were happy with my progress.


By stim day 7, it was time for another check! First I did my blood work, and then headed up for the ultrasound. I was a little nervous. Once I was in the exam room, one of my favorite doctors came in. It was really nice to have her do my scan! The first thing she checked was my lining, which was 8.6 mm. So my lining is already thick enough and is ready to go. My uterus had the 3 stripe pattern that they look for. So all looked good there.

Then it was time to check the follicles. The right ovary was first. As soon as she moved the wand over, you could see a bunch of follicles! Immediate relief from my anxiety! She measured 7 total on that side, ranging from 10-15 mm, with most of them being in the 12-14 range. We were so happy to see them growing evenly! There were also two follicles that looked smaller that were not measured. The doctor said they might still grow and continue to catch up.

Left ovary was next. It was pretty apparent that there wasn't nearly as much going on over there! She measured two follicles, both around 8 mm. There were also two follicles that were smaller and not measured. One of the things I noticed when she was doing my ultrasound, was that she had to put the wand in a kind of strange position to see the ovary on the screen. Now I've had a lot of these ultrasounds, and this has never happened before. But apparently, the left ovary has decided to shift into a funny spot. Which happens to be next to an absolutely huge blood vessel. If it stays in its current position, they are going to have to be extremely cautious attempting to retrieve the eggs from that side. If the eggs on that side don't grow too much, they may not even attempt to retrieve them. But if they appear to have a possibility of containing a mature egg, they will do all they can to retrieve them as long as it's safe to do so.

Based on my follicle sizes and the way they expect things to progress, they currently are expecting me to trigger on Monday with retrieval on Wednesday! Obviously that could change, depending how things look at my next ultrasound.We left the appointment so happy! It really seems like this protocol is working better for my body. We ran into my IVF nurse in the hall, who wanted to hear how things went. I showed her my follicle print out, and she was so happy for us!

Once my labwork came back, I was really interested to hear my E2. In my last update (on stim day 6), my E2 was 1142. By the next day, it was 1653. So originally I was supposed to skip a day of blood work, but because it was still rising quickly they wanted me to come in for another blood draw the next day. Arms are definitely getting a little sore. But they decided to keep my dosage the same for that night, with the possibility of decreasing the Gonal F the next day.

So this morning (stim day 8), I headed off for my blood draw. I got the call this afternoon that my E2 had risen to 2327, which is still rising quickly. The nurse wanted me to review the OHSS symptoms and take steps to prevent it (increase salt, keep drinking fluids, etc). The E2 will continue to rise, so we want to be careful it doesn't rise too fast. So they lowered my Gonal F more than expected, down to 300iu. They kept my Menopur the same (one vial), and kept my microdose lupron the same.

Tomorrow morning I head back for another blood draw (ugh! lol), and another ultrasound. I'm hoping to have a better idea of when we are expected to trigger, after my appointment tomorrow!

Poke Count
Arms: 6     Belly: 36     Ultrasounds: 3

Thursday, May 26, 2016

Stim Day 5 & 6: First Follicle Scan!

Yesterday was stim day 5 (and CD 7)! This cycle seems to by going by so quickly. My RE had me come in for my first follicle scan, which was after 4 nights of stims.


I did my bloodwork first and was only the 4th person in line. Once that was done, I went right upstairs for my ultrasound. As you might remember from last cycle, things really started going downhill after our first ultrasound, and the next day we cancelled our cycle and converted it to an IUI. So understandably, I was a little nervous prior to this ultrasound.

I got lucky and one of the main REs did my scan! Usually they have the younger fellowship doctors do them. The first thing they check is your lining. Mine was already at 8.16, which is excellent! Although I'm not surprised because I've never had any issues with my lining. Next, they checked the right ovary. I could immediately tell that the scan looked different than last cycle, which was a good thing! I saw quite a few follicles. The doctor measured the four of them that were above ten. There were two at 11mm and two at 13mm. As for the smaller ones, he believed he saw 3 under ten. Next they did the left ovary. I honestly didn't get a good look at this side, because I felt a lot of pressure when the probe was shifted. But none were above ten on that side, but he saw 3 clearly.

Overall, there were 4 follicles slightly above 10mm, and 6 under 10mm. Definitely better than where we were at last cycle!

But I still had to wait until the afternoon for my bloodwork results. I was happy to hear that my E2 came back at 749! Two days prior it was 234, so it more than doubled. Definitely rising quickly. So as a result, they lowered me down to 1 vial of menopur (I was previously on 2 vials). Because it was rising so fast and they had adjusted my dose, I had to go back for blood work again the next morning (which was today).

Today was stim day 6. This morning's bloodwork came back with my E2 at 1142! So still rising very quickly. That explains the headache I've had, which can be caused by hormones rising. My IVF nurse mentioned that they don't want me to go too quickly, so they are now lowering my Gonal F to 375iu (down from 450iu). With the way the numbers are looking, they feel pretty strongly that the smaller follicles are growing too! Which is exactly what we are hoping for.

I've been drinking ridiculous amounts of water, along with coconut water. And I am still thirsty! I am still feeling tired and have a dull headache. My tummy is still bloated and a little puffy. But I'm happy to say that after 28 shots, my tummy is not bruised or even sore! I can't even find where my previous injections were done. I do have a patch of irritated skin from a band aid I put on.. which I think is a little funny. 28 injections leave no mark, but one silly little band aid did? Thankfully I took it off as soon as I noticed it was bothering my skin.

I go back tomorrow morning for another blood draw and ultrasound. Hoping things look good in there and that those follicles are growing. I'm not sure when retrieval will be yet and we will know more once we see the sizes of the follicles. Keeping my fingers crossed all goes well tomorrow!


Poke Count
Arms: 4     Belly: 28     Ultrasounds: 2

Monday, May 23, 2016

IVF Cycle Day 1-5!

Today is already CD 5! So far, I've had 1 ultrasound, 2 blood draws, and 16 injections. Everything has been going very smoothly and all my injections have been painless.


The first two days of my cycle, I only used the microdose lupron twice a day. The purpose of the microdose lupron was to cause a FSH flare, to hopefully "wake up" all those follicles and take advantage of my body's ability to create it's own FSH. After those first two days, we added in the Gonal F (450iu) and Menopur (150iu), both injected in the evenings.

I was initially a tiny bit nervous about the Menopur injections, because I've heard countless times that it burns quite a bit. But I am so happy to report that my injections have been absolutely painless! My two tips are: 1) After mixing and drawing up the Menopur, let it sit for about 15 minutes so the powder can fully dissolve. 2) Inject it slowly. Don't be tempted to go quickly just to get it over with!

This morning was my first blood draw since my baseline. My doctor had asked me to come in early just to make sure I'm not responding too quickly, since I'm on the maximum dose of stims. Here's an updated copy of my stim plan:

As for side effects... I'm starting to feel tired. And just like last cycle, I'm very thirsty and have a good amount of EWCM. I've felt some twinges in the ovary area, but I know from experience that it's not a good indication of what's actually going on. My doctor had explained to me that abdominal cramps/pain/twinges are really difficult to interpret because of the way the nerves are in the pelvic region. I'll take his word for it! My lower tummy is also starting to get puffy and bloated, which I think is from all the shots. It happened last cycle too, but not until a bit later on in the cycle.

As for my blood work results.. everything looked good!! After 4 days of the microdose lupron and 2 nights of stims, my E2 rose from 45 at my baseline to 234 today! My doctor was very happy with that number and they told me everything looked perfect. My P4 and LH also came back perfect. So for now, everything is going really well! Last cycle, after 2 nights of stims my E2 went from 50 to 146. That's all I really have to compare it to. Based on that, it seems to be rising a bit faster than last time. So I hope that's a good sign!

I don't have any appointments tomorrow, but will go back the day after tomorrow for my first ultrasound since my baseline as well as another blood draw. Things started to go downhill after my first ultrasound last cycle, so we're hoping that appointment goes a bit better this time around!

Poke Count
Arms: 2     Belly: 16     Ultrasounds: 1

Thursday, May 19, 2016

CD 1: IVF Baseline + First Injections!

Today was CD 1 for me, which meant this was the first day of my IVF cycle! Since I was on birth control prior to starting this cycle, my baseline was planned ahead of time rather than needing to schedule it when AF arrived. So we started on CD 1 rather than CD 2 or 3.


First things first, I needed my blood drawn for E2, FSH, LH, P4, and HCG (can't be too careful!). My nurse usually calls me in the early afternoon with my results. One of the things I absolutely love about my IVF center is the phlebotomists. The are seriously amazing. I have always, always, always hated getting my blood drawn. It's always hurt me to have it drawn and I, without fail, get a nasty bruise that lasts 1-2 weeks. But at my IVF center... they are just SO good. They use the smaller needles and are serious experts at finding veins and making the process painless and quick. I never thought I'd see the day that I didn't dread bloodwork. And I never thought I could tolerate having bloodwork daily!

Next was the ultrasound. My lining was already down to 4mm, which is good. I was pretty nervous to see my ovaries, because last cycle it seemed like my antral follicle count was lower than normal. In hindsight, I wonder if that could have indicated that cycle was going to be an "off" cycle for me? I'm not sure. But my follicle count was great today! Back to what it normally is, which is 7-8 per ovary. So I had a huge sigh of relief when I heard that!

After my ultrasound, we met with one of the IVF nurses to just go over everything. She was such a positive, bubbly person and said that she feels really strongly that this will work for us. Which is so nice to hear! She also gave me some interesting information about how people respond to IVF meds. She said that someone can do two IVF cycles, with exactly the same protocol, with no changes, and have drastically different results. So what I was told about there being times when you have an off cycle does seem to be true! And she said there are studies to back it up. But we'll have to see how I respond this time, to see if last time was just something weird, or if I really do have an issue somewhere.

Since everything looked great, I was cleared to start my injections! Once we got home, I got my first MicroDose Lupron injection ready. These injections truly are a breeze. The needles are just so tiny! I didn't even feel it go in at all. I will do these injections every 12 hours until trigger time.

So it's official... this IVF cycle has started! :)

Poke Count
Arms: 1     Belly: 2     Ultrasounds: 1

Tuesday, May 17, 2016

IVF Medication Cost For The MicroDose Lupron Flare Protocol

In my last post, I explained the new IVF protocol that we are going to try this cycle, which is the MicroDose Lupron Flare Protocol. Sometimes you'll hear it called the Micro Flare Protocol, or the MDL Protocol. This is a much more aggressive protocol that many couples have success with. But being more aggressive usually means more medications! And the cost reflects that.


For those of us that pay out of pocket for all or part of our treatment, cost is pretty important! It's also one of the things that, in my research, I had the hardest time finding information about. Obviously the cost varies depending on the pharmacy and medication prices do fluctuate, but I wanted to share our costs in case anyone out there finds it helpful.

I'll list my meds from most expensive to least expensive.

Gonal-F Redi-Ject Pen

For my protocol, I needed five 900iu pens. Each pen also has 75iu of overfill of medication, which you can use. The price for each pen was $714, for a grand total of $3,570. I got lucky and had one pen left over from last cycle (thanks to being able to use the overfill in the pens for my last dose!), so that cut my cost a little bit. Plus it was nice to not waste meds that I had previously purchased! My dosage will be 450iu each day.

Menopur

My nurse ordered 24 75iu vials of Menopur, with me using 2 vials each day. So I will be using a total of 150iu of Menopur each day. The price per vial was $79.90, for a grand total of $1,917.60.

MicroDose Lupron

MicroDose Lupron is not the same as regular Lupron that is used in the Long Lupron Protocol. This medication is mixed up by your pharmacist, so it is diluted to the proper strength. The pharmacy I use mixes it in large batches, sends it out for testing to make sure the potency is exactly what they want, and then package it in individual vials. The cost for the entire vial was $125.

Pregnyl Trigger

It seems like most triggers, no matter what brand, are all around the same price. The total for the Pregnyl was $92.

Progesterone in Oil

This is the intramuscular progesterone, sometimes called PIO. My nurse ordered me 3 vials. I did not use these last cycle, so I didn't have to order anymore. The price per vial was $27.03, for a total of $81.08.

Syringes + Needles

For all the various needles and syringes I needed, the total was $36


Overall Medication Price: $5767.63

This is quite a bit more than last cycle with the antagonist protocol, but there are quite a bit more meds this time! 

Friday, May 13, 2016

MicroDose Lupron Flare Protocol for IVF #2

For IVF attempt #2, our RE has decided to put me on a much more aggressive protocol. To remind you, our first IVF cycle was converted to an IUI due to a poor response/lead group of follicles. This was totally unexpected! I've always had lots of follicles on my ovaries, a high AMH, and I am young. My RE was had said I had a higher risk of OHSS! But nothing is guaranteed in IVF, and you need to expect the unexpected.


Last cycle, my RE said that there might be something subtle and undetectable going on with me. And it might explain why our "mild" male factor has been giving us such a hard time conceiving - perhaps it's not really the male factor at all! Surely not what we wanted to hear. We got the impression that he's viewing it more as an "unexplained" infertility issue now, because my lab results simply do not match my response.

So we are going at this full throttle! A really aggressive approach, meant to maximize the number of follicles that develop and continue to recruit them as the cycle goes on. Last cycle I was on the antagonist protocol, and this cycle I will be on the MicroDose Lupron Flare Protocol (MDL). Here's a copy of my stim plan, and feel free to click on it to make it larger.


Here's how the protocol works. After my period arrived, I started birth control on CD 3. This is where I am currently in our cycle. I will be on the birth control for only 11 days, so I don't get over suppressed. After taking the last birth control pill, I will take no meds for 2 days. On the third day (which will actually be CD 1), I will have my baseline bloodwork and ultrasound, as well as start a light period that day. After my appointment, if I am given the all clear, I will start the microdose lupron that day. The microdose lupron is a diluted form of lupron and it's given in small doses, each 12 hours apart. I will use only 10 units for each dose, with two doses a day. When used in this way, the lupron actually has a stimulating effect and produces a "FSH flare". This takes advantage of your bodies own FSH production.

On CD 3, I start my Gonal F and Menopur. This cycle I will be taking 450iu of Gonal F and 150iu (two vials) of Menopur each day. That's a grand total of 4 shots a day! Two lupron shots, and then 1 of Gonal F and 1 of Menopur. On CD 6, I return for bloodwork to check my E2 and P4 levels. I will return again on CD 8 for bloodwork and an ultrasound to check my progress. My stim plan is blank after that point, because the rest depends on how I respond to the meds!

My medications arrived a couple of days ago... and we will be starting my injections next week! Hoping this cycle works a little better for me and trying to stay really positive about our chances.

Thursday, May 5, 2016

Another Chemical Pregnancy?!

Well, this cycle has certainly been full of surprises. A quick reminder of how things have happened: I started our first IVF cycle on the antagonist protocol, ended up developing a lead group of follicles (a few pulled ahead and grew faster than the rest, the smaller ones shrank), and we decided to convert to an IUI. Definitely not what we, or our RE, had planned or hoped for.


The IUI itself went well. Nothing we haven't done before! This was our 7th IUI, ugh. I had 3-4 mature follicles by the time the IUI was done, my lining was over 10mm days before the IUI.. everything certainly looked good! My nurse did the IUI and it was painless.

I decided to test out my trigger, and wasn't going to test anymore after it was out. Or at least that's what I thought I would do! But the day after the trigger seemed "out" to me, I decided spur of the moment to take a test with SMU...


Seriously?! We just couldn't believe it. It was so unlikely to happen.. yet it did! We had a few days of happiness, planning on sharing the news with my family on Mother's Day, looking up when our due date would be... But unfortunately, it did not stick. Suddenly, my tests were drastically lighter. And then I started spotting.


AF is here now, and with a vengeance! And lots of cramps. This is definitely a disappointment. At first, we thought we had our miracle! But it quickly turned out, we didn't. Chemical pregnancies are so common... but that doesn't make them any easier. Especially when you have to try so hard and long to see those two lines.

But we are looking ahead to the future, with a positive mindset. I have my new IVF protocol, my meds ordered, and we will be getting started very soon! I will do another post about our new protocol and what is to come :) But for now, we're just thankful for the good things we have and all the happiness in our lives.