Embryo Transfer

This is a picture of the two little embryos that they put back in me on Wednesday. The whole experience that day was pretty incredible and now after 36 hours of bed-rest I am just hoping that these little guys are super sticky and hold on tight.

The Dr. and embryologist both said that they are perfect, of the best possible quality and that I have 5 extra that will be frozen. The reason they look a little different is because the one on the left is a little ahead of the one on the right. They go from 8 cells on day 3 to a Morulae on day 4 where cells are not as distinct as in previous days, so it is difficult to count cell numbers.

I love my little embies already and am happy to finally have them in me, hopefully for the long haul.

I'm getting bad about updating this blog...

We have had an eventful past few days...

Sunday was my Egg Retrieval and they were able to get 12 eggs. The procedure went quickly and I spent the rest of the day recuperating, napping and decorating gingerbread houses with my sisters. At my appointment on Friday they counted 11 follicles at the right size so hearing that they got 12 eggs was an added bonus!

Yesterday I got a call from my nurse to let me know that of the 12 eggs they retrieved 11 were mature and 7 of those fertilized. This was great news! I also started a slew of medications that day.

Just now got the call from the embryologist at RMA. She told me that my transfer will be tomorrow at 1pm and I also heard back from the acupuncturist that my acupuncture appointment will be at 12 and then again right after the transfer. You have to go to the transfer appointment with an uncomfortably full bladder so I have to drink 1/2 of my allotted water before the acupuncture and the other 1/2 after but before my transfer.

The embryologist said that we have 4 "picture perfect" embryos and 3 good ones and one more that fertilized late and now is at 8 cells so they think it may be abnormal. She said that with how the embryos looked we could transfer one but we are going to stick with two. She also said we will probably have 4 to freeze.

I am super nervous and excited for tomorrow!! This is great news :)

My own personal rollercoaster ride

So I had my scan today and guess what? The news is good!!!

My follicles grew and right now I have about 7 at the right size and a few more that my Dr. thinks will catch up. Depending on my bloodwork from this morning they will either have me trigger tonight or do one more night of injections, add ganirelix and trigger tomorrow.

Sooo I will either have my ER on Saturday or Sunday and then a 3 day transfer on Tuesday or Wednesday!! I will know for sure this afternoon!

I seriously was not thinking it would happen and am so unbelievably happy that it will! On the way tot he Dr. office this morning I basically was having a panic attack, totally freaking out even though as of yesterday I had decided that I was going to be ok even if they decided to cancel the cycle.

Also, my RE said that he will transfer 2 for the 3DT so I don't have to worry about that anymore either. What a relief!

I am anxiously awaiting the call from the nurse with my lab results and trigger day!!

Completely Freaking Out

I cried at the doctor's office for the first time today. I couldn't help it.

My follicles have not been growing as they expected and even with all the increases in medicines over the past 12 days they are still measuring mostly at 11. In order to trigger (which is 36 hours before the retrieval) they need to be at least 17 or 18 but preferably 20. That is a long way to go and while normally it wouldn't be an issue that I am what they call a "slow starter" it is a problem now because the lab is closing on December 22nd. I was really hoping to see some significant growth after we didn't really see anything at our appointment on Sunday and the increase in my meds again, but unfortunately, my ovaries are being stubborn.

I am waiting for my Dr. or a nurse (my regular nurse is out of the office until Wednesday) to give me a call once the results are in about my blood work levels from this morning. I have my cell phone on my desk and my email inbox open on my work computer.

I know now that a five day transfer is out of the question. There will absolutely not be enough time to even make that a possibility for us. So we are left with a three day transfer, which I am fine with if that is the case but I am worried that I won't even be able to make it to that.

If the lab closes on the 22nd I am not sure if they still do transfers that day or if the last day to transfer is the 21st. If the last day to transfer is the 22nd I'll feel a little bit better because that means I could have my retrieval as late as Sunday but that is really cutting it close because if we have fertilization issues it will all be a waste. What I am really hoping for is that my retrieval will be on Saturday (Friday would be better but I really don't see that happening at this point). If Saturday were to be my retrieval date then my transfer would be on Tuesday and I would make it in before the close.

Problem is if I don't make it before the close. Not only would this be frustrating but it would be very very expensive. So expensive I don't think it would be a possibility for me and basically I would have wasted this cycle completely. If I do not make the transfer date cut off they will freeze my eggs or embryos. I have paid $1,150 for the freezing of any unused embryos already but my insurance does not cover frozen cycles which this would then be converted to. I am pretty sure it would cost me $4,000 in January to put the embryos back in. Here I was worried about coming up with the money for my deductible and another round of cryopreservation in February ($3,800) and then this would be another $4,000 on top of that - not covered by insurance. I really don't see any way that this would work and on top of that I would have wasted one of my two attempts at a fresh IVF cycle with nothing to show for it.

Basically I have been freaking out at my desk all morning waiting for some word from my RE office and it is just getting worse as the minutes drag on. All I can think about are dates and times and follicles and money and medication dosages. I just hope there is still some hope left for this cycle.

Upped my meds

I had another monitoring appointment today and my follicles are still slow to grow so my RE upped my dose of Gonal F to 225 IU. Next monitoring appointment is on Sunday and hubby is coming with. I'm excited to see with him what's growing! So here are a few photos of what my nightly injection routine has been for the past week. So far it is just the Menopur/Gonal "cocktail" with my other oral meds.

Here is everything I need to get started for the night:

This is the Q-Cap that makes mixing the drugs much easier than using a needle:

Mixing the Menopur:

Gonal F into the Menopur to make the "cocktail":

Cocktail into the syringe:

All ready to go...

Stimming for IVF

So I have been a little slow in updating this blog but a lot has been going on lately. We got our big box of meds delivered on December 1st. The box was big and all the stuff inside was a bit overwhelming at first but I am slowly getting used to it.

Here is a list of what I am using for my cycle:
1. Gonal F - 3 900 IU pens
2. Menopur - 20 75 IU vials (and 20 vials of diluent)
3. Dexamethasone - 7 0.5 mg tabs (I'll take 1/2 tab each night)
4. Ganirelex Prefilled Syringes - 5
5. Lupron 2 week kit with extra lupron syringes
6. HCG 10,000 IU vial
7. Doxycycline 100 mg - 10 tabs
8. Methylprednisone 16 mg - 5 tabs
9. Estrace 2 mg - 60 tabs
10. Endometrin 100mg
11. Metrogel 0.75%
12. Doxycycline 100 mg for the hubby - 14 tabs
13. 40 3cc syringes
14. 20 Q-caps
15. 40 5/8" needles



We also had an issue with getting one of the medications. Ganirelex, which will be used later in the cycle is on a worldwide shortage. My preferred mail-order pharmacy has been out for weeks and did not know when they would be getting more. This caused me to freak out a little because this drug is what makes sure you do not ovulate the growing eggs before they are ready to retrieve them. Fortunately my RE office was able to give me a few samples and was able to find a pharmacy that had some available and I was able to get the amount I needed. I did have to pay out of pocket for them though and they are not cheap. One injection costs $99 and I needed 5 total. I am so thankful for my insurance coverage. Even with insurance coverage this has all been so expensive and I know it would be so much harder if we did not have the coverage.

Friday December 3rd was a big day because I had the IVF teach class, where they teach you how to mix the medications into a cocktail so that you can give yourself multiple meds in one injection. Then we started with the meds that same night. The dose we started with was 112 units of Gonal F and 75 units of Menopur. I am also taking .25mg Dexamethasone. Gonal F contains FSH and Menopur contains both FSH and LH the hormones needed to grow follicles. Dexamethasone is a very potent steroid. Not sure why that helps but I am taking a very low dose of it. The Menopur comes in 2 separate vials, one is a saline diluent and the other is the medication in powder form. I use a needle to mix 1/2 cc of the diluent with the powder so that it dissolves and then I add the Gonal F to that mixture. This "cocktail" is then what I draw up into the injection needle and inject into my stomach every night at 8pm. The point of taking these drugs is to get my follicles to grow. Ideally lots of follicles will grow. So far we have only had to use three of the medications so I know that more are coming up. Hopefully I can keep track of everything that is going in to my body.

I have been going to the RE office frequently during this time for monitoring and bloodwork. At the first appointment they didn't see anything growing so I was instructed to continue and come back in 2 days. The second monitoring appointment (yesterday) also showed no growth so they upped my level of Gonal F to 150 units as of yesterday and I go back in tomorrow morning to see if anything starts to grow.

It is really taking a lot for us to make a baby. With all of this complicated science and painful procedures it is hard to imagine that people ever get pregnant the natural way. Sometimes I just wish it could be that easy for us.

Support

Support for me has come in many forms and from many different people.

First I have my husband who, like it or not, is going through this all with me. Sometimes I forget that he is just as much a part of this as I am and that he wants a child just as I do. Granted, I get to do all the "fun" (note the THICK sarcasm here) tests and procedures but this is something that affects both of us and our mutual desire to have a child. I love my husband and am so thankful for him and his support while I am shooting myself full of hormones and generally being extra moody and emotional. I know that this is hard for me but sometimes (ok - most of the time) it is easy to forget that he is dealing with the same things and it is hard for him too and he has really shown me just how great of a husband he is though all of this tough stuff.

I also have wonderful family who do their best to know when give me the space I need and are there for a supportive word and friends who support me through prayer and are there to encourage me when I am feeling down. They may be as fertile as can be and really not understand what I am going through but I know that they care and that is really important to me.

A group of women that I am so grateful for and who have offered tremendous support for me have been other women I have met who are also infertile. There are several ways I have met these women and by far they have been the best source of information, support and encouragement. It is hard to explain but going through something difficult like this, it is comforting to know that there are others dealing with the same stuff, all the tests, medications, injections, procedures, hope, stress, anxiety, disappointment and sometimes joy.

The first group of women I have met through a Fertile Yoga class and support group that is put on by my RE's office every Saturday morning. I started going to this as often as I could even before my lap surgery back in July - so for about 6 months. I have written before about how much I love Fertile Yoga but really it is the women who I have met through it and the encouragement and frustrations we are able to share knowing that we all really understand exactly what the other is feeling. Recently the support we have been able to give to each other has been incredible. It used to be that we would share whenever we were all at class together but we have formed friendships and bonds over this trouble in our lives that has extended past a peer support group and there are some of these women I talk to frequently, if not daily and keep up to date on what is going on with them and helping each other out though difficulties and questions.

The second group of women I have met through online support groups. Like the women I have met in my Fertile Yoga class they just get exactly what I am going through and are able to relate in a way that no others can no matter how hard they try or how well intentioned they can be. This is why I think the internet is so wonderful. It allows you to connect with people who you normally wouldn't have a chance to and in this case brings together tons of people going through similar situations when in real life you would be lucky to know anyone. If it were not for my RE office having the yoga class and support groups (which not many RE offices offer) I would know one person (in real life) who went through this and now she has moved away. Online support groups and forums help because you can ask questions and surely someone will know the answer and will be able to respond quickly too!

I don't know what I would do without all the wonderful people who support me through this, both those I know in real life and my online supporters :)

Getting Ready for IVF

I have been bad about updating here about things that have been going on.

Hubby did another SA a couple of weeks ago and I had a mock transfer and saline sonogram as well as another chat with my Dr. about doing IVF this cycle.

I have been on birth control pills for the past 10 days and tonight will be the last one I take. They say to take birth control pills to keep things quiet in your ovaries before starting the cycle. I think it is kind of funny that I, who have no chance of becoming pregnant the natural way, am currently taking birth control. Anyways...

My saline sonogram went off well. They inject a mixture of saline and iodine into your uterus and then take an ultrasound to see how the walls look. They want to see clean sharp lines and that is exactly what my RE said he saw. So this was good news because it means that there are no issues (as far as my uterus is concerned) that would make implantation difficult.

After the saline sonogram we talked about this cycle and the results from hubby's SA. RE told me that the SA they did this time was with the Kruger analysis which looks at the sperm to find ones that have the correct shape and angle in the heads to penetrate the egg. Apparently none of hubby's sperm have this shape/angle. My first thought was that maybe this was why my IUIs didn't work but RE said that this is specific for IVF and could not say if this would have contributed to my past IUIs failing. The other concern I had was if the sperm are not correctly shaped does this mean that there is a problem with the DNA or chromosomes carried by the sperm. RE also told me that this is not the case and that the sperm are normal as far as DNA are concerned. The only thing that this analysis means is that we will be doing our IVF cycle with Intra-cytoplasmic sperm injection (ICSI). This means that once they remove my eggs instead of putting each together with 50,000 sperm and letting them all attack the egg they will be selecting one sperm per egg and injecting that into each egg. Crazy to think how tiny that needle has to be...I have no idea how this actually happens but I think it is pretty amazing that it is something they can do.

I also got my protocol and a packet of information to review and sign including consents and information about what we want to do with our embryos. This is crazy stuff because for us this is the equivalent to asking what we want to do with our unborn children. Not something most people have to think about or deal with. The list of medications was pretty intimidating, not to mention the 160 needles that were ordered. I know that some of these are for mixing but it seems a bit overkill to me. Hopefully they just order way too many. I think the most I would have to use is 40 to actually inject myself with but I guess I will find out.

Another thing that has been going on is that my insurance is being annoying and saying that certain medications need additional authorizations. Hopefully all this gets straightened out soon. I was supposed to get my shipment of medications tomorrow but that is not going to happen because of the authorization issues and the fact that one of the medications is on back order. My nurse says that I must have all the medications by Thursday at the absolute latest since I have my teach class and start injections on Friday. This is making me a little (read - a lot) crazy. It certainly does not mix well with my need to be in control A-Type personality. Also I won't know how much this is all costing me until they actually ship it. Hope there is enough $ in my HSA account to cover it... Guess I need to figure out a way to relax until the medication gets here.

On Friday I go in for bloodwork an ultrasound and my 2 hour teach class. The teach class is basically where the nurses teach you how to be your own pharmacist: mixing and injecting and timing all the different medications I will have to take for 8-10 days starting on Friday.

I am super excited to get things started. My RE says that there is a 70% chance of success for me this cycle. Those are odds that make me happy. The big question for me right now though is still whether to transfer one or two. This is what is going on in my head about all this: If I transfer one there is a better chance that I will have a healthier pregnancy if it works. Also, raising one child is definitely preferable than raising two at the same time. The problem is what if the one does not work. I feel like I will always wonder if it would have worked if I transferred two. My Dr. is concerned about transferring two because of my young age he feels that my chance of multiples is very likely (about 50-60%) and he does not want me to have to deal with the complications that come with twin pregnancies, especially given my medical history with PCOS he is concerned about gestational diabetes, hypertension and other issues. I do want to be able to enjoy my pregnancy and not have to be on bed rest the entire time or on additional medications that could potentially harm our babies. So this is the current dilemma - one or two...it is a question that is constantly on my mind. I guess I will have to make a decision sometime soon...