Thursday, July 30, 2015

A day without shots....what?

You read that right!  Today I will not have a single needle injected into my body.  It seems strange.  (Which when you think about it strange in and of itself; I really want to give myself an injection....I need help!). The reason for the needless day is that I triggered yesterday.  Triggering is an injection of HCG that instructs the body to release all the eggs that have been developed.  This is specifically timed with egg retrieval occurring 36 hours later.  I took the injection at 8:30 last night, and I will be going into the operating room for my retrieval at 8:30.

The HCG shot was different than all the others I have been giving myself over the last few weeks.  For both my lupron and gonal injections, I had a nice little needle like this: 

Cute isn't it?  It would go into my stomach.  I would barely bleed (most days not all) and it wouldn't hurt...honestly.

Now my HCG gets injected intramuscularly (which means in my butt cheek) so it needs a slightly larger needle like this:
 Definitely a little more scary!  I won't lie these ones do hurt, but I try to ice it before hand (don't tell Olivia I use her Sofia the First BooBoo buddy) and it isn't as bad.  We used this "little" needle to inject 50,000 units of HCG into my body exactly at 8:30.  Now we wait and hope all things work the way they should.

How did they know I was ready for injection?  I have been going into Foxboro for monitoring (blood work and ultrasound) over the last couple days.  I had four appointments in total (Friday, Sunday, Tuesday and Wednesday).  At these appointment they test my estrogen level and count and measure the follicles in my ovaries.  At the final appointment, I had 10 measureable follicles in each ovary, so instead of feeling like this:
Lots of room for the few follicles to grow.  I was feeling more like this: 
No room for anymore growth or actually any movement.  I am definitely bloated and uncomfortable, though Olivia seems to think my stomach is a great pillow to jump on.  Gee thanks kid!

My estrogen level was the thing that really made them to push me to retrieval on Friday and not Saturday.  My estrogen is 3,500 and they don't like seeing it over 3,000.  It strange that my estrogen was low throughout both frozen cycles and now it sky rockets to possibly unhealthy levels.  High estrogen can lead to Ovarian Hyperstimulation Syndrome, which can be painful at best and deadly at worse.  The nurse said that there is a chance I could have a mild case after retrieval.  To help fight against this, they gave me half a dose of HCG. Instead of the normal 100,000 units I only took 50,000.  

Getting this news sent me to the one place that I shouldn't have gone: Google.  I have been reading all sorts of things about OHSS and high estrogen at trigger.  It can lead to poor egg quality and even early delivery if the embryo takes; it can push the RE to freeze all the embryos and not transfer anything.  After fully freaking myself out (You would think I would know not to go on Google!), I backed up and figured if it was going to be a huge issue (including possible complete freeze of the embryos) my nurse would've said something....right?  I will ask the nurse when I go in on Friday, but before that I will stock up on protein shakes and gatorade, both which help to ward off OHSS after retrieval.

I will give you all an update when I am done on Friday and am able to write coherent thought.  I will probably do a couple short posts for the retrieval and fertility report.  Send me all your positive thoughts for a good retrieval, strong eggs, and good fertilization.  

Tuesday, July 28, 2015

New cycle a little different than the old cycle

I've done this before and was actually successful one; I can totally handle this....maybe. For the most part this cycle is the same as the one that gave us Olivia.  The only the medication that I am not taking this cycle is an antibiotic after retrieval.  When I asked about the change, my doctor fully explained to me about the various studies that have been done over the last few years that show that the antibiotic is not helpful during IVF.  This is one of the reasons I chose Brigham and Women's; they are continuing to research and improve on their abilities.

My doctor has also been playing with my dosage of gonal.  I was supposed to start at 225 units, but after my baseline, my doctor lowered the dosage to 187 units.  I had a quite a few follicles so she wanted to take it slow.  I went in for my first follicle check after 4 days of stimulation.  I had only one follicle on each side, so my dosage went up to 225 to stimulate some of the "lazy" follicles that didn't want to grow.  Two days later I returned for another check and it worked!  I had a total of 12 follicles that had grown and still had quite a few smaller ones left.  To ensure that too many didn't pop up, my dosage was dropped back down to 187 units.  Ovarian stimulation is a careful dance between enough mature follicles and too many.  Not enough can lead to not enough mature eggs and lower chances of having success; too many can lead to poor quality eggs which can also lower chances of success.  I am actually glad with my yoyo dosage; it proves to me that she is actually looking at my scans and thinking about my cycle as a whole.  It's not just "continue with the plan".

While these are only small changes to my protocol, there definitely is a few things that I forgot.  I remember feeling full and uncomfortable, but it wasn't as bad as I remembered right?  It was only a couple days, right?  Not so much!  I am currently on day 8 of stimulation, and I can definitely say I'm uncomfortable.  During a normal cycle, your body produces 1 follicles right now I have 12 follicles growing and a handful that are still small.  There is only so much room in my body for all these to go, so it is becoming difficult to sit and to carry Olivia.  

This brings me to another difference with my earlier cycles:  a toddler!  Having a very active (very clingy) toddler while completing a fresh IVF cycle is definitely taxing.  Not only are my hormones all out of wack and I'm growing more eggs than any chicken in my ovaries, I need to entertain and care for an almost 3 year old.  In previous cycles, I could come home and relax when I was too sore to move or I could take a nap if I was tired from the medication and early morning monitoring.  These things aren't allowed with a toddler.  I have been trying to plan activities and go places because hopefully there will be other children or adults to help entertain Olivia.  Now I understand this sounds terrible and like I want to pawn my toddler off on other people, but it's not.  I can be a better mother if Olivia can play independently or with a friend even a few minutes at a time.  At home when it is just her and I, I normally don't get any of these moments.  It also helps me from having to come up with creative ways to entertain Olivia when I'm so tired I can barely function.  (Yes movies and TV have been part of my plan as well...MOTY I know).

Having Olivia with me also makes this cycle a lot easier.  With previous cycles, my IVF protocol and what was happening or could go wrong was on my mind 100% of the time.  This cycle I don't think about it constantly because I have a lovely distraction and IVF miracle with me most of the day.  While I'm still trying to do all the helpful things through this cycle (drinking pomegranate juice, drinking fertility tea, eating eggs and avocados, and meditating) I find I'm not able to do it every day and you know what that is okay.  My whole self-being isn't hinging on the success of this cycle.  Would I be heartbroken if the cycle didn't work?  Of course! However the emotions are different the second time through.  Firstly, I know it can work. I know it can work with this doctor at this hospital because it did.  I have living (and talking) proof of that.   I'm no longer in the "could it?" stage.  Secondly, if we could never have another child, we would actually be okay with that. Yes we want another child, and I know something would feel off if it didn't; however, we have Olivia and she could be enough if that is all we are able to have.  All this doesn't mean that we won't put all we have into trying for a second, but the need isn't as dire.

I went in this morning for my third follicle check.  I am feeling very full and uncomfortable.  According to the ultrasound tech, "it looks like it's time".  It is definitely up to the doctor when to trigger, but it could be this week.  If I trigger tonight, the retrieval will be on Thursday.  If I'm not quite there, I may have to go back in tomorrow or Thursday for more monitoring.  I will keep you updated!

Monday, July 20, 2015

It's officially starting!

I went in for testing bright and early this morning for what is called baseline testing.  This blood test and ultrasound checks to make sure that all the hormone levels are normal and everything in the uterus and ovaries is clear.

Like everything else with IVF, it is a process of hurry up and wait.  I woke up at 5:30 to make sure I got to the clinic in time to get the early morning testing done.  Then I had to wait until the nurse calls later in the day.  Thankfully I had swim class and some pool time to keep me occupied. However, if all the pregnant ladies who have toddlers Olivia's age could stay home, I would appreciate it.  Just another reminder that all we have to go through is NOT how most couples grow their families.

I received good news from the nurse.  Everything looks good, so I can start my stimulating medication (Gonal F) tonight.  In fact everything looks so good, I will take a lower dosage than originally prescribed.  The doctor said there were quite a few follicles ready to grown in both ovaries, so she wanted to go slower than in my previous cycle.  This is where IVF is a fine science.  You want multiple follicles to grow and mature, but too many follicles growing can lead to poor quality or a condition call Ovarian Hyperstimulation Syndrome, which can be very dangerous.

I now get to take two shots per day.  I have been taking 10 units of Lupron every morning for the last 13 days.  The shots really aren't that bad.  It is a small needle that goes right under the skin.
This is the drug that will keep me from ovulating all those mature eggs prior to egg retrieval.  Starting tomorrow morning, my dosage will drop to 5 units.

My other shot will take place in the evening.  Gonal F is a delivered by a "pen".  The pen has 900 iu of the medication.  You set the medication on the pen, put on a new needle, and it is ready to inject the needed amount.
Right now I will be starting with 187 units.  I go back into the clinic on Friday for more blood work and ultrasound and will continue to do so every other day (and even every day close to egg retrieval).  These appointments will be to test the estrogen level in my blood and to count and measure the follicles in my ovaries. Based on these appointments, my medication dosage may be increased or decreased accordingly.

This is the time period of an IVF cycle that become busy again.  It is a lot of appointments and a lot of medication.  My job is to make sure that I stay a relaxed as possible.  And to help make my body as ready as I can.  That means eating and drinking all sorts of "fertility" foods.  I'm all prepared with my fertility tea, pomegranate juice, avocados, nuts, and lots of eggs.  Who knows if any of this actually does anything; it give me some feeling of control during a very difficult process.

Tuesday, July 7, 2015

Summer of Shots....not the fun kind.

I woke up early this morning (5:15 on a summer morning..yuck!) to drive into Foxborough for the first step in our IVF cycle:  hormone check.  I had to have blood drawn to check my progesterone level.  It is important that I have already ovulated before started my first medication: lupron.  The blood draw took about 1 minute with about 2 hours of drive time.  Not too bad right? Not all of my appointments will be just blood work; some will require ultrasound as well, but those don't start until later in the process.

Earlier this afternoon, I received a call from my nurse.  My numbers looked good, and I have go ahead to begin Lupron tomorrow morning.  Lupron is a subcutaneous injection, which means the medication is injected in my lower stomach area using a smaller needle.   These injections I normally do myself.  At first I was petrified and had Sean do them, but that actually was more difficult.  Like many things in my life, I needed to be 100% in control.  I will take these injections every morning until at least July 20th (maybe later depending on my cycle) and then I need to go in for what is called "baseline monitor".  This time will include both blood work and ultrasound.

I am doing what is called a long Lupron protocol.  This is the same protocol that I used when I got pregnant with Olivia; if it's not broken don't fix it.  This is one of many protocols for IVF success; everyone reacts differently so each has flex room.  With the Lupron protocol, I will do at least 12 days of Lupron injections on it's own then I will go in for my baseline.  If things look good, I will begin stimulation medication.  For me this will be Gonal-F, also a subcutaneous injection but this one will be done at night.  I will be continuing my Lupron during this time as well.  Yup that means two injections a day!  Good thing my bathing suit doesn't expose my stomach; the instructors at swim lessons would be calling CPS on me.  I will do this anywhere from 5 to about 10 days depending on how I react.  During this time I will be going in every few days (daily towards the end) for blood draws (yes more needles) and ultrasounds.  Once things are where the doctors want them to be, I will take what is called a trigger shot.  This is an intramuscular shot (aka butt shot) that tells my ovaries to release all the eggs that have been growing.  36 hours later (yes that specifically timed), I will be having my egg retrieval.  I will be put until general anesthesia and the doctors will go through my uterus to remove all the fluids in the follicles, which hopefully contains eggs.  The same day all the mature eggs will be injected with the strongest of Sean's sperm in a process called intra-cytoplasmic sperm injection.  The embryos will then grow in the lab.  I will also begin progesterone injections nightly.  These are intramuscular like the trigger shot.  These are literally a pain in the ass.  I need help to do them, so Sean has to make sure he is available every night.  If the oil is too cool, it is hard to inject and can sometimes leave hard lumps under the skin.  On day 3, the embryologists will choose the best embryo and hatch it, and then it will be transferred into my uterus.  The rest will continue to grow in the lab until day 5.  Any embryos that a still striving will be frozen.  The process for freezing has changed greatly since we last did IVF in 2012, and the success rates have jumped from about 50% to closer to 90%.  We are hoping to not need the frozen embryos, but it is good to know that we have that option if needed.

This protocol is slightly different than the one the doctor originally recommended for us.  She wanted us to do a 5 day transfer.  There are many benefits to this.  Because they grow longer in the lab, the embryologists have a greater chance of picking the one that will be the most successful.  It is totally possible that the "best" embryo on day 3 fails to thrive by day 5.  On day 5 the embryos have developed to a blastocyst, so there is no need for assisted hatching and the less handling of the embryos the better.  All this sounds fantastic right?  Why did we choose to do a day 3 AMA? We have attempted a day 5 previously at our last clinic.  Our results were not good.  None of the embryos developed in blastocysts; they had stopped at a stage called a morula.  At the transfer our doctor told about the low chance of something even taking.  We left that day heartbroken but had an idea that assisted hatching could be our solution.  Just thinking about the possibility of having another transfer cancelled left me in tears.  I expressed my concerns with my doctor.  She listened to me, and even though she spent about 10 minutes explaining how labs and techniques have changed in the past 3 years, she expressed her desire to not have any additional stress put on me.  She came up with this "compromise".    We will do the 3 day transfer of a single embryo (no twins for us THANK YOU!) and the embryologists will closely watch the remaining embryos in the lab.  The embryos will be frozen on day 5 (those who make it).   We understand that the embryologist may not pick the right embryo, but if the cycle doesn't work, at least they have a clear idea of what blatocysts are the strongest.   Also, if none of them survive or develop into blastocysts, this will give all of us a deeper understanding about what may be causing our infertility, which is always a good thing.

I got a special package today in the mail....all my meds.  Want to see?  Here it is!
Just a few meds to take up my countertops.  Thankfully the new house has plenty of counters!

So ladies (and gentlemen if any of you have made it this far), that will be my summer fun!  I will be trying to inject (pun intended) my summer with some great activities with Olivia and the rest of my family.  We are unable to actually away because of this, so we will be doing a number of day trips: beach, zoo, Edaville.  Suggestions?