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.  

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!

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.

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?

TTCA is just as difficult as TTC the first time...only different

When we returned to this journey, I knew it would be trying, but I honestly thought it would be easier, physically and emotionally.  It is in some ways, but it is more difficult in ways I never expected.

Since we had three frozen embryos, we decided to start with a Frozen Embryo Transfer because we already had the embryos and it was "easy".  Well, easy compared to a fresh cycle; it's still a bitch compared to TTC naturally.  A normal frozen cycle looks like this:

     -Day 2 of cycle I go in for morning blood work (which for me is an hour away and constitutes a 5 AM wake up time)

    -If things check out I star estrogen day and night (I took four mg each time).  

    -After four days, I go in for more morning blood work (another 5 AM wake up).

    -About 10 days later, I go in for more morning blood work and ultrasound this time (another 5 AM wake up and missed work).

    -The next day I begin progesterone injections (now those are a pain in the ass...literally) and 5 days of another medication.

    -3-4 days after begin progesterone, I go in for the embryo transfer.  This is a fairly easy procedure.  The reproductive endocrinologist uses a catheter to transfer the embryo directly into my uterus.  It takes them longer to test and set up than the actual transfer takes.

   -About 10 days after the transfer, I go in for a pregnancy test.  If it is positive, I continue taking estrogen and progesterone.  If I'm not, I get to stop both.

Easy right?  Only 3 morning monitoring appointments, about 225 pills and 14 injections.  If it sounds like a lot you never had a fresh cycle completed.

While the cycle of itself was simple, one thing I didn't expect was the impact on my family.  Because of the early morning appointments, Sean had to get Olivia up and drive her to day care.   The day of the transfer and the day after I was on modified bed rest so I couldn't really play with her.  My incredibly intuitive daughter noticed.  At first she was obviously concerned.  Every morning she would ask if mommy needed to go to the doctor again.  After a few weeks, she started pulling away and connecting with Sean more.  (I was also take a graduate class at this time, so it was another night I was away from her).  At one point she told me, " I don't love you; you are never home."  While I knew it wasn't true, it broke my heart.  I didn't expect my journey to try to expand our family by one would affect the child we were lucky enough to have.

The other difficult thing about TTCA was having to deal with the negative result.  Yup my first cycle ended with a BFN.  Before Olivia, I could come home and crawl into bed with a glass of wine and throw myself a giant pity party.  You can't do this with a 2 year old.  I had to try to put on a good face at least until she went to bed.  Having her snuggle next to me did help, but oddly it hurt at the same time.  I no longer felt that I just failed Sean; I felt like I failed her as well.  The what ifs came back.  What if I couldn't give her a sibling?  What if I spend so much time trying that I permanently damage our relationship?

We entered our first FET incredibly positively.  This was the same group of embryos that gave us Olivia, so of course it would give us a second.   I ended up taking a pregnancy test the morning of my blood test to help me prepare.  It was negative; I was shocked but still slightly positive.  Maybe it was a late implanter. No such luck.

We then moved right into a second FET with our last straw of embryos.  Everything fell perfectly for this cycle.  The mornings I needed to go in for AM monitoring all fell on days I have period 1 off, so I didn't feel rushed and I didn't need to find coverage.  However the transfer fell right on the day of Sean's sister's wedding, but luckily we were able to push it back a day (one of the benefits of a frozen cycle versus a fresh).  This did require us to hide away in a bathroom on the boat while Sean gave me my progesterone shot.  I could've won most interesting wedding purse (3 needles, 5 pills, band aids, alcohol wipes).  It also limited my wine intake to 1 glass (though I snuck a small second one).  Honestly all the issues would be worth it if this cycle was successful.

We were optimistic heading back into Boston this morning (after leaving the city 10 hours earlier). The doctor came in with an update that we did not expect.  Out of the 2 embryos frozen in the straw, one did not survive the thaw at all and one only had 1 cell remaining.  This left us with a choice: we could cancel the transfer or take the chance (about 1-2% of success) of transferring the single cell.  With a heavy heart we decided not to even attempt the transfer.  I just couldn't put my body through the additional 10 days of medication for such low chances.

Out of the possibilities we thought of prior to the transfer, we never thought about this occurring.  We were both pretty numb heading home, and thankfully Olivia was with my parents at a family party.  It gave me time to begin to process the whole experience.  I don't know why but this was harder to handle than the BFN from the previous cycle.  Maybe it was because we didn't even get the chance to try. Maybe it was because this was our last frozen and we need to move on to a fresh cycle.

I need to call the doctor Monday to make an appointment to begin the insurance process and see what other testing we need.  I can't believe we are back here. I honestly thought one of these two cycles would work.  Timing would good with work.  They would also allow us to keep our Disney trip next summer.  Now that is back up in the air.  If I'm too pregnant or the baby is too young, we will have to cancel.  Again our quest to expand our family will impact the child we already have.  There is nothing easy about this process no matter where you stand in it.

And we're back in the game

 I know it has been quite a while since I last posted.  Life has gotten quite crazy with work, a new home, and a very active toddler!
   A few Olivia updates before I get to my journey.  She was 2 this past October and is very smart and verbal.  Her favorite thing right now is to ask us if we are her "friends".  It's so adorable.  She asked me the other day if we could go see her "friend Nana".  We have also just converted her crib to a toddler bed because she became Houdini over the weekend.  During her "naptime" on Monday, she escaped 15 times in under 10 minutes.  That must be a record.  I'm waiting to hear back from the Ellen Show and Guiness Book of World Records.  She doesn't stop and I love it all.  Even though I am normally exhausted and incredibly behind on work.  (I should actually be correcting now, but what's another 20 essays or so on the pile).  She is currently obsessed with the show Paw Patrol and takes her puppies most places with her.  She knows all 5 (now 6) puppies by name and tag line.  She's starting to really take to coloring and drawing and plays mostly with her easel she received for Christmas.  She showed some interest in potty training, but then decided that having mommy or daddy change her diapers is a much better choice.  We will readdress this in the summer!
    As for us, we have made our appointment with the RE for March.  Since we are now in a larger house with a yard (that children can actually play in...go figure!), we feel it's time to add to our family.   Since we were diagnosed with unexplained, we have been trying the best we could though our faith that a "miracle" will happen is low.  I'm excited to be moving forward, but I still have all the fears from the first time.  What if this time something major is wrong?  What if  the three IVFs we have left do not work?  What do we do then?  I know I shouldn't be thinking this way, but I can't help it.  I hate that we have to go through this process a 2nd time.  Why can't we get the opps?  What did we do to deserve this?  I know the answer to that is nothing, but it still pops in.  It is during this time period that my logical side stays at work and my emotions take over.
    I honestly feel like we are reliving the time before I got pregnant with Liv.  Yes I'm entirely grateful to have her, but it still feels as though something is missing.  We aren't quite complete yet.  Once again Facebook has become the enemy.  Almost daily, I'm seeing pregnancy announcements from friends that have children around Olivia's age or younger.  They are able to grow their family but we can't.  I honestly didn't think I would feel this way the second time around and feel a little ashamed that I do.  What about those people who don't get to have their "Olivia"?  Shouldn't I be happy with what I have and not want more?  Isn't that the "way" to happiness?  I don't truly know, but I do know that some days the tears can't help but come and my heart can't help but drop at those announcement.  Just the same as before.  The only difference is now I hear a voice interrupting my tears.  "Are you okay, Mommy?  I kiss your booboo better?"
 

Once an infertile, always an infertile

I know I haven't blogged in a while, but since it is National Infertility Awareness Week, I knew it was important that I did. 

I may be lucky enough to have my miracle baby sleeping in bed right now, but the memories and scares of infertility still run deep.  I have to be honest that I frequently fear that we will never be able to give Olivia a sibling.   I wonder if waiting until she gets a little is really a good idea.  What if it doesn't happen naturally?  What if we need to go to IVF and run out of insurance coverage?  Would I be able to handle the stress of an IVF cycle with a toddler?  Don't get me wrong, I love every single minute with her (even when she is screaming because she is so tired but she refuses to sleep); however, I feel a pang when I see a family with two kids or I see the new baby at daycare with her brother.  I know how hard I fought for Olivia and I know I would fight that hard for another, but do I have it in me?

The infertility also attacks when I see or hear of people who have an "oops" or it just happens easily.  I still have numerous friends who are struggling to add to their families, and one has gone through more heartbreak than anyone should have to.  Why are they still trying after all this time and it just happens for others? 

The one good thing about my infertility is that it has brought me some new friends.  When I started to struggle, I couldn't really connect with anyone in my real life, so I looked to online support boards.  From there I started meeting with a group of girls in my area who were also TTC.   All five of us had to have some sort of infertility treatment.   It was this that has helped us to become closer.  No matter how different we are, and we definitely have our differences, this one thing brings us closer more than any of those differences tear us apart.  By being open about my infertility, I have made even more connections.  As with anything else, it is important to talk with someone who knows what you are going through.  Women who have struggled to conceive just seem to have this bond.  We may not even really know each but we support each other in the hard times and celebrate each other in the good times. 

Infertility is something that still is taboo for many to talk about, and many people just don't fully understand how difficult this disease it.  To learn more about infertility, causes, treatments and ways to support those who are struggling with the disease, visit the RESOLVE, the national infertility association, website at http://www.resolve.org/.