Transfer!

The day after the retrieval, the IVF coordinator called to tell me that 8 of the embryos had fertilized.  They didn't know yet whether they would be doing the transfer three days after the retrieval or five.  If the embryos weren't growing well on day 3, they would transfer them that day under the theory that they might do better in the uterus.  If they were growing nicely on day 3, they would wait until day 5 so they would reach the blastocyst stage.  A blastocyst is formed when the cells have divided enough that you have an inner cell mass that will become the embryo and an outer cell mass that will become the placenta.

On day 3, the IVF coordinator called to say that the fertilized eggs were doing great.  Five of them were 8 cells and three of them were four cells.  It was decided to wait until day 5.  This was good news for us, because it's likely they would have put three in if they had decided to move forward on the 3rd day, since the embryos would have a lower likelihood of surviving.  This would have introduced the possibility of having triplets, which would be overwhelming to us. Holding off until day 5 was good news.

The transfer was pretty amazing.  The instructions were to drink about 32 ounces of water starting 90 minutes before the appointment and finishing up 45 minutes before the appointment, and to take a couple Valium with those last few gulps. The Valium is supposed to help you relax before the procedure and I think also assists with cramping. I had been warned that I would be extremely uncomfortable even before the appointment started due to the amount of water I had to drink, but I wasn't. It wasn't until the procedure actually started that I began to feel a bit uncomfortable and it never got to be too terrible.

The appointment started with a medical assistant telling us what to expect, and then the embryologist came in with our embryo reports.  I had been a little concerned that we'd lose all of them between day 3 and day 5 (that's the risk of waiting), but the embyrologist told us that we had two fantastic embryos ready to go.  One was graded 5AA and the other was graded 3AA.  The number indicated the degree of expansion of the blastocyst (1 being the least expanded, six being the most expanded).  The letters indicated the quality of the inner cell mass (the part that would become the embryo) and the outer mass (the part that would become the placenta).  A is the highest rating.  AA is the best rating, and both of our embryos got it!

The embryologist also told us that two of our fertilized eggs didn't make it and that they were watching the remaining four to see if they would grow enough to be frozen.  Everyone wants to be able to freeze extra embryos as it's a lot less expensive to do a frozen embryo transfer than it is to go through the whole egg retrieval process again.

After telling us about our embryos, the embryologist gave us a picture of the two they would be transferring.  And here it is:

As you can see, one of the embryos is larger than the other - that one is the 5AA. The other is the 3AA. The embryologist assured us that the size doesn't really mean anything at all in terms of success rates.  I read online that boys tend to develop more quickly, so I'm kind of hoping that this means we transferred one girl and one boy.  This, of course, is based on absolutely no scientific knowledge.  They could both be boys or both be girls.  IVF seems to tend to produce more boys than girls, from what I've found online.

The doctor came in and I got to have a normal, stomach-centered ultrasound (instead of the other kind) but then she inserted a speculum, so.  You know. Maybe not so comfortable, but not bad at all really.  Straight in front of us on the wall was a flat screen t.v.  The embryologist had moved to the lab, in the room directly next door and she had control of the t.v.  She first flashed a shot of the container holding the embryos that had my last name and my birthdate typed on it.  After that, she gave us a live video feed of the actual embryos.  Okay, I admit it, I was all "AWWW!  Look how CUTE!"

Just a few seconds later the best part happened.  The embryologist was pulling the embryos out of their liquid with a catheter.  I didn't notice the catheter at all, but all of a sudden both little embryos just seemed to scurry off to the left of the screen, one after the other.  It was the sweetest little thing.  A moment later the lab door opened and the embryologist brought the catheter in to the doctor.  The doctor inserted the catheter and used the ultrasound to pick the best spot to place the embryos in the uterus.  I couldn't really see the screen much at that point, but after she finished I could see where she had marked where each embryo had landed.  Everyone said that it couldn't have gone more smoothly and we were feeling pretty optimistic.

After getting all of the medical stuff removed, Mark and I stayed in the room with me lying down for fifteen minutes and then I ran out to use the bathroom (remember those 32 ounces of water? pretty darn uncomfortable at this point).

Instructions were to go home and stay mostly in bed for the remainder of Sunday and all of Monday.  I've been on the couch for most of the time (which explains my sudden batch of posts!)  Everyone seemed to think I'd be worried that the embryos would fall out, but I'm not worried at all about that.  I'm worried that I'll move around too much and they won't be able to latch on.  Kind of like being on a rolling sailboat in a storm - you just start thinking you're going to be able to grab something to hang onto and the waves roll you away again.  I hope that's not what it's like for the embryos.  I'm also already feeling like I need to hold my stomach when I walk around, which I admit is completely and totally ridiculous, but it's this weird impulse I've got.

Last night I added two little Vivelle patches, which are estrogen patches to my medications.  I put them on Sunday and Wednesday nights, on my stomach.  With all of these hormones, every time I have a stressful moment I end up stopping and wondering if it's the hormones.  So far I'm fairly even keel though.

They called today and let us know  that three of the remaining embryos made it to blastocyst stage and are being frozen.  I didn't think to ask about their grades, but it doesn't really matter to me just yet.  We'll get our results on October 6th.  Until then, progesterone shots and estrogen patches plus a whole lot of positive thoughts.

It has occurred to me that if this works, it does have one major advantage over natural childbirth.  I get to see the baby (babies?) from the very beginning.  I got to see the moment they arrived in my uterus, and I have a picture of them.  It's not enough to make me want this to happen (for anyone!), but it is a tiny silver lining.

Egg Retrieval

The instructions prior to the egg retrieval were to avoid eating or drinking after midnight the night before the retrieval, and wear comfortable clothes with warm socks.

Mark did his part at 7:00 am, and then my appointment was at 8:00.  After a short wait, they took me into a room and had me change into one of those nice little hospital gowns.  Then they brought me a warm blanket to keep me cozy until the procedure.  When it was time, they had me move to a different room where the procedure would take place.

There was a bed all set up for me and after I settled in, they gave me a shot in my hand to numb it up before the IV. The initial medication in the IV made me feel a little weird, but then after everyone had entered the room they started the full-on anesthesia. The anesthesia felt like pressure going down my arm. I noticed that all of a sudden all of the medical staff were standing over me, watching me, and I realized that they were watching to see me pass out. It's kind of strange to have four people standing over you waiting for you to be unconscious.

After I woke up, they told me that they had retrieved 11 eggs.  That was a lot better than I thought they were going to do because I thought we only had 7 mature follicles.  Four more must have caught up between Sunday and Tuesday.

I recovered extremely quickly from the anesthesia.  I didn't feel sick, and I was completely alert.  My friend who had come to give me a ride home went out to lunch with me and then I took a nap for the afternoon.

On Thursday I started progesterone injections.  Okay, up until this point, everything had gone extremely smoothly and the shots were no big deal.  The progesterone injections are completely different for me.  I'm not sure why they're so bad for me, but they result in a spot about the size of a fist in my muscle being sore for the day of and the day after the shot.  I tried numbing the area with ice, but that seemed to make it worse.  Then I tried using Emla cream (applied an hour before the shot) and heating the area for 30 minutes before and ten minutes after.  That worked pretty well the first two days, but we did that today and I think the Emla cream didn't work this time because I felt everything.  The gauge on the needle is pretty large, it's a long needle, and it goes into the muscle.  I don't like feeling all of that!  I think these shots keep going until at least the pregnancy test, potentially longer.  Ugh.

Next up - Transfer!

The last week - Ultrasounds Galore

Okay, so to pick up from where we left off, the next step in the process was to go in for an ultrasound to see how the medications are working out.  The first ultrasound was on the 14th, and it was done the same way as the SIS ultrasound.  Dr. Sparrow turned the monitor so I could see what he was doing, and he pointed out where the ovaries were and how many follicles were growing in there.  It was looking pretty good - we had seven follicles on the left side and five on the right.  Dr. Sparrow took measurements of each follicle with the computer by clicking on the top, bottom, left, and right edges.  You can see the measurements on the screen while they're being taken, and you're looking for the average of the two diameters to grow to be around 18mm per follicle (this is not likely to happen early on!!)  I didn't pay much attention to their size at this appointment because I didn't know what size we were trying to get to yet.

The same day as the ultrasound, they took blood to check my estrogen level.  It came out at 125 and everyone seemed happy with that.  Dr. Sparrow was guessing that we'd be doing the retrieval on Tuesday, the 21st. I went home and kept giving myself shots.  I don't remember the exact date that I started the Ganirelix shot, but it was around this time, and that meant that I was now doing two shots in the morning and two shots in the evening.  This still wasn't bad at all.

Two days later, on the 16th, we repeated the whole process, only a resident was there to work with Dr. Sparrow.  It was kind of funny, because she was supposed to be trying to find the follicles on the left side after he had found the ones on the right, but she was just really struggling with it.  After letting her try for several minutes, Dr. Sparrow took over and two seconds later, my follicles were on the screen.  I felt kind of bad for the poor resident!  This time, Dr. Sparrow sounded a little bit less enthused about my follicles.  He changed his prediction to doing the egg retrieval on Tuesday or Wednesday. I didn't say much when he said that, but I was a little worried because that meant that I needed to figure out coverage at work for both Tuesday and Wednesday in case it did get delayed.  My co-worker has been absolutely amazing about covering, but it's still stressful to be gone.  I've only called in sick once in four years, so taking time off for medical stuff is not something that I'm very comfortable doing.

Thankfully, my next ultrasound was scheduled on Saturday. This time Dr. Sparrow was out for the weekend, so Dr. Sheep did the ultrasound.  She was great.  She also wasn't sure whether I'd go on Tuesday or Wednesday, and scheduled me for yet another ultrasound the next morning.

Sunday morning, looking at the ultrasound screen again.  This time, everyone was happy!  We had seven mature follicles ready to go and Dr. Sheep told me to do the "trigger shot" that night.  The trigger shot is a shot of HCG (human chorionic gonadotrophin) that "triggers" ovulation so we can do the egg retrieval.  It was an intramuscular injection, which meant a big long needle, so I made Mark do it for me.  I also freaked out like a little kid (maybe something about not being in control?) and squealed while kind of laughing through the whole thing.  I always laugh when I'm kind of panicking over some medical treatment, it's a weird trait of mine.

The day after we did the trigger shot, I had a break from all shots for a day (yay!)  Then it was time for the egg retrieval.  And that deserves its own separate post.

And we're back...

As promised, we took a break and started everything up again in August.  Here's what has happened (other than buying a house, moving, and getting a new puppy):

After my July cycle, I went in to the clinic for an SIS ultrasound and went on the pill for the first time in about eight years.  The SIS (saline infusion sonohystogram) went a lot easier than I had read online it would.  I took a few advil before going in, and they injected me with some saline so they could take a look at my uterus.  It's a little strange when a woman you don't know is exclaiming, "You have a GORGEOUS uterus!" but I guess that was a good result!  The whole procedure went so quickly I didn't even have to pay for parking - I was out before the 30 minute grace period ran out.  I went straight back to work and all was well.

In terms of the pill, I was surprised to find that the only side-effect I had were really sad dreams at night.  For a couple of weeks there I was regularly waking up in tears due to the dreams.  Daytimes were great though - no side-effects at all.

I went through one packet of pills and then took them for three more days on a new pack (I skipped the placebos).  After that, we went to the clinic for what's called a suppression check.  They do an ultrasound to see how everything looks before you get started on your meds.  I'll try not to be graphic about this, but in the interest of giving people who are going to go through this accurate information, the ultrasound is not like an ultrasound checking on a pregnant woman's baby.  It does not involve your stomach.  It involves a big wand, a condom, and some gel.  That's probably enough said, except that it doesn't hurt.  My ovaries looked fine, so they gave me the go-ahead to start taking the medications at home.

Okay, medications.  I had heard that it was financially best to go to a variety of different places to get your medications (maybe one medication is cheaper at pharmacy A, another medication priced well at pharmacy B).  When I talked to Dr. Sparrow about that, he said that the team was in touch with all of that information and would set everything up for me.  That was mostly true.  The IVF coordinator did set up all the prescriptions and arranged for them all to be sent to me, but they all came from one place and in one big box. So I don't know whether I got the best price or not and I learned that I should have been more specific about it.  Anyway, someone had to be home to accept the shipment because a lot of the medication needs to be refrigerated.  NOTE:  not all of the medication needs to be refrigerated!!  Mark was the one who accepted the package and he just took the whole box and put it in the refrigerator.   I assumed that he had gone through the box and didn't pay much attention to it.  We ended up losing $300 worth of medication because it was NOT supposed to be refrigerated.  So, our loss could help you - check the boxes of the medications for storage instructions and don't assume it all gets refrigerated!

Something that some of you (all of you?) know is that Mark is a doctor.  At first I thought that I would just have him administer the shots for me, but when it came right down to it, I wanted to do it myself.  I started off on two medications - Follistim and low-dose HCG.

The Follistim comes in its own special kit.  It has a pen applicator and cartridges you drop in instead of a normal syringe-type needle.  There's a dial at one end of the pen that you turn to indicate the correct amount of medications (225 for me).  Then you swab the other end with an alcohol wipe, screw on a needle to that end, and pick a spot for the shot.  It just has to be a fatty area.  The first time I did it, I sat there with the needle poised, pointed at a spot I was pinching on my stomach for at least three full minutes.  Finally, I closed my eyes and pushed the needle in.  That part actually wasn't bad at all.  After it was in, I peeked at it to make sure it was in, and then pushed on the other end of the pen so the dialed-in part would push down and dispense the medication.  It clicks while it's going down.  Even that part didn't really hurt.  A minute or two afterward, though, I got a bit of a dull ache that lasted for about a half an hour or so. The Follistim needs to be refrigerated until you start a cartridge - as soon as you've started one, you can leave it out until you've finished it.  For me, each cartridge provided just under 3 doses.

The low-dose HCG is only taken in the evenings.  It's a more traditional set-up, with a little vial of medication and insulin syringes.  You poke a syringe into the vial, draw out 20cc's, then pick a spot and give yourself the shot.  For some reason, the liquid from the HCG hurts more than the Follistim.  The medication stays in the refrigerator, but I let it warm up for a while before administering it in the evenings.  I put it back in the refrigerator aftewards.

I do have a lot of bruises from the shots.  They range from the size of a quarter to the size of a pinhead.  They don't hurt and I don't notice them.  I also have had absolutely no other side-effects.  I'm not emotional, nothing hurts.

I have to take my puppy out now, but more later about the last few days of the process so far.