Frozen

We got the call yesterday afternoon about our embryo cryopreservation - and 10 of them made it to freeze! That may not seem like a lot considering that we started out with 48, but since we had so many we were able to let them grow in the lab for 5 days. By watching them for that extra time, the embryologists are better able to determine which ones are likely to be viable after freezing and thawing. The ones that are defective stop growing and the ones that aren't keep on dividing. The culture medium they use only allows this to work for around 5-6 days and after that it can't support their growth anymore - otherwise they might go for a lot longer to get even better information. It's rare to have this many still growing, so we're thrilled...thrilled, and a little bit undecided about what we're going to do with all of them. But we're taking it one step (baby!) at a time, and if we get to the point where it's clear that we're not going to use some of them, we'll make that decision when the time comes.


Since yesterday I feel like the OHSS is coming back, which is weird but it might just be in my head (or maybe bloating from the PIO shots?) I also feel like I'm coming down with a cold (Eric already has a bad one so it's like a ticking time bomb for me and Sawyer) BUT I'm very excited about my sister Erin's wedding this weekend! My Utah family is here and it will be so fun to spend time with all of them while we watch Erin and Josh wed. The perfect joyful distraction!

Transfer

I can't believe this cycle is almost over. It's gone so smoothly and has been so much easier than I remember it being the first time. During Sawyer's cycle I remember thinking that if it didn't work, I wasn't sure I could do it again. This time I feel like I could - although obviously we hope we don't need to.

Wednesday was transfer day, 1:15 pm. We didn't get put on the schedule until Tuesday afternoon, so this caused some scrambling as Eric dealt with his work schedule and I tried to find someone to get Sawyer off of the bus (again.) After not having any luck and considering me just going by myself, it dawned on us that since I could drive (no anesthesia this time) we could drive there separately and Eric could leave early if he needed to. Wednesday we spent a nice quiet morning all at home together, then put Sawyer on the bus and headed to Rockville for hopefully the last time in a long time. I stopped to grab some lunch on the way and to get something to drink since I forgot the bottle of Gatorade I had planned to bring. For embryo transfer they use an abdominal ultrasound, so you need to have a moderately full bladder when you arrive. Chick-fil-A and a big lemonade to the rescue!

We arrived at the Rockville center right on time (which I'm pretty sure is a first) and checked in. After just a few minutes in the waiting room a nurse called us back and showed up to the transfer room where we waited for the doctor. And waited. And waited. I don't know why the take you out of the waiting room if you still have a lot of waiting to do, but it was OK. After about half an hour we finally met Dr. Widra. After shaking our hands he told me "You've caused quite a stir around here!" because of my awesome ovaries. Not the number one thing I'd choose to be famous for, but I'll take it. Next we went over our consents for transfer. I had already spoken to Dr. K on the phone that morning and let him know that we had decided to transfer two embryos, even though he was recommending an e-SET.  Dr. W didn't give us too much pushback (and actually neither did Dr. K) which I appreciated. We signed the forms and checked the box for cryopreservation of any embryos we have left over, which hopefully will be several. An embryologist also came in and had us sign some stuff and checked once again that my ID bracelet matched the embryos. After everything was signed and checked they left us alone once again so I could undress and get set up on the procedure bed.

After another wait, Dr W came back with a nurse and we got started. The procedure is pretty simple and not painful at all, although I would say it's somewhat uncomfortable because of the needing-to-pee factor. First the doctor put in a speculum, just like for a pap smear. He cleaned the cervical area, and then the nurse used the ultrasound to visualize the uterus while he inserted a small catheter through the cervix (the nurse commented on how great my ovaries looked - they are already back to almost normal size, which is crazy considering how many eggs I had retrieved just a few days before. Yay, my ovaries! And yay Lupron trigger!) Dr. W told the embryologist we were ready for the embryos, which were in a lab right next door to the procedure room. While she went to get them a live picture of them appeared on a flat-screen TV on the wall, so that we could verify that the name and social security number on their petri dish were correct. Here's the picture. I think they're cute.

A few minutes later she came back in with our embryos loaded into another soft catheter. She said "two for Watts" and the Dr. repeated "two for Watts" - to confirm once again that they were the correct embryos and that we knew how many were going in. The Dr. threaded the catheter holding the embryos through the one that was already in me, and when it was at the top of the uterus he told the embryologist to empty the catheter. After she did, they waited a minute before removing the soft catheter (the nurse timed it exactly) and kept everything else in while she went back to the lab to look at the catheter under a microscope to make sure that both embryos had been transferred. Which is a step I fully support, because it turned out that one of them hadn't been! It was still inside the catheter. So we got to do the transfer all over again, this time with the instructions "one for Watts." Dr. W answered "one for Watts, which is almost certainly female." He assured us that this happens a lot, and that it doesn't hurt our chances of success at all. A minute later, the embryologist took the catheter back and confirmed that this time nothing was left inside. Transfer was done!

At this point Eric had to leave in order to get home in time for Sawyer, so it worked out perfectly. They had me stay lying down on the bed for 5 minutes, but that turned into 15 because the discharge nurse was running behind. It was fine because unlike with our FET, I didn't have to go to the bathroom that badly. When the nurse came in she went over my instructions for the next few days: 24 hours of bed rest, getting up only to go to the bathroom or get a snack, followed by 3 days of "light activity" which they define as no strenuous exercise, no lifting heavy things, no sex, and just generally taking it easy as much as possible. She asked me how many eggs I had retrieved and when I said "65" she stared at me blankly and I could tell she was thinking "This girl has no idea what she's talking about." I said "I know, it's a lot" and she said "Wait a minute, I heard about you! I can't believe you're not in severe pain!" I told her I felt better this time than I did when we retrieved 20 eggs, which is totally crazy but true (I chalk it up to the HCG trigger I had the first time.) She warned me that if I do get pregnant it's likely that the OHSS will return, which I hope doesn't happen (it didn't with Sawyer.) We went over my medications and realized I wasn't supposed to be taking both endometrin and PIO (one of the other nurses post=ER had told me I was) so she put in a call to Dr. K to make sure, and sure enough I'm only supposed to be on PIO.

Finally I was able to get dressed, go use the bathroom and check out. I crashed on the couch as soon as I got home because I hadn't slept much the night before out of nervousness. It feels so good to be done! And I have to admit I enjoyed the bed rest - although 24 hours was plenty, I was getting kind of bored at the end. We should hear back soon about our remaining embryos and how many get vitrified. My beta test is October 4. And now all we can do is wait!

Fertilization Report

Out of 68 eggs, 54 were mature and fertilized via ICSI.

On day 1, 48 embryos were dividing!!!

Of course we are thrilled about having such astronomically high numbers because it basically means this should be our last fresh cycle ever, and we might end up being able to have a larger family than we had anticipated. The nurse who called me said "You have definitely set an all-time record."

The ONLY down side is that with such a high number of eggs, I'm at a very high risk of developing severe OHSS. I already have a mild case, but if it doesn't get worse we should be able to proceed with a day 5 transfer. The nurse who called gave me some instructions for alleviating OHSS (chugging Gatorade all day long and eating plenty of protein) and symptoms to watch out for (trouble breathing, not urinating, severe abdominal pain, vomiting.) Because I didn't have an HCG trigger or an HCG booster, they're hoping I can avoid the severe version.

I'm not feeling so hot today, seriously bloated, still taking Vicodin and spending lots of time on the couch. Hopefully over the next few days I'll get progressively better.

Retrieval

Retrieval is DONE! The hardest part (for me) of an IVF cycle...well, except for waiting for those first beta results.

We arrived at the Rockville center at 11:00 on Friday. Actually around 11:10 since the GPS took us on an unexpected detour and I was so nervous I wasn't paying attention to where Eric was going. I was really glad I had been to the center before because it could have been much worse! Also the place is really intimidating, it's a huge office complex and the whole thing belongs to our practice. The whole 4th floor is the surgery center. When we arrived they checked me in and sent us to a waiting room where 3 other couples were already waiting. After a few minutes they called us back, only to find out that the bed they thought was open was not ready yet, so we waited in another waiting room for a few more minutes. Finally they took me to my bed, which was in a large open-plan hospital-like room divided by curtains. Which I know is very practical, but unfortunately does not provide very much privacy and the patient next to me was just coming out of the anesthesia and not having a very good time. She was moaning, crying, and threw up a couple of times. I felt so bad for her, and also on a self-centered note it was not the most fun thing to listen to as I was waiting for my surgery to start. I did see her as she left a while later and she seemed better at that point.

I changed into the hospital gown, booties and hat, and the nurse who would be taking care of me came in and asked me all the pre-op questions: Are you on any medications? (It would be quicker to ask me what medications I'm NOT on) Did you remember not to eat or drink? Any allergies? Did you take your antibiotic last night? And then someone came in to take Eric to another room for collection. I didn't see him again, which was kind of distressing to me since I thought I'd get another chance to kiss him goodbye before surgery, but it all worked out OK. Soon the anesthesiologist came in and asked me all the same questions the nurse had asked, and started my IV line. That can be kind of a stressful process with my tiny veins, but he did a great job and gave me some numbing medicine first so I barely even felt it.

I waited for what felt like forever on my own, getting progressively colder and colder from the saline drip they were giving me with only a thin blanket. I didn't know what time it was because unfortunately Eric had taken my purse with him and I didn't have my phone or the book I had brought to pass the time. I tried to do some deep breathing and meditate but it didn't work so well.

Finally Dr. Wolff, the doctor who would be performing my procedure came in and introduced herself and told me it wouldn't be too much longer. They had me get up and walk my IV pole to the bathroom to empty my bladder, and then the anesthesiologist came to walk me into the OR. They had me get up onto the table and put my legs into the stirrup thingies and the anesthesiologist gave me something in my IV that immediately made me feel drowsy and warm. I remember seeing the wall of medical supplies and one container in particular that was labeled "Hysteroscopy: Big Boy" and thinking I'm glad they didn't use the Big Boy on me during my hysteroscopy! (Bad fertility treatment humor, always helps in stressful times.) I don't remember lying down, although I must have at some point because the next thing I knew I was waking up back in the curtained room where I had started.

The retrieval itself is a quick process that takes about 20 minutes. The doctor uses a transvaginal ultrasound transducer just like the ones I get at all my monitoring appointments, but this one has a long needle attached to the top. They visualize the ovary on ultrasound and guide the needle through the vaginal wall, through the abdominal cavity, and into the follicles on each ovary. The fluid from the follicles is aspirated into a test tube, and that's where all the eggs are. After aspiration they look under a microscope to see how many eggs they got. For the non-squeamish, here's a drawing to help you visualize: http://amarkedman.com/2011/08/31/day-314-part-1/egg-retrieval/ For obvious reasons, I was very very happy to be asleep through the whole procedure.

They called Eric back as I was waking up and asked me how I was feeling and the answer was - ouch. Very much ouch. The nurse gave me some fentanyl through my IV and a heating pad for my belly and almost immediately I felt better, although I still had some pain. A few minutes later she came back and said that I looked much better already. Soon our egg report was ready and they told us how many they got. I'm glad I was already sitting (lying) down, because the answer was....68 eggs. 68!!!! The nurse said she thinks it's a record. We were totally shocked, because at last count I thought I had around 40 follicles, and not every follicle has an egg, so we were hoping for somewhere around 30. Plus, with our first IVF I felt much worse physically than I did this time, and only had 20 eggs. I never in a million years expected to get this many!

After the shock had worn off a bit, about 20 minutes later they had me get up and see if I could walk with support, and I could, so it was time to change and go home. Eric took me out to the car while he picked up my prescriptions in the pharmacy (in the same building, the place is a fertility mecca) for Vicodin (hallelujah) and my progesterone in oil shots (not nearly as fun.) At this point it was 2:45 and I hadn't eaten all day, and Eric hadn't had lunch, so we made a quick stop to pick up some food and then went home. My amazing friend Ti had gotten Sawyer off the bus and was watching him, and then another friend came by to bring us dinner for that evening and a bouquet of roses. There was some drama with one of the neighbors when Sawyer got off the bus (long story) but I was pretty out of it so I couldn't care that much. I crashed on the couch for the rest of the evening watching season 7 of The Office on Blu-ray and trying not to laugh too hard because it hurt way too much.

Retrieval=DONE and a huge success! Better than we ever imagined. Thank you so much for all of your prayers and well wishes. Next step: recovery, fertilization report, and transfer!

Ready for Retrieval

There it is - the big needle that gave me 0.4 of Lupron, and that thankfully I didn't have to jab into myself. I was supposed to trigger at 12:30 a.m., and Eric walked in the door from Dallas at 12:28! Just in the nick of time. The shot itself wasn't bad. And this morning my bloodwork confirmed that the trigger worked and my LH is nice and high.

LH-96.9 (they want it over 15)
P4-8.07, I'll be starting PIO tomorrow to get that number up before embryo transfer.

Tomorrow my surgery is at 12:30. We have to be at the main center at 11:00 with photo IDs and no perfume. Tonight I'll take Azithromycin and NO Lovenox. They didn't tell me about the Lovenox at first, but I randomly thought "Hmm, maybe I should ask about that" at my appointment today and the nurse told me not to take it tonight or tomorrow or we wouldn't be able to do the retrieval. Good thing I asked!

So that means...no needles today. All day. (Well, other than the blood draw this morning.) I almost forgot what it's like not to have all those shots. Turns out it's pretty nice.

Triggering

Apparently my ovaries didn't get the message that I always do the least amount of work possible, because they are being little overachievers again. You know something's happening when the nurse looks at the ultrasound screen and says "Holy crap!" Dr. K was quick to reassure me that this is a good thing, much better than the alternative of not being responsive enough. At this morning's appointment we were still on track for triggering Thursday and retrieving Saturday. But then my E2 level came back at 5347 - a big jump from yesterday. So I'm triggering tonight with a nice big Lupron shot, and retrieval will be Friday at 12:30. We're scrambling a bit with our schedules (mostly figuring out how to get Sawyer on and off the bus) but it will all work out.

The one down side - because of the high risk of OHSS I can't have the shot of HCG they usually do after retrieval for luteal support, so instead of progesterone suppositories I have to do progesterone-in-oil shots. Nooooooooo!!! I was really hoping to avoid those this time, but the nurse said if I get a positive pregnancy test we will probably be able to switch to the suppositories at that point, so I'll hold on to that hope.

I'm supposed to trigger at 12:30 a.m., which is WAY past my bedtime these days so I'm going to have to set an alarm to make sure I don't sleep through it. Eric is coming home from a business trip tonight but it's likely that he won't be back in time to do the shot for me, so I'm probably going to have to do it myself. I'm good with the little sub-q needles, but the intramuscular ones are a whole different story. Wish me steady hands and nerves of steel.

Monitoring

Notes on today's monitoring appointment:

-I still have lots of follicles, so many that Dr. K didn't count (but he did exclaim "Wow, that's amazing!") and the largest ones are in the 15-16 mm range, which is good. When they get to 18 mm it's time to trigger, so we're right on track for Thursday or possibly Friday.

-E2 - 2896. Another too-big rise, so we're reducing my Follistim to 37.5.

-The nurse had to poke me twice drawing my blood today, and on Sunday at Rockville they had to do it three times. She commented that I must feel like a pincushion. Which made me want to count how many needle sticks I've had all together. Are you ready? Since starting this cycle, I have been poked by a needle 55 times. And I have at least 24 more to go.

Diagnosis

Along with all our infertility drama this summer, we also have been in the process of trying to get a diagnosis for Sawyer. He's been under the Developmental Delay label, but now that he's 6 that label is no longer appropriate according to school system. We've been taking him to a developmental pediatrician but those visits haven't led to any useful information, which has been frustrating given that we have to wait 4-5 months for each appointment. A parent of a child in Sawyer's ECSE class last year mentioned to me that their son had been diagnosed by a local psychologist, Dr. W, so we made an appointment with her. The assessment took place over two days, with a total of 9 hours of testing. I couldn't imagine Sawyer sitting through 9 hours of anything, but Dr. W and her assistant did an amazing job of keeping it fun and light and after the first day he was excited to go back! After the testing it took her a few weeks to write up her reports and recommendations. Soon after this we learned that Sawyer needed to be reevaluated by the special ed team at his new school, so we scheduled all of those assessments too. (The testing with the school psychologist was especially memorable, because the earthquake happened right in the middle of it and we had to evacuate the school! Sawyer was unfazed.) Finally about a month later the results were all in.

The diagnosis: developmental mixed receptive-expressive language disorder and phonological disorder. Basically, this means his brain does not process language in a normal way, so he has a hard time both understanding and producing language. He does not have autism or ADHD, and he is not intellectually disabled - although he scored in the ID range on some of the testing measures, the team believes it's because his learning disabilities are so pervasive. According to Dr. W he has a lot of potential for improvement and growth.

So that's where we are. Even though it's a formidable diagnosis, I feel relieved that we finally have some answers. A name for his difficulties. And there's a lot that we can do to help him understand more and say more, especially in the next few years. At the eligibility meeting all of his teachers expressed what a good kid he is and how hard he tries. One of them pointed out that for Sawyer, daily life is like living in a foreign country where no one speaks your language. It's such a struggle for him, and he still manages to be happy and sweet 99% of the time, which is pretty amazing to me.

The next step is coming up with a new IEP (individualized education program) for him and the school will decide which services he qualifies for. We're hoping at a minimum to get speech, occupational therapy, and possibly extra time in a special ed class at least a few times a week.

Progress

Because of my high estradiol levels and large follicle count I've been going in every morning for monitoring. Our local office isn't open on weekends, so I have to go to one of three that are, and the closest ones happen to be about 45 minutes away. Getting up before 7 a.m. on both Saturday and Sunday to drive 45 minutes = not my happiest time. But things are progressing very nicely. As of this morning I had 40+ follicles, the largest one being 13.5 mm. They are growing steadily and pretty uniformly, which is good. The idea is to have as many eggs as possible mature at the same rate, so that on egg retrieval day they'll be ready to be fertilized. In theory, 40 follicles means 40 eggs, but normally some of them will be immature, and sometimes the doctor can't successfully extract all of the ones that are there.

I was worried about things moving too quickly because E has to go out of town this week from Tuesday night to Wednesday night. Unlike a frozen embryo transfer, it's crucial that he be around for the egg retrieval because 1) I need someone to drive me there and back since I'll be under IV sedation, and 2) we actually need his genetic material this time. So I was relieved when Dr. K said he doesn't think we'll need to change the schedule. Even though my estradiol is high, the rate of increase has slowed down and my follicle growth is right on track. Yay, my follicles!

Saturday: E2 was 898
Sunday: E2 1500+ (started Ganirelix in the pm)
Today: E2 2092

Meds dosage: Follistim 75, Menopur 75, Ganirelix 250, Lovenox 40 (4 injections a day - this is the real deal now!)

Documenting

I'm going to make an effort this time to document all the details of this IVF cycle, since I didn't do that last time and now I wish I had. Turns out that after seven years, I can't remember what my E2 levels were after 3 days of stims! Shocking, I know. And did you know that doctors don't have to keep your records for longer than 7 years? They can just throw them away - our last fertility clinic did just that. So I apologize in advance for the minutiae ahead...but hey, maybe someone else going through the same thing will find it helpful.

Today is day 4 of stims, and I had my first monitoring appointment this morning (7 a.m., ugh, but at least it was only 10 minutes away!) At monitoring appointments they do an ultrasound and bloodwork. The u/s looked good - my lining was at 8.6, and I had 12 follicles on my right ovary and more than 10 on my left, all under 10mm.

I got the call this afternoon (while I was at the movies seeing "The Help" - I figure since I might get pregnant soon my days of having time to myself might be numbered, so I better live it up now - thinking positive!) and found out that my E2 (estrogen in the blood) is way too high for this early in the cycle, 737. This means that I'm in danger of OHSS, and possibly cancelling the cycle if things don't slow down. So we're reducing the Follistim to 75 tonight and I have to go back in tomorrow morning instead of waiting until Sunday for more monitoring.

Kitchen Pharmacy

Drum roll please! Here it is - my big box of meds. You're seeing:

-3 cc syringes and 33g needles
-Follistim pen with cartridge inside
-Extra Follistim cartridges
-Menopur
-Enoxoparin (AKA Lovenox)
-Ganerelix
-In the pill bottles:
    -Lupron, which will be my trigger before egg retrieval
    -Azithromycin, antibiotic to take before ER
    -Estradiol, for after embryo transfer
    -Bromocriptine, Metformin and FABB, all of which I've been taking since April for my PCOS and MTHFR

(and I just realized I forgot to include my Levothyroxine and Endometrin. So imagine those are there too.)

I started stims (Follistim 150 and Menopur 75) on Tuesday, which makes today day 3. So far so good, although I have to admit the preparation of all the shots is pretty intimidating. The first time I did it I sat on the couch with my laptop in front of me and watched the demonstration videos from Village while I did the mixing and prepping and dialing and finally injecting. I think I have it down now. Kind of.

Next step: monitoring appointment early tomorrow morning so we can see if anything's actually happening in there!

Labcorp Lady

To the receptionist at Labcorp:

It is never OK to ask someone if she's pregnant. Even if the lab order calls for tests that are normally done on pregnant women. They're done on infertiles too. It's also not OK to ask if I have any existing kids, and then to exclaim about how far apart my kids will be if I have another one. I am aware of my reproductive timeline.

Thank you,

No, Really, Not Pregnant Me

Meant to Be

Embryo transfer, with 24 hours of bedrest after: September 22. 
Season premieres of The Office, Parks and Rec, and Community: September 22. 

Coincidence???

Here We Go...

(And yep, unfortunately I now have this in my head. What can I say, I came of age in the nineties.)




Yesterday we checked off a lot of boxes to get ready for this cycle:

-mock embryo transfer (me)  ✓
-saline sonogram (me)  ✓
-infectious disease panel bloodwork (Eric)  ✓
-CBC, blood type, etc (me, because our old fertility center threw my records away)  ✓
-consent forms signed  ✓
-genetic testing waiver signed  ✓
-meds delivered  ✓

The mock ET went well, and everything looked good on the sonogram. I take my last BCP tomorrow (thank goodness, I have been so nauseous on them!) and on Saturday I have my baseline sonogram and bloodwork. If everything looks ready at that point (ovaries "quiet") I'm scheduled to start stims on Tuesday the 6th.

The meds I'm on are different than last time - different protocol, different brand names, but also I don't think I'll be able to mix them down into one injection. I'm using the Follistim pen (can't mix anything else into that), prefilled Ganerelix syringes (ditto, I think), and Menopur. Add to that the Lovenox I'm already taking (also prefilled syringes) and I'm going to be doing 4 injections a day for a while. And having blood drawn every other day/every day. I'm going to run out of spots pretty quickly. IVF friends, any suggestions??