A Pregnancy in Pictures

Two blastocysts, ready for transfer. 11/28/2011 - 2 weeks 5 days

A beautiful sight! 12/3/2011 - 3 weeks 3 days

One little embryo. 12/16/2011 - 5 weeks 2 days

                ER trip for stomach pain, suspected ectopic pregnancy. All was OK and we saw the heartbeat! 12/23/2011- 6 weeks 2 days

Christmas Eve dinner on our Disney cruise. 12/24/2011- 6 weeks 3 days

Already looking like a baby! 1/3/12 - 7 weeks 6 days

Last sonogram at Shady Grove, 1/11/12 - 9 weeks 0 days

Ryan Adams concert at Strathmore, 1/24/12 - 10 weeks 6 days

Gender prediction test said girl - not quite! 2/3/12 - 12 weeks 2 days

2/6/12 - 12 weeks 5 days

Palio for Valentine's Day.  2/14/12 - 13 weeks 6 days.

In maternity clothes! 3/6/12 -16 weeks 6 days

3/6/12 - 16 weeks 6 days

Sweet little foot. 4/2/12 - 20 weeks 5 days

5/1/12 - 24 weeks 6 days

New York with my sisters. 5/5/12 - 25 weeks 3 days

Goodbye old house. 5/19/12 - 27 weeks 3 days

Hello new house! 5/19/12 - 27 weeks 3 days

Touching his foot to his head. 5/29/12 - 28 weeks 6 days

6/5/12 - 29 weeks 6 days

6/15/12 - 31 weeks 2 days

6/26/12 - 32 weeks 6 days

7/5/12 - 34 weeks 1 day

7/5/12 - 34 weeks 1 day

2 days before being born. Est weight 8 lb 6 oz 7/24/12 - 36 weeks 6 days

Little did I know this was my last day being pregnant! 7/25/12 - 37 weeks 0 days

7/26/12, 2:23 pm, 7 lb 15 oz, 21.5 inches - 37 weeks 1 day

Henry's Birth Story

He's here! Henry Spencer Watts made his entrance into the world on July 26 at 2:23 pm, weighing 7 lbs 15 oz and 21.5 inches long.

Since I was only 37 weeks along I was not expecting to go into labor so soon. I hadn't preregistered at the hospital and I hadn't packed my hospital bag or Sawyer's overnight suitcase - I was planning to do that the next day. I hadn't even made it all the way through my Hypnobirthing course. I had never been checked by my OB so I had no idea if I was dilated or effaced or anything. I never got really uncomfortable this time the way I did when I was pregnant with Sawyer, in fact I had just mentioned to my sister the day before that I felt so good that I wouldn't mind being pregnant for several more weeks. So of course I went into labor. 

Around 4:45 a.m. I got up to use the bathroom (my third visit that night - thank you third trimester!) and after I had emptied my bladder something kept coming out of me. I knew right away that my water had broken because the exact same thing had happened with Sawyer, only at 3 a.m. instead. I woke Eric up and told him it was time to go, then called my OB who told me to head on over to labor and delivery. I wasn't having any contractions yet (again, the same as when I had Sawyer) so we didn't rush. I took a shower and packed my bags - not the easiest feat when your water's broken and it's early in the morning - while Eric got Sawyer ready to go.  He was a bit disoriented about being woken up so early but excited when we told him baby brother Henry would be born today! Around 5:50 we were finally on our way to Leesburg to drop Sawyer off with my sister. She met us in the hospital parking lot. Eric was getting hungry at this point, and knowing that they wouldn't let me eat anything once I was admitted to the hospital, we made a quick stop at Chick-Fil-A to get some breakfast. I wasn't hungry but ate a bit anyway because I knew I would need the energy soon.

By the time we got to labor and delivery it was almost 7:00. They got me registered (they actually already had me in the system from a hospital visit in 2000! Funny, I have no memory of what that was for) and a nurse checked if my water had broken - it had - and checked if I was having contractions - I wasn't. Well, I sort of was, but they were several minutes apart and very mild. I was 1 cm dilated and 50% effaced. At 7:45 they officially admitted me and took me to a labor room, where my nurse Vanessa started me on pitocin and penicillin since I was group B strep positive. She also took some blood to see how well I was clotting. I had taken my last heparin shot at 10 p.m. so they needed to make sure all was good in case I wanted an epidural (I already knew the answer to that question. Ha!) 

A few minutes after starting on pitocin the contractions were coming fast and furious, 2 minutes apart and intense. I listened to my Hypnobabies tracks and they really helped me focus and relax. Eric was wonderful, rubbing my back and letting me squeeze his hands. Because I was on pitocin I needed to have continuous fetal monitoring, which I was fine with, but it actually made it much harder to concentrate. They gave me a wireless monitor so I could walk around freely and be in any position - great in theory but in practice it was horrible, because the monitor kept moving around and losing the baby's heartbeat, which would send Vanessa rushing into the room in a near panic to adjust it. I just about lost it when she came in while I was on the toilet (the body tends to, um, clean itself out in early labor). As it turned out it wasn't too long that I had to deal with the ever shifting monitor, because at 10:00 she told me the anesthesiologist would be available soon. Since it was 12 hours since my heparin shot I was in the clear to get one, so I told her I was ready for it. The pain was very intense at this point and Hypnobabies wasn't helping anymore. I felt like I could have gone for longer but didn't want to risk waiting too long. At 10:15 my epidural was placed, and I had several contractions during the procedure - they were coming a minute and a half apart and lasting more than a full minute each. Some choice words may have come out of my mouth. Thankfully I had complete relief about 15 minutes later and soon I was smiling again and texting friends. It. Was. AWESOME.

Loving my epidural

Around 11:00 Vanessa placed my catheter and checked me for the first time since they checked me in triage. I was 3 cm and 90% effaced. For the next couple of hours Eric and I chatted, called family members to update them, and relaxed. He went and grabbed a bite to eat. Around 12:30 I started feeling pain on my right side - the epidural was wearing off. Vanessa had me shift to my other side hoping that would help but it didn't, so another anesthesiologist came in and she gave me another dose of medication. It worked to numb the right side, but unfortunately made my left side REALLY numb. Like, no sensation whatsoever numb, which was a really weird and slightly disconcerting feeling. I started feeling nauseated and shaking, so Vanessa checked me again suspecting I might be going through transition. I was 6-7 cm and completely effaced.

Not feeling great

At 1:20 the nausea got very intense and she checked me again, and I was nearly complete. We waited a while for Dr. A to show up and to let the baby descend a bit more, and at 2:15 it was time to push. I had a moment of panic when I tried to pull my legs back and realized I was now completely numb on both sides all the way up to my chest; I couldn't feel what my muscles were doing at all and I thought there was no way I would be able to push. But apparently my body remembered what to do. I had requested no counting or yelling for me to push, and Dr. A seemed amazed that I knew when I was having a contraction even though I couldn't feel any pressure. Truthfully I couldn't have consciously said when I was having one, I just somehow knew when to push. At one point Henry's heart rate dropped dramatically and I could see on Dr. A's face that he was scared, which scared me too, but thankfully it came right back up when the contraction was over (I kind of suspect it might have been that annoying monitor again.) I had a mirror so I could see what was happening which helped with the pushing because I could see when I was making progress. As he was crowning I reached down and felt the top of his soft little head - amazing! We were excited to see his dark hair. A few pushes later, and Henry was born, screaming and curling his cute lower lip. I pulled him up onto my chest right away while we waited for the cord to stop pulsing so Eric could cut it.

Then the nurses weighed him and cleaned him off while I delivered the placenta (although I don't really remember that happening, I know it came out because Eric took a picture of it. Don't worry, I won't share that here.)

After he was all clean and wrapped up I held him and nursed him for the first time. He took to it right away and was very alert and gazing at both of us. I was feeling great at this point (adrenaline is an amazing thing!) so we told our family they could come visit as soon as I was in recovery. Henry went to the nursery and the nurses helped me get cleaned up and go to the bathroom, which was quite an adventure given my dead legs and the fact that my bladder always seems to stay offline for a long time when I have any sort of anesthesia.

A few hours later Megan came to the hospital and Sawyer got to meet his new little brother. When he came into the room I tried to hug him and ask him how his day was and he had no time for that - he just wanted to see Henry.

Megan brought us Cafe Rio for dinner, which is quickly becoming the traditional postpartum meal in our family. I was still feeling a little nauseous but I enjoyed it much more than the hospital food I would have had otherwise! And Eric definitely appreciated it. We were sad that the hospital wouldn't allow children to come in and Caroline, Mary Grace and Emery had to wait in the lobby, but happy that Henry at least got to meet his Aunt Megan. A little bit later Spencer and Samm, and Erin and Josh came by to meet Henry and hold him for the first time. We are so blessed to have such wonderful family members nearby to celebrate these times with us!

Soon it was time for Eric to take Sawyer home to bed and for me to try to get some sleep. Not so easy in the hospital, since they were still checking my vitals fairly often and I had to ask for help to go to the bathroom. Also because of my blood clotting risk I had to wear pressure boots on my legs, which noisily inflated at regular intervals. Not so restful. But I managed to catch little bits of rest in between feeding Henry. The nurses in recovery were amazing, so helpful and kind. And Vanessa came over to check on me, which was so nice. All in all I could not have asked for a better birth experience. I feel so lucky to have Henry in my life and can't wait to find out what kind of person he will become.

Tired but happy to be the parents of two!

Thanskgiving, and Giving Back to my Uterus

Our frozen transfer took place on November 28th. But first, Thanksgiving! It was wonderful having Thanksgiving the week before our FET because it gave me so little time to worry about it. Time flew by. We had a great Thanksgiving day at our house with family and a few friends.

My two sisters and I split the food making so that we each made 3 or 4 dishes, so it wasn't stressful at all to host. I even had time to make placecards...

...and "thankful cards." We each wrote down what we were thankful for, then we had to try and guess who had written each card.

The kids had fun at their table too, making Native American headbands and coloring pictures of turkeys. I think they even ate some food.

Once Thanksgiving was done, we had the weekend to relax and clean the house. I had Christmas card envelopes ready to address during my period of bedrest and Felicity DVDs cued up. Best of all, I felt great physically. It's amazing how much easier the FET process is on the body! No ovaries working overtime, no regimen of several shots a day. Just one a night. (Some nights it's two, but I figured out I could draw them up into the same syringe. Yay.)

My transfer time was 2:00 on Monday the 28th. Sawyer gets off the bus at 3:00, so Eric took the day off so he could be there to meet the bus. Which unfortunately meant that he wouldn't be able to be there with me, but since the whole process is getting pretty routine for me, I was OK with that. SG wanted me to arrive by 1:30 so I left around 12:00 so I'd have time to stop on the way for a quick lunch (I was already tired of turkey leftovers at home) and to get my mandatory beverage. For transfer you need to have a moderately full bladder, which means drinking about 20 oz of liquid an hour before. I got there right on time, which might be a first, and only had to wait a few minutes before they took me back to the transfer room. They had me take off my shoes and put on booties, and undress from the waist down and wait for Dr. S to come in. He went over the consent forms with me (no pushback about transferring two this time - the silver lining to two miscarriages in a row.) The transfer itself went very smoothly, and even though I apparently didn't have enough to drink they were still able to visualize well enough. Both embryos came out together this time. Afterward they had me lie still for 5 minutes, then I got up, got dressed, used the bathroom, and checked out with a nurse who reminded me to rest on a couch or bed for 24 hours, keep taking my meds, and not to freak out during the two week wait. I am a compliant patient but I made no guarantees about that last one. And that was it. I was pulling out of the parking lot by 2:25.

Bedrest was great. Nothing like lazing around reading and watching TV while all your meals are brought to you. We did have one minor incident in which Eric decided to play a video game in the basement and he couldn't hear us yelling for him, which caused me a sudden blood pressure spike and near aneurysm, but I survived it (and more amazingly, Eric did too.) By the next morning I was ready to be done, but I managed to hold out until 12:00 when Eric convinced me to come get lunch with him and drive around looking at houses. So I made it 22 hours. Don't tell my nurse and get me in trouble.

So now, we wait. For some reason SG makes us wait a full two weeks after transfer to have a blood test which feels eternal. I haven't been as busy the past few days so that makes it harder too. Maybe I need a new hobby.

As far as testing at home, I'm going to do it, but I'm not going to write about it on here. Once we get a firm answer one way or the other though, I promise you'll get the full story. I just can't put it out there yet, for my own sanity.

Here We Go...Again

There's something really different about this cycle. It's a different protocol than I've done before, but the biggest change is that I'm not excited at all. Last time was "Here we go!" and now it's more "Ugh, here we go again." I heave a sigh before every shot.

With two losses in the past 5 months, it almost seems impossible to me that this will work. And yes, I know IVF veterans are probably laughing at me at this point - 3 cycles in a year really isn't that much. But it's a lot for me. I'm not sure how many more times I can handle doing this.

On the bright side, this FET stuff is pretty easy compared to a fresh cycle, at least physically. Only two ultrasound and bloodwork appointments before the actual transfer (as opposed to about 10 for fresh.) And the meds are much easier too. Here's the schedule, trips to the doctor in bold.

Nov 12 - Baseline appointment, Delestrogen shot (0.2 ml)
Nov 15 - Delestrogen shot (0.2 ml)
Nov 18 - Delestrogen shot (0.2 ml)
Nov 21 - Delestrogen shot (0.2 ml)
Nov 23 - Ultrasound to check lining, bloodwork to check P4 and E2 levels; if all looks good begin progesterone (PIO) shots
Nov 24 - Delestrogen shot (0.2 ml), PIO shot (1 ml)
Nov 25 - PIO
Nov 26 - PIO
Nov 27 - Delestrogen & PIO
Nov 28 - Transfer, PIO
Nov 29 - PIO
Nov 30 - Delestrogen, PIO
continue both meds until....
Dec 12 - beta

I'm also taking all the same pills I've been taking since the spring: Metformin, FABB, Vitamin D, levothyroxine, bromocriptine.

So at this point I've had the baseline appointment and two Delestrogen shots. So far so good. Although the doctor who performed the ultrasound was kind of weird. I had to go to a far away office since it was a Saturday, so I didn't see my normal doctor. Actually, I'm not even positive she was a doctor, because she didn't introduce herself to me before shoving the wand in, and then she told me absolutely nothing about what she saw, except to ask me "Are you sure you haven't had anything removed?" Um...yeah, pretty sure. Apparently she found everything she was looking for though because she was done and gone before I could ask a question. Bizarre. They must have been running really behind schedule that day. Or she was just weird.

So that's the latest. Taking my big-A shots (they are both intramuscular) and waiting for the next appointment. Here we go. Ugh.

FET #2

It looks like we're ready to go...for what I sincerely hope is the last time. My period arrived on Sunday (and I'm using the term "period" very loosely, since I've learned that what happens after a chemical pregnancy bears almost no resemblance to my usual AF visit.) I had to go back to the RE this morning for one final beta test to make sure that my HCG level is down to the negative range. It is (yay?) so that means I'm cleared to start birth control pills again tonight. Here's the upcoming schedule:


October 12 - start BCPs and Lovenox (the shot-free days were nice while they lasted!)
November 7 - take last BCP
November 12 - baseline ultrasound, to make sure lining is thin and I don't have any cysts or anything. Turn in consent forms. Begin meds - Delestrogen, 4 mg every 3 days (unfortunately another big IM needle - but at least it's not every day.)
November 23 - ultrasound to check lining, bloodwork to check progesterone and estradiol. Begin progesterone-in-oil shots somewhere around this time.
November 28 - TRANSFER! The Monday after Thanksgiving.
December 12 - beta test


I'm still feeling very sad about this past cycle. Not knowing why it didn't work when everything looked perfect is really, really hard. At least with our failed FET we knew that the embryos we transferred weren't good quality and there wasn't much of a chance that it would work.  This time everything went so smoothly and all the pieces fell into place. I am definitely glad that we decided to go against our doctor's wishes and transfer two, because if we had only done one I'd be wondering right now if it might have worked had we done two. At least we know we did everything we possibly could. And there is a lot to be grateful for:

1) that we have TEN excellent embryos waiting. That gives me so much hope.
2) that despite having a record-setting 68 eggs retrieved, I only had mild OHSS. No fluid had to be drained. Seriously, that's a miracle.
3) that we have the means to continue treatment. This is not the end of the line.

Chemical ... Again

I hate that I have to do this update - but I do.

This cycle is officially a bust. At 8dp5dt (8 days past a 5 day transfer, or 13 days past ovulation) I got a faint positive on a First Response test. I was excited but worried because I knew it was fairly late to be getting a positive test and that usually means low HCG levels, which usually means chemical pregnancy (early miscarriage.) The tests kept getting darker over the next several days, but then when I had my blood test on Tuesday it came back at only 22. We tested again today to see if by some miracle the number would double, but today it was down to 7. Another chemical pregnancy. Here's the HPT progression - as gross as it is to post pictures of pee sticks, I find it really interesting. Especially keeping in mind that my HCG today was at 7, and I still got a clear second line. That is a sensitive test!

Obviously we are very sad and disappointed. Everything went so perfectly this cycle that we really had our hopes up. But we do have a lot to be grateful for. I'm relieved that it didn't take us weeks this time to find out that this pregnancy is not viable. And we have 10 awesome looking blastocysts that are frozen and waiting to be transferred.

We plan to move ahead right away with doing a frozen embryo transfer. Our insurance coverage is maxed out (amazing how quickly we reached that $15,000 lifetime maximum!) so from this point on we'll be paying for everything completely out of pocket. Needless to say, we very much hope that the next cycle will be the one that works.

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.

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!

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??

Ch-Ch-Ch-Ch-Changes

It's been a crazy summer. The FET, YW Camp (SO FUN), the miscarriage (really really not so fun), Sawyer's pre-kindergarten evaluations, and now we're gearing up for IVF #3.


After a lot of thought and discussion we decided to switch doctors. Our previous fertility clinic did a lot of great things for us, but increasingly we were running into problems there. For one thing it's about an hour away from where we live - it used to be the closest option, but we have moved three times since we started going there in 2003. In recent years they have downsized, and the office is severely understaffed. It was normal to sit in the waiting room for an hour before an appointment. There is only one coordinating nurse, and many times I called with a question only to find out she had already left for the day around 2:00 pm. I found this extremely stressful. And heaven knows IVF is stressful enough without stuff like that.

Before we could switch to a new clinic, we needed to get a copy of our records to bring to our new doctor. Sounds simple enough right? Wrong. It took an entire month of making phone calls to make this happen. The receptionist kept brushing me off and telling me she would get to it the next day (or week). She was actually quite rude about it and lied several times (she told me more than once that some of the records were stored off site and I later learned that this was not at all true.) Meanwhile, we were starting to get stressed because without the records we'd have to delay for an entire month. We did some research and found out that they are legally required to provide copies of our records within 15 days of requesting them. So we threatened legal action (I had Eric call, he's much better at being a jerk than I am) and guess what? The next day those copies were in my hands. We were still a bit on the fence about switching before this happened, and this made the decision MUCH easier.


We had a consultation with the new doctor the last week in July and were very impressed with him and the office. Besides the fact that they have an office ten minutes from our house (hallelujah!) it's the largest fertility center in our area, their success rates are some of the best in the country, and they have an extremely efficient system in place. This morning was my first real appointment (day 3 ultrasound and bloodwork) and not only did I not have to wait at all once I got there, I was in and out of the office in 20 minutes. It did feel a bit impersonal, like going through a factory, but I think it's a good tradeoff.


The best part about the new center so far is probably my nurse, C. She is about my age, and so nice - totally the kind of person I would want to be friends with. Every time I've left her a voicemail or sent an email she has responded within 1 hour. We haven't spent a lot of time with the new doctor, but he comes highly recommended (we know three couples who have gone to him in the past). He doesn't seem to be as personable as Dr. A, but he definitely knows what he's doing - and I hate to say it, but based on previous experience I'll take medical expertise and a well-run office over bedside manner any day.


Today's appointment went well, hormone levels are where they're supposed to be and uterus looks good. I picked up my prescription for OCPs (birth control pills) and I start taking them tonight. After some tweaking of the schedule to accommodate Erin's wedding (yay!) the rest of the cycle looks like this:

Lupron Trigger Protocol (High Responder Antagonist Protocol)  

August 19 - September 2 
-Take OCPs. 
-Day 3 bloodwork and ultrasound (done.) 
-Bloodwork for Eric and me (infectious disease panel for Eric, blood type, varicella and rubella titers for me.) 
-Mock embryo transfer. 
-Get clearance from hematologist to begin OCPs and Lovenox (done.)
September 3 - Pre-IVF bloodwork and ultrasound; sign all consent forms
September 6 - Start stims (Follistim 150 IU and Menopur 75 IU - these drugs stimulate the ovaries to produce multiple follicles/eggs)
September 11 - Start Ganirelix (this prevents eggs from being released before retrieval)
September 15 - Trigger injection (Lupron - helps mature eggs release so they can be retreived)
September 16 - Bloodwork - LH and P4 testing 
September 17 - Egg retrieval (I'll be under IV sedation, which will be awesome)
September 20 or 22 - Embryo transfer. (The exact date will depend on how well the embryos are growing in the lab - the 22nd would be optimal.)


Starting around Sept 11 the dates are a bit more approximate since everything depends on how well I'm responding to the drugs. I might need to be on them for longer or shorter than planned. We'll hope for shorter. I have become pretty tough about needles, I still don't want to be pricked any more than I have to.

Here we go... again!

Stats

Invasive fertility tests: 6 (HSG, SHG, hysteroscopy, endometrial biopsy, mock embryo transfer, pituitary MRI)

New things we've found wrong with me from said tests: 5 (high prolactin, high TSH, blocked fallopian tube, endometritis, PCOS)

Blood draws done in the past 2 weeks: 6

Blood draws where they had to stick me more than once: 3 (on one occasion it took 4 pokes. Nice going, LabCorp.)

Medications I'm taking daily: 7 (surely this is excessive, especially since I haven't even started cycling yet.)

Voicemails left for my coordinating nurse: haven't even tried to count.

My ability to focus on anything other than this FET cycle: negligible.