Three Little Embryos

"Three little embryos"... kind of sounds like the start of a very modern fairy tale or nursery rhyme (have you ever noticed that in fairy tales things come in threes? Three bears, three little pigs, three brothers.)

We had our embryo transfer today and I now have three little embryos in my belly. They were thawed early in the morning and all three survived. Dr. A said they were "fair" in quality, a bit more tactful than "not so pretty." E and I dropped Sawyer off at his cousins' house, I took my valium (which made me completely loopy and weird) and drank my water, and we arrived to our appointment right on time. We had to wait for about half an hour because there was another transfer right before ours.

In the waiting room I quickly discovered that I had consumed way too much water beforehand. The instruction sheet said to drink 8 oz one hour before my appointment, because a full bladder helps them visualize the uterus with an abdominal ultrasound. I drank 40 oz, because during my mock transfer I drank 8 and it wasn't nearly enough. Nurse L had to keep bringing me water, and the final amount was 32 oz. So I figured 40 would be plenty. And wow, it definitely was. I was in so much pain I had to pee in small amounts FOUR times beforehand to relieve some pressure. Because water was constantly filtering in, I was still in a lot of pain during the transfer, with the speculum in and the transducer pushing on my belly. OW. Afterwards they want you to lie flat with the stretcher tilted so your feet are higher than your head for 30 minutes. After 10 I knew I wasn't going to make it. Nurse A asked if I wanted a bedpan and I gratefully said yes. Normally I would have been so embarrassed but it was so painful at that point I didn't care (the valium probably helped too.)

The transfer itself was very smooth. First they got me set up on the table and had us verify our names and birth dates with the embryologist to make sure we were matched up to the right straw. Then Dr. A put the speculum in me and cleansed the cervical area to make sure nothing harmful would be introduced with the catheter. At the same time Nurse A worked the ultrasound to get a good view of where everything was going to go. When it was time for the embryos they dimmed the lights (bright light can be harmful to them) and the embryologist brought in the straw (kind of like a catheter) that held our embryos. Dr A very slowly threaded the catheter through my cervix and up to the top of my uterus. The embryos are suspended in a liquid solution with a tiny air bubble next to them so that on the ultrasound the doctor can see where they land - the embryos themselves are too small at this point to be seen with the naked eye. They went right where they were supposed to. I wasn't able to fully appreciate the moment because of other urgent needs but it is an amazing process. We got a picture of the little guys/gals, which I'll post once I get a chance to scan it.

And now, we wait. I'm on two days of bedrest (only getting up to use the bathroom, although I admit I haven't been that strict about it). My parents and baby sister are in town so my mom and Tanne are coming over tomorrow to entertain me, which I'm very excited about. We have a busy weekend spending time with my family, and on Monday I leave for Young Women camp for five days. I think this two week wait is going to fly by.

Not So Pretty

Yesterday I had an appointment to make sure the birth control pills are suppressing my ovaries. Lan (the coordinating nurse) was out of town so they were running late and we had to sit there waiting for over an hour. I didn't think I was going to make it back home in time to get Sawyer off the bus. This is where living an hour away from the center can be problematic. Finally Dr. A was ready to see us, and everything looked good. I'm suppressed (in more ways than one now, haha) and the cyst is shrinking. The hormones are doing their job, beyond just making me really really cranky! I got the go ahead to start Lupron, 20 units a day.

Eric came with me to the appointment because we also had to sign our consent forms. The forms give basic medical information about the various procedures and their risks, as well as the risks of pregnancy. You sign off on those, I guess so you can't later sue the center if things go wrong. Then you have to decide what will happen to any leftover embryos. Since we only have 3 it's not likely that we'll have any left, but we're thinking ahead to fresh cycles in the future where that is a possibility. They take you through every possible scenario - for instance, if your husband dies, what do you want to do with the embryos? If you die but your husband's still alive? What if you both die? Or what if you get divorced? Yeah, all really fun to think about. For each scenario there are several options - donate to another couple, donate to research, store indefinitely, or discard. So we made all those decisions and signed off on them with the notary, Carol at the front desk - who by the way is hilarious. (Our decisions: If I die, discard; if Eric dies, discard; if we both die, donate to another couple; divorce, discard. I would rather donate to research, but Eric is not comfortable with that.)

Then we discussed our embryos and how many we should transfer. This part was pretty discouraging, because after reviewing the images taken 7 years ago, Dr. A said "They are...not so pretty...no offense." (To which I wanted to respond, "Hey buddy, tell YOUR embryos to look in a mirror sometime!") Last time we did IVF we used the best 2 embryos to transfer, which was obviously a good choice because it got us Sawyer. Unfortunately the ones we left behind are much lower quality, and will likely be even worse after thawing (the thawing process can sometimes damage embryos; interestingly, the amount of time they have been frozen is irrelevant.) Two are blastocycts, but not expanded, and one is a morula, which is not great at all.

We are doing assisted hatching, which could help, and the fact that we've had a positive result in the past works in our favor. But still, Dr. A gives us about a 20% chance with these embryos and told us to be prepared for a negative result. Which is kind of funny, because that's already the way I've been feeling about this cycle. I'm prepared for it not to work. But we are still going to give it our all, because we both feel strongly about giving these embryos a chance. As far as how many, we decided to go ahead and transfer all three - since they are lower quality the chances of all three implanting are "zero to minuscule...it would be an absolute miracle." So I feel good about that.

I also asked how likely it is that things will go according to schedule and he said "Extremely likely...98% chance." REs are really good at speaking in percentages.  So I need to reschedule Sawyer's opthamologist appointment that's the same day as embryo transfer.

Next step: I stop birth control pills on Tuesday, go in for another ultrasound on Friday and start Estrace that day if everything looks good.

I'm Only In It For The Drugs

I'm on a lot of medications right now. Like, a LOT. Here's the list (full disclosure: I have to look at my list on my iPhone to remember them all.)

-levothyroxine (for hypothyroid)
-metformin (for PCOS)
-bromocriptine (for elevated prolactin, probably also related to PCOS)
-birth control pills (part of FET cycle)
-prenatal vitamins (doesn't hurt to be prepared)
-vitamin D (because I am always pasty white)
-baby aspirin (increase blood flow to uterus)
-Lovenox (to prevent blood clots, since I am "blessed" with Factor V Leiden and MTHFR.)

The last one is what is causing all the trouble, and not just because it stings like a mofo. My insurance doesn't seem to want to cover it. At first they would let my pharmacy fill it, but only 6 syringes at a time. With a $10 copay, that's actually pretty reasonable compared to the out of pocket price (at least ten times that amount, even for the generic, which explains their reluctance to pay for it.) It was just kind of a bother to make such frequent trips to Target. Then last time when I tried to fill it I got rejected - they now will only give me 6 syringes every 23 days. Which is pretty useless since I need to take it daily or I could, you know, die from a pulmonary embolism. (Also, 23 days? Why not 20? Or 30? Or 42? Who came up with 23?) I've talked to several customer service reps who have been about as useless as their current Lovenox policy. It's supposed to be a straightforward process: have my doctor call them and tell them I need to take it every day, but that's happened twice already and for some reason that hasn't been enough to change it. Thankfully my hematologist had some samples in the office and she let me have enough to cover me for the next few days while we battle things out.

Watch out Cigna. I'm willing to fight for a long time to earn the privilege of not dying of a blood clot.

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.

Anyone still out there?

Wow, 11 months. That's even longer than I thought.

You can probably guess what brings me back - the same reason that starting me blogging in the first place: We're getting ready to embark on more Adventures in Infertility.

Last time on A.I.I.... Three years ago we visited our R.E. to plan the transfer of our remaining 3 frozen blastocysts (embryos). All systems were go...and then we discovered that our insurance wasn't going to cover a single cent of it. So we decided to save up some more money and wait a while longer.  In the meantime we discovered Sawyer's developmental delays, moved and bought a house, and Eric changed jobs several times.

Finally, we seem to have reached an equilibrium. We're settled into our new home, Sawyer is doing great, and we have enough money in the bank to proceed. The time is right. AND joy of joys, it looks like our insurance is actually going to be very helpful this time around (if our paperwork is correct, everything should be covered at 90%.)

I had a consult with Dr. A on February 21 and we have a game plan. Since it's been so long since our last IVF, I need to undergo all the screening tests again. That will include:

-Baseline transvaginal ultrasound
-Preconception bloodwork/female infectious disease panel (more bloodwork)
-HSG X-ray (this was the really painful one for me last time; this time I will be armed with narcotics)
-SHG/pelvic exam
-Hysteroscopy and endometrial biopsy (another ouchie)
-Mock embryo transfer

If all goes well with the testing, transfer should be sometime around mid-April. 

As soon as my next cycle begins I can schedule the tests and get the ball rolling. It feels slightly terrifying to be plunging into all this again, even more so than the first time, because now I know what it entails. Sometimes ignorance really is bliss. But I feel ready, definitely more ready than I ever have been before. Probes, shots, stress, hormones, headaches, hope. Bring it on!

Back to my roots

For some reason I've been thinking a lot about the origin of my blogging career (using the term "career" very loosely, since my posting is sporadic at best, and no one is paying me. I have to pay people to read it. Usually with favors.) When I first started blogging, it was about our adventures with infertility and IVF. Since Sawyer is now 3 1/2 we've had a lot of people asking us when we're going to do IVF again. I've brought the questioning on myself by being way out of the IVF closet, and by announcing openly that we were going to transfer our embryos last year - before we found out our insurance was cheaping out on us. Anyway. It's really hard to explain to people that I'm just not ready to go through the whole process again. I know my kids (if we're successful) are going to be several years apart, which is probably not optimal, etc, but...I just can't bring myself to make that phone call to Dr. A right now.

Part of the problem is that people don't realize what the IVF process entails. They think of it as a one-time visit to the doctor, one procedure, and then you find out if you're pregnant or not. In reality, it's a multi-step, months long process of painful testing, invasive procedures, lots of money spent, more needles than I ever thought I'd see in a lifetime...and the whole time no one knows whether or not it will even work.

And I haven't even experienced what a lot of IVFers do. We have an official diagnosis - at least 10% of IVF patients have "unexplained" infertility. Knowing what our problem is (bad sperm) actually makes us feel better about going through the treatments. Our first IVF cycle worked, which makes us extremely lucky and probably means I shouldn't complain about the process at all, given that a lot of couples I know have undergone multiple cycles with no success. I must be a wimp, because just that one cycle (and the testing/surgery) that preceded it makes me terrified of doing it again. Maybe terrified is too strong a word. It's more of a big, fat, "I don't want to."

Of course the end result is worth it. Of course. I would go through 100 IVFs to have Sawyer again. But when the best chance anyone has of success is 30% (much less for a frozen cycle, and less now that I'm over 30) it's difficult to be excited about going through it all again. I definitely want to give our frozen triplet embryos a chance. And doing a transfer only cycle will be a lot less stressful than a full IVF cycle, in theory anyway. It's just going to take me a little while to work up the courage again.

Lack of Coverage

And no, I'm not talking about my new bikini. (Those of you who know what my body looks like these days probably just threw up a little bit.)

Our insurance company officially will not cover any part of our embryo transfer. I was right that we have coverage for infertility. I was wrong in assuming that included embryo transfers (or anything related to IVF in any way - it's in the fine print section of the exclusions.) So Eric is looking for a new job. I know that sounds extreme, but he's been thinking about it for a long time anyway.

On a related topic, we recently rented Sicko, the latest Michale Moore film. Talk about eye opening. I don't agree with Moore's politics, but you can't argue with his basic premise that the health care system in the US has some serious issues. I loved the segment about France - when he'd ask people how they were going to pay for their medical bills, they'd first say "What?" with a blank look, and then they'd think he was joking. Even IVF is fully covered for everyone. Can you imagine? Maybe we'll have to move there. Vive la France!

This Sucks

I got a call from the insurance secretary in our RE's office yesterday. Apparently our insurance company is saying we have no infertility coverage. Which is very strange, because the policy booklet that I'm looking at right now says we're covered at 50% for all infertility diagnostics and procedures (including IVF related ones). Eric's going to talk to his office's HR guy today and see what the issue is. If we find out that the company opted us out of the coverage I will be all kinds of pissed. We chose this company based (among other things) on their insurance coverage for infertility!

We're really back in the game now, it's just one thing after another. If we have to self pay, we can (although not right away, we don't have enough saved up). It just makes me mad that something this basic and common wouldn't be covered. I mean for heaven's sake, getting pregnant is supposed to be free - and for some people, it's even fun!

Back in the Stirrups

Well, it's official - after three years of frolicking around happily in the land of the Fertile, we are patients of a reproductive endocrinologist once more. We had an appointment with our RE yesterday to discuss our options for Baby #2 (as he or she will known on the records of the Church - just kidding.) We are very (VERY) lucky to have three embryos which were frozen after the IVF that got us Sawyer. That means we don't have to go through the whole (horrible, expensive, painful, and did I mention horrible?) process of a full IVF again, we just have to transfer the embryos into me and hope they take. Our RE gives us about a 30% chance that it will work. With a fresh cycle it's about 40-50% - the thawing process can damage the embryos, so a frozen cycle is always riskier than fresh. As with last time, our chances are better than most people's because we are young and because our diagnosis is male factor (as far as we know, all my stuff is working.)

Here's the protocol, for those who are interested in the gory technical details.*

Beginning with my next cycle:

Diagnostic Tests

Day 3 - Sonohysterogram. This is where they fill your uterus with saline and do an ultrasound (the "fun" kind.) This allows the doctor to do some measurements and check the general shape of things.
I'll also have some blood work done to check my hormone levels.

A few days later - Hysteroscopy. Another diagnostic test where they feed a thin telescopic camera through the cervix to have a look around. Here they're looking for fibroids and polyps and anything that's not supposed to be in there. As you can imagine, this one isn't very pleasant to go through, but thankfully it's pretty quick, and it's actually kind of cool to be able to see inside your own uterus up on the screen during the procedure. While they're in there they'll do a trial transfer - measuring to find the best place to deposit the embryos on the big day.

The best part of my diagnostic protocol is ... NO HSG! And no laparoscopy! Those were the most painful procedures for me last time (apart from the ovary stimulation and egg retrieval) so I am thrilled not to have to go through those again this time.


Medications

The normal protocol is to go on birth control pills for the first 14 days, but since I have the Factor V Leiden gene, our Dr. wants to avoid this. What I'll do instead is use another form of birth control (oh, the irony) and use ovulation predictor kits. When I get a positive (meaning I'm about to ovulate) I'll call the office so they can schedule me for the next step - medications.

I'll have some more blood tests, then I'll start taking:

Lupron (20 units) - subcutaneous injections, once a day. This suppresses the ovaries.

Estrace - Estrogen, taken vaginally or orally (woohoo, no needles!)

Progesterone - the Big Ones. Eric will once again have the joyful experience of stabbing a 1.5" needle into my hiney. The RE did say that if the injections are painful for me I could switch to vaginal capsules instead, for which I will forever bless his name.

Somewhere around 6 weeks after my cycle begins (end of December or start of January), we'll do the actual transfer. We're transferring all three embryos (two blastocysts and one morula). This sounds scary, but with a frozen cycle the chances of ending up with triplets are almost zero. And they're only slightly higher for twins. So we're hoping and praying for one healthy, adorable baby.



*If you're wondering what Eric has to do for this cycle, here it is: he has to get bloodwork done to screen for infectious diseases. Which he did yesterday. So yeah, he better be nice to me for a long, long time.

HPTs Are The Devil

I'm totally messing with my own head, all because of those evil little plastic sticks we all love to pee on. You're not supposed to test at home after an IVF cycle, because the HCG injection you're given before egg retrieval contains the same hormone that HPTs detect, and it can stay in your system for up to two weeks. Plus, REs usually schedule the beta test early enough that an HPT might not be accurate anyway.

Even so, I couldn't resist peeing on one yesterday. And what do you know... negative. That's the only result I've ever seen, so I wasn't shocked, and I knew it was still very early, so I didn't lose hope that I could still be pregnant. I decided not to test any more and exercise a little bit of good old fashioned self control until Friday.

But predictably, I broke down. Today I used a First Response test, which detects very low levels of HCG.

It was positive. Instantly positive.

So now, I'm even more confused than before. Is this test just picking up residual amounts of HCG from my injection 17 days ago that the first test wasn't sensitive enough to detect? Or is it really detecting a pregnancy? And in the name of all that's holy, why do I do this to myself? Why?!?

Out of the Closet

Well, it's too late to buy tickets and see it, but this looks like it was a fun show: Infertility: The Musical, the only show to bring you songs such as "Infertile Love Song" and "I've Got Sperm in my Pocket and I'm Talkin' to Eileen." It's kind of cool to me that fertility has become such a publicly discussed issue that people are writing musicals about it now. Since I'm way out of the infertility closet (I've told virtually all my friends and family) I can't understand why people have historically been so secretive about it.

Eric is coming home tonight from his business trip to Atlanta. It's only been a couple of days but I've really missed him. I was a little annoyed with him for leaving me right in the middle of all this IVF stuff, but apparently he was the only IT guy in the DC area who could fix this particular problem, and if he didn't go the entire internet would like, blow up or something. You know, I actually am proud of him that he's doing so well at work. I admire the fact that he's so good at what he does and that his hard work is valued. It's just that I get a little jealous of his time every now and then. Going through IVF has turned me into a big squishy emotional ball of neediness, so it's probably my issue, not his.

On the IVF front (nope, I'm really not capable of talking about anything else right now, sorry) yesterday I found out that my progesterone and estrogen levels are too low. So now I'm wearing two estrogen patches on my inner thighs (super sexy), and supplementing my nightly progesterone shots with twice a day vaginal suppositories (again, sexy.) I won't go to the RE's office again until my pregnancy test a week from tomorrow. That sort of freaks me out. It means this is IT. The end. We'll have an answer: yes or no.

All Alone With a 22 Gauge 1 1/2 Inch Needle

I just intentionally impaled my right hip with this. Go on, look at it. Be impressed.

Eric is out of town for a few days on business so I have to take over progesterone injection duty for a little while. I just about fainted before I stuck myself with the monstrosity (more like an ice pick than a needle) but once I got it in it wasn't so bad. I'm not sure what I'm going to do tomorrow night; I may have to call my sister and ask her to help. I feel weird about this, because I know if someone asked me to do the same thing it would freak me out. But my right hip is really sore and I don't think I can do it with my left hand. I was talking to my brother about my dilemma and he suggested that to amuse myself while Eric is gone, I should come up with a list of people who it would be extremely awkward to ask to inject me. So far I've come up with: my bishop, the FedEx guy who's bringing me a book from Amazon, any of Eric's ex-girlfriends, and the missionaries. Any other suggestions?

Babies! Get in my belly!

Today was embryo transfer day. We transferred two blastocysts and decided to freeze three others that looked promising. The procedure went perfectly. In fact, the whole experience was one of the most amazing ones I've ever had, which I didn't expect at all.

We arrived at the fertility center at 8:00 a.m. and I was given a bottle of water to drink so my bladder would be nice and full for the sonogram (that helps the uterus lie flat so the doctor can easily insert the catheter loaded with the embryos.) When I was sufficiently hydrated they had me change into a hospital gown and hat and Eric changed into scrubs. We both had to wear a mask so the operating room would remain sterile. Before the procedure, Dr. A took us into the embryology lab and introduced us to the technicians who made our embryos. "Your first baby-sitters," he called them. As soon as we walked into the room I had an intense feeling that we were in a holy place. It was exactly the same feeling I have when I enter the temple. I sensed that something sacred was taking place; so many lives were being created. I had honestly never thought of it that way before so the impression surprised me greatly. The doctor let us look at our embryos through a microscope, which was incredible. He printed a picture of them for us (I'll post it once I have it scanned.)

Soon we were ready to proceed with the transfer. Dr. A had me lie flat on the operating table with my legs strapped in, then he tilted the table so that my head was lower than my feet. He asked us if we had any questions and Eric responded, "Yeah, can you give us the quiet ones?" Dr. A and and the nurses found this hilarious. One of the nurses took a sonogram of my belly so they could find a perfect little landing strip in my uterus. (It took her a few seconds to find it because my ovaries are bigger than my uterus from the OHSS and they were hogging the screen - I know, EW.) When they had located the correct position, Dr. A inserted the catheter through my cervix and up into the very top of my uterus. All I felt was some slight cramping and pressure from the speculum against my full bladder. Not fun, but not terrible by any means. Dr. A turned the sonogram screen so that Eric and I could watch and he even let E hold the transducer for a while so he could be an active participant. They load the catheter with tiny air bubbles next to the embryos so that the doctor can visualize where the embryos will be deposited, so we could see them go in. It was incredible to watch.

Afterward I had to lie flat for 30 minutes, and then I was allowed to change and go home. I'm on bed rest until tomorrow morning, which is difficult because I feel better today than I've felt in over a week. But I want to do everything right, so I'm trying to stay entertained. It's so strange to think that there are two embryos inside me right now. I keep talking to them and telling them to grab on and hold on tight, but since they're created out of my genetic material (not to mention Eric's), I don't expect them to be overly compliant. They're probably fiercely independent little buggers, so all I can do is hope they decide on their own that my womb is a good place to be.

Ugh

I'm feeling miserable again today. I called Lan yesterday and she said if I didn't feel better by this morning I should come in for a sonogram. I had Eric drive me in because I was in too much pain to drive myself. Dr. Asmar did my sonogram and confirmed that I have OHSS. Luckily, it's mild enough that we should still be able to do the transfer on Sunday, provided it doesn't get worse. I can't imagine what it must be like to be severely hyperstimulated, because I wouldn't classify what I'm feeling as "mild" by any stretch. Last night I was doubled over and crying with the pain. During the ultrasound Dr. A found that my ovaries are about three times their normal size, so that's what's causing the pressure in my poor bloated tummy. (Speaking of the bloating, I damn well better be pregnant after this, because my belly is so distended I already look like I'm about four months along.) Knowing that what I'm feeling is normal and not cause for alarm actually helps a lot. I can get through it if I know it's not going to kill me. Dr. A even offered to call in a prescription for Tylenol with codeine if the pain gets too bad, but I only want to do that if I absolutely have to and so far I've been OK. I feel a bit better today than I did yesterday, so I hope that's a good sign that things will get better rather than worse. Either that or my ovaries will fulfill their threats and spontaneously combust.

On a more positive note, our embryos are growing wonderfully. We have 5 at the 8 cell stage that are Grade A (yep, embryos get graded, just like cuts of meat). And the rest of them are pretty good too. We have to decide if we want to freeze them so that we can use them in a few years when we want to conceive again. My mom remarked to me today how strange it would be to explain to our kids that they were all conceived at the same time, but born years apart. I'm not sure how I would feel knowing I was made in a petri dish. But I'd like to think once we tell them how much money we spent just to get them in my belly, they'll feel pretty darn special.

My Fourteen Kids

Well, I survived egg retrieval on Tuesday. The whole procedure went perfectly. I was under anesthesia for about 40 minutes and woke up feeling so good that I drunkenly told the anesthesiologist, "Thanks for the great nap!" Dr. A performed the retrieval. He was able to extract 20 eggs, and as of yesterday we had 14 healthy embryos growing like crazy in their little petri dishes. This means that we have great odds of at least a few of them surviving to the blastocyst stage, 5 days after fertilization. We'll go in at 8:30 on Sunday morning for transfer, and then all we can do is wait until I go back for a beta pregnancy test. We're getting closer to the end! (Or the beginning, depending on how you look at it.)

Today, two days after retrieval, I'm feeling positively terrible. My belly is so bloated and tender that it hurts to breathe. Since I was hyperstimulated this is normal, but I have to keep an eye on my weight and make sure my fluid intake is high enough. If I gain more than 5 lbs in one day I have to call the doctor. In the meantime, all I can do is lie around the house and watch the Olympics. Walker, my kitten, has been incredibly sweet and calmer than usual for the last couple days. I think he knows I'm not feeling well. He follows me wherever I go in the apartment and is constantly at my side. Yesterday he took a nap with me, curled up against my tummy, and I woke up to him licking my chin and purring contentedly. He's like my little living heating pad.

Overachieving Ovaries

My life is pretty one-track these days. With all the time and attention it takes to complete an IVF cycle, I don't have much energy left to think about anything else. And here it comes...more IVF drama.

I've been going to my RE's office for blood draws and sonograms every day since Wednesday. It is beginning to feel like a true home away from home. I knew I was a true IVFer the day that I realized that all five of the rotating receptionists know me by name.

The reason I've had to go in every day is that on Wednesday I started showing signs of being hyperstimulated. (See OHSS.) Basically, that means that my ovaries are proving themselves to be little overachievers (in stark contrast to the rest of me, which lately has been stuck in slacker mode.) On Wednesday, Lan decided to reduce my Gonal-F injections from two to one vial a day. On Friday, she reduced it to one half a vial a day. And on Saturday afternoon I got a call that said, "Your estradiol levels are sky high. Stop all stimulation drugs." The idea was to help my ovaries "coast" for a while in hopes of slowing down egg production to a more reasonable level (i.e. one that won't cause them to explode, which is what it feels like they're about to do right now.) During my sonogram this morning the weekend RE didn't even bother to count my follicles because there were so many. I knew it was bad when the first sonogram image came up on the screen and the nurse who was there to record the measurements said, "Oh, lordy. I'm going to have to sit down for this one."

I waited on pins and needles for my afternoon call from the nurse and was relieved to hear that my estradiol levels are back to a safer level. I'll give myself the HCG shot tonight, which tells my body to go ahead and ovulate, and I'll have the egg retrieval on Tuesday (pushed up from Wednesday, yay!) and then with any luck we'll be able to proceed with the embryo transfer three to five days later.

And then, maybe my poor hardworking ovaries will get a break.

Excellent Responder

I had my first monitoring appointment today to see how I'm responding to the stimulation drugs. I'm happy to report that I am an excellent responder! In fact, I'm responding a bit too well. Lan could see 12 follicles on one ovary and 16 on the other. (In theory, each follicle develops one egg, although I'm told that there are normally more eggs than can be seen by ultrasound.) In order to avoid becoming overstimulated, I have to reduce my dosage of Gonal-F to one vial a day instead of two and for the next five days I have to go in every morning for bloodwork and a sonogram. That's right: every day for five days. I'll be spending lots of quality time on the beltway.

Stimulating

On Saturday I had an ultrasound to see if the Lupron has been doing its job. Eric came along with me and saw the whole internal sonogram process for the first time. (He was appropriately squeamish and sympathetic) Because Dr. B had a busy morning, my coordinating nurse Lan did the ultrasound. I love Lan. She's a petite Chinese-American woman with a strong accent who is simultaneously sweet and efficient. And she was much more gentle with the magic wand than Dr. B is, which I greatly appreciated. She turned the screen to show me what she was looking at. "See that? That your uterus. Next time, I wanna see babies in there."

My ovaries are nice and suppressed, just as they should be at this point, so it's on to the next step: stimulation drugs. I'm on a cocktail of Gonal-F and Repronex as well as a reduced dosage of Lupron. Lan showed me how to mix the three medications into just one shot, for which I will bless her name forever. I'm getting used to the injections, but if I can take one instead of three I'm not going to argue!

In other news, E and I have decided we want to move when our lease is up at the end of September. He's tired of spending three or more hours a day commuting, and we're both tired of our ward. During Relief Society yesterday someone asked me if I was new in the ward. Since we've been here for a year now, and are very involved in ward activities, our callings, etc, it's an illustration of how transient this area is. People don't get to know each other. We want to be somewhere where we'd feel a bit more grounded, especially once we have kids. Right now we're thinking about moving to downtown DC. This would be a huge change for us but I think it would be exciting. We'd get to know the city better and E would have an easy time getting to work and more time with me. Since he's been working so hard (lately it's pretty normal for him to work 70+ hours a week) it would make his life much easier to have more time at home. We've always thought we'd like to build a house in the country, have some property, and deal with the commute in order to have peace and quiet and space at home. If we move downtown, we'll be able to see the other side of it and experience what that's like. And I'm always up for new experiences.

Don't mind me, it's just the Lupron talking

I've been taking Lupron for seven days now. So far it's gone well. The worst side effect has been the headaches. They start every day at around 2 in the afternoon and grow steadily worse until I go to bed. I'm very lucky that I don't have to deal with stress from work or school. I can lie down whenever I need to, do yoga, cook, and just focus on getting through this cycle.

The part I was most worried about - actually giving myself the injections - in reality has been the easiest. The first time I did it I sat there with the syringe pointed at my belly for 10 minutes before I finally got up the courage to plunge it in. I did it - and all I could think was, "Is that it?" The Lupron needle is so tiny that I barely feel it going in. The medication itself does sting for a while afterwards, but it's nothing terrible and I feel much better now about the prospect of giving myself heparin injections for nine months if I am lucky enough to become pregnant.

Other than the headaches, the only thing I can complain about is the mood swings. And really, Eric should be the one to complain about that. For a while he was puzzled every time I'd have an uncharacteristic outburst, but now he seems to be catching on to the fact that I'm going to be crazy as a loon for the next little while. He's been marvelous about everything so far.

I have a tentative calendar for how this cycle will go. Come on and follow the bouncing fertility ball with me!

Phase One: Ovarian Suppression
August 4-13 Lupron 10 units daily; Dexamethasone .5 mg daily

Phase Two: Ovulation Induction
August 14-24 Gonal-F 2 vials daily, Repronex 1 vial daily; Lupron 5 units daily; Doxycycline 100 mg daily (E will take this as well to prepare his sperm for ICSI); baby aspirin therapy
I'll be closely monitored during ovulation induction with daily visits to the RE for blood draws and ultrasounds.

Phase Three: Egg retrieval
August 25 I'll be under IV sedation (hallelujah!) while the doctor aspirates multiple eggs from my ovaries using a long needle.
Begin progesterone-in-oil injections; begin heparin injections.
E will give a sample of his sperm the same day, and the lab techs will combine a few of the good swimmers with a few of my eggs through ICSI (a procedure that has only existed for a few years in which a single sperm is injected with a needle directly into the egg. It is used in cases of severe male factor.)

Phase Four: Embryo Transfer
August 28-30 Depending on how well they develop, up to 3 embryos will be transferred into my uterus either 3 or 5 days after they are created in the lab.
Continue progesterone-in-oil and heparin injections.

Phase Five: Beta Test
September ? This is where we find out if it worked or not. If it did, I'll continue PIO and heparin shots; if not, we'll decide whether to go straight on to attempt #2 or take a break.

The really scary part is that anywhere along the way the whole thing could fall to pieces. I could be a poor responder and not produce enough eggs. I could produce too many eggs and develop OHSS (ovarian hyperstimulation syndrome) which can be very dangerous and result in a canceled cycle. Our embryos could fail to thrive in the lab. Or they could simply fail to implant after the transfer. As straightforward as the process seems to be, there is so much that could go wrong. Our chances of success are about as good as they possibly can be, but I'm doing my best to prepare myself for disappointment. I'm assuming we'll have to do this several times before succeeding. That way if it happens on the first try, I'll be pleasantly surprised.

And we're go!

Today is the official start of IVF/ICSI cycle number one. Yesterday I had a hysteroscopy to follow up on the D&C I had during my lap in June. They removed several polyps, and before we begin the IVF process we had to make sure those hadn't resurrected themselves. My first hysteroscopy was last October, and it was a breeze. I actually enjoyed it because the nurse turned the TV screen so that I could see the images they captured of inside my uterus. This time...all I can say is holy frijoles! As soon as the hysteroscope was in I had cramping like I've never experienced before (and I have endometriosis!) I think my innards were still sore from the lap/D&C because every time Dr. B moved the instrument it felt like she was stabbing me from the inside. Luckily the whole procedure was over in about 5 minutes.

Today I had my baseline ultrasound (date with the dildocam) to see if the birth control pills have suppressed my ovaries enough. They have, so Dr. B gave me the green light to begin Lupron injections tonight. That is, assuming my meds arrive today. They were supposed to come yesterday but there was a mix-up in shipping at Freedom Drug. The last person I spoke to assured me that I would receive them between 8:00 and 3:00 today, but it's now after 2 and there's no FedEx guy in sight. So we'll see what happens. I'm more than a little nervous about injecting myself; I'm trying to be a grown-up about it and mostly succeeding by forcing myself to think about other things.

The most surreal part of today's appointment was making out the check to the fertility center. We're participating in their shared-risk program, in which they require you to pay the full amount for 6 cycles up front. I won't shock you by mentioning amounts, but let's just say it'll be a long, long time before I write a check that large again.