Progester-Woah!

I went in for my progesterone draw this morning, fingers crossed that my progesterone decided to climb, at least a little. We had to go in early since the lab closes by 9:30am on Saturdays and I was moving extra slowly from the lingering shadow of a migraine. I had a feeling some head aches would be forthcoming from the hormones I started yesterday and they certainly didn't disappoint. After this many medicated cycles, it's pretty much a guarantee that high estrogen and progesterone will give me at least one migraine within the first 12 hours.

Still, I made it there in time and was finished with the draw in just a few minutes. I had gotten home, put in a new Endometrin and changed my pad (ew - I got lucky yesterday with a clean pad but last nights pill pretty much dissolved and fell out this morning. GROSS) and started prepping breakfast when the phone rang with results.

By today, they're looking for your progesterone to be 8 or above. Since mine was only 1.5 when they were looking for 2.0, I was a little worried it might still be low but all that anxiety, and the chocolate bunny head I ate, were for nothing! The nurse immediately said my progesterone looks great and told me my level was 15 today! This officially clears us for our Tuesday transfer and we're now just waiting on the lab to assign us our official time. Only 3 days to go until our frostie is home!

Gratuitous photo of Milou that a fellow agility student took today. Look at my lady rocking that tire :)

O is a Go!

More good news from this mornings appointment! It looks like my LH is surging right on time - it was 6 yesterday and jumped to 13.8 today so I am definitely ovulating. Estrogen was up to 219,  my progesterone was 0.7 so it should be getting ready to rise and my lining was nice and thick. This gives us a tentative transfer date of next Tuesday, the day after E's birthday. I should really find a way to be more articulate about how I feel but I keep circling back to a messy combination of anxious and excited that makes me want to cry. After almost 3 years, it feels like our take home baby is So Clos, even though I know we still have so far to go.

On Thursday I start the first of my medication - a Z Pack, Medrol and Baby Aspirin. The Medrol, a steroid that is supposed to help with implantation, is only for 4 days and the Z Pack, protection against infection since we're inserting something into my uterus and breaking the mucous barrier, is a 5 day course. I'm pretty sure the baby aspirin is also to help with implantation by improving blood flow and I might take that a bit longer.

Still a lot of meds for a natural transfer

The next appointment will be Friday to check in on my progesterone and make sure it's rising appropriately. Then I'll be starting the Estrace (estrogen) and Endometrin (progesterone) that I'll take for the first 12 weeks of pregnancy. My clinic also prescribes Naproxen for the day of transfer, it's actually not a pregnancy safe drug but it prevents uterine contractions that can push the embryo out of the uterus. Since I'll only be taking it that day, before our little embie has implanted, it shouldn't have any effect on them.

Just typing this out I'm so excited and nervous I think I might throw up. By this time next week I'll have our embryo on board, crossing everything and praying to the universe and any deities out there that this little one sticks!

It's On Lupron!

Everything looked nice and quiet at this mornings ultrasound, the birth control pills have done their job, and I was cleared to start Lupron! I did my first injection this evening and it was exactly as I had expected, barely worth the stick.

Lupron Kit

This time I'm using a multi-dose vial with no mixing (yay!) so I'll be drawing from the same vial for the next 15 or so days. Like the HGH, the Lupron needs to be stored in the fridge and I'll be injecting with teensy little insulin syringes.

I will be on 10 units of Lupron and birth control pills for the next 5 days and then just Lupron for a couple days after. My period should show up in the couple days after I've stopped the pills, I'll have yet another ultrasound, and then should be allowed to start Estrace with the lower dose of Lupron.

See how tiny? 10 units to start and then down to 5 units.

One step closer to transfer, one step closer to getting this frostie home. I know it's dangerous to get my hopes up but I keep having vivid dreams about this baby being delivered, growing up. I'm already so attached, I don't think I could bare to lose this frostie baby so they had better settle in for the long haul

Day 5: Mature Morulas

We got a call this morning saying that our embryos were still plugging along, growing well, but weren't quite ready for biopsy. When the embryologist checked on them in the morning they were super mature morulas, right at the end of the morula stage and the beginning of the blastocyst stage.

Ideally, we want the embryos to be nice, expanded blastocysts before they're biopsied so you can get a really clear distinction between what will be baby and what will be placenta so Dr. D and the embryologist have opted to let them grow another day. It occurred to me after the phone call that we also did our retrieval a lot later this time, several hours later than our first one, so these embryos are actually a little younger on day 5. They might have been nice blasts if they were checked in the evening instead of the morning so I'm staying positive and not getting discouraged.

I'm also pretty sure that if they were going to arrest they would have done so already, but I'm not ready to celebrate just yet. They still need to clear this last hurdle though I'm really optimistic now that they can do it. Grow embies, grow!

Day 4: Wishing, Hoping, Itching

Today is day 4 of our embryo's growth and following the traditional protocol, we did not get an update. I'm choosing to take this as a good sign since I'm fairly sure they would have let us know if something happened to our embie babies today. One of the women in my online PGD support group also had two embryos growing at the same time as mine and she lost both of them on day 4. I'm so crushed for her and am now even more worried for our two, this is such a big jump for them to make.

I'm hoping that our next update will be tomorrow, but there's a chance we won't hear from Dr. D until Monday. Last cycle we had 2 embryos biopsied day 5 and 2 biopsied day 6 so these two could be ready on either day. My nerves seriously hope they're healthy and ready for biopsy/freeze tomorrow because I can't take much more of this waiting.

In other news, I haven't been reporting too much on recovery but I'm doing okay. I had so few eggs that I didn't get OHSS this time and only needed some Advil/Tylenol for the first couple days. I've taken an odd one here or there for a hormone headache and some muscle aches as everything returns to normal but overall it's been a pretty uneventful recovery. They didn't even need to give me Fentanyl after the retrieval, just two Tylenol and a hot blanket on my belly. Mostly I'm just exhausted, like can't keep myself awake tired, have to pee all the time and am still crazy bloated. I've been sustaining myself on a diet of Matzo Ball soup (thank you E for repeatedly playing delivery man) and Gatorade/Electrolyte water and feel like I have the flu.

Cillian takes advantage of my exhaustion and bloated pillow belly to get in a good nap

My most obnoxious complaint is probably the bruise on my hand from my IV. The nurse, who was quite experienced and really nice, had to try twice to get my IV in. She tried first on my right hand, which is usually my good one, numbed it up with lidocaine and popped in the IV needle. The needle went in correctly but she was right up against a valve so the catheter couldn't go into the vein. She tried to apply some gentle pressure to open it and then tried to float the catheter in but neither worked. She ended up taking it out and going for my left hand, where she repeated the process and the IV catheter went right in. That site doesn't hurt at all and didn't bruise but my right hand has this nasty, deep bruise that has been surprisingly painful. It was really bad the first day, definitely worse than my sore ovaries, and the bruise is still there and still tender today.

My other big complaint is that somehow, the hivey rash has returned to my stomach. This leads me to believe that I had two separate rashes last time - hives on my belly from the medication, and an allergic rash to E's shaving cream on my bikini line. They were there at the same time so I assumed they were connected but apparently not. The new rash is pretty close to where the old one was on my belly, a little lower, and has to be related to the hormone injections. Just like previous flare up, it itches like a bitch and I have to keep compressing Yin Care, slathering on Cortisone cream and pouring on Benadryl.  Maybe it's related to falling or rising hormone levels or a reaction to the HCG (please don't let this happen when I'm pregnant!) but whatever it is, I really wish it would take a hike.

The Rash Strikes Back!

Just one more day to get through. One more day and then we can move on to testing, find out that all our embryos are magically healthy and perfect and we can start putting them back where they belong. If we're able to do a successful FET in early December we could be bringing home one of these fighter embryos as a baby at the end of August. I hope, I hope, I hope, come on embryos, you can do it. 

Day 3: Quality Over Quantity

Every time I get the morning update I'm floored by how lucky we're getting with our two little embryos. Amazingly, here we are at day 3, and both little fighters look perfect. They are 8 cells each and according to the embryologist, are the highest quality possible. This means that their cells are even and regular, all the same size, and that they have no fragmentation. In short, they look like this:

High Quality Day 3 Embryo

I'm really starting to feel hopeful that these could be our babies. On day 3 last cycle we had 7 embryos - our 4 strong ones that became our frosties, 2 weaker ones that eventually didn't make it and one super slow grower that fizzled out. At this point, those two weaker ones and the tiny one lagging were already noticeably behind the main 4, not so behind as to count them out completely, but not looking fabulous. It gives me hope that our 4 that were growing well continued to grow well, we just need these two to follow suit.

Just twoish more days to go now. Days 4 and 5/6 are the hardest for the embryos, they need to make the big leap from simple cell division to compacting and differentiating. I know this has been a really disheartening and crummy cycle, but these little fighters are strong and I feel like they're going to make it. Come on babies, grow, grow, grow!

Day 2: Cautiously Hopeful

I've been having a really tough time staying positive and hopeful for our two little embies. So much is riding on these little guys making it that it's impossible for me to not be scared of a poor outcome.

Somehow, it appears that our embryos are taking a much more positive outlook on things. The embryologist was feeling quite sorry for us and all our empty follicles, so even though he doesn't usually do a day two check, he decided to look in and see how our embies are growing. The results were really encouraging, both embies appear to be high quality and they're growing strong and even. One was already 5 cells at day 2 and the other was just behind it with 4 cells. At this point last time we had some embryos that were only 2 cells so a 5 and a 4 are really wonderful.

I know I've mentioned before that E and I originally decided to just do two IVF cycles before turning to donor eggs. That plan was based largely on cost, each cycle is $20,000 and two is already an incredible amount of money. But then we had this cycle, and it was so far off that I think E is having to come around a little to the idea that we might need a third.

E has a hard time watching me go through these cycles, even though I think I do pretty darn well with fairly minimal side effects. Watching my stomach bloat up like a balloon and seeing it covered in bruises from all those tiny needles upsets him and he's been pretty set on just two cycles till now. After I woke up in recovery it took a little while for Dr. D to come out and give us our count. I know now it's because he was asking the embryologist to check and double check for more eggs but at the time we were expecting good news. It's hard to remember what happened once he told us we only got two eggs, the anesthesia makes you a bit foggy for a little while, but I know I cursed, turned to E and he told me not to worry, that nothing was off the table at this point and that we'd do whatever needed to be done.

Still, if we do need a third, I don't know where I'm going to find another $20,000.  Before all of this we were saving to buy our first house which is no easy feat in Los Angeles where a tiny two bedroom 900 square foot place runs 600k+. This is another one of those moments where I so, so wish that our insurance would cover IVF, I feel like there would be so much less pressure if we could just focus on the medicine instead of the price tag.

Day 1: Disappearing Eggs

We went into my retrieval yesterday expecting to get at least five mature eggs. Instead, we got two.

Two?

Two :(

Dr. D aspirated and flushed each follicle. They were all still puffy, filled with fluid and drained well. No signs that I could have ovulated early. A mature egg puts out at least 200 units of estrogen and my estrogen was over 1500, an excellent number for all those follicles. So where were they?

Dr. D was so surprised when the lab said two that he asked them to double check the tubes. There's no way I only had two, estrogen doesn't just come out of nowehere, the eggs had to be there. E and I are crushed :( 

I know there are no guarantees with IVF, every step of the process is an exercise in hope, patience and superstition and sometimes things just happen. But where did my eggs go? We know they were there, we have the estrogen has proof of their existence, but they just disappeared. It's like seeing the smoke but you can't find the fire. Dr. D says this happens in less than 1% of cases and he doesn't know what could have caused it. The eggs should have been there.

Our minimum number for proceeding with the PGD testing is six. We need six healthy blasts before it's worth using our PGD coverage and aCGH testing (~$10,000). We really wanted eight but figured just in case, six is still an okay number.

I paced around all morning feeling sick and holding the phone and finally got the call from Dr. D that both of our eggs fertilized. Thank goodness they still have a chance. If both of these little fighters make it, we can proceed with testing. If they don't we're going to need to do another IVF cycle but I have no idea how we're going to pull that off. 

Come on little embies, you can do it. The first step is done, now you just need to grow, grow, grow. 

Day 5: TWO Frosties!

It's only 11am here but we've already had a crazy, stressful morning. My phone apparently rang at 7am but E and I were both sound asleep and I didn't hear it. Waking up 3 times a night to pee is exhausting -_- Then E's phone rang a minute later, and we woke up just in time to hear the end of the call vibrating on the night stand. Fully awake now, I jumped out of bed and recognized the number as belonging to the ART center currently in possession of our embryos. Our updates come from Dr. D at a different number so it was really unusual to get contacted directly by the lab.

I called them back right away and got a somewhat frantic woman on the phone - apparently they never sent us the correct paperwork to sign for PGD consent! They can't biopsy our embryos without this paperwork, we're holding up the embryos and she was worried we might be on vacation or might not have a scanner or printer and she wouldn't be able to get a hold of us. Ahhhh!

Luckily we do have a printer/scanner and we've been waiting on tenderhooks for embryo updates so there's no way we'd be far from home right now. She emailed me the paperwork straight away and E and I quickly signed and initialed another 20 pages, scanned them in and emailed them back to her. Phew. This was not the start I was hoping for this morning but I'm glad she caught the oversight in time.

Knowing that we now had at least one embryo to biopsy (!!!) I carried my phone around with me all morning until 9:30 rolled around and Dr. D called! He said that out of the 6 embryos at our last update, TWO were now hatching blastocysts that were being biopsied and frozen! YESSS!!! Two more are early blastocysts this morning so baring any problems, they should be ready to biopsy and freeze tomorrow! Ahh!!!  I know we're not supposed to count our embryos before they're hatched, but we have a very real shot of having FOUR embryos on ice to test!

Original Photo came from here

I am so, so excited for these embryos. There's a good chance that our baby could be one of those hatching blasts in the freezer Right Now. Now we need to decide if we should take a month off or start our next IVF cycle straight away with this upcoming period. It should be starting in about a week or so, maybe a little more or less. If there is any benefit at all to doing back to back cycles I am ready to go and I will stick myself with all the needles all over again. Dr. D said my OHSS symptoms, primarily the fluid retention that is causing all the discomfort, should start to go away when the trigger leaves my system which is about 7-10 days after taking it. Today makes 7 days so I should start feeling better in the next 3 days which is awesome. If there's any lingering discomfort, the 12 days of birth control should take care of it and by the time I start stimming again, I should be feeling normal.

I have heard before that there may be some benefit to back to back cycles and Dr. D seems to be leaning in that direction as long as I feel good. If that is the case, we're repeating the same protocol and I'll need to place my next order with IVFMeds.com straight away.

Please send good thoughts to my two little early blasts, they need all the positive vibes/thoughts and prayers they can get to grow up and hatch tomorrow!

Day 4: Acupuncture and Patience

Today, I'm finding it difficult to be patient. We don't get an update on our embryos and I know they're in the most difficult phase of growth where many embryos are often lost. Last we heard, four were doing very well with 7-8 nice, even blastomeres (cells) and two were growing nicely but a little slower with only 6 nice, even blastomeres.

On day 4, we need those embryos to be in the Morula stage, the last phase before they grow into blastocysts, form the blastocoel (fluid filled cavity) and start differentiating cells. Today, and possibly tomorrow if they're slow growers, they should have between 10 and 30 cells.  They might even have begun compacting like the embryo below, which is where the cells start squishing together like the embryo below.

Nice quality Morula

Hopefully they'll make it through the morula stage and grow into nice blastocysts tomorrow. If they're not quite there yet it's still okay as long as they're progressing. They'll be allowed to grow to day 6 when plenty of embryos are frozen and I probably won't sleep until we get the call. As blastocysts, they should be dividing into the inner cell mass (ICM), the Trophectoderm (TE) and the blastocoel (fluid cavity), which gets bigger as the embryo expands.

Nice Blastocyst

We need good cell differentiation to get a clean biopsy of the embryos for PGD. They need to sneak some cells out of the TE on the side there, the cells that will become the placenta, so we can test the fetal DNA for abnormalities.

Since there's nothing I can do to help my embryos grow, my distraction for today was a much needed acupuncture appointment. I haven't been since my retrieval and it's supposed to really help with recovery and the symptoms of OHSS. I laid down on the table, S took one look at my belly and said "Oh boy, you're definitely hyper stimulated". Clearly other people think I look 6 months pregnant too.

I already knew that I probably had OHSS but it's still a bummer to have it confirmed by a nurse. I also woke up sore this morning, my hamstrings and back felt like I'd worked out, and S said it's because of all the fluid I'm retaining. The fluid is responsible for my bloat, my repeated peeing, the heart burn and now the muscle soreness. Oh the joys of IVF.

Dr. D's nurse also called today to ask us about aCGH testing for our embryos and to see how I'm doing. I told her we'd probably base our decision for chromosome testing on the number of embryos we get, our lab doesn't really need an answer until they have all of our biopsy samples but as long as we get a good amount from each cycle I think we'll probably go ahead and add it on. If we only end up with a couple of embryos from each cycle, I'm not sure if it's worth doing, but if we get six lovely frosties each time I'd say it's worth the extra $2500.

As for next cycle and the crazy bloating, she said Dr. D usually takes a "flush" cycle in between IVF cycles to allow all the hormones to flush out of your system. It would also give me a good amount of time to order my meds from IVFMeds.com so I wouldn't be doing things so last minute. She made a note for Dr. D to chat with me about it tomorrow when he calls with our embryo update, so I'll probably be holding my breath until the phone rings tomorrow morning. I so, so hope our six embryos are doing well, I worked so hard for them and I won't be able to relax until they're safely biopsied and frozen.

Day 3: Growth Report

We got our growth report this morning and our embryos are still dividing! We have 4 that look really good with nice, even cell division and 2 that look good but are growing a touch slower. We also have 1 that fertilized but is pretty far behind the others with only 2 cells so we're not sure if that little guy can catch up. E is calling it our runt, Wilbur, but I don't think there's any chance of him catching up.

Original Photo came from here

I talked to Dr. D about our next cycle and he thinks we're on track to start in about 6 weeks. I didn't get to really clarify what that means since I later realized it could mean taking a month off or not taking a month off. If I get my period in about 2 weeks, then go on birth control for about 2 weeks, then stim for about 2 weeks, that's 6 weeks right there. I was asking if we'd take 6 weeks off doing nothing before starting the next cycle but I don't think I got that across. I'll have to bring it up again another time.

I also asked about the crazy bloating which he said is probably from the HCG as well as the estrogen. He said I should expect it to stick around in my system for at least 10 days so I don't see this belly going down anytime soon. I have no illusions about the physical side effects of infertility and the IVF process but it would be nice if I could save some growth for a baby.

As far as recovery goes, I'm feeling a bit crappier today than yesterday. I'm still only mildly sore but I have a weird nauseous/imminent cold feeling that probably wasn't helped by the fact that I woke up every 2 hours to pee and didn't get great sleep. I'm not sure where I could have picked up a cold since I've been taking it pretty easy and not going anywhere but I can definitely feel it hovering at the edges of my throat. Hopefully it's just the hormones because I can not get sick right before our next cycle.

Day 2: Recovery

Thus far I think I've been pretty lucky with my recovery. I'm still good with just a couple Tylenol or Advil every 4-6 hours and if I don't take it, there's only a minor ache of discomfort. I never really had any bleeding, nausea, constipation, or serious pain. I know every egg retrieval is different and I don't want to jinx it for next cycle, but I hope I can get off this easy next time. Maybe it's my reward for having such a shot heavy stim cycle :)

The two symptoms I am experiencing at the moment are two I could definitely do without. For starters, I'm still super, super bloated and uncomfortable with a belly the size of a watermelon. Possibly even more bloated now than on retrieval day.  I haven't tried to wear my jeans yet but I doubt they'd button comfortably right now, even my loose jeans would cut right across my ovaries. This is probably still mild OHSS so I've just got to grin and bear it and hope it goes down.

In the same category, my grapefruit sized ovaries must be pushing on all sorts of things because I'm getting awful heart burn. No matter what I eat or how I sit, I have the worst acid indigestion. This is another one of those things you just have to wait out, so I'm popping Gaviscon like candy and hoping that it passes quickly. I just ran through my last bottle so getting more is first on my list of things to do tomorrow.

My secret weapon

For anyone else getting ready for an egg retrieval, I absolutely think that the crazy amount of water I've been drinking has played a big role in why I've felt okay. I drank 100-150oz the day before the retrieval and another 100-150oz the day of. I've been drinking at least 100oz a day since and despite the anesthesia, it's probably physically impossible to be constipated with that much water in your system. I know a lot of clinics push laxatives after a retrieval but I prefer to avoid that stuff if I can. In this case, I think the water is a pretty viable alternative. Plus, peeing every 10 minutes, while also tied to OHSS, helps clear the extra hormones out of your system which should mean less bloat and misery. I'm still sleeping with my feet up on a pile of pillows as well, which is supposed to help all the excess fluid drain.

The acupuncture has probably also played a roll. Even the regular treatments that just keep all your energy and such flowing normally can really help with clearing out your system. The surgery center was a little weird about herbs so I stopped drinking my herbs a couple days before the retrieval and I just started back up again today with my acupuncturist's blessing.

The embryologists try not to bother the embryos on days 2 and 4 so I sadly didn't get an update on my embies growth today. They should be growing and dividing with at least 4 cells so that they can reach 6-8 cells tomorrow. I'm on pins and needles waiting for tomorrows phone call and I'm hoping and praying that all six are still growing well.

 

Original Photo came from here

ETA: I totally forgot to talk about boobs! My boobs are SO SORE. They feel awful if I'm not wearing a bra, which luckily is almost never since they're on the gigantic side and I never go braless. This is probably from all the hormones too and just another thing I have to wait out :(

 

Day 1: Fertilization Report

Dr. D called this morning to give us the news that we now have SIX wonderful looking embryos. I was getting kind of starry eyed there for a bit, dreaming about having 11 embryos, but I'm very, very happy with our six.

Out of the eleven, 3 ended up being too immature/small to fertilize, leaving 8 good mature eggs, and 2 of those 8 don't look fabulous after fertilization, giving us the 6. The six all fertilized quickly and easily and are looking really good thus far. Dr. D said getting 80% of the mature eggs to fertilize is very good and I'm really excited for these six. Our next report will be on day 3 when we should be seeing 6-8 cells in each embryo. 

Original Photo came from here

As far as recovery goes, I'm doing better than I expected. I heard all sorts of horror stories about people being in terrible pain after a retrieval and I've been extremely lucky that that hasn't been my experience. I took two Tylenol around 1am and went to sleep with my feet on a big pile of pillows to try and help the bloat go down. Aside from getting up at 1:30, 2:30 and 5:00am to pee, I slept pretty well.

When I finally woke up, it was to the sensation of cramping and stabbing, but in my stomach not my ovaries. My first thought was:

"oh nooooo, is this the god awful constipation everyone talks about??? Noooo do not want!"

Ten seconds later I realized they weren't. Nope. Not even close. They were actually hunger pains! Apparently my body has not caught up to the fact that it's no longer feeding 11 protein leeching follicles and I'm still starving and craving soup. I did end up being a little constipated later but it wasn't anything like people had described, it did not make me feel like my ovaries were going to die and fall out, so clearly guzzling all this water is helping.  I'm averaging somewhere between 100-150 ounces a day of PH/electrolyte water, 2-3 of the big bottles from Whole Foods, and I have a couple more left to get me through today. 

I took two more Tylenol around 9am just in case and Dr. D told me to take it easy today. Since I inhaled all the Matzo ball soup E brought me yesterday, my first trip out of the house was to Factor's Deli to get two more Matzo ball soups. I'm pretty sure E thinks I'm a little crazy but it's nice to be craving the stuff I'm actually supposed to be eating. Clear, salty broth and protein is exactly what the doctor ordered, and as long as it continues to help, who am I to disagree??