Day 6: FOUR FROSTIES

We have FOUR frozen embryos!!! FOUR potentially healthy embryos that could grow into four potential babies! The two early blastocysts from yesterday continued to grow beautifully overnight and they were able to biopsy and freeze them this morning.

Original Photo came from here

I am so over the moon! The doctor said I responded so well that you can barely tell I'm a DOR/FXPOI patient :D It took a whoooole lot of meds, but it will be so, so worth it if these embryos are healthy. I need good chromosomes without Fragile X or trisomy problems.

Our breakdown for our first IVF cycle:

• 12 days of BCPs
• 3 days off
• 11.5 days of 600iu Menopur, 0.83mg Omnitrope, 1mg dexamethasone, 5 days of Cetrotide
• Novarel trigger - 10,000 HCG 

 This protocol resulted in:

• 14 follies
• 11 eggs retrieved
• 8 mature eggs fertilized
• 6 embryos
• 4 frozen day 5/6

My mild OHSS symptoms are starting to resolve today as well. I still got up to pee three times last night, but I think the swelling in my abdomen has gone down a little this morning which means the HCG must finally be leaving my system, I didn't test out the trigger since there was no reason but it would have been interesting to see how long it sticks around. Maybe I'll test it out next cycle to see if it really takes 10 days to get rid of it. The horrible acid reflux is also starting to go down, I don't feel like I'm going to throw up stomach acid, which is awesome. I know I got off a lot easier than many people do  so I'm not complaining.

Now, we need to do the whole thing alllll over again. The big question is, do we take a month off or start right back up with this upcoming period? I've been looking into it and research has shown there's a definite synergistic effect in back to back cycles, especially in really low AMH/DOR/Advanced maternal age patients.  The cumulative effect of both cycles ends up being greater than the sum of both cycles - if the med effect from cycle one is 2 and the med effect from cycle two is 2, the cumulative result is 5 instead of 4 in the second cycle. I think that's why Dr. D was leaning that way until I got 4 awesome embryos.

The wild card here would be cysts, last cycle I had the most stubborn follicular cysts on the planet that took two periods and two weeks of birth control to resolve. I don't know if I'll have them again this time since they aspirate the follies during my retrieval, which you'd think would mean no more cysts but who knows. It would definitely make the decision for me though, if I have cysts hanging around on my next CD2 baseline ultrasound, I have to take a cycle off.

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 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 :(

 

Getting Ready For My First Egg Retrieval!

According to this mornings blood draw, the HCG trigger was properly absorbed and I'm good to go for a Monday morning retrieval! I'm so excited/nervous/bloated/sore/tender that I don't know what to do with myself. Time seems to be crawling and flying by at the same time and I still can't button the jeans that were falling off my ass a week ago.

I never understood what people meant when they talked about sore ovaries and IVF bloating until now. I guess I never made enough eggs in my previous cycles for my ovaries to swell up like balloons but they're definitely there now. I'm not concerned about serious OHSS (Ovarian Hyper Stimulation Syndrome), it's definitely a mild case, but I look like I'm at least 6 months pregnant, it hurts to bend over and my lower back is tender too. I'm also peeing like crazy since I need to keep guzzling water to ward off OHSS. 

Mild OHSS usually comes with the following, per Mayo Clinic:

• Mild to moderate abdominal pain that may come and go - Check!
• Abdominal bloating or increased waist size - Check!
• Nausea - Check!
• Vomiting - No, thank goodness!
• Diarrhea - No, but I'd take it over the projected constipation O_O
• Tenderness in the area of your ovaries - Check!

Things don't get dicey until the pain and nausea/vomitting turn severe, you get dizzy and you start packing on 10lbs per day. While I probably look like I've gained 10lbs per day,  I'm definitely still in the normal-mild category. I'm ready to get these eggs out though so we can make some beautiful embryos!

Our trigger for this cycle was Novarel, which contains 10,000 units of HCG, way more than the 1,000 units in my last trigger, Ovidrel. Just think of the positive pregnancy tests I could get with this much HCG running through my system!

Stock photo since I used mine last night

I'm unclear as to why the manufacturer felt the need to include such a huge bottle of diluent. Even splitting it into multiple doses, I can't imagine any circumstance that would require 30mls of liquid. Since I was taking the whole dose, I used just 1cc of liquid with the powder and injected it into my belly at exactly 10:45pm.

Like the Menopur, this one is definitely a stinger. It burned going in and unlike my other injections, has had a lasting effect. My skin is red, hot, and tender even 18 hours later and I can't stand anything touching it.  Major ouchies.

I try to avoid posting photos of my bare flab, especially crazy bloated bare flab, in public places but I figured it was better to be honest about the reaction so other people know what to expect. The photo ended up washed out, but my reaction is red/purple, streaky, raised and hurts like a bitch. But again, it's unfortunately normal.

Since my retrieval is only hours away, I'm trying to get everything ready tonight. You're supposed to drink large quantities of sport drinks like Gatorade or Powerade, but since I'm not super into those, I'm going for PH water and other electrolyte infused waters. They're supposed to help flush the hormones out of your system so the OHSS symptoms don't get worse and go away quicker. You also have to watch out for super constipation from the anesthesia which I'm really, really hoping to avoid. That sounds like the last thing you'd want when you have tons of needle holes in your lady bits and ovaries.  I'm hoping tons of regular water, PH water, watermelon and soup are enough to ward off that unpleasant side effect.

I'm also prepping soft, stretchy clothes to wear tomorrow since my jeans feel awful and tight. I've got my lucky panties, rainbow cheetah print trimmed in hot pink lace that I've worn to all my IUIs and I'm thinking of upping the ante with new blue, puffer fish toe socks with googly eyes and pink glitter shoes. Now that's a lot of good luck :)

Since I'm still crazy hungry despite the incredible bloat, I think E and I are going to get some meaty take out for dinner. I'm craving steak like nobody's business and once midnight comes I'm cut off from food and water. 

Please send all the positive vibes, thoughts, prayers, and energy you can muster my way tomorrow morning. I've got everything crossed for these follicles to contain healthy, mature eggs that fertilize perfectly and turn into healthy, viable, Fragile X free embryos. I know that's a tall order but come on follies, I know you can do it! We need some healthy blasts!