November 30, 2015



Well, I hope I still am anyway. On Thanksgiving Day, our doctor called to let us know that all 7 little eggs were still alive and well, although a few were growing slower than the others - including one that was a full day behind the others despite obviously having been fertilized at exactly the same time as his siblings. ::cue suspicious side-eye at my already-falling-behind potential offspring::

But the good news was that all 7 were still growing, and the very good news was that one had developed into a Grade A blastocyst, looking excellent for transfer.

This is typically the next inflection point, when you and your doctor decide *how many* blasts to transfer. A lot of it depends on the woman's age and the quality of the blastocysts you have to work with. I have a friend whose doctor advised she put in two. She countered that she really really did not want twins. The doctor replied yes, I know: we need to put in two to get you one.  (So she put in two, and now has one healthy baby!) Apparently, women over.. I forget the exact age now, 37 maybe? 38? are also frequently advised to start with at least two.

The reason for this is you do increase your overall chance at getting pregnant (with one baby) as you add in eggs, especially as you get older. In our situation, we had a 5% greater chance of coming away with a baby if we put in two.

....and a 40% increased chance of having twins.

So we swiftly and happily agreed to put in just the one good-looking blastocyst, and freeze any others that looked viable.

The transfer is quick and painless, and SUPER COOL. The room they had me in opened on one side to the waiting room, and on one side directly into the lab. Once they had me all set up (nether bits a-flappin') they opened the door to the lab and called out "ready for [my last name]!". A screen just above the sonogram screen illuminated with a view from the technician's microscope, which first showed my name and D.O.B to (re-)confirm the proper embryo, then actually pulled up a view of the exact blastocyst they were about to transfer (!!!). Meanwhile, a tech in the room pulled up a sonogram of my abdomen with a clear picture of my uterus, and I watched (right on the screen!) as the doctor inserted a tiny catheter right into my uterus. The lab tech popped in with a syringe containing my blast, and then we all watched as a tiny flash of light squirted out the end of the catheter right into my uterus. (The blastocyst is far too small to see with the naked eye, but it's in some liquid, and that's what you could see on the sonogram.)

Oh, and for the transfer? No one in the room can wear any scents, like perfume or scented lotion. Because smells *agitate the embryos* during the brief period they're out in the open. Isn't that weird / cool / amazing / crazy!?

So now, hopefully, that little blast is digging into my lining, getting nice and cozy, and setting up shop. On Saturday they called to let me know that of the remaining 6 embryos, 4 had looked good enough to freeze. So that's really fabulous news too - it's a huge relief to know that even if this doesn't work, we have a few more tries available to us without having to go whole hog with an entire course of injectables and another retrieval.

And for now... I wait. I'm still on the estrogen and progesterone, which thankfully stopped causing nausea after the first day, and are now onto generating super crazy, novel-worthy weird dreams every night. And even better, I FINALLY have started to de-bloat and - perhaps TMI, but I think we've long passed that point - things have started.. ahem.. moving in that region as well. The worst side effect for me by far was well over 2 weeks of going poopless. That is NOT COMFORTABLE, people. But I went nuclear on the situation during the days between retrieval and transfer with some serious laxative action, and I am OVERJOYED to report that although it took a few days, Things Are Now Much Better.

So! One blastocyst, hopefully enjoying its new surroundings, and no updates for LIKE EVER, aka the dreaded two week wait.

::drums fingers::

::whistles tunelessly::

::repeats for 13 days::

November 23, 2015

Retrieval update!

So! Saturday was the big day: egg retrieval. So far, it's been by far the most taxing part of this process for me. The procedure itself was as quick and sedated as advertised, but recovery has been surprisingly challenging. I guess I figured since I've been so low on the side effects ladder so far, I'd bounce back from this easily as well (...assuming no OHSS!). And I should clarify, by "challenging" I still don't actually mean "awful" - I'm typing this from work, I'm not on prescription pain meds or anything - just, well... I guess I didn't know what to expect. So I don't want to oversell the awfulness of this, just the surprising nature of it.

As it stands, I'm pretty sure I've avoided any symptoms of moderate or severe OHSS so far, which I am REALLY GRATEFUL for. I have been obsessively weighing myself, and I am pleased/relieved to report that I am NOT gaining weight due to fluid retention, and I am peeing an entirely appropriate amount in relation to my liquid consumption. But man oh man, my abdomen is SORE. I was crazy bloated on both Saturday and Sunday (I mean, I was already super bloated leading up to the retrieval, and additional bloating from having people muck around with your ovaries is to be expected.) At this point, the bloating has gone down somewhat, but my entire abdomen is awfully sore and tender. You know the feeling after having food poisoning, where your guts feel like they've been physically wrung out and it leaves you aching and sore? This feeling is very similar. Except I'm also sore even to the touch - I can't abide having a cat walk across my belly right now, for example. They prescribed me Percocet, but while this is very uncomfortable, it's definitely not in the narcotic pain reliever realm, and I'm fine taking the edge off with regular Tylenol.

I spent virtually all day yesterday recuperating on the couch. The cats helped. 

I also started estrogen and progesterone supplements yesterday, to get my body all amped up and ready to be pregnant. The estrogen is a wee pill that I pop twice a day, whereas the progesterone is *awesome* to administer... in that I have to jam it up my hooch. Seriously. It's a vaginal suppository. It's very dignified. And I get to do that 3x/day! The other bummer is that I think it's making me pretty nauseated, which is lame. I am allowed to eat and drink whatever I want for the next few days (aka BOOZE) and right now I am hardly interested in even the occasional sip of water. So, hoping that chills out today and I can go full glutton by Thanksgiving.

But, back to the retrieval itself! The process itself is kind of fascinating. This is the only procedure that I was knocked out for, and that's due to the method used to extract the eggs: they get you all set up in the standard ob/gyn chair (aka thighs spread and nether bits waving in the wind) then knock you out... so that they can stick a big ol' needle THROUGH YOUR VAGINAL WALL into the ovary and suck out each egg that way. Then they repeat it on the other side. I am more than pleased to not have been awake for that.

It only takes about 15-30 minutes, depending on how many eggs you have, and then they bring you back out and wake you up, and let you know immediately how many eggs they were able to retrieve. I was surprised to learn they "only" got 9 from me. I put only in quotes, because don't get me wrong, 9 is a GREAT number and I am thrilled to have that many to work with. I was surprised though, because.. uh... what the hell were all those other follicles doing!? Why bother getting all hot & bothered (and swollen!) with all those lame follicles, OVARIES, if you weren't even going to produce eggs!?

But putting that aside, 9 is fantastic. They called yesterday with my first update, which was that of those nine, 8 were fully mature (yay!) and of those eight, 7 successfully fertilized (double yay!). They'll call again today with the Day 2 update, to see how many of the 7 continued dividing away overnight, then they'll let the remaining embryos alone for the following two days to let them grow and divide in peace. I'll find out pre-transfer how many made it to blastocyst stage.

So for now, I just mentally encourage my 7 embryos to keep on keepin' on, encourage my body to remain OHSS-free, hope for a morning appointment for my Thanksgiving Day transfer, and hope that all turkey baster activities go well on Thursday :)

November 20, 2015

Trigger happy

I've triggered!

...meaning, at 2am last night, I woke up and jabbed myself with yet another medication. This one is to "trigger" the final maturation process of the eggs. Before the eggs are released during natural ovulation, they go through meiosis to halve their chromosomes from 46 to 23, and that's what this trigger shot does for me via SCIENCE! instead.

The tricky thing is, ovulation will naturally occur between ~38-42 hours after this process, so the timing of the trigger shot is VERY SPECIFIC so they can schedule the egg retrieval for exactly 36 hours after you administer the shot, and catch as many perfectly mature eggs as possible right before they would normally be released during ovulation.

And seeing as my retrieval is scheduled for 2pm on Saturday... my trigger shot was at 2am last night.

They are SUPER SERIOUS about the timing of this shot, and were at great pains to impart on me how crucial it is to administer the shot at the EXACT RIGHT TIME, no seriously literally THAT TIME EXACTLY, we cannot stress how important it is (and given the window with which we're working, it's easy to see why). But that means I was in turn SUPER STRESSED about sleeping through my 2am shot time. I set two alarms to try to put my mind at ease. It did not work. I dozed fitfully, waking up in about panic about once an hour, sure I'd missed my trigger time. When I did it again at 1:30, I gave up and just waited in bed until 2 at that point.

...and then got up at 6:30 to have one more blood test done at the office before work this morning. I'm a wee bit groggy.

I also spent all day yesterday frenetically googling signs, symptoms, and prevention tactics for OHSS, because once I started googling, I rapidly terrified the pants off of myself with horror stories, which led to more googling to figure out how I could make this NOT HAPPEN OMFG. And guess what! There is absolutely nothing you can do to prevent it! If it's going to happen, it's going to happen, and you can only try to treat it once you have it! HOW REASSURING!

(Quick recap of OHSS, or ovarian hyper-stimulation syndrome: after egg retrieval, your now-empty follicles often fill with fluid, which causes your already swollen and tender ovaries to swell even more. This kicks off a chain reaction of events that can be "just" painful abdominal bloat and swelling, or can cartwheel into fluid leaking into your abdominal cavity and even start collecting around your lungs because your blood vessels become "leaky", which in turn leads to severe dehydration because any fluids you consume just leak out of your blood vessels into the now-giant collection in your distended abdomen OMFG.)

SO. Having the doctor sort of offhandedly mention that my follicle count + hormone levels might put me at risk for OHSS, but the next move is everyone just sort of shrugs and hopes it doesn't happen? I'm not usually inclined to be a hypochondriac, but this is freaking my shit out. Last night I ate pho for dinner (hydrating but with salt and protein! both of which are supposed to help suck fluids back into the rest of your body should your veins get leaky!) and bought a scale for the first time in my life, so that I can weigh myself daily to ensure I am not rapidly gaining weight due to IMMINENT DEATH fluid accumulation. And I mean, I fully realize it's all just to make myself feel better in the face of something I have no control over, but I'm still going to eat the hell out of some salty food, hydrate with gatorade, and stock up on protein bars.

On the cheerier side of things, because I *am* at risk for OHSS, they had me trigger with Lupron instead of HcG which should absolutely help the situation. And I don't know whether it's the Lupron trigger specifically, or just the fact that I stopped stimming with the other meds, but I feel WAY better today. Yesterday I had gotten to the point where I had to slowly waddle, with my arms clasped around my midsection, because walking was too "bouncy" for my ovaries to take. Today I feel great! Much less pain, and can walk like a normal human again! (I - of course - also had to google whether THIS was okay, or meant that my ovaries had already, like, shut down or ovulated or something, but it seems this sometimes happens and hopefully I should just enjoy the respite while I can.)

So. Assuming I stay OK, and assuming they are able to get some mature eggs at the retrieval, and assuming some of those are able to fertilize, and assuming some of THOSE make it to day 5... I'm looking at a Thanksgiving Day transfer.

We'll be putting both a turkey and a bun in the oven, with any luck ;-)

November 18, 2015

Simmer down

Two days ago I started a third daily injection, Cetrotide, which is used to prevent ovulation (since we don't want my body blithely releasing all of these eggs into the wild after working so hard to grow them). I take this injection in the morning, which on the one hand is nice, because I don't have to give myself three shots at once this way, but on the other hand... I am not at my sharpest, first thing in the morning. This is one of the slightly more complicated shots - while the syringe comes pre-loaded with fluid, you first attach a mixing needle (thicker gauge) to the syringe to transfer the fluid to a vial with the powdered medication, then carefully pull the mixed medication back up through that needle into the syringe, change out the needle for a smaller injection needle, and have at it.

This morning, I carefully attached the first needle, blearily wondered why I was having such a hard time getting the meds back up into the syringe, discarded the first needle... and then realized I had used the injection needle to mix the meds - and then thrown that needle away. Whoops. And there was no chance in hell I was using the giant mixing needle to stab myself. Interestingly, even though I've been giving myself two injections a day for over a week now, my body seems more offended by the Cetrotide than the other meds - I've bruised every time I've injected the Cetrotide (which has not happened with any of the other 20 (!) injections) and I get an itchy, hive-like rash at the injection site. It goes away in about an hour, but the bruises stay. Things are starting to look a little sad on my (increasingly bloat-puffed) midsection.

However, more concerning for me right now are my hormone levels. I'm now at daily appointments for a wand up the hooha to check on follicle number and size, plus a daily blood draw to check hormone levels. My estrogen jumped like 1000.. uh.. points? numbers? between Sunday and Tuesday and I'm now over 2,000. I have several follicles measuring around the 18mm mark, and I believe we're shooting for about 20mm, so I need another day or two of growth. But if my estrogen gets over 3,000, added to the fact that I seem to have a fairly large clutch of eggs percolating, they might be hesitant to do an embryo transfer at all due to the risk of OHSS while my hormones are so exuberant. The HCG my body would produce if the transfer resulted in a pregnancy could cause me to overstimulate, which they definitely do not want. Which means that there is now a possibility that I will not have a transfer next week at all. Which freaking sucks.

Nothing I can do about it, though. If my numbers are too high, they will freeze all of the viable embryos that they get from this cycle and we'd have to delay until a new cycle - I don't even know what the timing would look like in that scenario. For now, I wait for my daily call from my nurse with today's results and go from there.

Edit: I found the following article while manically googling acceptable estrogen levels during an IVF cycle, which was helpful - according to various women in various IVF forums, they were reporting levels of 10k or higher (!?) and still doing transfers. This post offers some clear & insightful data on exact numbers with studies & results. 

November 16, 2015

Me + prune juice 4EVA

Eight days down! And things are starting to get awfully uncomfortable in the ovary region.

It's weird how this process gives you SO MUCH information, and at the same time still leaves you guessing so much. I'm going in every other day for bloodwork and sonograms at this point, but I still don't *really* know how the cycle is going. They call me after each appointment to check in and give me my dosages for the next few days (they set up a protocol with your meds and dosages up front, but based on these frequent monitoring sessions it's not uncommon for the med dosage to be tweaked mid-stream if things are not progressing at the ideal rate) and so far there has been no change to my prescribed protocol.

One of the few concrete data points I have access to is the number of follicles I'm working with. Except each time I go in, I get a different count. (In general, more follicles = good, because you want to start with as many viable eggs as possible. However, TOO many follicles = bad, apparently; you can end up with lower quality eggs if you have too many, and/or you're at higher risk for a fairly alarming condition called ovarian hyperstimulation syndrome, which can at the very least cause you some intense discomfort, but can also force a delay in the process where they need your body to calm the hell down before they'll put an embryo in, or worst case can even lead to hospitalization.)

ANYWAY. At my very first appointment to start this cycle, they counted 9 follicles in each ovary. Which is good! 18 is a decent showing. But at my Friday appointment, the nurse only counted 6 on each side, which seemed to me like an alarming drop, but the nurse didn't seem troubled by it. Then yesterday, they counted 10 on one side and 12 on the other. Follicles, u cray.

Meanwhile, whether it's 22 or 12 or 18, that is a hell of a lot more bulked up follicles than I usually carry around in my ovaries, and their presence is starting to make itself known. My abdomen feels... full. Uncomfortably full. It's almost like the feeling when you eat too much, except... below my stomach. Basically my ovaries have overeaten.

I've been lucky with the symptoms so far, probably because I'm on really low doses of the hormones. But I can now authoritatively say that The Bloat Has Arrived, and it is no joke. (Although after 4 straight days of a close personal relationship with prune juice, at least SOME of the bloat and general.. uh.. "fullness" in the region has been alleviated today. I have never gone more than like 2 days without pooping before. This was a full week. A WEEK. Praise Jeebus for prunes, is what I'm saying.) But man, even with The Bloat in full force, there is still not enough room for all of my plump new follicle friends.... and I still have several days left before they go in and relieve me of my clutch of eggs.

And all of this is BEFORE the myriad discomforts of pregnancy! #blessed

November 14, 2015

Day 6 update

I miss pooping. :(

November 11, 2015

Shots! Shots! Shots-shots-shots-SHOTS! (Errrr'body!)

And not the fun kind! The kind you jab into your belly fat!

My new vanity set up: a pretty Kate Spade box filled with syringes, needles, and alcohol wipes; hormones ready to be mixed and injected; and a sharps container for allllll the needles.

First, a quick overview of how IVF works, which I may or may not get right:

We ladies all have a bunch of follicles hanging out in our ovaries at any given time. Each month, a hormone called FSH (follicle-stimulating hormone) is sent down from the pituitary gland to stimulate [snort] a follicle and cause it to produce an egg. As the follicle grows, the FSH also encourages estrogen production in the follicle. Then once the estrogen level reaches a certain point, that signals to your pituitary gland to knock it off with the FSH and start producing LH (luteinizing hormone), which in turn causes ovulation. (That peak in LH is what you're testing for when you pee on ovulation sticks. If you happen to be someone who pees on ovulation sticks, I mean.) Once the egg is released, the empty follicle starts producing progesterone, which you need in order to maintain a pregnancy; if the egg doesn't fertilize, progesterone production calls it quits and everyone shuffles back to their places to start the process over again the next month.

With IVF, they use the same FSH and LH hormones, but control when & how much you're getting. Instead of your pituitary gland focusing on just one follicle, ALL follicles get a participation trophy and get stimulated equally with the FSH. The hope is to make every single follicle you've got hanging out in there produce an egg at the same time, then once you have two ovaries crammed full of ripe follicles, they trigger final egg maturation and ovulation (with an appropriately named "trigger shot") but swoop in and harvest the eggs from the follicles before they release into the wild (or, uh, I guess your fallopian tubes) on their own.

Then the mad scientist piece happens: in the lab, they individually fertilize each viable egg that they retrieved, then pop them in an oven to bake for a few days. (They do not actually bake them in ovens.) This is the danger zone for the newly fertilized little eggs though: there tends to be a lot of attrition over the next few days as nature takes its course. So it's not uncommon to have, say, 18 follicles, but only 16 eggs, and only 12 of those might be high quality. Then they can fertilize all 12, but maybe only 10 "take." Then of those 10, only 5 make it to the blastocyst stage, which is like a pre-embryo, and what gets put back in your cozy uterus (in my head, they're on a piece of parchment paper, and someone sort of rolls up the paper and tips it into my waiting uterus. I am told this is also not how it happens.) Then you pump yourself full of progesterone to convince your body to hold on for one more day to the wee blastocyst(s) and hatch 'em into babies.

SO! I'm still in that first stage, where I'm coercing all available follicles to get off their lazy asses and grow into nice, big, egg-harboring follicles. And to do that, I need to inject Gonal-F and Menopur into myself.

These are two of the EASIEST injections one can have: the Gonal-F is in that pen up at the top, and I just have to put a fresh needle on it each night and dial up the correct dosage by twisting the cap.

I mean, and then there is the part where I have to jam a needle into my own stomach, but the process leading up to it is simple, at least.

The Menopur is a little more complicated. I start with the big syringe, remove the needle it comes with, and put that plastic cap thingy in the center of the picture on it. The cap has a needle in it too, which I use to jam into one of the wee vials which contains sterile saline and draw the saline up into the needle. Then I jam the needle through the top of the other wee vial, which has the Menopur (which comes in the form of white powder). I shoot the saline into the Menopur vial, let the powder dissolve, then draw the mixture back up into the syringe, pop off the mixing cap, replace it with a (thankfully) thin small needle, make sure there are no large air bubbles, THEN jam the needle into my stomach. This is still on the easy side of the spectrum when it comes to mixing and preparing injections.

They have you go to an injection class before doing this because it's kind of overwhelming. And the injection class was great! I felt very informed and competent afterwards.

(I was also the only woman at the class who came sans husband. Apparently most people prefer to have their menfolk do this for them. One woman brought her husband AND her sister with her. I was all, psh! Whatever! I am totally fine with needles and giving blood and getting shots; I can do this! Plus I didn't want to make it Chris's responsibility, especially since he sometimes has to work late and there will be plenty of opportunities for him to have to miss work during this process; giving me daily meds didn't seem like a good enough reason yet.)

But man. Feeling competent, and physically jamming a needle into the tender flesh of your stomach? They are not the same. After learning what to do and how to do it, I was all, I'm cool! This is no big. I don't see what the hullabaloo is.

Fast forward to me standing in my bathroom, after having successfully mixed my first injection, with the primed needle ready and pointed at my stomach for like 45 straight seconds: ....ah. OK. I now see what the hullabaloo is.

I mentally shook myself, told myself to stop being a baby, and counted backwards in my head helpfully for myself. OK self, just stick it in on 1. Ready? 3.... 2.... 1!

[Self remains standing there, doggedly not stabbing self with needle]

Getting over the mental hurdle really is the worst part, though. The needles are wee. I can barely feel them going in. And fortuitously, I had been saving up a niiiice layer of fat around my abdomen for just such an occasion. Non Sequitor Chica warned me that the Menopur burns a little, which is true, but it really is just a little, and it goes away almost immediately. I'm now a 3-day veteran of the process, and even with all of the hand-washing, alcohol-swabbing, mixing, and stabbing involved, I'm down to about 3 minutes soup to nuts.

I'm also lucky in that so far I'm very low on the side effects meter. A lot of women are VERY uncomfortable during this process. My main complaint so far is a low grade but persistent headache, plus a dramatic, newly-developed flatulence prowess. I hear that I will soon be able to feel my ovaries, once they get jammed full of big-ass follicles, which I find equal parts intriguing and alarming. My sister - who was blessed with not only a robust set of her own extremely volatile emotions, but apparently also inherited all the ones I am lacking - is eagerly hoping that I become an emotional wreck as a result of the hormones.

Me: Wait, what?!
Her, literally cackling with glee: It will be HILARIOUS!!!

At least one of us is looking forward to that stage.