After my husband and I had a discussion with our doctor to cancel the completion of IVF Retrieval #2, he mentioned a few other ideas we could try, one of which I had been curious about since I started looking into IVF about a year ago. The doctor mentioned that there is some evidence that your follicles are already developed for the next monthly cycle before the current one ends, so there is a chance that I could have produced more "follicles" that are already primed for this round should we dive right into it again. I thought to myself - I think I'm going to go nuts either way so I might as well try again right now while I still have bruises from the injections....
Side note: When I talk about follicles, they are essentially a fluid-filled sac that should contain an immature egg. However, not all follicles necessarily contain a mature egg,so even if you have like 15 follicles when you are getting looked at, its not unheard of to get less than 15 eggs from all the follicles. And having eggs does not mean you automatically get a fertilized egg (embryo) to make a baby with. These embryos have to be able to produce cells that divide and mature into 3 or 5 day embryos or blastocysts. THEN you have a change to transfer an embryo for a potential baby.
Low Dose IVF:
After discussing my poor response to what Shady Grove considers to be extremely high dosing (anything over 600IU's total per day), my nurse mentioned that there have been some "unique" patients like myself that have had better success with something called Low Dose IVF. She said the focus is not to produce a whole ton of eggs, but in people with a high FSH number (a fertility blood test will tell you this) like myself, the protocol seemed to produce less but better quality eggs by using a lower dose protocol of injectable medications combined with Femara tablets (breast cancer medication) to stimulate the ovaries more gently. There is a theory that it could be helpful to give tired ovaries a "break" by utilizing lower doses of medications to stimulate the ovaries. The Femara also works similar to Clomid, but with much less side effects. I started my Infertility journey on these meds so perhaps this is comng full circle?
A link to read more about it:
http://www.infertile.com/mini-ivf/
Low Dose vs Natural IVF:
There is a difference between low dose and natural IVF. I have seen discussions on both and I just want to clarify natural IVF is basically like they are just going after the one egg you would naturally ovulate anyhow, and then combining it with semen that they go through to pick a "good one" to inject (called ICSI) to form an embryo. It's similar to how they do things with the full blown IVF only on a much smaller scale and its definitely very expensive to do it this way, but it will not involve all the medications that IVF includes. This is more for people that cannot get pregnant because of tubal issues or that have complete blockage. I myself ended up with one blocked thanks to my fibroid surgery (read that post if you want to hear more) but I felt that at least with the low dose I could potentially get more than one embryo. Anyhow that is the difference between low dose and natural IVF. I hate the injections, and I hate doing all of them for NOTHING, so I was intrigued to try this "low dose" option as well as to take advantage of the possibility that my follicles were already developed in terms of quantity that will be available for this round of medication.
A quick drive to MD:
I love my nurse. Today, which is a Sunday, my husband and I drove 442 miles at 4 am this morning to pick up medications that my nurse saved me from her previous IVF patients who were finished with their IVF journey. Thanks to those women and my compassionate nurse, we were donated 8 boxes of injections to help us with the financial burden that my medications have been throughout this journey. The fact that this women took the time out of her Sunday morning (she has 4 kids too) to help us out was just so nice and beyond helpful. I hope that all of this is a good sign for our future cycle. Now we wait for my body to decide its time to start...
And so it starts...
I got my period right on time 14 days after I did the trigger shot. Unfortunately that meant another month we didn't get pregnant. We were hoping somehow we'd be able to get pregnant the good old fashioned way since we timed my ovulation and all....but the usual.
Cycle day 2 (Meds day 1):
I went in for my day 2 blood work locally before work today. The tech was quiet, measuring a lot, which was a bit alarming for the first day of a cycle. My lining should be thin, there shouldn't be much to measure at that point....I finally just asked her and she said "well you have a cyst on your right ovary." I said does that usually mean they wouldn't be able to proceed? And she said well it would depend, I would wait and see what your nurse says.
Finally my nurse called around 4pm with my results (its soo hard to wait all day, that part never gets easier busy or not at work!). To my surprise, she said that my blood work actually came back good, for once! My estrogen was really good and low, so the cyst doesn't seem to be an issue. My nurse told me that if your estrogen is under 50, thats ideal, and mine was 30! I felt better after that call, but then again she is always good at that which was something I was lacking on my last 4 cycles with a different nurse. You have to really put your own feelings first during this process, which I have a hard time doing because I am always worrying about what other people think of me. My nurse informed me that although the day I needed to go back fell on a Sunday, which would mean we needed to drive to Rockville MD for it, she had already talked to the doctor to agree that I could wait till Monday to do the monitoring locally and save the 500 mile round trip.
So the next morning I called the local office, and they informed me that they have nobody to do an ultrasound in the damn office on Monday. I call my nurse and she's out and I am unsure what to do. I email the doctor and say "now what?" I knew the answer already...of course, the answer was to "go to Rockville, MD Sunday." So another trip and another entire day of my weekend gone to IVF. I just hope that it will result in some continued good news. Somebody upstairs has to eventually give us a break I hope.
Cycle Day 6 (Meds day 5):
We left the house at 4am to get to Rockville, MD by 8:30am for my 8:45 appointment. Even though getting up at 3:30am on a Sunday sucks, getting home at midnight when you have to work the next day sucks more. When I talked to my doctor on Friday, he felt that if we went into the local office on Saturday for the blood work and ultrasound, it would be too early, and if we waited till Tuesday it would be too late.
We had a nice sunny drive down at least. When we got there and they did my ultrasound, the tech said that I was "nowhere near retrieval." This angered me a little bit, as we had just spent 4 hours driving there for a 10 minute appointment that we could have done on Tuesday locally. She found two follicles at or above ten so that was good though. My lining was under a 4, blah. So we got back in the car, and I drove the 4 hours home so my husband could do some stuff for his masters program since he had lost the whole day to this trip. I waited all day for the weekend nurse to call me (aka when we finallly got home), and her instructions were "no changes and go back on Tuesday." Sigh.
Cycle Day 8 (Meds day 7):
I had to go to the doctor before heading out east of Pittsburgh for work meetings this morning. As soon as I got there, the technician reminded me that they want payment before I leave. Good lord. They are so not tactful at bringing this up, like this time it was right before the very painful ultrasound I had. The technician was having trouble finding my second over 10mm follicle that Shady Grove Rockville had identified only 2 days prior. Follicles do not just shrink, so it was very frustrating/baffling how it could have disappeared. Of course my damn cyst on my right ovary grew another 2 mm, which isn't much but its starting to become noticeable in my every day life. Like I tried to do body pump on Monday (the day before) and it was a bit uncomfortable. I think I'm going to take it easy on the exercising until we figure out where things stand this cycle. I missed my nurses call because I was in a meeting, so although I tried to call her right back we didn't end up connecting. I was very frustrated! She left me a message that my estrogen increased to 89, and the local office had only identified one lonely follicle measuring as enough to count for this round. Same dosing for two nights. Not good.
Cycle Day 10 (Meds day 9):
The nurse had suggested we come back to MD to do this monitoring so they could "see for themselves." She said that follicles don't just shrink, so either the tech in Rockville Sunday measured it wrong or the one locally did. I just want to have at least 2-3 follicles that we can retrieve. I went to the local office today before work again. I was expecting more of the same, maybe one follicle. Little to my surprise, the tech said she was able to locate 3! According to her measurements, she found 1 x 12 on my right side next to the 21mm cyst, and then on the left the measurements were 19 and 12 mm. I cautiously asked her about my lining expecting maybe a 6....she said it was an 8!! I almost cried I was so happy, I'd never heard an 8 before! I left the office so happy, for once in my life, calling my husband and mom immediately after leaving the office tears running down my cheeks for something good for once.
I immediately wrote my nurse and doctor excited and wanting to hear that they agreed it was great news. I waited all day to hear back from them but they didn't respond. I figured that they were just waiting for my blood work to come in. I knew I probably wouldn't hear back until around 4pm, but one can always hope, right? Sure enough my nurse called me around then and said "well this is good news! But you are going to have to come to Maryland tomorrow for the start of the daily monitoring." I said "I am happy to! It means things are finally going well!!" She informed me that I was going to be doing 225 IU of Menopur (3 vials) and also would be starting my antagonist medication that evening (Ganirelix). She then transferred me to scheduling and I made the latest appointment I could (8:45am in Frederick, MD). To my surprise the doctor called me next, wanting to discuss my questions in the email and the plan for moving forward. He sounded a little pleased, but not as excited as I felt. I think he just knows to be cautiously optimistic because there are NO guarantees with IVF. He informed me that he would be in the office tomorrow (he is never there when we need to be even though he has been assigned to follow our case the last year or so now), and that he would like to do the ultrasound to see things and measure it out for himself if he is not with a patient. Good I thought, even better to have him doing it since he is my doctor after all.
Cycle Day 11 (Meds day 10):
Another 4am drive to Maryland today. This is where things start to get really complicated and its tough not to stress because I had to tell my boss at 5pm that I was going to be unexpectedly out of the office for one or two days, maybe 3? And that was really all I could do. If you are new to a job and doing IVF, this would be 10 times more stressful even because employers aren't just going to let you do this. Especially if you don't even have healthcare that covers this as an illness. I was optimistic, and excited this morning just like I was before our first transfer of a healthy baby embryo last December. You try not to get overly optimistic, nor overly pessimistic because both are setting you up for something bad.
So we get there early, thankfully, and the doctor ends up being available to do my ultrasound. We haven't seen him in over a year! I felt like we could trust what he measured, so I was glad he was doing it. As he said to me on the phone the day before, every machine, every technician, is different. Therefore its tough to get an exact measurement. And then he said "I don't quite agree with an 8 for your lining, it looks more like a 6.5 to me." My heart sank to the floor. Again. Why does this keep freaking happening?! And to add salt to that wound, "I can't seem to get above a 9.5 on the one follicle that they told you was a 12. I don't think that we can count that one anymore."
Next we had to make the decision, again, if we have a 19 and thank god the other one did grow to a 14, are we ok with proceeding with only two now? Of course we are, we just drove 4 freaking hours for this bad news. I knew I shouldn't have been so optimistic. So now we are spending the weekend in Rockville, MD. I have to go back to the doctor tomorrow morning to hopefully confirm that 1. my lining is at least a 7 and 2. my little baby 14 follicle has now become at least a 16. If both of those things happen, we will be triggering (doing a HCG intramuscular injection) exactly 36 hours before they schedule me for a retrieval in the Rockville Hospital for the outpatient procedure. Please pray for us...
Cycle Day 12 (Meds day 11):
My next appointment was in Rockville, MD at 10:45 am. I was now in the daily monitoring phase of this cycle. This was the day they would let us know if we would be triggering that evening, or waiting another day. I already knew my lining was not ideal, and I also knew that our 2nd follicle was not quite where it needed to be. I was very nervous going into the ultrasound. The doctor had told me to mention that they should call him and see if he was available and not in surgery to see my ultrasound again. Of course both nurses I told acted like I was being a pain in the a**. I don't think they believed me that he said to ask for him. So they just said "he's unavailable" and away we went for the ultrasound. This nurse was nice enough, but she definitely didn't seem to take her time to carefully measure things. She seemed to ignore one of my follicles too, and after quickly measuring my lining as a 5.6mm, I felt a wave of panic come over me when she asked "are you doing an IUI this cycle?" I said "no I'm doing IVF." She looked bewildered and then said "you're going to need to speak to a nurse. Your lining is too thin." I started bawling as soon as those words came out. I got really angry after she walked out of the room in addition to my anger, and I started yelling "what the hell is wrong with me, why do I keep on having to go through this sh*t?! I just can't take this anymore, I don't know why nothing can ever go right for me even one goddamn time." My husband just stood there, waiting to figure out a good time to hug me. I am so sick of this!! So I had to walk out of the room still crying, and go meet with some other nurse. The nurse was asking me questions but I couldn't answer through my tears. My husband responded for me "the other nurse said there was only one follicle and a cyst that she had measured and that she had said my lining was too thin for IVF." The nurse tried to calm us, then offered to try and call the doctor again. He actually came down too, in his surgical hairnet and all. When he saw me crying he could tell that he needed to look at the pictures. "Your lining doesn't just shrink, its probably just the way your uterus was contracting/laying when we did the images, its still around a 6." And I said "well what about the other follicle? How does a 19mm follicle just disappear??" He then looked a little irritated and said "It doesn't, I don't think I was clear about what we were looking at for today. It is still there. You still have 2." He then left to continue his surgeries, and the nurse gave us instructions to do a retrieval on Monday.
What a freaking whirlwind of a few days. I literally had 3 different lining measurements, all to a variety of extreme changes, I mean who the heck even knows what we will have for the retrieval. I can only hope that my two follicles have eggs in them that can be retrieved. (That is not a guarantee)
After I was able to compose myself, my husband and I decided to take a drive to DC because I wanted to get outside and enjoy the day as much as I could. The scheduling department called me around 4:30 with my instructions for doing my trigger that evening, as well as continuing the 225 Menopur injection, and taking my 1000 mg of azithromycin the following evening to prevent infection from the surgery. My retrieval is officially scheduled for 7:45 am Monday morning. I hope to have good news to report after.
Retrieval Day! Cycle day 13 (meds for fresh transfer start this evening) :
Monday morning was stressful despite thinking we had enough time to go since we stayed right across the street from the hospital. Naturally, we were still late for the time they wanted us there (we arrived at 6:30 vs 6:15). My husband was so stressed about having to give a sample, especially at the time we were supposed to be at the hospital, so I hope that didn't mess anything up with his swimmers. Once we arrived, they called me back to start the IV fluid and then we sat and waited for like an hour before meeting with the doctor that did my retrieval (she also did the first one). I was a bit disappointed, because she was not my doctor, and I trusted him the most. Once they took me back and I laid down on the good old operating table, they put me to sleep and the next thing I remembered was being back in my slotted #2 waiting operating room bed area. The doctor came in and said we got 2 eggs. I was half happy and half sad because I had hoped she would have gotten the third one from what measured to be a 12 two days prior. But two is better than zero, so now I have to wait another 24 hours for them to tell me if the eggs were able to fertilize.
Day 1 post retrieval:
My nurse called me around 10:30am today. I was a ball of nerves and totally struggling to function all morning waiting for that news - and my two embryo's are doing good, they are officially a zygote, or fertilized egg!! Thank the lord for that news!
Day 2 post retrieval:
Today I had to wait till about 1:15pm and the doctor was the one that called me. My nerves hit an all time high when I'm waiting for that damn call. All morning long I was moody and anxious about this. He said that they are now both 4 cells! Praise Jesus for that news!! We also had a discussion about the future (potential) transfer of one or both embryos. I am obviously still concerned about my lining as well so I had asked my doctor about the potential to get another lining measurement before transferring one of my babies for hopeful implantation. What he said makes sense, but didn't quite make me feel any better. "There is no useful data that you'll get out of doing another lining check. In fact, I can tell you that we have no data whatsoever on the lining after you have started progesterone." I was confused and I said well won't it be thinner from taking progesterone? He said "yes it will be, but that is not a concern and it is necessary to have progesterone in order to prepare the lining properly. It's supposed to be thinner actually. " I was a bit surprised, but then he also added "by doing another ultrasound, you could actually do more harm than good because the ultrasound gel could disturb the embryo when we go to implant it." After he said that I decided - no need. I would never want to do a damn thing to disturb my babies after how far we've had to come to get here.
The doctor said that from here on out, I will not be getting any further updates on the embryos until we are in route to Maryland. Apparently someone will call me tomorrow to schedule my transfer (which he recommended we only do one and freeze the other god willing we still have two as of Saturday), and then he will call me the day of to give me the update on if both embryos have divided their cells adequately for a good transfer. Fingers crossed this will continue to be good!
Transfer day (Day 5 post retrieval):
We left at 5am today (Saturday) to head back to Rockville for my transfer. I anxiously awaited my doctor's phone call on our way out, which we received a little before 8am. "One of your embryos is looking perfect, but the other one is not ready for transfer or freezing as it is falling a bit behind." My heart sunk a little bit but I was trying not to get upset since we were doing this today and I didn't want to mess with my chances for the good one to transfer well. "Ok, so I should just continue forward with the one that we have then?" He kind of made it up to me "if you feel comfortable continuing forward with that plan." Why wouldn't I? He and I both know my lining isn't ideal, but I'm hoping God will give us a miracle this time. We got to Rockville and checked in about fifteen minutes early. I had to pee soooo bad (sorry if TMI), but you have to have a FULL bladder in order to do a transfer, so I had took my nurse's advice and not peed the entire 4 hour drive out. I still had another 45 minutes to go too! I kept telling myself, "It's worth it all, just try to remain calm and hold it!"
They took us back, asked me to confirm date of birth, SSN, name several times. We waited in a freezing patient room with the lights out, me of course waist down no clothes on, and both of us with booties on our feet because you have to keep things extra clean for a transfer. They don't want any scents (hubby and I bathed with scent free body wash) to mess with the embryo, since they are EXTREMELY sensitive to everything. The doctor finally came in to insert the catheter and then a small tube through my cervix into my lining for the retrieval. The ultrasound tech put the gel on my belly and had the visual ready for guidance of the tube. The tube is basically the worst part aside from the full bladder (which you could see taking over the screen LOL), but compared to everything else its just another uncomfortable thing that you deal with. This time around the tube went in pretty easily, as the last time I did a transfer it did not. I'm going to assume this is because I had a FULL bladder and last time the doctor said I needed to drink more water before they could continue. So far so good. They then confirm the name on the screen, and zoom in on your baby embryo to show you it before they transfer it in. I never know what looks good or bad, but it looked nice and round and had lots of cells so I'm going with good. Next the doctor tells the embryologist your ready, and they bring it into the room for the transfer via the tube. "Please make sure to pick the best spot you can find in my lining! I've had a lot of issues with that..." I asked the doctor. She smiled and said "Of course." So it went - now the embryo was inside me! They confirmed it was out of the tube, told me to sit for 5 minutes laying down on the table, then a nurse would come with discharge instructions, and we could go home.
Basically they tell you nothing strenuous, not even bending at the waste, no walking the mall, laundry, dishwashers, sweeping, tying shoes, lifting dogs, etc. However, they don't want you just sitting or laying in bed all day either. So off we went back onto the 4 hour journey home, hopeful and happy that we were given the opportunity to transfer a beautiful embryo. I had cramps the rest of the day, probably from the procedure, but hopefully from my embryo finding a comfy spot in my lining! Fingers crossed!!
Day 4 post transfer:
Today is 4 days since the transfer. I am still taking 300 mg of progesterone (endometrin) and 4mg of estrogen daily to maintain the embryo. I am trying to remain positive, but its been tough. People tell you they know that they are pregnant as soon as they are, and I worry that if I don't feel that way does that mean I'm not? Its hard to say there are symptoms because I've had them the whole time since I started these two medications two Saturday's ago after my retrieval. I do get some pains on the right side, but I wonder if that was from the cyst I had. I hope its something greater! Progesterone makes you feel nauseated, bloated, and very tired. All pregnancy symptoms of course too, but I've had them since before the transfer! So I will try and avoid taking a HPT since I know that the HCG stays in your system for 2 weeks, and a positive could be a negative still. People say that hopefully work "keeps your mind off of it" but it feels harder than ever right now. Trying not to stress and believe that everything happens for a reason when its meant to be. We found out on Day 2 post transfer that our second embryo stopped growing and started to regress, so unfortunately this little bean is all we have from the last two months of me doing all these meds and appointments. I don't think people get how hard this all is on you. I don't think I'd ever understand until going through it all. Anyhow, that's where i am at currently.
HCG Pregnancy test:
I took a pregnancy blood test to detect for HCG on day 15 post transfer. I had already tested my urine with one of the cheap dollar store brands the morning before, so I could prepare myself if it was negative (at least a little bit). It was of course negative, not even a faint line, so I was upset and emotional all day at work about it but I tried to have an ounce of faith for a miracle. The miracle never came. I took Friday off because I just knew it would be bad and I have been emotionally and physically drained anymore with the constant appointments, testing, driving, and let downs that have been my experiences with IVF. After the blood test I tried to keep busy in the garden pulling weeds and walking my dog, but sure enough my nurse called about 5-6 hours after I went for the blood test and she said "I'm sorry but it was negative. Your doctor will give you a call to discuss what the next steps and options are." When I hung up the phone I wanted to throw something and break it so bad. I didn't know what to do. I screamed, I cried, and on goes the extreme depression I've been feeling for the failures of IVF. My doctor called, sounding pretty somber himself, and said the next logical thing would be to "try a cycle without medication and see if my body will allow the lining to thicken naturally, then trigger when it would appear to be ready and do a frozen transfer of our last embryo baby." I'm scared, because this is all I have left. I don't want to lose any more embryos to my lining :(
Comments