Retrieval update

Sorry for the string of boring titles... I haven't felt inspired by these relatively mundane updates.

Egg retrieval was this morning. I asked for the IV to be put in my arm, not my hand, but they insisted ("the anesthesiologist prefers it there") and the new nurse had trouble getting it in, which was incredibly painful, and then blew the vein.

So that IV came out, and they decided to let the anesthesiologist decide where to put the next one. She was awesome, and used a spot on my forearm that I was initially squeamish about, but actually worked really well. Different anesthesiologist from last time -- I really liked this woman. Listened to my description of how nauseous I was after the last egg retrieval and made sure to add stuff to my mix to help avoid it. I continue to think the anesthesiologist is usually the most important person to have a good rapport with for medical procedures...

Procedure itself was easy. I was just on relaxing meds and an anti-nausea med initially, while the doctor did an ultrasound to check the follicles, but then they knocked me out for the retrieval.

Woke up with no nausea - yay!

Ate a few snacks, had some water and juice, and then they started the Intralipid. I was relieved, because I had had the impression there would be a longer break. And, drum roll please, I even sat up for the whole Intralipid! (This is a big deal because I have vasovagal episodes and pass out easily when needles/IVs are involved. So my previous Intralipids I've stayed horizonal the whole time.) I did go horizontal when they took the IV out, tho. Better safe than sorry.

We were perturbed that the doctor didn't come in to tell us how the retrieval went. Last time he showed up about 30-45 minutes into my recovery period and told us what happened. This time I recovered (30 minutes), had the Intralipid (1 1/2 hours), and he still hadn't showed up.

When the Intralipid finished, they unhooked the tube from the IV but left the IV in me. I guess their standard procedure is to have the patient get dressed first, but a) there's no reason to leave it in once the Intralipid is done, and b) last time we did that I passed out. So they took out the IV, and then I got dressed.

Waited another 5-10 minutes and the doctor finally showed. Turns out the big follicle from my last update (was 15mm at my Tuesday ultrasound) had nothing in it, nor did the other follicle on that side. The other side, which had been dormant last IVF cycle, had 2 follicles and he got 2 eggs.

I don't know for sure, but I think one of them is likely to be mature and one of them may not be, because he talked about how they'll do ICSI tonight if they're mature, and if one isn't mature, they'll do ICSI on that one in the morning. And that being a day behind isn't a big deal, even with a Day 3 transfer.

So, assuming we have embryos to work with (still a big assumption), we'll do a Day 3 transfer.

Right now, I'm not feeling very optimistic. With no egg in the big follicle, it means the two eggs came from follicles that were 7-9mm on Tuesday, so they had to have been still pretty small today (certainly <18mm).

If we can transfer one or two embryos on Monday, I think I'll be able to be optimistic again, since it did work the first time around. But right now I wouldn't be surprised if we don't get anything out of this cycle.

After the miscarriage on IVF #1, my thinking is definitely adjusted. No embryos, or a BFN at least means we can move on to the next cycle immediately. A BFP would be awesome, but I'll be scared to death for 3 months, and if something goes wrong again, it slows us down so much. (This IVF cycle is almost exactly 5 months after our first.)

Rationally, we talk about it taking 1-5 IVF cycles to get our baby. But emotionally that's so much harder to accept.

Fingers crossed for fertilized eggs! I'll get a call before noon on Saturday from the clinic with an update.

Day 13 update: trying to stay positive

Another ultrasound this morning.

The bad news is that one follicle leapt ahead and is measuring 15mm. The good news is that there are 4-5 follicles between 7mm and 9mm that could cross 10mm (minimum to be potentially mature) by the time we do the retrieval on Friday.

My lining is great at 10mm. Estradiol is up to 496.

My TH1 came back elevated, and my NK cell levels are just slightly above the acceptable range, so I'll do another Intralipid with my retrieval on Friday.

And in the small-things-that-don't-matter-in-the-big-picture, I'm annoyed that the retrieval will be Friday, because we'll almost assuredly do a Day 3 transfer, which means missing Natalie Merchant on Monday night. Poop.

I'm trying to remind myself that things didn't look much better last time, and we still managed to get 2 mature eggs, fertilize both, and get pregnant.

But it's hard. We upped the meds this cycle, and it's so frustrating to not see any improvement.

Day 11 update

Another ultrasound this morning...

We're making progress -- 5 follicles (don't know where the 6th went), between 7-11mm. My lining is up to 8.0mm, which is now in 'ok' range. It'll be plenty thick by the time we do the retrieval, tho...

Estradiol is up to 244. This is a relief because my estradiol on Day 8 was 59, which made me really anxious. So it's climbing as my follicles (slowly) grow.

I go back in on Tuesday for another ultrasound, and my doc thinks we'll probably trigger Wednesday night for a Friday retrieval, but could go another day. This will be two days longer than last time, when we retrieved on day 14. Frustrating, since this was a higher dosage cycle, and was supposed to push my ovaries harder. I guess they're not playing along.

Although in good news, I have follicles on both sides, which didn't happen last time.

I've been spotting continuously since my post-BCP period last week, but that should stop as my estradiol levels climb. I hope it stops soon. It didn't phase my doctor, but it causes anxiety for me -- too many bad associations with bleeding post-D&C.

Tonight was another injection fail (I think I only tweeted about the first one...) I prepped my shots, did the Menopur, did the Follistim, then realized I hadn't mixed the saline and the Menopur. So I had injected myself with just saline, and had to give myself an extra shot tonight. Doh! I blame it on the hormones... :)

So, just slogging through this. No amazing news, but steady, albeit slow, progress.

Day 8 update

I had a monitoring appointment this morning. It's officially cycle day 8 (they get to dictate these things when you're on an IVF cycle -- it's not necessarily linked to when you start bleeding post-BCP).

My doc found 3 follicles on each side, which is good news because last time one ovary took a break. They vary from 5-8mm, which means they're close enough to all potentially mature at the same time. They were smaller than I expected, but I don't know why I had expectations -- last time we stimmed until day 12, and retrieved on day 14, so there's still a lot of stims to go. Lining is decent for day 8 at 5.8mm. And it's possible that there's another follicle on one side because my bowel was in the way digesting breakfast.

Next monitoring appointment is Sunday. Because my local pharmacy isn't open on Sunday, I had to get more Menopur today (current batch runs out Sunday morning). I also need another Gonal F pen. But the nurse who walked me through the updated stim schedule found 900 iu of Follistim for me, saving me $800. Yay nurse! She also found a menopur vial, saving me $70. I only filled half the Menopur prescription (for 4 vials), since Sunday I'll know better how long I'll be stimming for.

Retrieval will probably be Wednesday or Thursday of next week. Which would mean transfer would be Saturday or Sunday if Day 3, or Monday/Tuesday/Wednesday if Day 5 and/or we do genetic screening.

*Ideally* transfer won't be Monday, August 9, because we have Natalie Merchant tickets and I'll be on bedrest the day of the transfer. :)

I'm a little disappointed in the number of follicles. Yes, it's more than we had last time (4 that we were tracking on ultrasounds), but we upped my medications this time, and we saw 7-9 antral follicles in my baseline ultrasound. So it's likely this is as good as it'll get. I'm hoping that all the follicles grow together so that we have a chance of getting eggs out of each one.

So I'll keep slogging through the injections and hope Sunday things look bigger and better!

Hormone Hell

The IVF meds are definitely kicking in.

I'm on day six of Lupron, and had my first crying jag last night. I'm on day four of Menopur and Gonal F, and the Menopur is screwing with my ability to sleep. Ugh.

It wasn't this bad last time, so I'm thinking the Menopur is probably making things worse. After all, that was the point in adding it -- more stims to hopefully make more eggs.

It's really a pity that being self aware of the extra hormones doesn't help me avoid the moodiness, snippiness (my poor husband) and extra sensitivity.

I had acupuncture today, and she worked on all of this stuff for me. The points she used were super sensitive, which is pretty rare for me in acupuncture now. I had hoped I could nap during the session (rare for me, but with poor sleep last night I thought maybe it would happen). but alas 'twas not to be. I'm also taking evening primrose oil (did last IVF cycle too) which helped with the overheating while sleeping and helped grow my lining. She gave me some herbs (tablet form, for once) to help manage the hormones too -- they should also help with my lining.

I can feel things working -- curling up to sleep is less comfortable as my ovaries are swelling, hopefully with lots of follicles!

Shots themselves are fine. Lupron in the thigh rocks. Gonal F is easy, and I've resigned myself to icing before Menopur since it has a strong sting. The others I just use alcohol wipes with benzocaine.

Two more days of stims, then ultrasound at 8:30 on Thursday morning.

Quick update

A few quick updates from my last post.

Estradiol came back <5, which is great -- means no activity and a clean slate to grow good follicles.

I have been doing my Lupron injections in my thigh, which I'm (weird word, I know) loving. Most have been painless, and even when it pricks a bit, it's less intimate than my tummy, so less of a big deal. Apparently it varies a lot woman to woman, so I'm happy it's working for me.

This morning I started the Gonal F and the Menopur, and decided to do one on each side of my tummy. That way when I pinch to get some flesh, I don't make the previous injection spot bleed. (The things you learn after hundreds of shots...) And with the Lupron in my thigh I don't have to worry about that one.

Had an Intralipid infusion today. It went fast -- about an hour and a half. I usually listen to a podcast and play solitaire on my iPod nano. I'd use my phone except that I lay flat for my infusions so I don't pass out (vaso-vagal) and dropping it on my face hurts (yeah...) So I'm limited to the mediocre games on the nano, but it works to pass the time. I also entertain myself by watching my blood pressure rise as the infusion goes in. I start around 99/60 and got up to about 108/63 by the end. Hee!

Found out today that the backup semen sample from last time is still frozen, so I won't need to shuttle another backup when I go in next week. We're re-running my immunology blood work on Wednesday, and I have an ultrasound on Thursday morning to see what's happening in my ovaries (hopefully *both* my ovaries this time!)

And I have my fingers crossed for Holly over at Ready To Be a Mom who's in her two week wait for a FET!

New cycle details

I've used this blog as a way to document my big thoughts about what's been happening with our IF journey, but I'm going to start trying to use it more regularly for more mundane updates (I usually do those on twitter.)

I went to acupuncture yesterday for the first time since the D&C in early May, although I've been trading regular emails with my acupuncturist.

Had my baseline ultrasound this morning to confirm my ovaries are clear before starting meds tomorrow. Everything looked good (we even saw my right ovary, which hid last cycle and didn't grow any follicles -- hopefully seeing it means it'll participate this time around!)

My doctor didn't count antrals, but my educated guess based on today and the ultrasound pre-birth control pills is 4-6 on one side and 3-4 on the other. Which I'm happy about, and would be ecstatic if they all produced eggs.

Last time we did a microdose of Lupron (20 units twice a day) and then added 225 units of Gonal F twice a day. This time, we're also adding one vial of Menopur (which I've used before on IUI cycles) when I start the Gonal F. So, *gulp*, six shots a day during the stim period. Good thing it's not my first cycle -- it sounds overwhelming even knowing I can handle it.

I may try the Lupron injections in my thigh -- I've only ever done tummy shots (and my husband did the progesterone shots in my butt last time around), but I'm still bruised from the Heparin after two months recovery time, and I'd love to avoid poking my tummy for a few more days.

As long as my estradiol levels come back normal today (which based on the ultrasound, they should), I start my Lupron tomorrow, and add the Gonal F and Menopur on Friday. I'm going in on Friday for an Intralipid infusion to calm down my NK cell levels (slightly elevated at what my doctor considers a 2/5 level; but my TH1/TH2 levels are normal -- yay!). We redo the immunology bloodwork next week to determine if I need another infusion at the time of my retrieval.

The next ultrasound will be next Thursday (July 29), so we'll see how everything responds to the meds this time around.

I'm glad to be starting meds tomorrow -- I feel distant from the process right now, and it's still incredibly surreal that I was pregnant a few months ago. Like I dreamed about it instead of it really happening.

We know that realistically it's likely to take 1-5 more IVF cycles for this to work, but I can't help hoping this one will do it. If we get enough embryos, we'll probably do preimplantation genetic screening to avoid another chromosonal loss. It's pricey, but if it means we put in two good embryos instead one 0-1 good embryos, it's worth it. Particularly since we now know based on IVF #1 that I can get pregnant.