Don't Twist an Ovary

I'd be jumping for joy if I wasn't still at risk for twisting an ovary.  (I am under strict instructions, "no jumping.")

AF arrived in full force this morning.  I called the clinic as instructed and expected them to schedule an appointment to discuss a calendar.  Instead, the receptionist said our nurse, G, was with a patient but wants to talk with me directly and will call back.  She called and explained that due to our travel dates and Dr B's travel dates if we go with the calendar she is proposing I need to start BCP's tomorrow.  Given the short turnaround G emailed me a calendar to review/approve, rather than scheduling an appointment.

The virtual jumping for joy is because this calendar leads us to a FET on Nov 11 and pregnancy blood test Nov 25!  Previous conversations and speculations had us thinking the transfer would not be until early December.  I'm just so tired of waiting and am thrilled ecstatic to learn it will happen a whole month sooner than I was expecting.  AND, being a girl who loves numbers, a transfer on 11-11-11 is fabulous!  AND, confirming we are pregnant (remember, I will be getting pregnant this cycle) Thanksgiving weekend is the ultimate gift to be thankful for!

Now, how am I supposed to focus and get any work done today?  I'm SO excited by this news I can't possibly concentrate on anything but how perfect this is.

Doctor, Doctor Give Me the News

I got a bad case of, "I want to knows!"

I had a follow-up visit with Dr B yesterday for the OHSS concerns.  Wednesday morning I took a slight but noticeable turn for the better, but on Monday she said unless I feel a "million, thousand percent better," keep the appointment, so we did.  I am able to take deep breaths and yawn without the sharp pain I had been having, which made me think the swelling in my ovaries was decreasing.  The U/S showed that, yes, the swelling is slowly starting to decrease, but the free fluid has slightly increased.  I wanted to know, when I am going to feel normal again and the answer is, "In a week you should feel 50% better than you do now, and in a month you should be back to normal."  Wow, that's a long haul, maybe I didn't want to know...

On to my next question, Dr B.  We have these 15 excellent embryos; when we're ready for a FET how many do we have to thaw at a time to make sure we get 2 to transfer?  She explained that they are all graded and frozen individually so in preparation for a transfer they will thaw the two best of the best.  If one of them doesn't look good, they'll thaw the 3rd best, and so on until they have 2 that thawed well.  I like this answer, because having 15 embryos to work with means I will never have to go through another retrieval!

Frozen in Time

The report from the Embryologist is good news!  We have 15 frozen embryos, 8 on day 5 and 7 on day 6.  They all look, "Very, very good," just a couple are grade AB and all of the others are the highest grade of AA.  Hallelujah!

IVFluids

In spite of a quiet weekend, drinking 80oz per day, faithfully eating protein, and no weight gain I woke up today feeling the worst yet. P has been a saint taking care of me, and how do I reward her?  I wake her up Monday morning vomitting.  That got me a ticket to Dr B's office, which led to IV Fluids.

The good (?) news is an U/S showed my ovaries are swollen*, but I have minimal free fluid.  From a risk standpoint this is better than normal size ovaries and significant fluid, from a comfort standpoint both are miserable.  Basically my ovaries are pressing all of my other organs up against my diaphragm so it hurts to take a deep breath, yawn, sneeze, burp, cough, anything other than sit on the couch.

*Ovaries are usually 30mm by 50mm, mine are currently 45mm by 65mm and 55mm by 80mm.

Freeze it, Sister

It's offical, there will not be a fresh transfer.

Dr B called me during her lunch hour so she could talk to me directly and said she does not recommend doing a transfer, it is just too risky.  Today it just feels like a bummer, since we cried our eyes out about this when she talked to us a week ago.  P and I want to do a transfer and have a baby, but we know we should be safe about it and wait. So we'll freeze all of the embryos that make it to blastocysts by Tuesday.

I will be stopping all meds as of today and AF should show up in a week and a half.  Dr B said flow will be heavier than usual and probably more cramps than usual.  We'll call the clinic with day 1 of AF and make an appointment to discuss a FET calendar.

I still feel quite uncomfortable in my abdomen, which Dr B said is normal and will probably continue through Monday.  Walking around seems to be too much "bouncing" so P and I are going to lay low watching movies and reading books this weekend.  I'll keep drining my gatorade and protein drinks to help keep OHSS at bay.  Cheers!

We've Got Cells, They're Multiplyin'

When I got up this morning it felt weird getting ready for work.  I felt like I was a different person than the last time I got ready for work.  I kept thinking about how I have 42 eggs out there, hopefully meeting sperm and growing into little embryos.

The news from the embryologist is 34 eggs were mature and 22 of them fertilized over night.  She said they expect about half of those to grow to blastocysts by day 5 (Monday) and we'll get our next embryology update then.

I called and talked to our IVF nurse late this afternoon to try and get a better sense of whether or not we are still considering a transfer.  She didn't know how strongly Dr B cautioned us about most likely not doing a transfer, so initially she said we are waiting to see of OHSS symptoms show up in me and a decision could go to the last minute.  When I mentioned that a week ago Dr B said the only way she would do a transfer is if I only had 1 mediocre embryo that they didn't think would survive freezing the nurse said she would talk to Dr B and call me back in the morning.  So, we wait.

This evening I'm starting to wonder if I have fluid building up in my abdomen.  I feel uncomfortable from my belly button to just below my ribs.  Not painful, just bloated, I guess.  I'm keeping a close watch on my weight and thus far it has remained steady and I don't have any nausea.  Keep your fingers crossed for me.

One last thing.  Does anyone know why, when I post from my iPad the paragraphs don't show up.  It just strings the whole post into one, big paragraph.

Ova Achiever

They retrieved 42 eggs this morning. Needless to say, they continue to worry about hyper stim. The doc who did the retrieval, the nurse who took care of me, and Dr B who came to check on me between other patients since it wasn't her day to do retrievals are all concerned about me. I have continued to feel well, just a little full feeling in my lower abdomen but not really pain, and me weight has remained steady. The weird thing is, they haven't called it yet. We keep hearing, "We might need to freeze,," or, "We should probably freeze," but no one is making a firm decision or proclamation. All we can think of is that they want to see quality fertilized eggs before they say, "Freeze." P said as I was waking up and asked how many eggs she told me 42 and my response was, "Eggsellent!" She was impressed with my pun (it is a talent of mine) and knew it was a sign I was okay. I have zero recollection of this exchange. I remember being wheeled into the procedure room, they put my left leg in a stirrup and the next thing I knew Dr B was in my recovery room and I groggily reached out to shake her hand. I'm not sure why I did that, but I do remember doing it.

Hard News to Swallow

The short story: I look like a classic case of OHSS even though I feel fine thus far and Dr B says freeze.

My follicles are big enough that we are doing the trigger shot tonight and retrieval Wednesday morning.  After the measurements Dr B had a heart to heart with us.  She is really worried about me and thinks we should freeze all of the embryos.  Although she has been trying to prepare us for this, I still started crying.  Dr B was quiet and just looked at us.  P said we want to do what is safest and this is why they pay Dr B, to tell us what is safest even if it isn't what we want to hear.  She likes to look on the bright side, so this isn't easy for her either.  Then she said the only way they might do a transfer is if it somehow turned out I only had 3 eggs and 1 mediocre embryo that they didn't think would survive a freeze and thaw, and even then she would be really worried about me.

After I had my blood draw we met with the nurse to talk about the retrieval schedule and protocol.  She didn't know what Dr B had just told us about having to freeze, so when P started asking questions about timing for a frozen cycle she was caught a little off guard.  She was very sympathetic and I got all teary again.  When we were done with our conversation she left us alone and I started sobbing.  Somehow this news is harder for me to swallow than previous BFN's have been.  At best we'll wait 2 months, but more likely it will take 4 or 5 to get back to where my body is today, ready for pregnancy.

Later in the day they called with my blood results and estrodiol is down to 4000.  They had me take a dose of menopur and 50 units of follistim, too.  I am an eternal optimist and can't help but wonder if the drop in estrodiol and lack of physical symptoms changes the OHSS picture.  Of course, I let the call go to voicemail because I was at work, so I didn't actually ask the question.  Am I crazy to hope this is a good sign?

A Well Worn Path

We are wearing quite a path to the RE clinic these days.  The Nurse Practitioner was on duty this weekend and when she came in the room she said, "Dr B warned me about you!"  She was referring to the hyper stimulation concern.

I have followed several TTC blogs in IVF and it seems like most people get measurements for each follicle.  I don't know if my clinic just does it differently or if they just handle me differently, but they only measure 6 or 7 follicles in each ovary and calculate an average size, which is 16.5mm today.  Then they try to count how many follicles are growing and today was 25 in each ovary - total 50.  The NP told us she didn't see any "free fluid," which is a good thing.  That is another indicator of hyper stim.  Since my follicles aren't quite big enough for the trigger tonight we will see Dr B tomorrow morning.

When the nurse called with my blood results Friday she said they don't like to see estrodiol levels over 5,000.  That is when you are at risk for hyperstim, but it doesn't mean you absolutely will.  On Friday I was at about 3,500 so they cut the follistim to 25 Friday night and none on Saturday.  Today my estrodiol is 7,054 so I will not take any follistim tonight.

I'm feeling pretty good, drinking my gatorade and eating my protein.  P reminded me, though, that the risk for hyper stim continues after retrieval and increases with the transfer, because your estrogen goes up with pregnancy.  So, we continue to wait and monitor.  I feel my stress/worry rising the longer this uncertainty of whether I'll hyper stimulate goes on.  I continue to practice my IVF meditation daily, which is helpful and makes me optimistic about getting pregnant when we do get to do a transfer.

Proceed with Caution

After my last post I was going with the helpful comment, "If they're not worried, you don't need to be worried."  You are a great community and I deeply appreciate the support.

This morning we were at the RE again; my follicles are an average of 13mm and there are lots of them.  I go back on Sunday and if they are fast growers we will trigger Sunday and retrieve Tuesday.  Dr B wants to see the average at 18mm and the average rate of growth is 2mm per day, so it is possible I won't get to 18 by Sunday and we'll go back Monday for one more check .

After the U/S and conversation about retrieval Dr B let us know she is concerned I am on track to hyper stimulate.  Crap.  She explained that I have lots of follicles and my estrogen level has been doubling each visit even though we've been decreasing the follistim (Wednesday was 1,500, so it will likely come back around 3,000 today and 6,000 by Sunday), which are classic with OHSS.  She doesn't want to call it too early, but we need to be prepared for the possibility.  She instructed me, "Not to be stoic," and we'll keep monitoring.  She will make the decision as early as possible, but even if things look good they will watch me closely and the transfer could be cancelled right up until the day it is scheduled.

As I said before, I am really tired of waiting to get pregnant and I just want to get the show on the road.  I don't want to wonder whether or not we'll be able to do a fresh transfer, especially right up until the last minute.  That means 10 or 11 more days.  Dr B said, "It's too early to call it, but it looks like that is the track you are on."  So it seems to me like I have to shift my thinking to a frozen transfer in early November. There went my June baby and here comes being hugely pregnant in the summer (because remember, I will be getting pregnant my first IVF try!).

Immaturity, I'd Like Some Immaturity, Please

We made another trip to the RE clinic bright and early this morning.  Dr B was out of the office so we saw the nurse practitioner.  She measured 15 follicles between 8 and 10mm.  As I watched I kept wondering, how does she know she isn't measuring the same dark spot on the screen multiple times?  (I guess that's why she went to school!)  The part that has me worried is that she told the nurse, who was making all of the notes, that there were about 25 follicles on one side and 18 on the other. Hello, that is a total of 43.  We know I have PCO so it could be that, but I worry about hyper stimulation (OHSS).  I asked the NP about it and she said OHSS is a concern and the goal is to keep my meds low enough that all of those follicles don't mature.  They started me on 150 of follistim and dropped it to 75 after 3 days.  I just got a call about my blood work from this morning and we are dropping the follistim back to 50.

Has anyone else out there gone through IVF and had lots and lots of follicles?  If so, did you end up with OHSS or not?  I am grateful my local clinic happens to be one of the top clinics in the nation and I know they are watching me very carefully.  I just have to say, I don't want to get truly sick from this process and I really don't want to have to put the transfer off another month or two so my body can recover.  This journey has been long and I'm ready to be pregnant.

Early

We had our first check after starting the stimulation meds today. It was actually two early morning visits. We got a call yesterday to let us know their blood machine was having problems so I would have to go in for a draw at 6:45, that they would send out, and come back at the already scheduled time of 8:30 for the U/S. When I got there for the bloodwork they gave me a $10 Starbucks gift card for the inconvenience - nice! During the U/S Dr B said she had us come in sooner than most patients because she wants to stay ahead of any potential hyper stimulation. Every thing looked good, I think there were 9 follicles in the 6-8mm range and they would call with the blood results around noon. Well, my estrogen turned out to be high so we are going to cut my follistem dose in half. When we were in the office Dr B said she didn't expect to need to make changes based on what she saw on th U/S so I am thankful she started seeing me early and hopefully cutting back on follistem now will keep me from hyper stim. In other news, P and I went to the outlet mall today. I had said I wanted some looser fitting tops so that as my belly grows it won't be obvious immediately. There is a maternity store at the mall and I went in and tried a couple things on, but I couldn't bring myself to purchase anything. It felt too much cart before the horse, even though we are going with the, "I'm pregnant unless proven otherwise" approach. P, however, saw such a good deal on a cute sweatshirt that she bought it and says she is practicing for when I'm pregnant! Later in the day she bought a child's dish set too - she likes to be prepared and she loves a good deal. It makes me a little nervous in an I-don't-want-to-jinx-this kind of way, but it makes me smile, too. Okay, time for more shots, gotta go.

Fortunate

Earlier this week P got a fortune cookie with her lunch and the fortune read, "Your greatest wish will come true this month."  Wow! We are are feeling the love from the universe!  

We decided to get out of town one last time before the RE appointment craziness begins.  Fortunately we live in a beautiful area and didn't have to travel far.  We stayed in a bed and breakfast Friday night and spent the day hiking and exploring Mt Rainier National Park.  It was a gorgeous day and I love taking pictures so here is one to share with all of you.

We are also feeling fortunate that everything looked good and the blood tests came back normal at my supression check Thursday.  Hearing all of that gave us a sigh of relief, even though it didn't really feel like we had a been holding our breath.  I think the meditation is really helping me stay relaxed with each step.  Yesterday I started the stimulation meds, boy does that menopur sting!  Our first U/S is tomorrow morning and hopefully we'll see those follicles beginning to grow.