Welcome Home

I couldn't be happier with the way things went today. I had a relaxing massage, then lunch with my sweetie before heading to the clinic. The nurses got me ready and gave me blankets from the warmer. Then my acupuncturist did my points and I listened to relaxing music for 25 minutes. The nurses used U/S to looka t my bladder and determined it was too full. So, my big challenge of the day was to pee 3/4 cup and no more. I did my best. Dr B came in and talked with us about the procedure and gave me a dose of valium. The embryologist gave us the report that they only thawed 2 embryos and they had started to expand (I can't remember the technical word for that), which means we have 13 more frostiness should we need them in the future. After that I got my hat and booties on and P got the same plus a jump suit and I was wheeled in to the surgical suite. The transfer itself was pretty quick everyone complimented me on my level of relaxation. When I was wheeled back to my room T did more acupuncture and P held her hand over my uterus welcoming the embryos and encouraging them to make themselves at home! We both feel like it is working, everything just seems right this time. I don't know how to explain it except to say I feel confident rather than just hopeful.

I Love Shots!

Okay, maybe that's a little strong, but I was braced for an uncomfortable experience and it has just been a series of little pokes.

Our IVF nurse told us about the welts and soreness most women experience at the IM injection site.  My accupuncturist warned me about the same thing and asks me every visit if I'm having any pain or reaction.  The answer is no!

For those of you who have not done IVF, these are shots in your upper gluts.  The needles are 2 inches long and the medication is in oil.  At the recommendation of my accupuncturist I ice the area before the shot and apply heat after.I have had multiple IM delestrogen and progesterone injections and so far so good.  These shots are helping my body prepare for pregnancy and they are going really well.

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.

Annual Review

I had my annual review at work today.  It was my first review at this job and I have had 3 bosses in the year and a half I've been here.  It was interesting to take look back at all that I've done and experienced during that time.  I know I do a good job and give my best effort so I wasn't really worried, but the nerves do creep in until I see what is written on that piece of paper.  I was pleased with what was written, and I relaxed.

This calendar marker in my professional life leads me to think about a review of my personal life the last year.  In August 2010 we were still jumping through hoops leading up to TTC, with my first IUI in October.  I find it interesting that I went into that cycle with confidence and excitement and one BFN after another really squashed my optimism.  After about 4 of them I stopped believing IUI's would work, and I was anxious to move on to the magical IVF.  Surprisingly (to me), after the 6th BFN and the decision to move forward to IVF my optimism did not return.  Over the summer my hope has been growing as we do testing and prepare my body. The last few days I event feel excited.  So, looking back at the full year it truly has been a roller coaster in the hope department and I'm nearing the summit of positive emotions at a crucial time.

Last Night, Tonight, Tomorrow Night

Last night we planned to meet with a small group of TTC bloggers at the most appropriately named place in town, Mother's Bistro.  Lucky for us they have fabulous food as well.  I'm not sure exactly what happened to everyone, but it turned out P and I got a table for two and enjoyed a lovely dinner.  While it would have been nice to meet the others, we really enjoyed an unexpected date night.

Tonight we are headed to our first IVF class and I've started to wonder if we'll be the only female couple.  We live in a very gay friendly town so I have no worries, it is just my curiosity.  If it is anything like the intro to fertility class we had to take when we started with the clinic, it won't be interactive and it will be a review of the info Dr B and our nurse have already told us and given us info about - just another hoop to jump through.

Tomorrow night we're going to a kd lang concert.  Our local zoo does a concert series every summer outside on a big amphitheater lawn.  They are a lot of fun, we just go after work, put out our blanket, enjoy a picnic dinner, and the concert begins at 7:00.  At the moment we are trying to connect with friends who we think also have tickets, because that is even more fun!

Let's Get this Party Started

I took my last BCP this morning, so AF should be here soon and I am ready for CD1 of IVF.  I did all of my homework and testing, I'm enjoying a little break, and I'm ready to start using all of those check boxes on my calendar.

Oh yeah, and I'm going to get pregnant this time!  I loved this post and I've decided to ride in the optimism car on my hope coaster.  Also, last week my acupuncturist (T) was asking me about my support system. I told her about the TTC blogging community and mentioned liking Isa's approach.  T specializes in fertility so she sees this cycle a lot and pointed out that we get disappointed even if we try to protect ourselves from it, so why not assume you're pregnant unless proven otherwise.  I like it.  I'm going with it.  Let's get started!

10 Day Coast

After all of my stress and complaining around the intensity of IVF, I have 10 days free of appointments, tests, and homework.  Sweet!

Yesterday was our consultation appointment with Dr B to talk about the risks related to IVF.  We already read the packet (part of our homework) and were not surprised by any new info.  She hit hard on the possibility of multiples and to be honest, I kind of hope for twins.  I prefer not to raise an only child and we aren't getting any younger, so I would welcome 2 at once.  For me, the scariest part of twins is the potential for premature births.

The next thing on our calendar is IVF class #1 on August 12.  If it is anything like the introductory workshop we had to attend before our first appointment with Dr B, it will be repeat info on the process of IVF, in a group setting.

In the meantime, we are enjoying some perfect summer weather in Oregon and spending time with our 17-year-old niece who is staying with us for 2 weeks.

Problem Solving

My body is telling me something.  I have woken up between 5:30-6:00am for the last 5 days (I usually get up at 7) with an upset stomach.  I take a low dose SSRI daily to manage anxiety, but every once in awhile something stresses me so much that I get a miserable flare up.  The early waking and upset stomach are some classic signs for me, and they are usually accompanied by circling thoughts of worry.  This time (so far) I don't have the worried thoughts, so it is completely clear to me the root source of my anxiety, all I know is that my body is telling me I'm wound up tight.

It's not really surprising that someone who suffers from anxiety would have a particularly hard time with it while TTC.  People who don't have anxiety share a lot of "what ifs" related to process and outcome.  I am questioning whether I will produce enough healthy follicles?  What if I produce too many and get hyperstimulated?  What if I don't get pregnant?  In my 5th and 6th IUI cycles I felt like I knew it would take IVF, and I guess I expected that would work for us.  Now that we're here, about to try IVF I'm not as confident.

I know it is best to be optimistic and I think I need inspiration so I'm rethinking my plan to only follow TTC blogs.  There are so many blogs out there I had decided to focus on building community with people in the same place as me. While that is helpful, I've only been following TTC blogs for about 6 weeks and so far no one has gotten the BFP.  Perhaps I should also follow a couple people who have had recent success with IVF.  So, who should I read up on and follow?

Overwhelmed

I know that some people are excited to get their calendars, because it makes it all seem real.  I, on the other hand, feel like my head might explode.  How am I going to keep up with all of this?  It's another dose of reality, this is a big deal.

Backing up...I went to the bathroom about an hour before my appointment for my trial transfer and doppler ultrasound.  Fortunatly I remembered rather quickly that I was supposed to have a full bladder and basically chugged a 20oz bottle of water.  Dr B called me an overachiever on the full bladder request, phew!  As far as I understand everything looks good on those two tests.  Then they took 5 vials of blood for all of my "pre-cycle blood tests".  Next, we met with a nurse to go over our calendar.  Ah, yes, the official yet flexible calendar.

The calendar is based on a projection of my next CD1 being August 8.  Currently I'm on birth control to help regulate the length of my cycle, but if AF doesn't arrive by the 8th the whole calendar gets revised.  Just looking at all of those dates and meds and tests stresses me out.  This is a big investment of time, emotion, and money.  For a split second I wondered if I could handle it.  Then I reminded myself I always stress out looking at the big picture, and I get to my goals one day at a time.  I like the quote, "The journey of a thousand miles begins with one small step."

I came home tonight and put the important dates into my google calendar.  Dates of appointments, date to start each med, date to stop each med.  The calendar they gave me at the clinic with 6 check boxes for each day can be put aside for almost a month.  I don't need to fret about all of those details now.  As we wrap up appointments at the clinic I try to be good about asking, "So our next steps are x, y, and z, right?"  I need to focus on taking one step at a time.

My Heart Sank

I have been following In Flux's blog and my heart sank when I read this post this morning.

The BFNs are miserable (each one worse than the previous, in my opinion), but I haven't thought about the end of the line being a BFN and it could be.  I was shaken by the transition to starting an IVF cycle after IUIs, what will happen to me if IVF doesn't work?  So many of you in blogland have pulled yourselves up by the bootstraps and kept on trying.  That is the hope that I hold onto and appreciate.

At the same time, I have learned it is important to *imagine* what my friends are going through.  I used to say, "I can't imagine...," when I really meant, "I don't want to imagine...."  While imagining is hard and usually terrifying/horrifying/depressing, it helps me be a more sensitive and caring friend.  Of course I can't really *know* what my friend is experiencing, but I can at least do my best to imagine.

So today I imagine what J and M are going through.  The disappointment is raw and the questions about what life will look like going forward are plentiful.  My heart breaks for them.