IVF #1 - It worked...and then it didn't.

Previous to starting this whole IVF process, Derek and I discussed how and when we were going to do a pregnancy test following the transfer. I am a self admitted POAS addict, so had originally planned to test out my trigger and then (hopefully) watch the line get darker again to indicate a pregnancy. However, Derek pointed out, and rightfully so, that this whole process should involve the both of us, and we both needed to be involved in the testing. In an effort to take the pressure off, and to keep this as close to a shared process as possible, we agreed to test together on a day where we would be sure the trigger was gone, and any second line would mean a pregnancy.

There was some disagreement about the test date, but I recall that we decided to test 14 days post trigger (or 9DP3DT / 12DPO) while Derek remembers 14 days past the retrieval (11DP3DT / 14 DPO). Either way, we ended up testing on 10DP3DT / 13 DPO, this past Saturday. And we got this:

It's light, but it's a line, a line even Derek could see. It's a line that is reasonable for ten days past a three day transfer. It worked, and I cried. Derek asked why I was crying and I said I was just so happy!

But alas, it was not to be. I tested again the next day and the line didn't get any darker. Looking to calm my fears, I went in for a beta and tried my hardest to remain positive. I didn't get the results until the next day, Monday, and I knew what was coming. My beta was only 4, which is technically 'not pregnant' (below 5 is classified as not pregnant). My test that morning had been almost negative (damn those FRER's are sensitive!). By this time, I was 12DP3DT, or 15DPO.

Today is my official test day with the fertility clinic - yes, they make you wait until 18 days past retrieval - and I'm not even going to bother going in. I'll give them a call and let them know I've tested negative and schedule our WTF appointment. This is our third uterine loss (I also had an ectopic last summer) and I'm convinced there is something going on with implantation. Our plan going forward is to review the results of my repeat pregnancy loss panel and request additional immunology blood work for potential problems including increased NK cell activity and lupus.

We also need to take a few months off. Though I was happy, positive and emotionally stable through the whole IVF, I feel mentally drained at this point. In retrospect, this took a much bigger toll on us then we thought. In less then two weeks we will be in Hawaii with my parents and sister Lara for a couple of weeks, and then we head to Penticton, B.C. for ten days in mid-May, and we need it. We'll start the immunology testing in June and expect the results to take a few months. That puts us at August or September for our frozen embryo transfer (FET).

At this point in time, I don't feel like I could handle another IVF cycle. Adoption seems like a reasonable option for us at this point, and comes with a much better guarantee at close to the same price. That said, we'll see what the next year brings.

IVF #1 - 4dp3dt and we have Totsicles!

4dp3dt = four days past three day transfer, otherwise known as 7 DPO.

I'm not going crazy yet, but I can feel the crazy right around the corner. Time is slowly moving forward and I'm thankful for a very busy week at work (including travel from Wednesday to Friday) and a final assignment for University due next Sunday. My few symptoms, sore boobs and light cramping, can be attributed to the 600mg of progesterone and 4mg of estrogen I'm on each day, but that doesn't keep me from analyzing every little twinge and pushing on my boobs every once in a while to make sure they still hurt (they probably hurt because I keep pushing on them).

We got some amazing news yesterday! Left with little to no hope for frozen embryos after the transfer last Wednesday, we got a call from Chris the embryologist early yesterday afternoon to let us know that they had successfully frozen two day six hatching blasts yesterday morning! Last we heard, we had a few embryos that were a day or so behind that they were going to leave in culture to 'see what happens'. We didn't have a lot of hope, but figured there was no harm in letting them sit, right? Well, two of them caught up, and we have two more 'average' blasts on ice for when we need them.

Not only does this let me breathe a bit easier, but it will really help me to relax for the rest of this cycle, because we have a couple of totsicles in the fridge for a second go if we need it. Hopefully we use them for sibling(s), but it is a relief to know that we have a plan B.

IVF #1 - Embryo Transfer

One day post transfer and I'm already starting to obsess. Logically I know nothing has implanted yet, but every twinge and cramp draws my attention immediately to my abdomen and my thoughts to those two little embabies in there. How am I going to get through the next two weeks?

The transfer was right on schedule yesterday afternoon. Derek arrived shortly before the appointment and we were ushered into the same room the egg retrieval was performed in. I had a full to bursting bladder for the ultrasound guidance - too full, even, and they asked me to empty about half. Once I was up in the stirrups, the embryologist came into the room to talk to us about our embryos. We had two 'average' day three embryos, one a six cell and one an eight cell, which are exactly where they should be for how old they were. There are a few slow four and five cell embryos still in culture that they'll continued to monitor until day five (tomorrow) to see if we have any that catch up for freezing, but it didn't sound hopeful.

Dr. Scott and the nurse started to work on inserting the external catheter, which was painless - a nice change from the usual pain I experience because of my bent cervix. Apparently the pressure of my full bladder straightened it out. I was seriously shocked when she said she was in, my hand in Derek's ready to squeeze the living hell out of it! I think Derek was somewhat relieved that it went so well.

On the same monitor where I watched them harvest my eggs only a few days prior, they brought up a magnified image of our two little embryos. We watched on the monitor as he sucked them in to the needle, verify they were in there, and then come into the room with the catheter and hand it to the doctor. We were also able to watch on the ultrasound as she injected them - we could see exactly where they were injected. Of course, you can't see the embryos themselves, but there is an air bubble in the catheter between the two embabies that shows up as a white dot on the screen. In less then ten minutes, it was done.

She pulled all of her tools out and covered me up. I lay still for about 10 minutes while Derek and I reflected on the fact that we had two of our own inside me at that very moment. I was moved to a recliner and told to relax for 30 minutes before getting dressed to leave. We sat beside a couple who had gone in before us and wished each other luck as they left.

I spent last night lazing on the couch under direct orders from my husband, who cleaned, cooked and wouldn't let me get up unless it was just to go to the bathroom. We are both in a very positive place and feel like this is going to work for us. We're trying not to talk too much about what will happen if it doesn't, and I sincerely hope we never have to.

One of the best parts of the whole thing was when they handed us a picture of our embryos, which is now hanging up on our fridge with the other family pictures. Here's to hoping that this will be the first page in our baby book:




Six cell on the left, eight cell on the right.

 

IVF #1 - Fertilization Reports and Transfer Day

After a hugely successful retrieval, we were pumped to get a call from the embryologist on Monday morning telling us that 14 of the 17 eggs had fertilized naturally over night. This was much, much better then we expected, and I got to shock Derek in to silence when I called him to say he's a father of 14!

Unfortunately, we got some bad news on Tuesday (yesterday). Apparently most of the embryos had fragmented over night, and we only had between two and four that were of decent quality. Because of this, they recommended a three day transfer, which happens in about two and a half hours.

The website Advanced Fertility (a clinic in Chicago) has a pretty good explanation of what they look for in an embryo, including proper and timely division, and degree of fragmentation. You can read about it here. Fragmentation is when little bits of the cells break off from the main cells. There isn't a definitive explanation as to why this happens, it just does. Some theorize that it's due to poor egg quality, or possibly sperm issues, or even the type of protocol that's used for the IVF. That said, some fragmentation is ok, and even expected (up to 10% is normal). When we go in this afternoon, I expect them to tell me how fragmented the embryos were as well as at what stage they started to fragment.

Because of the fragmentation issues, they clinic recommended assisted hatching. After an egg is fertilized with the sperm, it develops a tough zona pellucida, in part to prevent other sperms from getting in a ruining the embryo (that does happen sometimes, and you can end up with too many chromosomes, or other issues). Assisted hatching uses a laser or needle to pierce the zona pellucida and allow the embryo to hatch. A summary of how and why it's done can be found here. Because our embryos have undergone assisted hatching, I started taking a steroid yesterday, and will continue for another five days, to prevent exposure of the embryo to inflammatory cells in my uterus.

What we are hoping for this afternoon is two good quality embryos to transfer over. We would be very happy if we had some to freeze, but that seems unlikely at this point.

So, with fingers and toes crossed, Derek and I head to the clinic for our 3:30 appointment to be PUPO. Pregnant Until Proven Otherwise!

IVF #1 - Egg Retrieval

Today was the big day! I was a bit stressed out because I stupidly spilled some of my HCG trigger shot on Friday night. I was supposed to be injecting 2 mL split between two syringes, but in the end, I had 1 mL in one, and just over 0.7 mL in the other. However, when I talked to the doctor doing my retrieval this morning, he said that the 10,000 units I was supposed to take (a total of 2 mL) was more of a safeguard, and half of the dose works just as well for most women.

We arrived at the clinic at 9:30 am and were ushered in to the back where the nurse sat me in a chair and put a heating pad over the arm that was going to get the IV. She explained the process to both of us and went over the post-ER instructions, including my doses for estrogen and progesterone to be started tomorrow morning. After about 20 minutes, the doctor came by and did my IV (he said I have nice veins - but really, it's just that he was great at inserting it). They walked me in to a darkened room with stars painted on the walls and roof and a TV screen on the far wall. He immediately gave me Fentanyl for the pain and Versed to relax me. I was awake and responsive for the whole procedure.

He inserted an ultrasound probe and I was able to watch what he was doing on the ultrasound screen. He gave me a heads up before he inserted the needle through the vaginal wall and in to my ovary. I felt a lot of pressure and some pain, so the nurse gave me some more pain meds. Afterwards, I felt very little until the very end of the procedure when he had to dig a bit to get at the last two follies on the left. It wasn't any worse then period cramps though, so tolerable.

I could see the needle go in to each follicle on the ultrasound, which looks like a dark, almost circular spot on the screen. I could actually see him sucking the fluid and egg out on the screen - pretty cool to watch! Every few minutes, the embryologist would come in to the room and pick up a bit of the fluid and take it in to the lab on the other side of the wall. I was able to see what he saw in his microscope on the TV screen at the end of the bed. Every few minutes he'd tell us how many eggs we were up to.

"...five eggs..."

"Up to seven now..."

"...eleven!"

I was out of the room and in recovery before he had counted them all, but he came by within about 15 minutes.

17 eggs!


If you recall, at my last ultrasound I have 11 follies on the right and five on the left (with only two looking promising), so we ended up with more follicles and eggs then we thought.

Now it's more of a waiting game. The clinic hasn't called today, which means they had enough sperm to attempt natural fertilization. The embryologist will call tomorrow morning with our fertilization report. According to the clinic's typical rates, we're looking at around 70% mature, so of those 17, around 12 will be mature. Of those 12, 70% will fertilize properly. We should end up with eight or nine embryos.

By Tuesday morning we should know if we're doing a three day transfer of two embryos, or a five day transfer of one blastocyst. It's really up to the embryologist to decide what will be best for us.

Either way, I'm very, very pleased with the retrieval and can't wait to get that call tomorrow. It's amazing to me that at this very moment, Derek and I have a bunch of our potential babies in a dish at the lab. Crazy.

IVF #1 - Final Monitoring Appointment

Last night sucked. Around 8:30, Derek called me from the union meeting he was attending to tell me he had very serious stomach cramps and was throwing up, so was on his way home. He arrived home and went right to the bathroom, where he continued to suffer out of both ends (poor guy). He crawled on to our bedroom floor and laid there in pain while I called Health Link (our nurse hot line) to ask for advice. Of course, the advice was to head to the hospital, as it could be his appendix or gall bladder.

At this point, the pain was so severe that Derek couldn't sit up long enough to ride in the truck to the hospital, so we called an ambulance. The paramedics gave him morphine and gravol and transported him to Foothills. Once there, a barely conscious Derek sat in a wheelchair while we waited to be admitted. Around midnight, we finally got on the wait list to see a doctor, and actually saw him around 1:30 am. After some blood work and diagnostics, the doc said it was a severe stomach flu and not something requiring surgery, thank goodness. I was seriously starting to question our karma as there seems to be issue after issue happening during this IVF that keeps threatening to cancel. Luckily, it appears that Derek's flu will not affect anything, and we're still good to go.

They gave Derek Buscopan, which relieves stomach cramping, and sent us home around 3 am. Derek seemed to feel a bit better and settled in to the couch while I went to bed for about three hours of sleep before I had to get up for my monitoring appointment this morning. Thankfully, while he still feels pretty horrible, he has no stomach cramps today and the vomiting is gone.

I spent what felt like forever at the clinic this morning, but got only good news. Seems that my right ovary is picking up even more, as they found eleven follies today compared to eight just two days ago. The left still has five, three of which look pretty good. We have a leader at 19mm on the right, and a 16mm lead on the left. My lining is at 9.5, so pretty much perfect. My estrogen has continued to climb and is at 6665 (Canadian units) / ~1800 (US units), which I am happy with. The rule of thumb is about 1000 (Canadian) units of estrogen per mature egg (which is what we need - keep in mind we'll get more total eggs, but about 70% of those will be mature and ready to fertilize). At this point, I'm looking at about six or seven mature, but likely another one or two on top of that by retrieval, as my estrogen will continue to climb.

We had expected to trigger tonight, but the doc has me doing one more night of stims with trigger tomorrow night. That puts egg retrieval on Sunday, which works perfectly for us. I had my HCG mixed today and got instructions on how to inject. Just about there - only one more night of injects and we're done, not to mention no more Suprefact nasal spray. To be honest, it will be somewhat strange to not have my life ruled by such a strict schedule, not to mention being able to actually sleep in on the weekend instead of waking at 6 am to do my spray and being unable to fall back asleep.

Almost there!

IVF # 1 - How to Mix and Inject Luveris (and a monitoring appoitnment update)

*Update - the clinic just called with my E2 and we're up to 3879 (1057 in US units). Holy huge jump! I'm very pleased with this!

*Monitoring update at the end!

Today we are going to learn how to mix and inject Luveris, one of my daily injections. Luveris is synthetic lutinizing hormone, aka LH, and is used in conjunction with Gonal-F (which is a follicle stimulating hormone, or FSH) to stimulate oocyte growth. I'm now on day ten of injections, so I've kind of got this one down, but the first couple of times I was really nervous that I was going to miss a step and screw something up.

First thing first, you need to get all your supplies in front of you on the table. You need a box of Luveris, a syringe, needle, Q-cap, and two alcohol wipes.

Now go wash your dirty hands. I dry them off using paper towel just to avoid lint and possibly dirty dish towels. First step is to take out the two vials (one saline and one the powdered Luveris) and pop off the tops.

Using one of the alcohol wipes, wipe down the tops of both vials really well.

Set 'em down and open up the Q-cap and syringe. Make sure you don't touch either end of the Q-cap, especially the pointy end (that goes in to the vial).

The Q-cap screws in to the end of the syringe. Screw it in so it's tight (not too tight), and the pull back on the syringe plunger and fill it with 1 ml of air. You do this so you can displace the volume of fluid in the vial as you're drawing it out. Makes things easier, apparently.

Now that you have air in the vial, you can flip it over and push the Q-cap down in to the bottle of saline. It takes a teeny bit of force, but shouldn't be difficult to snap it in. Push the air in to the vial. Then, holding the plunger down (the air will try to push back out), turn the syringe/vial upside down and slowly draw in the saline.

Once you have it all in there, flip it back over and pull off the vial. Don't worry, it won't spill. Next, take your vial of powdered Luveris and pop it on with the syringe right side up. Slowly push the saline in to the vial. Now, swirl it around. Don't shake it, or you'll create bubbles, which are bad. It'll only take about 30 seconds for everything to dissolve.

Now that it's all mixed, flip it back upside down and slowly draw the mixture back in to the syringe. I usually draw back so I have a bit of air in the top, then push it back up so the liquid is right at the very top of the syringe. Next, screw off the Q-cap and open the needle package. The needle screws in similarly to the Q-cap.

Holding it needle point up, take a look for bubbles and flick the syringe to get them up to the top. It's ok if there are a few small bubbles, it's not like it's going in to a vein. Once you get the bubbles to the top, remove the cap and slowly, slowly push on the plunger until a few drops of liquid come out of the needle. Now you're set to inject!

Now is where the second alcohol wipe comes in. I inject in my stomach, but you can also inject on the outer thigh. I tend to move around a few inches each time too, just to avoid too much bruising. Take your wipe and wipe down about 2 or 3 square inches on your injection spot. Let it air dry for a few seconds and then take a good pinch of fat.

Keeping it in a pinch, insert the needle. It really doesn't hurt, just try not to hesitate too much. The anticipation is the worst part, trust me! Once it's in, slowly inject the liquid. It does seem to sting a bit if I go too fast, so I take about 10 - 15 seconds to inject it all. Once it's all in, hold the needle in for another few seconds to make sure it's all in there. Let go of the pinch, and pull the needle out.

Cap the needle, take it apart, and put it in your sharps container. Easy peasy, right?

Honestly, in the beginning of this all, I was thinking there was NO WAY I could give myself injections. But, I will do anything to have a baby, and it is not bad at all once you get comfortable with it. Good luck!

Monitoring update: my ultrasound this morning went well! I now have eight follicles on the left, with the leaders at 16mm, 13mm and 13mm, and five on the right, with the leaders at 13mm and 11mm. My lining is triple stripe at 8.3mm (this is good). They have me on the same dose of Gonal-F and Luveris for two more nights, and then my final monitoring appointment on Thursday morning. I should be triggering Thursday night if it all looks good, which puts the retrieval on Saturday.

Just wanted to post this cute note my husband left for me on our whiteboard the other day:

Yup, I'll get right on that!

IVF #1 - Day Six Ultrasound and Bloodwork and How to Inject at a Party

Bright and early yesterday morning (I never get to sleep in anymore) I headed to the fertility clinic for my day six ultrasound and blood work. Surprisingly, the clinic was pretty busy, so I had to wait about an hour and a half. One of the other clinic doctors did my ultrasound and he kindly showed me everything on the screen. He started on the left ovary and counted seven follicles. He measured five of them and they were all around 10mm or 11mm. The ideal size for trigger is about 18mm to 20mm, so we are just over half way there. The right ovary was not responding as well and only had four follicles, of which only two of them were around the 10mm mark. Not too bad, but I guess I was hoping for more.

I got the call with my E2 results a couple of hours later: 501. This is still pretty low, so they've significantly bumped up my Gonal-F to 375 UI. Hopefully this gets things going a bit faster! Either way, the nurse thinks we'll be triggering on Wednesday with egg retrieval on Friday. I can't believe how fast this is going!

So last night Derek and I travelled an hour and a half north of the city for his cousin Jon's 1920's dress up Murder Mystery birthday party (We had a ton of fun! Derek is still sleeping off the fun he had!). We arrive just a few minutes before six, which is when I do my injections, sos soon as I was in the door, I beeline it for the bathroom. Normally, it takes me about 10 or 15 minutes to do both injections, what with mixing the Luveris and making sure I'm doing everything properly. Considering there were a bunch of loud people outside the bathroom door, and a knock or two, I was trying to hurry up and get it done. I was nervous I was going to mess something up and tried not to drop plastic caps and needles off the small bathroom counter. I was unable to use ice on the injection sites, but surprisingly it didn't hurt at all - guess I don't really need it! I was so shaky and rushed that I had to take a few deep breaths before each inject to make sure I got it in straight. I think I was in and out in about seven minutes.

I've heard stories of women who've had to do injects in an airplane bathroom or in a vehicle - I don't envy them! Doing it in a strange bathroom was bad enough. Anyway, I got it done, and the side effects are certainly kicking in. I'm bloated and crampy, have a constant headache and am tired all the time. Hopefully my body is just preparing for the next ten months!

Next appointment is Tuesday for another ultrasound and blood work. Fingers crossed for good news!

Hobbling to my First IVF Appointment

First thing this morning Derek and I headed to the fertility clinic for my first round of blood work. They are looking at my estrogen levels, which are indicative of how my follicles are developing. Ideally, at this point, they like to see between 250 and 500.

While there, we spoke with the nurse and I had her explain to me what it was the doctor used during my ultrasound on Sunday to straighten out my cervix. Apparently they use what are basically forceps and pull on the cervix to straighten it out and get the catheter in. No wonder it hurt so much! I also learned, as the nurse was describing this process, that the non-pregnant uterus is about the size of putting your pointer finger against your thumb and making a tear drop shape. Way smaller then I thought. Must refresh self on anatomy, apparently! Derek is also having bad side effects from the antibiotics he has to take - lots of nausea. She said that if he's still having issues after tonight's dose to call and they may let him forgo the last day.

Following this appointment, we went to my physical therapy appointment for my knee to determine if I will need surgery or not. If I did need surgery, we would postpone the embryo transfer, freeze everything, and do the knee surgery first. Our primary concern was that my knee would not be able to support the pregnancy weight, and I wouldn't be able to get around during or after. Of course, I thought this was fine ("I'll figure it out!" says I, in tears), but Derek pointed out that this would put a lot of unfair pressure on him and the baby, which is not what we want. 

Anyway...I don't need surgery! Well, I might some day, but the therapist was confident that I will be able to rehabilitate and strengthen up enough to support pregnancy weight and even go back to cycling and running. He did say I will have to avoid the harder skiing, but could probably get away with skiing resort runs (not this year, of course). He did an assessment, said he felt some laxity in the forward/backward movement and thinks I may have partially torn my ACL and MCL. I am planning to pay for a private MRI in the next week or so and will see him weekly. We did a bit of acupuncture and ultrasound on my knee to help with swelling and he gave me two exercises to help increase the range of movement in my knee.

As I'm laying on the table with needles in my leg, the clinic calls. My estrogen today was 130, so not even close to where they want it. All this means at this point is that I increase my dose of Gonal-F to 225 UI, and continue with 75 UI of Luveris. Not a big deal, but this does mean our drug costs increase. We do get it back from insurance eventually, but it's still hard to pay thousands of dollars up front.

So, next step is to go in for an ultrasound and more blood work to check estrogen levels on Saturday morning. Fingers crossed everything looks good! If I progress as expected, it's only ten more days to egg retrieval!

IVF Number One - Day One

Bright and early this morning, I hobbled in to the fertility clinic (I hurt my knee pretty bad on Friday - more on that later) and had my baseline ultrasound and blood work. I remember when I used to be scared of needles and would almost cry any time I had to get blood taken. Ah, those were the days. Dr. S came in to do the ultrasound, check my lining, and check the depth of my uterus. She said my ovaries look nice and quiet (the right looks really good, apparently, whatever that means) and my lining is nice and thin. She had to insert a catheter to measure the depth of my uterus to determine how deep they insert the catheter during the embryo transfer in a couple of weeks. The last time I had catheters inserted was during our IUI's last winter and it hurt a lot back then. It still hurts now. She tried two sizes and still couldn't get through, so she ended up using this painful tool to straighten my cervix out and finally got in. I had some pretty good cramps for a few minutes, but nothing I've never felt before.

I came home and waited for the clinic to call with my blood results and the final go ahead. I got the call at 11:15 - my blood work showed my estrogen was 'below 72', which means I have no cysts or rouge follicles growing. So, I start injections tonight - 150 UI of Gonal-F and 75 UI of Luveris. I continue to take the Suprefact, which I've been on since February 2, but drop from five sprays a day to three.

Now, when you do IVF, there is a lot of information and...medical stuff to deal with. The afternoon I pulled the Luveris and one of my Gonal-F pens out and set everything up on our kitchen table.

It's a bit overwhelming

The Gonal-F is a pen, so all I need to do is insert the needle, twist the dial to '150', and inject in to my stomach or thighs.

Easy-peasy!

The Luveris is a bit more involved. It comes in two vials - one of saline, and one of the medication in powder form. Using a syringe (no needle on it yet) and something called a Q-cap, I pull the saline out of the first vial and inject it in to the powder. I swirl it around until it dissolves (no shaking - it creates bubbles) and pull it back in to the syringe. Add the needle and inject in to my stomach or thighs. I've read that this one might sting, so I'm planning on icing for a bit first.

Let's hope the instructions are clear enough.

I go in on Wednesday to get more blood tests to check on my progress. My estrogen should be rising indicating that my ovaries are being stimulated and creating those precious eggs. As long as my numbers are not too high, I don't go in again until Saturday, when I get more blood work and an ultrasound to count follicles. I'm just so glad we've passed this first hurdle and can get going!

Now, the knee injury. On Friday, Derek and I went skiing and I fell pretty hard on our first run. My ski got caught up and I twisted as I fell. When I fell, I felt and heard a loud pop in my left knee and had significant pain. After about 10 minutes, the pain started to subside and I tried to stand on it...no go - it felt like it completely dislocated and collapsed inwards. I was taken out by ski patrol and we went to the hospital. The preliminary diagnosis was a dislocated knee, but after some of my own research, I think it's more likely I tore my Medial Collateral Ligament (MCL). I am in a brace and on crutches, but the knee still feels pretty unstable. The bad news is that if it's a complete tear, I'll need surgery, and I'll need it before I attempt to support pregnancy weight on my knee. That means we might have to postpone.

I spoke to the nurse and she suggested we continue on with the injects until I can see the physical therapist on Tuesday. If it's something that is going to require surgery, we do have to option of freezing everything, or there is the possibility of doing the surgery with an epidural instead of general should I become pregnant (general anaesthetic isn't really recommended in pregnancy). If it does not require surgery, I'll be undergoing intense physical therapy to rehabilitate my knee as quickly as possible.

So, fingers crossed for lots of eggies and no surgery! Here we go!

Lucky Cycle Number 48!

When I went in to pick up my medications and review the instructions with the nurse the other week, she specifically told me I may or may not get my period while taking Suprefact. Regardless, my period was late, so I started to panic a bit. My first thought was that I must be pregnant, so tested. BFN, of course. And then I started worrying that this might delay things, and was ready to call the clinic this morning, when AF was six days late, to ask their opinion.

What happens when AF is six days late and your lining gets to build up an extra little bit before it lets go? You have a massive period, that's what. I was violently awoken at about three this morning in a sweaty mess with horrible cramps. I laid in bed, afraid to move, trying to breath through the pain. It's a tough spot to be in - thankful it's finally here, but pissed off that it sucks so much. I finally got out of bed and started searching for pain relief. I normally take Naproxen/Aleve, but it's off the table during IVF, so my only option was aspirin, which never works well for me. Because it never works well, I don't really keep it in the house. All I had was the low dose aspirin I take daily as part of my protocol. I check the bottle and see that one to four pills at a time are recommended. I take five, which is almost equal to one extra strength aspirin. I crawl back in to bed and waited for it to kick in, finally falling asleep around 4:30 or so for an hour.

So, yay, Valentines period! I'll take that as a good sign, er, somehow. We're at t-five days and counting until the baseline appointment this Sunday. The last four or five days have gone by surprisingly fast, and my week's plans are starting to fill up, so Sunday will be here in no time. I am a bit nervous about starting the injections, and hopeful I can do them in the evening rather then the 1:00 pm to 5:00 pm window they give on the information sheet. Bringing the needles and sharps container to work is not ideal.

Fingers crossed for a good baseline appointment and for finally getting going on this! We're now officially in lucky cycle number 48 - yup, about four years of TTC now. Crazy how time can fly but seem to drag on at the same time.

IVF #1 begins with Suprefact!

A couple of weeks ago I excitedly went and picked up the first two thirds of my IVF medication. I was excited until I saw the price, anyway. Oh, the costs of having a baby the science-y way.



Oh, the fun!


Along with low dose aspirin and prescription prenatals (with 5 mg of folic acid), I started my down regulation last Thursday (February 2) with Suprefact. Suprefact is synthetic LHRH analogue and the purpose of it is to put my ovaries to 'rest'. It stops me from ovulating on my own by supressing hormone production in my pituary gland. Suprefact is a nasal spray that I spray once in each nostril, every four hours, five times a day. As soon as I wake up in the morning, I grab it from my nightstand and squirt, squirt the stuff up my nose. Right before I go to sleep, I take my last dose. It's not horrible, but it does run down the back of my throat most of the time and it's not that tasty. Fortunately, the only side effects I've noticed so far are occassional hot flashes, and they aren't that unbearable.

I'm on Suprefact until my baseline bloodwork and ultrasound on February 19th. If my estogen levels and ovaries look good, I start injects of Gonal-F and Luveris to stimulate the production of follicles. More on that when the time comes.

While all this is going on, I'm also holding out hope that this last month of TTC worked. I know it likely didn't, but I am still analyzing every pinch and cramp. I'm 12 days past ovulation and should be getting my period on Wednesday or Thursday, but I'm holding out on testing (again!) until then. However, I do feel much more positive about the fact that if this cycle doesn't work out, we have a fantastic next step lined up! While I'm scared the IVF won't work, I'm hopeful that it might be our turn this time.

By the way, next cycle is cycle 48, so about four years of TTC now. Time flies, but not when you're TTC!

IVF #1

The clinic called this morning and we are good to go right away!

I will be doing the Long Lupron protocol for this cycle. We start Suprefact on cycle day 21 of this cycle (which is February 2) and I'll have my baseline ultrasound on February 19th.

If all goes well, I start my injections on the 19th as well, followed by more bloodwork and ultrasounds every second day to adjust doses as needed. My tentative egg retrieval date is March 3, and we will do a three or five day transfer depending on how the embryos look.

I'm waiting for the pharmacy to call with my final list of medication and the cost. Oh my goodness, the cost. The IVF must be paid for by next Thursday and we are looking at almost $7000. That doesn't include the medication, which will be anywhere from $3000 to $5000. We are hoping our health care will cover some of the cost, but it's tricky, because while they do cover the medications, the don't 'if it's part of fertility treatments'. Stupid.

I am nervous and scared, and when I called Derek this morning to tell him the clinic has us booked in for right away, he sounded the same. We know there are no guarantees, and there are so many emotions going on in my head right now. Excitement, fear, impatience, sadness for Lara, worry that something will go wrong.

Fingers crossed for success with number one, and pray that time flies for the next five and a half weeks (how am I going to deal with an IVF two week wait? Gah!).

Here we go

This afternoon I had my appointment with Dr. Scott to discuss our revised plans to do a frozen cycle for Lara and Roland, followed by a fresh cycle for us. After an hour wait (ugh, I hate end of the day appointments), I met with the doctor and her resident.

Holy dramatic change of plans!

Dr. S recommended that we do not do a frozen cycle for Lara and Roland. She showed me the statistics, and a fresh transfer for 31 year old eggs shows a 70% pregnancy rate. A frozen transfer shows only a 35% success rate. So, if we freeze all of Lara and Roland's embryos, we effectively cut their chances of a pregnancy in half.

The other glitch is that if for some reason Lara never responds well and can not build up her lining enough, she'll need to use a surrogate. We have always thought that I'd be the surrogate. However, this is illegal in Canada. Surprising, right? The reason is that it's my egg, so it is effectively an 'adoption', and illegal in this scenario, where I am the donor and surrogate.

So what does this mean? This means that Derek and I are doing our own IVF first, and that will happen soon. As in, possibly starting at the end of this month or mid-February. We will do a fresh transfer, and if it takes, we will do a cycle for Lara and Roland after I finish breastfeeding. If it doesn't take, and if Lara is responding well by then, we can do a fresh cycle for them.

Now we just do what we do best - wait! If they call this week, we will go ahead with it this month. Otherwise, I call the first day of my next period (in just over two weeks) and schedule in.

Calling my sister with this news and new plan was very hard. I understand how upsetting it is to wait for what seems like a million lifetimes to become a mom, and now her wait is extended even more. I know she understands why this is the recommendation and new plan, but I also know she's hurting. It is frustrating when we can't just do it on our own, and more so when you are dependant on another person to help you build your family. Lara, I love you, and I just want you to know that I know you're hurting and upset right now. And that's ok. It will happen for you, trust me. Like you said, 'this is fate', this is how it's supposed to happen.

Change of Plans

Should have updated this at least a week and a half ago, but I've been busy with work, life and University!

Lara went for her ultrasound on January 3 to check her response to the increased dose of estrogen and viagra. Unfortunately, her lining was only 5.5 - 6 mm, which is not enough. She spoke to our nurse, who conveyed that the doctor wanted Lara to take a couple of months off, then try mock cycles again, putting us well in to the summer for IVF.

The infertility journey seems to have very explicit ups and downs. You have the rise and fall of emotions during treatments - Clomid cycles, IUI, trying naturally, using something new. I had the rollercoaster of pregnancy loss three times, where I had days of joy and excitement followed by days of sadness and pain. Even then, getting a good beta after a bad one can renew hope, which is just crushed when you get the next call. Some months I'm perfectly patient, knowing our time will come, and some months I am practically biting my nails with impatience. The last six months I have been patient. I am now impatient. I can't wait any more.

So, this is what we're doing: I am going to do a cycle for only Lara and Roland right away. All eggs will go to them, they will fertilize, and freeze it for when Lara is ready. I will take the requisite month off, then we'll procede with our own IVF. I have an appointment with the doctor on January 23rd to discuss this and hopefully get moving. I will be mid-cycle at the appointment, so I hope, hope, hope we can get started right away and do the first egg retreival in February. If so, after a month off, that puts us in to April. We are planning a trip to Hawaii with my parents and Lara for the first half of the month, so hopefully it doesn't interfere, but if so, we'll bump ourselves to the next month.

So, fingers crossed for moving quickly! I'll update after the appointment on the 23rd!

(P.S. Lara may do a fresh transfer even if her lining is less then ideal. The nurse did say that they have had successful IVF's where the lining is not as thick as they want it...)

They're putting my sister on Viagra

My sister's last ultrasound did not bring good news. Her lining had only thickened to 5 mm, far below what they like to see. So, we're on to the next protocol.

Interestingly enough, the standard prescription for men with erectile disfunction also works for women with issues related to thin uterine lining. Viagra works by improving blood flow - like it does to the penis - and therefore facilitates better transfer of estrogen to the uterus. This makes total sense for Lara's situation. She has not had a period in over ten years, and I know that the body, over time, will reduce blood flow to areas of the body it is no longer using. The veins and vessels will retract and shorten, and her uterus, which hasn't been in use for over a decade, minimizes the amount of blood flow. The body is amazingly efficient!

Going forward, Lara has started taking progesterone to bring on a period and shed what lining she built up. She will be going on a combined estrogen patch and pill protocol, along with the Viagra. If this works out, her first ultrasound to measure her lining is on January 3.

Another bump in the road, but at least we're making progress! I'd much rather we figure this stuff out now then later, when we're in to the big bucks.

In other news, Derek and I leave next Sunday (the 18th) to drive up north to see my family and meet my new niece for the first time. I can't wait to see my family!

Mock Mock Cycles

(Only my family will get that title!)

So we're still in a bit of a holding pattern at the moment. As I mentioned in September, my sister has to do two mock cycles to see how she responds to the protocol they have her on. Basically, they're forcing her uterus to go through a menstural cycle, but without the ovulation bit. So they give her estrogen to build up the lining, and then once it gets nice and thick, they give her progesterone so she gets her period.

Unfortunately, through a series of miscommunications, her first mock cycle in October was a complete bust. There was a mix up in dosing instructions somewhere between the clinic and the pharmacy, and Lara ended up taking progesterone during the first half of her cycle, which she isn't supposed to do. She did build up a nice lining eventually, but the test results weren't going to be representative, so we had to start all over again.

Her second first mock cycle started almost three weeks ago. She had her first ultrasound last week, and after two weeks on Estrace, her lining was only at 4.4 mm with a barely there triple stripe (trilaminar). They like to see 7 mm or more, and a clear triple stripe, for an embryo transfer. So, she's continued on 6 mg of Estrace for the last week and has another ultrasound today. Hopefully her lining is developing well and we can move on to the second mock cycle. If it's not doing so well, they're going to try a different protocol and we have to start all over AGAIN! So much waiting. Fingers crossed for a good ultrasound!

By the way, my baby fever has lately kicked in to overdrive. I am surrounded by pregnant women and babies right now, and my craving for one of my own is sometimes overpowering. It's doubly hard because Derek and I are preventing right now in preparation for the IVF and it feels so weird. I guess it gets rid of the stress of the TWW, which is nice, but it still makes me a bit sad that we are losing time.

A little of this and a little of that

Wow, it's hard to believe it's been over a month since I've updated! I've been so busy with school and work that I hardly had time to think about TTC, let alone post.

I left home for Victoria, B.C. on October 1 for the first three week residency of my Masters program. The pre-residency course work was a stuggle, especially Economics, so I was apprehensive and maybe a little bit scared. Long, long days (sometimes 15+ hours) and spending the weekends working on group assignments left me with little time or energy to stress about the upcoming IVF, which was actually sort of nice. Sometimes we get so wraped up in this whole TTC mess that we forget there are other things to focus on, which is why I'm happy with my decision to keep living my life while we're waiting for our family to happen.

One of the best things about my three weeks away was the people I met. It's nice to be around people who have similar goals to me, people who I can relate too, even if we work in different industries. When I started this program, I had decided that if we do the IVF this January, I would take a year off from the program and skip the next October residency. Now, I wonder if that's really such a good idea. A month ago I was struggling with the decision to donate all my best eggs to Lara, but the last three weeks has really helped me to the realize that it might actually work out for the best if we do it this way. Of course, if I am a great producer and there are lots of good ones left, we'll still give it a shot on our own, but if that doesn't happen, I'm now at peace with it. I'd like to think that we'd try IVF on our own again in April or May, but I guess we'll have to see where life takes us.

So, back to the current IVF/Donor cycle - Lara is in to her third week of estrogen/progesterone and her lining is growing very slowly. Last week she was at 4 mm and this week she's at 7 mm. Both ultrasounds showed she had a triple stripe (this is something you want), and it's good to see her body is working the way it should. They've upped her dosages (Lara: "Now I have to shove the pills you know where! OMG!") and once she hits about 10 mm, they'll let her shed then go for one more mock cycle. Things are starting to get exciting!

IVF Shared Cycling - Part III

Our last appointment for the day was with our doctor and nurse. They met with us separately and the whole process took about two hours.

Our original and agreed upon plan was to split whatever we got 50/50, or biased in our favour if we ended up with an odd number of eggs. What we didn't realize is that there are three different types of eggs you can pull from a follicle: mature, borderline and immature. I think I mentioned these earlier, and perhaps mentioned that about 70% of mature eggs fertilize, 40% of borderline eggs fertilize, and immature eggs are destroyed. Let's just think about the mature eggs because those are really the only ones that count. Of those 70% that fertilize, about 70% of those make it to a good quality embryo on day 3. So if you start with six eggs, you end up with three or four high quality embryos, of which you would transfer two and freeze whatever is left. Around 70% make it through the freeze thaw cycle, so there is a chance you can lose these ones too.

The doc thinks I will probably produce six to eight mature eggs, and a number of borderline eggs. If this was not a shared cycle, we'd have plenty to go around. But it is shared, so we had to decide who gets all the good ones.

The point the doctor made was that if I get pregnant with this cycle, Lara has to wait upwards of two years before I can cycle again (after I have the baby and breastfeed), while I only have to wait two months. Thinking of it that way, the doctor suggested that Lara be the primary, and therefore, she gets all the best eggs first. The number she threw out there is six mature eggs. Lara and Roland get six of however many mature eggs I produce, and we get the rest, giving them the best chance at a successful pregnancy. So, if I produce eight mature and four immature, we end up with two mature, and four immature after they take their guaranteed portion.

Over the last few days Derek and I have discussed this, and I've done some soul searching, and I think this is the right thing to do. I think I am ok with waiting a few extra months if I need to, whereas Lara told me that they'd pursue other options if they can't use me. I'd like to give them the best shot at using Lara's genetic material first.

So, we just have to figure out the details, put it down on paper, have it witnessed, and send it to the clinic. Getting it on paper prevents two very hormonal women (remember all the medication we're on!) from getting in to a fist fight after egg retrieval if anyone should change her mind (and I'd totally win, by the way).

Just to wrap up, Lara got her prescriptions for her mock cycles (she has to do two) and starts October 4th when her and Roland get back from Jamaica (lucky jerks!). She'll be on Estrace (estrogen) and Prometrium (progesterone) to simulate a normal cycle. She has an ultrasound on day 13 to check her lining and make sure she's responding properly. Once her two cycles are done, we can move forward with the IVF(s). Based on her schedule and the fact that the clinic closes for Christmas, we're now looking at January for cycling rather then December.

So that's the whole situation. People keep telling me that I have so much patience with this, but really, what else can I do at this point but keep waiting?

IVF Shared Cycling - Part II

Day two. First appointment of the day is the psychology appointment. The purpose of this appointment is to help them ensure we are all on side with this whole process. The appointment itself took about 30 minutes and the psychologist seemed really interested in our situation. The Calgary Regional Fertility Clinic has free services for everyone going through the program, which is a huge benefit that I'll be taking advantage of.

Following the evaluation, the guys had to do their analysis. Derek is an old pro at the deposit in a cup game, so was giving Roland a very colourful commentary on what to expect. It seems like situations like this call for a little humour, and Derek is gifted with this skill, so although it was an uncomfortable situation, it really wasn't that bad, especially since the guys didn't end up in rooms next to each other. Luckily for Derek, we were able to get in early - before I had to go to my ultrasound - and I could go in with him. Yes, the ladies can go in to help. Considering all these poor guys have in there is a slim selection of magazines (Big n' Busty, Barely Legal, etc.), and the porn on the TV really isn't that great (the TV was broken anyhow), having the wife in there can really help move things along. Just make sure you don't contaminate the sample with saliva ladies - that's right, no actual BJ's (or sex!). Use your imagination.

Once we were done there, I had my ultrasound. We sent the guys downstairs for coffee and Lara waited with me. The purpose of the ultrasound was to take a look at my antral follicle count. AFC is a way for specialists to get an idea of what my ovarian reserve is (how many eggs I have left). Apparently, I'm perfect (I already knew that), and have nine on the left and 14 on the right. The total number of antral follicles can correspond with expected response and IVF success rates. 23 falls right in the middle of the 'good' count, and I 'should have an excellent response to ovarian stimulation'. This is really good news, and sort of puts me at ease about everything just a little bit.

Next was our mid-day break before our final meeting with the doctor and nurse to go over our game plan. Unfortunately, our original plan was pretty much vetoed by the doctor and now we have some very tough decisions to make. But, more on that later. I have a horrible cold today, was up late last night, and need to get to the lab for my CD3 blood work. Also, the homework I've been putting off while Lara and Roland were here. Good times!