IVF #2 - Trigger Day

After eleven days of stims, tonight is my last injection - the HCG trigger shot. The purpose of this injection is to essentially force me to ovulate and allow the eggs to be collected from the follicles. The trigger is very time specific and taken 35 hours prior to retrieval - I take it tonight at 9:30 pm.


At the ultrasound this morning we counted eight follicles over 17 mm with the lead at 21. There are also a couple of stragglers in the 14 - 16 mm range that will catch up by retrieval Wednesday morning. My estrogen continues to rise quickly (similar to last time) and was 5388 pmol/L (~1500 pg/mL) this morning. All good news!


In other good news, we received an email from Genesis Genetics this morning (this is where we are having our genetic testing done) and the cost is about half what we expected at $2,600 CAD. This covers up to eight embryos over a nine month timeframe. So, if something happens (i.e. we send our embryos and none are genetically normal), and we decide to try another IVF, we are covered in this respect cost-wise if we do another cycle right away. It's good to have that peace of mind.


Next stop, egg retrieval! I show up at the clinic Wednesday morning at 7:30 am with everything but my legs crossed.

IVF # 2 - Day Ten & we're almost there

This is an update from yesterday's ultrasound and blood work - for some reason the patient portal is not working for me so I had to get an update verbally during my appointment this morning.


Yesterday we had seven strong leaders on the right ovary, and three on the left, with the lead follicle at 17 mm. Estradiol was 2024 pmol/L (around 550 pg/mL in US units). For comparison, on day nine of IVF #1, we were at eight on the right, five on the left, with the lead follicle at 16 mm. My estradiol was at 3879 pmol/L.


I am on a Femara/Antagonist protocol, which suppresses estrogen in the early part of the stim cycle, so I'm not really surprised that my levels are slightly lower. The use of Femara (aka 'letrozole'), which is an aromatase inhibitor, acts to block the conversion of androgens to estrogens in the body. This results in less free estrogen in the blood stream. The benefit of Femara as part of the Antagonist protocol, and the subsequent reduction of estrogen, is that it makes my follicles more receptive to FSH, which is part of what makes the eggs grow. You can read a bit more here.


We went in for another ultrasound and blood work this morning with instructions to return again tomorrow. I will likely be stimming for one more night (tonight) and then trigger tomorrow night, for egg retrieval on Wednesday.


I think side effects are kicking in to high gear because I feel slightly nauseous all day, with a pretty serious aversion to coffee and espresso drinks of all things. Anyone who knows me knows this is serious! Luckily, it isn't so bad that I can't be out and about enjoying the beautiful weather all day, and we've had a lovely time touring Victoria with Derek's mom and aunt for the last four days.


Almost go time!

IVF #2 - Day Eight of Stims / First Ultrasound

This post is a day late because I spent most of the day yesterday in bed with food poisoning (thanks Salmon Wellington). Luckily, before it hit me too hard, we were able to make it to the clinic by 7:30 am for blood work and my first ultrasound. It looks like we're on track and things look similar to IVF number one, which resulted in 14 mature eggs. Here's my follicle report:

We are looking for follicles close to 17 mm for trigger. The more that are close to that number at trigger, the better. In some cases, they'll let me go an extra day or so, resulting in follicles upwards of 20 mm, to allow slightly smaller ones to catch up.


During our first IVF my right ovary looked much better than my left as well, however during retrieval they found a handful of hidden ones (my left ovary itself likes to hide). I'm hoping for the same result this time as well. Estradiol yesterday was 890 pmol/L, which is right where I need to be.


Next ultrasound and blood work is tomorrow morning.

IVF #2 - Day Four of Stims

I had forgotten how much nerve it takes to stab yourself in the abdomen with a needle. I started stims four days ago, and as I stood over the sink with my first of three daily injections, I almost started crying when I realized that I ACTUALLY had to put this needle in my stomach. Tears in my eyes, I looked at Derek sitting on the edge of the bathtub watching me, planted my feet, and jabbed it in. And it stung going in, but wasn't so horrible that it stopped me from preparing and taking shots two and three.

Now I've got my routine and I'm done in 20 minutes flat. 150 IU of Luveris (two 75 IU vials with multiple prep steps) and 450 IU Gonal-F. I'm also taking 7.5 mg Femera mid-morning (pills), and steroids in the evening (also pills). In a couple of days, I add a new injection mid-morning to prevent me from ovulating too early. I've added all of these reminders to my phone and check often to make sure I'm not missing anything. Good thing I'm organized by nature and enjoy routine!

When I was contemplating what I would write in this blog post as an update earlier today, I was reflecting on the fact that I've had very few symptoms so far. My abdomen is tender for sure, and I haven't been sleeping well (this is normal for me, so not sure if it's a symptom or not), but otherwise it's still early, so no major bloating. Then, this afternoon, I started getting irritable. And then, about an hour ago, I had a cry. For no reason. Yup, side effects are starting. Now the fun really starts!

This picture is worth $9,004.38

I picked up the last of my medication for our IVF this evening and had a sudden, shocking realization about how much this is going to cost us. It's one of those things people wonder, but never ask - how much does it cost? It depends on how much and what type of medication you need, how long you stim for, what your insurance covers, what types of intervention you need (i.e. genetic testing), and what your clinic fees are. In our case, my insurance covers zero IVF medications, but will cover things like antibiotics, steroids and even the letrozole (Femera). But the most costly medications, which in my case is Gonal-F, Luveris, and Cetrotide, are not covered. Luckily, we can coordinate benefits and hopefully upwards of 80% of the medications are covered by Derek's benefits and we will be reimbursed in a month or so.

In addition to this, the fee for our IVF with the Victoria Fertility Clinic is $9,500. This includes the egg retrieval and associated twilight medication/IVs, sperm collection, embryo culture, biopsy (for PGS - genetic testing of the embryos), vitrification of the embryos (freezing), our first year of cryostorage, and our first frozen embryo transfer. This does not include the PGS itself, which will be an additional $2,000 to $3,500 and is performed by a lab in the U.S. All ultrasounds and lab work is covered under our provincial health care, so no out of pocket costs. We also have travel costs to Victoria, as well as accommodations and food.

Known costs for this IVF: $20,500 -  $22,000 (not including travel and accommodations).

Pro Tip: All medical costs not covered under provincial health care or insurance in excess of around 3% of your total income can be claimed on your income taxes. In general, you should receive around 25 - 30% of your claimed expenses back.

It's a very, very expensive process, and we are lucky we can afford it as many can not. Regardless of the ability to pay, it's still a punch in the gut when you add it all up. Hopefully, in the end, it's all worth it.

Here we go again

Last Thursday we had our scheduled consult with Dr. Hudson with the Victoria Fertility Clinic. Originally, our plan was to cycle in October or November, in part so we could enjoy the summer, and I also had a few cycling goals, which I met (yay, upgrade!). During the call with Dr. H, he asked where I was in my cycle. I was expecting my period over the weekend and said as much, and also mentioned that my cycles were becoming irregular after two decades of almost textbook cycles. Based on that, as well as some of my blood work results, he thinks I might be treading in to diminished ovarian reserve and poor egg quality territory. Then he said 'You know, based on your medical history and what's going on with your cycles, you could and probably should start right away.' A little bit terrifying, but we're ready, so here we go.

Today is cycle day four, and I'm downregulating until the end of August. On September 1st, I start injections. I will be starting with a high dose of Gonal-F and Luveris, which I used for our first IVF. The difference this time is that I'm starting at a high dose, whereas during the first IVF we started low and ramped it up quickly due to poor response. I ended up stimming for longer than normal, which may have overcooked my eggs and resulted in poorer egg quality. This time we're starting with the big guns.

Interestingly, I will be taking Femera at the same time. Femera is also used for hyperovulation, but usually on it's own, and usually for timed intercourse or IUI. From the limited research I've read so far, this should do what I'm referring to as 'slow cooking' my eggs in a way that slightly counteracts the high dose of Gonal-F. This will hopefully result in many high quality, mature eggs.

Starting on September 6th I add Centrotide to stop my body from ovulating and keep things cooking. We head to Victoria to finish things off on September 7th with estimated egg retrieval somewhere between September 12th and 15th. Using a combination of natural fertilization and ICSI (where they take a single sperm and inject it in to the egg - see image below), they will culture the embryos until day five. Each embryo will be biopsied before being frozen and the biopsy cells will go to the U.S. for Pre-Genetic Screening (PGS). This will be done to determine which embryos are genetically normal and ready for transfer, which will take place, if everything works out, sometime before Christmas.

Fingers crossed it all goes smoothly - here we go again!

Hope and Fear

Our seven year wedding anniversary was earlier this week (July 18). Derek took a long time to get around to proposing, so we have been together for more then double that, 15 years. The first time I got pregnant (that I knew of) was in 2007, right around the time Derek started with the fire department. Up until that time, we had never used any type of contraceptive, and I'm honestly not sure why I didn't think my not getting pregnant wasn't a big deal - maybe my mind just wasn't there yet. The day I found out I was pregnant I was bleeding heavily with what a thought was a really long, really bad period. At some point I figured I should probably take a pregnancy test, which I did, mid-day and at work, and it was blaringly positive. I left work and went to the hospital, had the requisite blood work and ultrasound done, and found that I was in the midst of my first documented miscarriage.


It was shortly after that loss that I began to track my cycles, and we agreed that maybe we should just go ahead and start trying to conceive. At our wedding in 2009, I remember thinking to myself that it would be just perfect if I became pregnant right around the same time, but a week after our wedding I got my period. Finally, in 2010, we started TTC in earnest, including working with the fertility clinic.


Despite the time that has gone by, and the losses we've endured, I still, sometimes, hold out hope each month. But when I think of what might happen past that positive pregnancy test, it's a fuzzy, scary black hole. I think it's inherent for us IF survivors, whether we do finally carry to term or not, to be fearful. The joy has been taken away and it makes me sad. I will never get to 'surprise' Derek with a positive test in a cute little gift box, blissfully unaware of what could happen a few weeks down the road. I will never go for just one pee-on-a-stick pregnancy confirmation test at the doctor's office, nor get a single blood test to confirm. I will never go for that first ultrasound full of joy, I will only be full of worry that there will be no heartbeat, that there is nothing there. The first 25+ weeks will be full of fear that I will lose the baby before viability, and then the months leading up to the birth will be full of the same fears plus the fear of birth complications. It won't stop there - I will be a helicopter mom, so worried that our precious prize from our hard fought battle will be hurt, injured, might die in childhood.


As we approach our last IVF, with my renewed hope that this new protocol might be what we need to stay pregnant, I think of these sorts of things and wonder if we can handle it. It's hard to rationalize these conflicting feelings - hope and fear - and I can only hope that the feelings of joy and love can overcome it all.