embryo transfer

it has been quite a week. yesterday we had the embryo transfer. it was a day 3 transfer, called such because the embryos had been developing for three days since the retrieval. they do IVF transfers on either day 3 or day 5, depending on the quality of the embryos, as i explained in my last post. when we got there yesterday, the doctor explained to us that the five embryos we'd had on tuesday were all still developing, but that two of them had fallen behind and three of them were doing great. those three were 8-cell embryos, which is just what they should be after dividing for three days. the remaining two were only five and four cells each, which means they might continue dividing and be good enough to freeze, but probably not. but still... three out of five isn't bad!

the doctor told us that the embryologist who, (in his words) is "never wrong," highly recommended doing the day 3 transfer and not waiting to see if the embryos would make it to the blastocyst stage. i know this has a lot to do with my age, because it's more likely for younger women's eggs to survive longer outside of the uterus. it would have been ideal to wait until tomorrow and have blastocysts, but... what can you do? we'll just hope that my uterus is a fantastic incubator and they're happy to be back in there rather than in the lab.

i was a little freaked out about transferring three embryos, i have to admit. both doctors (the two institute directors, Dr. K. and Dr. B.) were highly in favor of this approach to maximize our chances of having at least a singleton pregnancy. i get their angle, but i needed to think about my own priorities, too. my goal was not to transfer more than i actually wanted to carry as babies, because i couldn't stand the idea of not rooting for total success. but i had told the hubby the night before that i was hoping for two, but if there was a really good case for doing three, that i would. and even in my valium-induced state in the doctor's office yesterday, i felt the same. he assured us that the chances of us actually ending up with triplets is less than 1%, but i had to be at peace with the idea that if we end up in that tiny percent... i will have three babies. i guess the valium helped, but i ended up saying "let's do it."

the procedure itself wasn't much of anything. i went upstairs to the IVF area like i did for the retrieval, wore the robe and everything again, but then it was pretty much like having another IUI. i was super chill, thanks to the valium, and it went really smoothly and quickly. then they had me lay down for about a half hour, and they gave me the best thing i'd ever seen...



an actual printed photo of my embryos! like a keepsake you get after riding a roller coaster at an amusement park or something. this is probably the most amazing scientific thing anyone has ever shown me. thinking that those tiny little cells were made by me and the hubby together, and that they were now inside my body with the potential to turn into actual people... it absolutely blew my mind. and it's a good thing that i had already decided that i was okay with the possibility of three babies, because as soon as i saw that photo my eyes welled up and i instantly knew that i wanted them all.

insane, i realize. but i don't know how anyone could react any differently, truthfully.

after the half hour rest at the office, the nurse gave me my post-procedure instructions (basically continuing all of the medications i started in prep for the transfer) and sent us on our way. i go back on monday for blood work, and again later next week for more blood work, and then on february 9 for the blood test to see if i'm pregnant. it feels like a long, long way away.

the fertility institute recommends that i stay mostly on bed rest for the rest of the weekend. i definitely did for the first 24 hours... i really only got up to pee. i've read a lot of different things about these post-transfer rest requirements, and i know that many doctors don't think that this is necessary after the first day. so i'm taking their advice about 3/4 seriously. i'm certainly not going to do anything strenuous, but i can't imagine staying on my butt for four days. i went to acupuncture today, because that is incredibly important to me and i know the benefits that i likely received by going negate the fact that i sat on the subway a half hour there and a half hour back. so far other than that i've been following the rule of not being on my feet for more than 15 minutes at a time. the hubby is trying his best to attend to me, but he's not very good at it. i think he wants to be, and he's very serious about me taking it easy, but it's somehow very frustrating to him to have to incorporate extra chores into his day. it's kind of funny to watch.

and there you have it: one full cycle of IVF finished and in the books. obviously i am hoping beyond all hope that this one is all we'll need. but, if it's not, at least we know what it entails now and that we CAN get through it. i'm feeling really happy, really optimistic, and doing a lot of talking and singing to these little embryos and thinking about them finding a comfy place to stick around in my uterus. wishing and hoping...

folks, we have fertilization!

in the shower this morning i was having imagination nightmares that the doctor would call and tell me that there'd been some catastrophic event where my eggs imploded upon the addition of the sperm and that we were back to zero and this whole thing was a waste of everyone's time. if you can believe it, that's not what happened. in fact, we have FIVE fertilized little embryos! it is so strange to think about there being tiny little multicellular creatures made up from my dna & the hubby's, just floating around in the lab at the hospital. but i'm so glad they're there!

from what i've read, it seems like typically between 75-80% of eggs retrieved are fertilized, so we were a little on the low side. but hey, five is five more than i had before. even if they don't all make it to transfer (which they likely won't) it appears that we'll definitely at least have something to work with. i'm actually kind of glad that we didn't prove to be Super Fertilizers, because maybe that's the issue that's been plaguing us all along. with only a couple of eggs at most in these past couple of years of cycles, maybe our stuff just couldn't fertilize... but with the increased odds and with assistance of the lab perhaps we've overcome that obstacle. i'd like to believe that, anyway, to prevent me from going into the transfer with the worry that our issue has been implantation and that we won't be successful this time, either. i know it's best to wipe all of those negative thoughts out of my mind... i guess that's why they've prescribed me valium to take before and after the transfer! ha!

the doctor said we should come in on thursday (day three of the embryo growth process) and we'll see if it's time to do the transfer. he anticipates yes, but if all of the embryos are still developing well, there's a chance they will postpone the transfer until saturday to try to get some blastocysts (the advanced stage of development that has a much better chance of implanting). there's no way to know this for sure until it happens, so we'll just go on thursday expecting that they'll do the transfer then, and we'll discuss numbers to transfer and if there's any good enough to freeze at that time. right now they're just waiting and seeing how things progress. but this is certainly a good start and there's no reason to believe that anything disastrous will happen between now and thursday.

today i feel totally fine post-retrieval, now that the sedative has worn off, and i started the antibiotic and the progesterone oil injection to prep for the transfer. the oil injection is super weird... it doesn't hurt at all, but it is so hard to inject because it's so thick. really strange. otherwise today is a normal day... it's just that there are tiny embryos of mine growing and developing across town. so weird.

egg retrieval!

today they did the egg retrieval, which is the most intensive procedure of the IVF process. we got to the hospital at 6:30, pretty tired but excited. i don't think either of us got a ton of sleep last night due both to the late football game and the anxiety of the situation. i drank about a quart of water right before 11pm since i wasn't allowed to eat or drink anything after that, and of course i had to do the douche... which i do not recommend. so weird! and slightly stinging, which i didn't expect. anyway, this morning they took me upstairs while the hubby went to "gather his specimen" and then sit around and wait for me to be done. i think the whole thing took just over an hour. no sweat!

the procedure was certainly more serious than i ever imagined baby-making would be, but it wasn't as surgical of an experience as my real surgery in the spring, that's for sure. the room was a more hospital-like kind of room than my regular exam rooms, but not an official operating room. there were two nurses and a ton of equipment, i was wearing the robes with a hairnet on my head and the booties on my feet, and they strapped me into the stirrups, which was lovely. the anesthesia wasn't full-on general anesthesia, but a general sedative. basically, i slept through the procedure. the anesthesiologist hooked me up to an IV in my hand and once the doctor (the executive director of the fertility institute, Dr. K) came in and said hello, they started pumping me with the sedative. they told me i would start to feel sleepy and as things got blurry i closed my eyes, said a mental loving goodbye to my eggs, and that was it.

when i woke up the nurse told me that everything went well and that they were able to get 9 eggs! i guess that's about the best we could have hoped for. i know i had 10-12 follicles on friday, but not all of the follicles develop eggs. they took me downstairs in a wheelchair and i got to recover in one of the regular rooms with the hubby. i felt (and still feel) crampy and a bit uncomfortable, and definitely groggy and fatigued from the sedative. i'm spotting a little bit, but that's normal, and otherwise i feel pretty okay.

after i had a few minutes to wake up, the nurse came in to tell me about the next steps. this entailed a lot more than i anticipated at that moment. thankfully the hubby was there and signed all the paperwork as the "responsible adult" who was hearing all the instructions and would be escorting me home and taking care of me. today i just had to rest and recover. fine. tomorrow morning, the doctor will call me to tell me how the fertilization is going and when the transfer will be. and tomorrow all the drugs start, in spurts.

tomorrow i have to start taking an antibiotic and a progesterone oil injection to prepare for implantation. she said the oil is very thick and will be hard to extract from the vial and hard to inject. gee, i'm really looking forward to that. i'm still supposed to take my vitamins and the blood sugar pill that i've been on for the past year.

on wednesday, i also start the progesterone suppositories again. whee, what fun. then there are two other things that i'll start depending on when the transfer is. there's another injection - a blood thinner - that goes in my stomach (that's new!) called Lovenox, that i will start the day before the transfer. and then there's a steroid pill called medrol (methylprednisone) that i will start after the transfer, apparently to keep my body from rejecting the embryo during implantation. i am also getting valium(!) that i'm supposed to bring with me the day of the transfer. and then there's something else i might have to take after the transfer, but they're not sure yet. holy medications. but -- all for a good cause, i know.

right now i just can't wait to talk to the doc in the morning. i'm planning to go into work a little late tomorrow and have an easy day but try to get some stuff done... since i don't know if i'll be back in for the rest of the week. i'm a little anxious already about this whole bedrest after the transfer situation. i have had trouble doing nothing today when i didn't even feel 100%. but i guess when i have greater motivation to do nothing it will be easier. the hubby has been so busy with work that he'll do his best to take care of me and the pets, but he's certainly not going to be home for three days straight so i'll need to negotiate that as it happens, i guess. anyway, nothing to do now but rest and relax and imagine our little eggs and sperms doing their thing back in the lab. science. amazing.

ready to rumble!

it's all happening... holy crow.

when you're doing IVF you're like a VIPatient, it seems. when i went to the doctor this morning i got to have one of the big guys, the associate director Dr. B., do the the ultrasound. he was really pleased with how everything looked. he estimated that i have around 10 appropriately-sized eggs, give or take a couple, and said that we should do my retrieval on monday!!! i think part of me wasn't quite letting myself believe that it would happen this time but now it seems to be a reality. i'm mostly excited, but also a tiny bit terrified. both because of the process itself and because it's just so intense... and there is no guarantee that all of it will be worth the ordeal. but i know it's the right thing for us right now and i am pretty sure i'm ready.

so - here's the logistics. Step 1: monday morning the hubby and i will go in at 6:30. we bring the sperm specimen just like we did with IUI. i'll be put under general anesthesia (ugh) and it should take them about an hour or so to take the eggs out of my ovaries with some kind of superlong needle. they said the length of the procedure depends on how many eggs they find when they get in there, but it should take around an hour. then i'll have to recover from the anesthesia and whatnot for a little bit, and then they'll send me home with the hubby. for the rest of that day i have to take it easy but as soon as i'm feeling alright i can get back to normal life.

Step 2: on monday after the retrieval, they'll fertilize the eggs with the specimen and see what happens with them over a couple of days. they watch them super closely and there are several ways they can intervene if things aren't happening normally. (they can inject the sperm right into an egg, for example.) i think, if i have enough good ones, they may keep some eggs to freeze for the future, and only try to fertilize a few this time. at this time i don't have to do anything, as it will all be happening in their lab. really weird to think about.

Step 3: then, when they have a few healthy fertilized eggs (hopefully!!!), they will do the transfer - which is when they put the fertilized egg or eggs back inside me and hope that it implants the way that it's supposed to. the number that they transfer varies a lot depending on the person and the situation, so we'll see. the number of days they wait before the transfer also varies. Dr. B. said given my age and the number of eggs (not young, and not numerous) they probably won't wait too long. it's sometimes advantageous to wait a bit so that the eggs reach a stage of development called blastocysts, when implantation is more likely. but there's also a risk that they won't make it that long. so his estimate at this point is that the transfer will happen on thursday next week, though it won't be definite until they see how the eggs are doing. the transfer procedure is quick and painless, but i will have to be on bedrest for 2-3 days afterward to allow the egg or eggs to hopefully implant.

so clearly there are still a lot of loose ends and things that can go wrong, but that's the basic way things *should* proceed. this weekend i will be continuing some of my injections: i do the same icky one i've been doing one last time tonight (Repronex) and then tomorrow morning i do the Ganirelix to make sure i don't ovulate early and the Gonal to keep the follicles developing. then tomorrow night i give myself the HcG injection (the ovulation trigger shot) at EXACTLY 6:30pm. the precise nature of all of this is still funny to me. sunday i don't take any drugs, but i have to douche that night! ewww! i've never done that before but i have to do it twice prior to the procedure. i'll certainly let you know how THAT goes. sunday night i can't eat after 11pm and monday morning... we're ready to roll.

90% excited, 10% scared right now. i'm just so glad it's finally time for the next step... let's hope we get to carry it all the way through and see what happens next.

it has been a trying week.

my friend and coworker, a fellow IVF-er who has supported me so much throughout this process, lost her baby on tuesday. she went into early labor and the baby wasn't viable. she lived for about an hour and then she passed. and now my friend, who thought she'd finally found success after years of fertility challenges, is back to square one. i have shed more tears over this than i thought possible. at this stage of the game for me, i just can't imagine the depths of what she's going through... but i know it is hell.

in the meantime, things are going pretty well for me this cycle. at least so far. when i went back to the doctor yesterday they were pleased with what they saw. the doc said it's hard to tell exactly how many follicles there are just from the ultrasound, but that there are definitely four or five good ones in my right ovary, and three in my left and she thought more would develop in my left. so i have stayed on the same meds these past couple of days (4 doses of Repronex and Ganirelix to keep me from ovulating) and i will go back in the morning to see how things look. i'm thinking they should schedule my retrieval pretty soon, assuming that everything is still progressing as it should be. i'm at day 11 of my cycle today, and i've had eight days of stimulation. i feel almost guilty being excited after everything that my friend has been through, but i think i'm starting to see just how unpredictable this fertility journey really is. it's even more complicated than i've lived so far. so i'm thankful for this optimistic upturn in my luck right now. one day at a time.

IVF, attempt #2

after another trip to the doctor, i started the stimulation drugs last thursday. i went in friday morning to see how things were progressing and all looked good: a total of 8 follicles were developing, four good-sized ones in my right ovary and four smaller ones in my left. i continued the meds (four doses of Gonal) through the weekend and went back this morning, hoping to see a huge change. but nothing really had changed. there are still 8, and four of them are still too small. this was frustrating, though the doctor isn't alarmed yet like they were last time. they are putting me back on the Ganirelix (the ovulation-prohibiting drug) to give us more time for stimulation before i ovulate, and changing my stim drug to the Repronex. which, of course, is the one that f*cking hurts like hell. i'm taking four doses of that tonight and four more tomorrrow, and the Ganirelix every morning, and then going back to the doctor on wednesday. by then they should definitely be able to tell if this is going anywhere this time.

i'm trying to remain optimistic, even though i was hoping to walk in this morning and have 15 follicles sprouting. it really does vary from person to person, i've read, and while doctors would like to see 10-12 eggs prior to retrieval there are often more and often less and people do IVF anyway. so as long as the ones i have continue to grow i'd say we'll be fine. but if i end up with just those four in my right ovary and the left side slows down, i'm not sure what will happen. it seems like a lot of risk and money to try it with only four follicles. but maybe this is just the best my ovaries are going to do with this. anyway, nothing i can do now except continue stabbing myself with needles twice a day and update again on wednesday.

ugh. well, while i don't feel like writing any updates i guess i should.

i went, grudgingly, to the doctor last thursday. the doc told me to come that day because it was about a week before the end of my cycle, so we could get me started on some of the meds in prep for theoretical IVF. she said i definitely ovulated last cycle, my ovaries looked great, and i started the one injection that makes sure the ovaries don't start getting ready for next cycle. they also put me on three antibiotics. the nurse told me they often give them to patients prior to IVF just to make sure there aren't any infections that might complicate things. i asked why i didn't get them last time we tried IVF, and she had no answer. she said maybe they're just pulling out all the stops for me this time since it didn't work last time.

so that was that. until i started bleeding sunday night, at least five days before i should have.

stupid me let myself think for about 12 hours that maybe i was pregnant and it was implantation bleeding. the timing was perfect, but the amount of blood wasn't. i have now sadly realized that it is definitely my period, and that this past cycle was just a royally screwed up one... the shortest one i've had maybe ever. i probably ovulated around day 8, which is early even for me. the hubby and i still did a really good job trying, though... we basically had sex every other day until i went back to work last week. so it still could have worked. but it didn't.

this put me into quite a state. i have been thinking (and feeling!) that my body was regulating and that acupuncture and the herbs were helping and that if we had to do IVF my body was so much more ready for it than it was in the past. but it seems like it's still the same old slightly screwy mess it was before. which i guess bodes better for complete medical intervention like IVF than for us trying on our own, so... so be it.

i went back to the doctor this morning. they said my ovaries look fine and normal for the beginning of my cycle, so there's no reason to think that anything weird or bad happened. i stop the ovary-hostage drug today and am starting the stimulation hormones on thursday. we're starting out again with the less powerful one (Gonal) that i took for all of my IUIs. we started that one for my failed IVF cycle, too, but then they bumped me up to the stronger stuff (Repronex) when it wasn't working. hopefully this time it will work, because Repronex is the one that had me in agony (super painful injection, sore and bruised legs). i do two injections thursday morning, two thursday evening, and then go back on friday to see what's what.

and there we are. i'm feeling a bit less likely to hurl myself from my 4th floor office window today than i was yesterday at this time. which is to say i am still incredibly depressed and frustrated to be back on this rollercoaster. but i know it's the right thing to do, because it's the only way we're going to make any progress in this journey. so i press on.