Drafted to the Big Leagues… IVF

* Foreward…

 

I’ve been procrastinating and delaying writing this part of the year.  This is the part of our journey where things got tough.  Real tough.   Hormones, emotional hell, physical agony and an empty wallet would be the short version… Here is the longer one.

 

 

 

We have just been switched to IVF and our heads are spinning.  We have been talking about IVF as our next route, but had no clue we would be making these decisions now.

 

We signed the consents and had another brief overview with the nurse about other changes.  I was now given another medication call orgalutron- another needle to give myself in the evening.  This is used to prevent immature ovulation in women being stimulated in fertility treatments.  There is no use growing these amazing follicles if we can’t do an egg retrieval to catch them all!

 

Now our goals had shifted- we now wanted as many follicles as possible while maintaining a safe level of estrogen.  The clinic gave me a couple days off from monitoring and I was to come back on CD 36.

 

My body felts like I was falling apart.  I had been trying to go to work and keep up, but at this point, I could barely walk due to the pain in my abdomen.  Additionally, I now had the shakes and was sweating like you’ve never seen.  Between my hot flashes, track marks on my arms from blood work, and trembling hands, it was getting harder and harder to convince people I’m not an addict coming off a high.  My boobs and abdomen were so swollen that one would actually think I’d be pregnant and in my third trimester.  Anything that touched me below my neck and above the knees felt like a knife stabbing me.  I tried to tolerate the physical symptoms as best as possible, but at this point, I was breaking down.  I eventually gave up and called work to let them know that I was going to need some time off.

 

CD 36: The most painful transvaginal ultrasound and blood work.  Ever.

 

I step into the clinical room to receive my results and now understand why I am so ill.  I now have 29 follicles growing in my ovaries.  Twenty-nine.  Now keep in mind, a normal person grows one, maximum two follicles, once a month. 

 

To perhaps put this in better perspective, a normal and healthy ovary is about the size of a Greek olive.  Both of my ovaries now are approximately the size of large grapefruits.  They also don’t really have any room to move so one has migrated up and under my ribcage, and the other is squishing everything else in there.

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Right Ovarian Follicles- Black circles are follicles

 

 

After seeing the ultrasounds, we decided to wait for my blood work before making any decisions.  The reports came back around noon and they gave me a call.  My estrogen had sky rocketed, and was so high that the clinic was worried about Ovarian Hyper Stimulation Syndrome (OHSS).  More about this later, but what this meant was that we couldn’t wait any longer, we had to move ahead with the egg retrieval. 

 

This wasn’t an optimal time as even though I now had 29 follicles, many of them were under 18 mm so were not big enough to have a mature egg.  This didn’t matter, waiting and continuing treatment was not an option.  Plus, we have about 15-16 follicles within the size range that we want- still a great result!

 

By this time, Dan had officially given notice to his old employer and was full speed ahead doing the last minute preparations for opening our Pita Pit.  Construction was underway and he was able to be home and help me as needed.  The better news was that I had now (finally!) convinced Dan to list our home on the real estate market and shop for a new one.  We decided to move closer to friends and family, so we had picked a smaller rural town close by.  I had found my dream house, and even though it was a tad over our budget, my negotiation skills prevailed and we had a 30 day closing!  (As if we weren’t busy enough….)

 

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Our Soon-to-be Pita Pit

 

 

After we received our results from the blood work that afternoon, Dan drove back to the clinic to purchase a trigger shot for me to take.  The goal this time was not to trigger ovulation, but instead, to trigger the eggs to mature.  When he came home, I gave myself the trigger needle.  Tomorrow was the big day- egg retrieval!

 

Egg Retrieval

 

I woke up the next morning and we got ready to go into the clinic for our egg retrieval.  The clinic had given me a prescription for an anti-anxiety medication to take the morning of.  I took the pill and tried to concentrate on the bigger picture and end result- a baby!

 

We got to the clinic and Dan handed the clinic a fresh sperm sample.  As soon as the eggs were out, the lab would be fertilizing the eggs to make embryos.

 

They had me get dressed into a hospital gown and took us to the back where the procedures happen.  The RN started an IV and gave me special medication that I required to assist me due to my bleeding disorder.  This made me start to get very nauseous… trying my best not to puke, the nurse came over and added in some gravol to the IV.  These meds, plus the anti-anxiety meds, had me pretty darn calm.  I waited until it was our turn to go in- no big deal.  I can do this.

 

Another nurse arrived who was scrubbed in and ready to go.  They lead us to the room and I got onto the table and put my feet in the leg holders.  I was now lying down with my legs spread and in the air.  Dan was sitting beside me holding my hand. 

 

As the RE arrived ready to begin the procedure, the RN started to add medication to my IV.  Different clinics do this different ways, however instead of knocking you out, our clinic chooses to do something called conscious sedation.  The purpose of this is to give you a combination of medication to help you relax (a sedative) and to help block pain (an anesthetic).  The goal is to be semi-awake but not to be able to feel the majority of the procedure.

 

The RN started to give me the medications.  They continued to ask me questions and then said they were ready to start.  This isn’t a pretty procedure- basically they are shoving a transvaginal ultrasound in with a suction needle on it.  They push the needle through and into your ovaries.  The needle then sucks out the contents of each of your follicles (eggs).

 

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Egg Retrieval Diagram

 

 

As the RE started to insert the ultrasound probe I was in incredible pain- they hadn’t even started yet, however due my physical symptoms, everything hurt.  I asked them to stop and to give me more medication.  They did.

 

They went to start again… and again I’m in excruciating pain.  Dan is squeezing my hand as I try to calm myself down and stop from crying.  I request more medication.  The RE nods and the RN gives me more.  We start again…

 

This time I try to grin and bear it.  It hurts… no, it is terrible.  I’m not able to stand it and am now extremely upset and sobbing loudly.  The RN then informs the RE that they have given me the maximum amount of the medications allowed in a non-hospital setting.  They cannot give me any more medication.

 

The RE says that we can stop due to the pain.  I ask what that really means- does that mean we aren’t going to go through with it?  She says we don’t have another choice.  Due to the timing of the trigger injection, the eggs are ready now.  If we wait, they will ovulate and be over mature.  It was now or never.

 

I looked at Dan… he looked more scared than I did.  He was handling this amazingly considering the state I was in.  I looked at him and said, let’s just do it.  The RE explained that it would be very painful, and she understood if I wanted to stop.  They could not explain why the medications were not taking any effect on me.

 

Here we go again…  Dan was now standing and holding my arm, half supporting me, half trying to keep me still as I sobbed and moaned through the procedure.  They called another lab tech into the room to assist to hold my other side.  The RN was trying to encourage me through it as the RE sucked everything that was viable from my right ovary.  I have never experienced pain like that before.

 

They then went for my left ovary.  The RE stopped and explained that she was unable to reach it as it was shoved way up under my ribs due to its excessive size.  She tried a couple more times, however she couldn’t get it.  They checked to see if they were able to access it from my abdomen with a bigger needle, however the pathway was blocked by bowel and intestine.  They could not safely access my left ovary to get the eggs out.  She just shook her head and apologized.

 

After the most painful 30 minutes of my life, they could only do half of the job.  My body had yet again failed me.

 

I don’t really remember most of the rest of the day.  I believe Dan took me home and got me into bed.

 

Fertilization

 

We received the report.  They were able to extract 8 eggs from my right ovary.  Out of the 8 extracted, 6 were mature.  The clinic went ahead and fertilized those eggs.  Due to the small number, we decided to go with a method called ICSI.  I don’t even know what that stands for (and I’m too lazy to google it!), but basically instead of just putting Dan’s sperm with the eggs and crossing our fingers, we fertilize the eggs with a bit more science.  The lab picked out good healthy sperm from the sample and held the egg still.  They then injected one sperm into each egg in hopes that they all would take.

 

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ICSI

 

 

We got the call the day after the retrieval that all 6 of our eggs had fertilized and were now growing in the incubator!  The disappointment of the retrieval day was behind us, and we were now focusing on our 6 growing embryos.  We continued to get an updated report each day to find out how the embryos were growing.  Just because your eggs fertilized does not mean they will grow.  Ours were good quality so we had high hopes, however nothing is guaranteed.  We finally had a spot of luck on our side and all six embryos made it through three days of growing. 

 

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Embryo Development Diagram

 

 

In the meantime, I was now done with injections, but was giving myself progesterone suppositories three time daily.  The purpose of the progesterone was to keep my uterine lining in good shape and prepare my body to accept an embryo- and hopefully attach!

 

I was under the impression that once they took these eggs out of my body, I would be feeling much better.  However, the opposite was true.  I was now full fledge into ovarian hyper stimulation.  My stomach had distended (I literally looked 9 months pregnant), I was throwing up and having classic OHSS symptoms.  I actually got so sick that Dan had to get me into the car and get me back to the clinic to be seen.  They reviewed everything and said that I had moderate to severe OHSS.  My estrogen was over 25x higher than an average woman.  The good news was that I did not have any free fluid in my abdomen.  This symptom of OHSS is life threatening, not to mention, they would have to cancel my transfer.  Part of the problem was that my left ovary never released the substantial amount of follicles. 

 

I continued being very ill for three days.  Dan took good care of me and was feeling like a human again by day three post egg retrieval.  The clinic reviewed my symptoms and approved me to continue with the embryo transfer.

 

As a side note, we had received possession of our new home.  However, because the first one had not sold yet, we didn’t have to rush and move.  I spent the 3 days between the retrieval and transfer lying on a sunbathing chair in my kitchen wrapped in bedding.  My family assisted us each day in moving some items over.  My Mom actually unpacked my whole kitchen as I laid in the chair pointing.

 

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Our new house on moving day- still no sod or paved driveway! But couldn’t be happier.

 

 

Transfer Day- June 4, 2013

 

After all the hi-tech science that has happened to get us here, the actual transfer was fairly uneventful. They guide a catheter into my uterus using an abdominal ultrasound.  Once the ultrasound is in the exact position, the RE injects the embryos in the top 1/3 of my uterus.

 

The crazy part is that she is actually injecting two small babies into my belly!  Depending on your philosophical thinking of course, but for me, life begins at conception… so here is a picture of the ultrasound they gave us when leaving.  The bright white spot near the top centre (inside the darker circle which is my uterus) is the two embryos that were transferred.  This was the first ultrasound of our pregnancy!  I took a pic and sent it to my family and close friends!

 

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Our embryos after transfer!!

 

 

I went home, relaxed in bed for another day, then went back to work.  Technically I was now pregnant.  However, the bigger question was would it last?  All that these little guys had to do was snuggle their way into my uterine lining.  Two embryos meant a very good chance of two babies…

 

Let the wait begin.