Hear Ye, Hear Ye....Fertilization Report

Out of the 22 follicles that they retrieved yesterday, we had a whopping 16 fertilize. This is great news, and it is above the average number for fertilization. Tomorrow we will receive another report telling us how all of the cells are dividing. We will find out at that time whether we will be doing a 3 day transfer (Tuesday) or a 5 to 6 day transfer (Thursday or Friday). We hope to make it to a five day transfer, as the embryos reach the blastocyst stage at this time and have a much better implantation rate.

More Photos from ER Day at Shady Grove

Me all hooked up. Also pics of my two fantastic nurses. The staff at Shady Grove is top notch!

ER DAY

Well, today was the big day....egg retrieval day. I woke up at 5am to get some food in my tummy and then went back to bed for a bit. I drank a bunch of Gatorade up until 8:30am and then I was cut off from all food and drink. I was able to shower this morning, but I could not put on lotion, perfume, makeup, or jewelry, so I was looking absolutely stunning today.

We arrived at Shady Grove and got things started immediately. I was first hooked up to an IV to get some fluids in me. After that, one of my nurses took my vitals and got me admitted (please note: "admitted" NOT "committed"). A bit later my anesthetist came in and got me prepped for the procedure. I had to empty my bladder and then walk with my IV into the procedure room. He pumped in some meds that would start making me sleepy, and oh did I love those! I was awake for another minute, and the next thing I remember is coming to in the recovery room. Because my heart rate / pulse dropped to 50 during the procedure, I had to have additional special meds given to me via IV. These meds caused me to have severe cotton mouth and made me feel a bit sick. Upon coming to, I was given anti-nausea meds in my IV and I took some Tylenol. The Tylenol wasn't cutting it, so I was given Vicodin, as well. Given the amount of discomfort I felt, my nurse administered some pain medication to my IV on top of the Vicodin and Tylenol. This helped tremendously, and I was able to go home soon after that. All in all, the results were quite pleasantly surpising. They were able to retrieve 22 follicles.

The ride home was brutal with all of the bumps and turns, but I have been feeling much better since arriving home. Matt administered my first progesterone in oil (PIO) intramuscular (IM)injection this evening, and it wasn't too bad. My muscle sort of jumped / contracted when the needle went in, but outside of that it was fine. Matt needs to massage the area for me after I receive a shot and then I need to put some heat on it. I also walk around for a bit to work out some of the pain. All of these things help to make the muscle feel better and help to keep the oil from pooling in that one spot and becoming lumpy. I need to take the rest of my hormones, vitamins, aspirin, and meds later this evening. I have to take it easy the rest of the day today and tomorrow, but I will should be all better come Monday. We will receive a fertilization report tomorrow afternoon from my primary nurse, and she will be able to tell us how many eggs fertilized and how many of those are dividing into multiple cells. By Monday we will know what day our egg transfer will take place.

"Trigger" Happy and The Egg Retrieval

So, the trigger shot went fine. Crazy, though. I had Matt set his clock alarm and his watch alarm to get us up. We had really bad thunderstorms move in last night, and I was worried that we would lose power, the alarm would never go off, and we would not wake up. That would be just my luck! Anyway, the power did go out, but the storms woke us up at 12:24am. The power was back on by that point, and I went downstairs to mix up the shot. I think I was still half asleep. I had a few minutes left prior to shot time, so I asked Matt if I should ice the injection area to help numb it up. Just then...BOOM, CRACK, KA-POW....the power went out again. I was swearing like a sailor, and Matt was frantically searching for the lantern. He was prepared to shoot me up via lantern light if necessary. Thankfully - two minutes later the power came back on. I skipped the icing part and went straight for the shot. Matt didn't hesistate, and he did a great job. The needle did not hurt going in. I only felt some pressure, especially while he was injecting the HCG mixture. After the needle came out, though, I was like...OUCH. It felt like someone had been using my bootie as a punching bag. I had this really deep muscle ache, which I suppose makes sense since the injection is supposed to go deep into the muscle. I massaged the area for a bit and then went back to bed. This morning it still ached, but I went to the gym to try to walk off some of the pain. It isn't too bad now. All in all, today....my belly hurts from the bruising from twice daily shots, my arms are sore from having my blood drawn about 4 times, my bootie hurts from the trigger shot, and my ovaries are totally barking! Well, not literally barking...but barking because they are sore. Don't I make the IVF process sound so appealing? Makes you feel like you missed out by having kids the "traditional" way, doesn't it?

I do not have to have any shots today. I only have to take two antibiotics tonight. Tomorrow I will be up at 5am to get some food in me (I can't eat after 5:45am). Then back to bed and up by 8am to get some liquid in me (no liquids for me after 8:45am). We will leave here by 9:30am to make sure that we are in Rockville by 11:15am. The acutal procedure is scheduled for 12:45pm.

The egg retrieval is a simple surgical procedure, but I will be given a general anesthetic (aaahhh...sleepy time) in order to keep me comfortable. A large needle, guided by ultrasound, will be pushed through the vaginal wall in order to access the ovaries. The follicles will be aspirated into the needle, and the needle will then be removed. An embryologist will be on hand to take the follicles and assess them. We will be given an initial egg report after the procedure. We will continue to get daily fertilization and growth reports from the nurses up until the time of egg transfer. Starting tomorrow night, we will begin the progesterone in oil (PIO) intramuscular injections. These shots are used to prepare my body for a potential pregnancy and to better equip my body to maintain a pregnancy. These are intramuscular (IM) injections that I will receive daily until the time of a pregnancy test. In addition to these shots, I will continue taking my prenatal vitamins and baby aspirin, and I will begin taking another hormone supplement called Estrace. So - the really big stuff all gets started tomorrow. We are well on our way!

Trigger Shot Tonight!

Well, I missed the call from my nurse, but she did leave a message that we are to administer the trigger shot tonight. I do not know what my estrogen level was, but apparently it was high enough to make them want to trigger to help avoid OHSS. Pictured above are the vials of water and HCG powder to make up the shot, and the needle that Matt will have to use to inject the mixture. This shot will be an intramuscular shot, so it will be given in the outer/upper part of the buttocks. My nurse drew large circles on my backside to give Matt an idea of where to shoot me up. The shot needs to be given at an EXACT time, and the OR scheduler called to let us know that we have to give the shot at 12:45 AM. We will be setting our alarm for 12:30pm to get up to do this. Uggh! The egg retrieval will be scheduled for 36 hours after the trigger shot is given. So, egg retrieval will take place at 12:45PM on Saturday. We need to arrive at the office at 11:45AM to get things started. Tomorrow I will need to continue taking my prenatal vitamins, and I will have to take two Zithromax pills tomorrow evening. These are antibiotics that are given just in case an unknown infection is raging somewhere in my body. Outside of that, tomorrow will be the only day that I do not receive an injection of some sort. Woo hoo! I will give more details on the upcoming egg retrieval tomorrow.

Thursday

We are getting close. Today's ultrasound still showed around 19 total follicles. In my right ovary I have 5 follicles greater than 12 mm, and five other ones are ranging from 14.8mm to 17.8mm. In my left ovary I have 5 follicles greater than 12 mm, and four other ones ranging from 16.7 to 18.3. I am borderline for being triggered at this point, but they would like me to do another day of stims (lower dose) to get the smaller follicles to catch up. However, if my estrogen levels come back too high, they will trigger me tonight in hopes of warding off OHSS (ovarian hyper-stimulation syndrome). OHSS can be very serious and can lead to fluid build-up in the abdominal cavity. This can sometimes force a patient to be hospitalized. So - if necessary, I will trigger tonight with fewer mature follicles, but we should still have at least eight good ones. Ideally, though, I will have one more stim shot tonight and trigger tomorrow night. This would give us the best chance of more mature follicles at retrieval.

A Side of Me You Have Never Seen (that being the inside...)

Above is an ultrasound photo of my right ovary and left ovary. The darkened "ovals" are individual follicles. I have approximately 19 follicles in both ovaries combined, more follicles being in the left than in the right. The size of the larger follicles ranges from 13.6 mm to 16.6 mm. My estrogen level came back at 1783 today. Given that number, the RE is reducing my dosage of Gonal-F from 2 vials down to 1.5 vials. We are still on schedule for doing our trigger injection on Friday, which would mean that the egg retrieval would be performed on Sunday. In the interim, we will continue administering the lupron injections in the morning and the "stim cocktail" injections in the evening. I will go back to the RE's office in the morning for monitoring once again.

(please note: ultrasound photos pleasantly provided by Stephen J. Greenhouse, MD, FACOG of Shady Grove Fertility Reproductive Science Center)

My Endometrium

Above is an ultrasound picture of my endometrium. Today it was measuring 10.2mm.

(please note: ultrasound photo courtesy of Stephen J. Greenhouse, MD, FACOG of Shady Grove Fertility Reproductive Science Center)

Monday, Monday

Well, today was another visit to the RE's office for monitoring. I had to have my blood drawn once again and submit to another ultrasound. After three blood draws I am starting to show some "track marks" and some bruising (see above). This will get much worse by the end of the week. As of right now, I am carrying a total of 20 follicles...12 in my left ovary and 8 in my right ovary. All of the follicles are measuring between 10 and 15mm. Everything is growing nicley at this point. I can now "feel" my ovaries when I sit down. They are starting to get just a bit uncomfortable, especially the left one. My endometrium is measuring 8.8 mm, which is a nice increase from Saturday. My estrogen level came back at 810, which is also a very good increase from Saturday. I get to take one more day off in between doctor's appointments, so I do not have to go back until Wednesday. Starting Wednesday, I will be going in every day. My RE thinks that we could be doing our trigger injection (HCG, or human chorionic gonadatropin) on Friday. This trigger injection is an intramuscular injection (long needle that has to be jabbed into the backside of my hip / upper part of my buttocks) that will "trigger" ovulation. IF we do get to have the trigger injeciton on Friday, that will put us having the egg retrieval on Sunday. Things can always change, though, so nothing is written in stone as of yet.

Saturday's Update

Just got back from the RE's office. Everything is still looking great, and I have a lot going on in my ovaries. My right ovary has one measurable follicle (9.7 mm) and five other follicles under 10 mm. My left ovary has three measurable follicles (11.2 mm, 10.7 mm, 9.5 mm) and 10 other follicles under 10 mm. My uterine lining (endometrium) is showing a triple layer, which is exactly what it should be doing at this point. The endometrium is measuring 6.6 mm as well. By the time of trigger / ER the endometrium should be anywhere from 8 - 16mm. The nurse called and noted that my E2 level (estrogen) is 307. This is an excellent number for this stage of the process. It needs to be above 800 by the time of the trigger injection (E2 levels should rise 50 - 100% every other day during stims). I have to return for monitoring on Monday morning at 8:30am. After Monday's appointment, I will probably have to go for monitoring EVERY day. Once things pick up, the RE needs to keep a close eye on me to make sure that I don't overstimulate, and so they can know when to best trigger ovulation. So - that will be all until Monday!

TGIF

Well, today is Friday. It is my fifth day of stim shots, and it is my eleventh day of lupron shots. By the end of the day today, I will have received a total of 16 shots. For fun, Matt and I might start playing connect the red dots on my belly. There are plenty of them to connect. I am extremely happy that Matt has returned home, as I have had to give myself five stinkin' shots. It is no fun to shoot yourself up, and I really wonder how anyone becomes an IV drug user. I am suffering from persistent headaches every day. This is a side effect of the lupron, I believe. I go to bed with a splitting headache, and I wake up with one, as well. I am only starting to get a little bit bloated. Yesterday was another day of monitoring at the RE's office. I had more bloodwork and another ultrasound done. I was told that it was just to measure how things were getting kicked off, and I am kicking things off quite nicely. So far, I have eight potential follicles growing in my right ovary and nine potential follicles growing in my left one. Not all are guaranteed to mature, and there is still a possibility that I could produce even more. However, seventeen is a great number with which to start. I will go back to the RE's office tomorrow morning (yes...I have to go in even on Saturdays) for yet more monitoring. Tomorrow's update will provide more insight on how well the follicles are growing. As of right now, it looks like egg retrieval could be as early as next Friday. It is still all just a guessing game at this time, though.

Stim Cocktail Hour

The baseline ultrasound and bloodwork went well today. My uterine lining was fine, and both ovaries were free of cysts. One ovary had five potential follicles waiting to be stimulated, and the other ovary had six. My primary nurse called me this afternoon to tell me that I should start taking my stim shots tonight. I will be having a "stim cocktail" every evening consisting of two vials of Gonal-F (150 IU) and one vial of Menopur (75 IU). They are pictured here with my sharps container which holds all of the discarded needles. This stim cocktail is given approximately twelve hours after the lupron shots in the morning. Tomorrow the lupron will be reduced to only 5 units (down from 20 units). I will continue on the same dosage of stims and lupron through Thursday when I return to the doctor's office for more monitoring (ultrasound and bloodwork). We accidentally nicked a vein this morning while administering the lupron shot. I now have a tiny blood blister on my belly. This evening's shot was a little bit better, but we still had a small bleeder. I am officially becoming a pin-cushion! Oh the joys of IVF!

One Step Closer...

Well, my cycle day one ended up arriving earlier than expected. Cycle day one was on Saturday, June 10th. It is required that I go to see the RE (reproductive endocrinologist) on cycle day 3 to have a "lupron evaluation". They will do a baseline ultrasound and bloodwork. This will let the doc know where my hormone levels are at this time and if my uterine lining looks as it should. If everything looks good, I will be instructed to start my stim shots (gonal-F and Menopur). These stim shots will be given in the evenings, and they will help stimulate my ovaries to produce multiple follicles (which will hopefully yield a good amount of viable eggs). So - tomorrow morning I will have the tests done, and I will more than likely begin the stim shots tomorrow night. Stay tuned!

Done with BCPs!

So - today is my last day on birth control pills (BCPs). Matt is in NYC, so I had to give myself the lupron shot in the belly this morning. The first stab was not hard enough, but I made sure the second one was. All in all, it wasn't too bad. Now that the pills are done, I have to wait for my next "cycle" to start. Once that happens I will be scheduled for a "lupron evaluation" to see where my hormone levels are at and what my uterine lining looks like. At that point they will let me know when to start stims. So - we are in a waiting pattern for a few days, but luckily enough I will still be getting a shot every day.

Let the Games Begin!

So - here we are, officially kicking off the IVF journey. Today was our first day of shots. At least for now, all we have to do is one shot of Lupron in the mornings. The process goes something like this:

• wash hands
• take cap off of lupron vial, and clean top of vial with an alcohol wipe
• take cap off of disposable needle
• pull back on plunger to draw 20 units of air into syringe
• push needle through top of lupron vial and inject the 20 units of air
• tip vial upside down, and draw plunger back to get 20 units of liquid
• tap on needle to get air bubbles to top, and prime needle if necessary to release air
• pinch a bit of skin under the bellybutton, but still near it, and wipe with alcohol
• jab needle all the way into the skin and inject all of liquid
• remove needle and place in Sharps container
• stare at each other in amazement that you actually have to do this

Doesn't it all sound very romantic? We like to cuddle afterwards...

Also, I started taking the baby / children's aspirin today. It is the chewable kind, and it tastes a bit like orange flavored rat poison. No wonder children don't like taking their medicine.

All of our IVF Meds

For those of you who are getting anxious to see / learn more about our IVF process, here is a photo for you. This is a picture of all of our IVF meds...pills, shots, etc.

First Shots Begin Tuesday, June 6

The first shots we will be doing are Lupron sub-q shots. We will do the shots each morning. This particular drug is used to keep me from ovulating, so the doctors can control the entire process. I will also begin taking baby aspirin the same day. The baby aspirin is used to improve blood flow. I will continue administering the lupron shots in the belly once a day up until the time of egg retrieval (ER).

The Whole Fam-damily....The In-Laws

Sprinkler and Smiley

Batman versus his nemesis...the Sprinkler! Also - he mentioned earlier that he can smile...well, here is the proof!

NATURE'S CHILD - a poem by Megan R.

NATURE'S CHILD

The wanton child tipped back her head

To suck the seeping sun

Golden drops of angels' flesh

Ripped through the chosen one

Drowning shadows on mountainsides

Danced to violent thunder hymns

Tripping down paled rays

Hexed by shrilling lightning screams

A rocky crest led to the shore

Swallowed by the light

Solar with lunar havens met

Spitting out the night

Halos wrapped around her head

Stretched taut with clinging bands

Harnessed winds disbanded ties

Cradling her with unseen hands

A hungry cave cut back its grin

Opening wide for its meal

Fate unwove, though shell of life,

The lone morsel stone could steal

Carefree soul now wanders earth

Bonding spirit with the land

Protected by her ancient caller

Separate now from man

Keeper of eternal growth

Meshed tight with flower sheath and tree

Her harboring body trapped forever

But her soul forever free

-Megan R.