THE RESULTS ARE IN!

This is a picture of a home pregnancy test that I did this morning. We have had positive results going back about seven days, so we have been cautiously optimistic. We were looking forward to the beta test today to get confirmation and to find out how strong our "number" was. Well, it was great news. At 13 days past a 5 day embryo transfer, our HCG number was 945! According to one website, the average number for a positive test 13 days past transfer is 522. Anything over 100 is considered a decent number, so we blew both of these numbers away. This is a very good sign that this is a strong and viable pregnancy. Today I am officially 4 weeks and 4 days pregnant. If everything goes well, our estimated due date (according to one online calculator) would be March 16, 2007.

I need to go back on Friday and again on Monday to have additional blood work done. Per standard procedure, the doctor wants to make sure that the HCG numbers double every two days. Once I have my beta completed on Monday, and if everything is still on track, we will be able to schedule an ultrasound for about my six week mark. At that time the RE would look to see how many sacs are in the uterus (one or two) and if we have a heartbeat(s) yet.

We wanted to use this site to congratulate all of the grandparents, aunts, uncles, cousins, and friends to be! Just to let you in on a little secret, we have come up with some potential names for our baby (or babies). These are the number one choices for a girl or a boy...I'm sure you will agree that they are just splendid!

• Girl: Judith Joanne Ritter
• Boy: Jerome Robert Ritter

Runners up for the list are as follows:

• Girl: Woodrina Hayes Ritter
• Boy: Santa Pizza Ritter

Of course we would welcome any input regarding our short list, but we are fairly certain that these are the best options....aren't they all just beautiful?

(disclaimer: for those of you who don't know our senses of humor all that well, we have to admit that these names are a joke! As lovely as they are, we will not actually be using them for our child (children). Thank you.)

Stay Tuned!

Only two more days until the beta test! Wednesday afternoon will be the big announcement (one way or the other) on this blog. Wish us luck!

The Waiting Game

Well, as you all know, we are still waiting for our upcoming beta test on July 12th. Only six more days to go, so it isn't too bad. I am feeling much better these days. My hips and butt only mildly ache, and the shots seem to be getting more comfortable. I hope things stay this way. Matt is traveling this week and driving race cars down in Alabama, so I have to have a friend (who is also a nurse) come over and shoot up my behind. I am lucky to have a back-up for when Matt is not here. I am fairly tired at various parts of the day, and I am a bit short of breath. These things are both quite out of the ordinary for me. The progesterone injections can cause fatigue, so I am blaming them for the moment. Not much else worthy of mention right now...so, onto the 12th already!

Frozen M&M Minis

Good news! Of the nine "leftover" embryos that we had on Thursday, five made it to the cryopreservation stage! If this cycle does not work for some reason, at least we have these five frozen minis left that we can use for a frozen embryo transfer (FET) some time down the road.

tick tock...Tick Tock...TICK TOCK

We are three days post transfer, and all we are doing is waiting. Tick tock.... I am feeling much better these days. Tick tock.... My bloating has mostly subsided, and my abdominal area feels almost back to normal. Tick tock... My only complaint is still the soreness in my hips / butt due to the daily IM injections. Tick tock... I am dealing with it better, though, and am just pushing forward. Tick tock... Only ten more days until the beta test and then we can celebrate or move forward to our next steps. TICK TOCK...

The M&M Minis!

Yesterday, Matt and I went to "pick up" our M & M Minis at the Shady Grove facility in Rockville. Of the 16 eggs that had originally fertilized, 6 made it to the blastocyst stage and five made it to the pre-blastocyst stage. We made the decision to put back only two, leaving us with nine leftovers that will continue to be monitored. Any embryos that are still doing well in a few days will be cryopreserved for potential future use. I am now done with my 24 hours of bedrest, and I must begin my 2 to 3 days of light activity. During our wait until the beta test, I must still take a prenatal vitamin, a baby aspirin, 2 estrace tablets, and my PIO intramuscular injection every day. I am feeling just fine, outside of the fact that the PIO shots have the same effect as arthritis...make me very achey in my butt and hips and forces me to walk like an old woman. If it weren't for that, all would be right with the world!

Pictured above are the M&M Minis that we put back. In two weeks we will know if they are planning to stay with us or not. We will keep you posted!

(photo image of our day five blastocysts graciously provided by Martha Anderson of Shady Grove Fertility Reproductive Science Center of Rockville, MD. Thank you, Martha! Dr. Stephen J. Greenhouse must receive credit for putting the M&M Minis back where they belong!)

Blastocysts come home tomorrow!

Tomorrow is the big day when we go to collect our little blastocysts. Our appointment is scheduled for 11am at the Rockville, MD clinic location. We need to arrive at the clinic by 10:30am. On the trip in, I need to drink approximately 36 oz. of fluid, preferably Gatorade. It is necessary for me to have a full bladder for the egg (blastocyst) transfer. Once I am ready for transfer, the RE will insert a sterile catheter through the cervical opening and into the uterus. They will place the selected blastocyst(s) into the desired location in the uterus and then the catheter will be removed. I need to lay down for at least 20 minutes and then I will be released. I must remain on bedrest for a 24 hour period following the egg transfer. I plan to gather a good collection of books and magazines today for my down time. The 24 hours of bedrest are followed by two to three days of light activity. After this time, I should be able to go back to my normal routine.

My nurse will be calling on Monday of next week to let us know how many blastocysts were cryopreserved. Any that make it to this stage could be used down the road.

We are scheduled for our beta test (test to check for levels of beta-HCG, or pregnancy hormone, in the blood) on July 12th. If the test comes back positive, then we celebrate. If it comes back negative, we are already scheduled for a follow-up appointment with our RE on July 26th. At this appointment we would talk about any next steps that we might take, such as FET (frozen embryo transfer).

"How to give your horse an intramuscular injection..."

In my search to justify my pain related to PIO intramuscular injections, I came across this weblink. I did a Google search for "intramuscular injections PIO" and the above quote was splayed across the screen under the title: useful links. I had no idea that learning how to give my horse (which I didn't even know that I had) an intramuscular injection would help me in any way, but who am I to judge? Isn't the internet a god in a sense...all-knowing? Isn't it supposed to provide me with all the answers that I seek? Ah...or do I actually have to disseminate the information that it so willingly provides? I am going with the latter. I will skip learning how to shoot up my non-existent horse for now.

My actual quest was to find information that would help me to rationalize and to justify my fear of the PIO shots. I kept telling myself that I was a being a total sissy....that I dreaded these shots for no reason. Everybody is doing it (well, everybody in the IVF world, that is), right? So - what is the big deal? I didn't often hear other people complain about these injections, so I thought that my fears and pain must be irrational. Apparently, though, I was wrong. Through my internet searches, I have learned that I do not lack for company at this party. Women across the infertility world are banding together to compare notes on the side effects of these injections and tips for avoiding the unpleasant ones (which, frankly, they all are).

I have learned that regardless of what you do beforehand, afterward, or in the middle, that you will end up sore. There will be bleeding. There will be bruising. There could be lumping under the skin. This will not get better during the duration of the time that these injections are necessary. You must only get more clever in your attempts to avoid hitting a previously injected site, as this will just make all of the side-effects that much worse (this feat, however, is nearly impossible given the potential timeframe for the shots). Some general tips for making the most of it:

• Thoroughly warm the oil prior to giving the injection. This will thin the oil and make it easier to inject. You can warm the oil by placing it in your bra for ten minutes, or by running it under very warm (not hot) water.
• Make sure that the person who is administering the shot gets the injection site pulled as taut as possible. This will help to eliminate some of the potential bruising involved.
• Always remember to pull back on the plunger once the needle is inserted to check for blood. Blood would be a sign that a vein has been hit, and this can cause serious problems.
• Inject all of the oil slowly and steadily.
• Pull the needle straight out after completing the injection, and do this quickly.
• Apply gauze or a bandage, and gently massage the oil into the muscle.
• Apply heat (heating pad or warm washcloth) as you massage. This will keep the oil thin and help it dissolve into the muscle more easily.
• Walk around, walk up stairs...do whatever you can to keep your muscle loose. This will cause less aches and pains in the morning (although not much less).
• Avoid punching the person who has given you the shot. They are only doing their "job", therefore retaliation would be seen as less than called for. Remember...your partner is suffering through this process, too (yeah...right!)

Even by following these instructions, women have complained that they still have sore spots MONTHS or more after receiving their last shot. So - we pay a great price to gain a great reward. Hopefully any children produced via this process will appreciate later in life the true sacrifice of their mothers. If not, I do think it is fair to punish them for their insolence....well, ok, maybe not. But - I do think bigger presents would be in order for Mother's Day for sure!

No Transfer For Us Today!!!!

This is fantastic news. We have officially been pushed off until Thursday for our embryo transfer. This means that at least the majority of our embryos are still dividing and progressing well, so we will be doing a five day blastocyst transfer. Given that we will be doing a five day transfer, we will only be putting two embryos back.

I haven't heard back from my nurse yet to find out how many of the embryos are still going strong, but I will update this post as soon as she calls!

Today is the first day since my egg retrieval that I am feeling almost human again. These last few days have been very difficult for me physically, but I am turning the corner. Now, my biggest complaint is that my backside aches all of the time. As soon as one side starts feeling better after receiving a PIO injection, it is time to get shot up on that side again. I am very willing to look at this as a happy problem to have if we end up pregnant in the end.

Still looking good!

Today's fertilization report showed that all 16 eggs that fertilized are now "cleaving". This means that they are dividing as they should. It is a very positive sign that all of them have continued to progress. I have to wait until tomorrow morning for another report to tell us if we are doing our embryo transfer tomorrow afternoon, or if we get to wait until Thursday. I should know by 10am. We are certainly hoping to be able to do the five day transfer, as the odds of implantation are much better at that stage.

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!