The Little Embryo That Could

I started this morning off a little different than usual.  Patient's must have a full bladder prior to transfer to aid in the visualization via ultrasound.  I have a bladder the size of a walnut and was not looking forward to this part of the IVF process.  My alarm went off at 0800 and I proceeded to drink 32 ounces of non-caffeinated, non-carbonated beverage.  (This doesn't sound like a lot, but YOU try it.)  I take a shower, but neither of us can wear anything scented i.e. lotion, perfume, or deodorant.  Just au natural, baby!   We hop in the car at 0915 and I try to find a delicate balance between finishing my 32 ounces and not having to pee every 10 minutes during this 90 minute drive to the surgery center.  We pull into a lovely McDonalds at 10am which is to be my last pee stop before GO time.  This is where it got fun.  I'm already entirely full of water, but must drink 28 more ounces before 1030.  You know how if you drink too much too fast after exercise or when it's really hot and you can feel your stomach sloshing around?  That's what I felt like.  Like my guts were floating.  Traffic in Seattle was horrendous today so we pulled up right at 1045.  I couldn't sit comfortably, so I walked around the waiting room impatient and nervous.  1100 comes around and we are taken back to a darkened exam room.  J has to leave his coffee behind - the smell will disturb the lil embie!  Inside is a fancy stirrup table with a huge ultrasound machine, a window that looks like it belongs at the McD's drive-through, and a small t.v. screen up on the wall.  First, we talk with the embryologist.  She was a super nice lady.  She gives us the schpeel, we sign the consent papers, and she tells us that our little embryo is a beautiful, "good" grade 10 cell!  On day 3 (which is today for me), they like to see embryos at 6-8 cells, so we are above the wicket, YESSSS!!!  She hands us the first picture of our little embryo.  Talk about cool!!  People think the fancy ultrasound pics they post on Facebook are the shiznizzle, wait til they get a load of THIS.  Next, an ultrasound tech comes in to make sure my bladder is full enough for action.  I tell her that I KNOW its full enough but she checks anyways.  Low and behold, its too full. ugh!  I have to try and pee out about 100cc into a paper cup...  Kegels, anyone?  Apparently I must have some adhesions from my other surgeries and these make my uterus rise higher than normal with a full bladder making it tough to see.  Anyways, I figured it out and now she can see perfectly.  Next, Doc comes in and they do another trial transfer.  They make sure the catheter goes in easily, they can see everything they need to see via ultrasound, and that everyone is ready for the handoff.  Then, the tv screen in front of us they switch over from the ultrasound to the camera in the back.  We can literally see the microscope on tv!  They show the label on the dish, the tech and doc check my armband to make sure I'm getting the correct embryo transferred, and then we watch wide-eyed as the embryo gets sucked up into a little tiny catheter.  The embryologist passes it off through the drive-through window to the doc who then puts the catheter into my uterus.  They measure and look and measure again to make sure it's exactly as deep as they want before they deploy the catheter and little embie is inside.  Then they check the catheter to make sure its empty and little embie is, in fact, safe & sound in the ut.  I laid there for my mandatory 15 minute resting period and off we went, back to home!  I gotta tell ya, I am kind of a sciency geek, but seeing this was SO. FRKN. COOL. 

Our transfer couldn't have gone better.  Though we were hoping twins would be in the future, I am super happy with the high quality singleton we have!  I am to be on modified bedrest for 48 hours and then light duty for 2 weeks.  Like I said, I was too scared to POAS before my blood draw, but J talked me into it.  I took one this morning and it is still lightly positive.  We shall see what happens the next few days!  By my calculation, the trigger should be gone by Sunday...  My official quantitative HCG is schedule for Sunday, August 19.  10 days away.  Eeeeeek!

My poor tummy after 68 injections.  This is after the purple has faded a bit.

Before retrieval, feeling nervous!

After Retrieval... I have no recollection of this being taken!

Transfer:  The setup

Transfer: The Drive-Through

Our little 10 cell embryo!

" Grow embie, grow embie, GROW!  "

Quality over quantity, right?

Retrieval went fairly well! Minus being a little sleepy I don't feel any worse than I have the past couple days with cramping & bloating.  I still had 7 follies but 2 were too small to have mature eggs ( we anticipated that).  For whatever reason one of the other big follies was empty so we ended up with 4 eggs retrieved.  Of course I was hoping for more, but I am certainly happy with 4! Everyone continues to tell me quality over quantity is the best chance for success.  Easier to say than actually believe.  Our future family rests on these 4 lil eggs getting fertilized.  I'm trying to suppress my thoughts of "maybe they missed one? Did they drop any on the floor?"  I am focusing on relaxing and trying to find comfort in the fact that the rest of this process is out if my hands.  J and I have done everything possible, now it's up to doctors, embryologists, nurses, and mehbe the man upstairs!

I had a super freaky dream last night.... I dreamt I had a huge baby bump and everyone was shocked because I was so early in pregnancy but I got to break the news that i was huge because I was carrying twins!  I didn't tell J about it.... It seemed irrelevant and unimportant as we woke up at buttcrack a.m.  and scrambled out the door this morning.  Apparently I had the same dream during anesthesia because he said I woke up mumbling to him about the same exact thing! I don't remember telling J about my dream in the surgery center but hopefully this is a good omen!!  I remember walking to the OR, hopping on the table, the oxygen mask and monitors while reciting my mantra ... next thing I know I'm waking up behind the preop curtain.  I asked for my surgical cap off, my socks on, and then sleepily slurred to the nurse to make sure they were going to do ICSI on the eggs!  I can't wait to hear the fertilization report tomorrow.  Since we had only 4, I'm willing to bet the odds are pretty high we will do a 3 day transfer on Wednesday.   

I'm really trying to take one day at a time.... However, I am entranced by the POAS (pee on a stick) phenomenon!  I have consulted my calendar to figure out when I will be able to start testing.  I triggered with 10,000 HCG.  The body metabolizes 1,000 units every 24-28 hours.  Of course some bodies are more or less efficient than this.  According to the rule of thumb, a BFP on Monday Aug 13 could be fo rizzle.  My other option is to take a test every morning until I get a negative showing the trigger is out of my system.  A positive after that would be due to bebe!  At the same time, I'm super scared to test early, as in before a blood quantitative HCG by my RE.... What if all my poas's are negative???   Decisions, decisions.  One day at a time...  Let's get some eggs fertilized first.

Day 8

Yaaaaaaaaaay! Today's check was fab! I haven't received my E2 results yet but had some big fatty follies growing! Two are a nice 19mm, two are at 17mm, one is at 15mm and two at 13mm. Today before leaving the office we got our instructions for trigger and retrieval. The practitioner said it looks promising for trigger tonite or tomorrow! We will know this afternoon after Dr K makes the decision and when nurse Katie calls. This would put retrieval at either Sunday or Monday. Yikes!


This part of the process is why we pay the $big bucks$.  To be successful it is imperative they follow a strict timeline.  If the follicles aren't big enough or mature enough and are aspirated early, they might not contain mature eggs and/or the eggs won't fertilize properly.  If they wait too long, I will ovulate all these eggs on my own and we lose the chance to retrieve them.  I've had heard they want follicles between 16-20mm for the best chance to find nice, juicy ripe eggs.  The other balancing act is the HCG trigger shot (aka "money shot").  The HCG acts as the LH surge in a natural cycle and puts the follicles through their final maturation process.  Without HCG (or LH) the follicles and eggs they contain are useless and won't fertilize.  The trigger MUST be given precisely 36 hours before retrieval.

Why do I say yikes! when I refer to retrieval?  It is a complicated and delicate process.  First, it involves me undergoing anesthesia.  Though I could administer it to myself thanks to my CNOR certification, it scares me to be the receiver and not the giver.  Second, I will be up in stirrups with coot for all to see.  Third, in order to get those lovely eggs, via ultrasound guidance they stick a giant needle through the vaginal wall to aspirate the follicles.  This might also involve pushing/pulling my already bloated tummy or a hole through the uterus if they can't get them via vag.  Oh by the way, please don't put a hole in my ureters or bowel, thanks!  Finally, I work in the operating room, I KNOW what goes on....  Sometimes it's fun.  Most times it's good, but when it's bad, it's b.a.d.  The reassuring angle is I know what to expect and really, this is a fairly minor (though nerve-wracking) procedure.  I also plan on wearing my own cute scrub hat instead of the ugly, itchy blue bouffant most patients are subjected to.   After retrieval, I'm hopped up on propofol (the Michael Jackson drug) and Vicodin and the rest of the work is up to the embryologist and his gang of pros.  They do some fancy work that involves isolation, incubation, and fertilization.  Most times they just mix up sperm and eggs in a dish and they fertilize.  Because of J's lazy ass sperms we will be doing ICSI or intracytoplasmic sperm injection.  After he gives it up in a cup, they'll pick out the bestest looking ones "going for gold" and inject one single sperm into each egg via a seriously tiny needle.  Like microscopic.  The next day we find out how many actually fertilized-  usually 80% do.  This is where they turn from eggs to embryos.  Then, we wait!  After fertilization, they start to divide.  Some will arrest after fertilization due to chromosome issues and whatnot.  The transfer (when embryo goes from petri dish to warm, comfy ut) takes places either 3 or 5 days after retrieval.  5 days is preferred as this is the point when the embryos have reached blastocyst stage.  A 3 day transfer is still o.k. And sometimes is done if waiting until day 5 has no advantage; say if you only had 1 or 2 embryos to transfer anyhow.  If more embryos than what we will transfer are still viable and growing at day 6, they can be cryopreserved or made into embie-cubes!  Even if we have eggs that fertilize and embryos that make it to blastocyst stage, our chances of making it to implantation and a screaming kid 36 weeks later are 65%.  In the IVF world, this is actually pretty darn good.
So, as you can see we have only managed to jump one of several hurdles.  I've made it past what i think is our biggest one, egg growing!  As J said, you can't make it past the other hurdles until you make it over the first one.  Man, he's awfully philosophical at 9am.  We are hoping and praying and crossing all possible appendages that retrieval, fertilization, blastocyst, and implantation will leave us with the biggest, fattest, BFP there ever was!!!




UPDATE: Retrieval will be Sunday at 0830!  E2 was 2603 today.  Wowza!  Once again J rocked out the money shot.  We ended up triggering with 10,000 units which means it'll take me ~10 days to flush it out of my system... Delays my POAS accuracy a lil more but i'm prepared.  I believe I have 10 pregnancy tests along with like 12 strips to pee on.  I'm going to be a POAS freak!  


Since trigger is done, NO MORE NEEDLES!!  Hallelujah!  

IVF #2, Day 7

Hit up the doc again this morning, only this time the fam waited at Target instead of the REs waiting room. I would have loved to see the reactions of everyone seeing a 69yr old couple at a fertility clinic!  While I haven't gotten my E2 (blood estrogen) results yet, I am absolutely ecstatic about my follie count and size today! I should have my E2 this afternoon.  I had a few follies under 10mm that weren't measured, but also had two 16mm, three 15mm, and two 13mm.  A total of seven nice ones. SEVEN!  I just about cried right there on the table, feet in stirrups with my coot hanging out. I had to calm J down a lil bit and remind him we still have to make it through retrieval, have follies fertilize and then implant which means a long road to go but it's looking good. The nurse practitioner doing my ultrasound said she's not sure what I did the past two days but to keep doing it cuz its working! That means plenty of ice cream and couch time. :)  I had a headache all Tuesday night and yesterday and so spent the day yesterday at home by myself chillin while the fam visited Seattle for the day. A day to grow some eggies was apparently what the doctor ordered. Getting dressed this morning I came across my starfish necklace (the one I wore at our wedding) and figured I'd start wearing it. Momma said to "wish upon a starfish" so that I am!

I am so relieved! We will be going back tomorrow at 0800 for another ultrasound. What a great frkn day!

UPDATE: Nurse Katie called, estrogen is at 1723 today. Holy cow! She was really happy with my ultrasound and said how great it is that I'm responding so well this time. There is a good possibility I may be ready for the HCG trigger shot tomorrow night which would make retrieval Sunday morning. Yikes. I will be really glad to be done with all these injections but am scared for the anesthesia part of retrieval. 2 needles a day for 10 days followed by 5 needles a day for 7 days has done a number on my belly! Though I don't have near the size of bruises as last cycle, there are a number of bright purple and green areas. It's real cute. Tomorrow is a big day, wish us luck!

IVF #2, Day 5 so far so good!

I had my Day 5 blood and ultrasound check yesterday. At this point last cycle when I was cancelled, my estrogen was barely over 50 and though I had 6 follies, they were too small to measure (<5mm). Yesterday, I had only 4 follies, but one was already 10mm! My ut lining was 7mm and my estrogen was a whopping 1100. Wowie!! I was supposed to go back Friday but they want to see me tomorrow for another blood draw and ultrasound. I was a little worried cuz my estrogen was so high but Nurse Katie reassured me it's fine. I probably have more follicles hiding than they can see. Retrieval is 50% chance for Tuesday but could be any day between Sunday and Thursday. We will hear more tomorrow. Of course nothing is guaranteed at this point, but I'm super stoked that I'm responding to stims this time! YAY!!

I am The Luckiest

Today marks a very special day, our 4 year anniversary! I never thought it possible to love, laugh, enjoy, and have so much damn fun with one person. I definitely consider myself the luckiest to have such a great man to call my partner :).

Quick IVF update, my suppression check went fab! No cysts, ut lining looking good, yay yay yay! I started microdose Lupron injections (10u units) Wednesday and take that twice a day. Tomorrow I'll keep doing Lupron and add 450 units Follistim and 75 units menopur which comes out to 4 injections a day. Yikes. I'm going to be a big, fat, purple pincushion! I'll have my first blood draw and ultrasound Tuesday (Day 5) to check progress. Game time is here, and I'm getting very nervous!

Round 2, "DING!"

In gearing up for the fam to arrive and craziness fixing to start, I figured now would be a good time for an update! I have been taking my estrogen pills and ganirelix injections. No complaints there. I had a real fear I wouldn't get to take either because of my nonexistent LP but here we are, 10 DPO and going strong! Right on track with the calendar; a huge, HUGE reassurance. I have a few minor bruises but nothing compared to what I'm sure is coming with 450iu of Follistim. I learned a little trick to ice my belly before injecting to dull the pain a tad, works great! I'm not near as hesitant to stick my fat (otherwise I'd stand there with my "inch" pinched for 30 seconds and have a 1, 2, 3 attitude). It is hard to stick yourself when you know the poke is coming. My suppression check should be early next week and if all is well, stims will begin by late next week! I am super excited for this time around. I am still very scared IVF might not work again, but so many positive things have happened and are happening, I just can't help but be positive.

For instance:
- it was a little more than 7 months ago I met with Dr Z when he told me to check into IVF stat. He said with a little luck we'd be holding baby M by next May. At the time I though, "May?!? Ef that, I want it in 10 months! now!". And wouldn'tcha know it, EDD with this cycle will be right around April 30.

- We were also hoping to get lucky on our Maui vacay, our last ditch TTC effort before spending the big bucks! Our hotel concierge was very excited for a Maui Baby and let us know it. Of course it is just coincidence, but where we're we April 30th this year? You guessed it! While not quite a "Maui baby," still pretty cool.


The eggs have def been getting lots of love and I'm am all but convinced that makes a difference. With all my yoga, imagery, and mantra-ing, my chakra has got to be centered by now! I've also been a baby book and article reading ho! Yesterday I took "What to Expect When You're Expecting" to read for entertainment while the oil was being changed in the jeep. ;) A few months ago I was too afraid to read any pregnancy or baby related articles as I didn't want to 'get ahead of myself.' I thought the disappointment would be worse if I was all prepared to not eat sushi and had the crib already picked out. Unfortunately I found out disappointment really sucks whether I was educated or not. With the power of positive influence on my brain, I have to say I have really enjoyed eyeballing maternity fashion and getting smart about all things baby. Even J has taken a stroll or two through the baby section in the store checking out the goods... Awwww. I started using green cleaners and making a lot of my own. I started lifting light weights(affectionately known as my "granny weights"), ya know, cuz babies and carriers and diaper bags are heavy! We've also started eating a bunch more veggies and *pout* less cheese. I've all but given up wine and even J has put down the beers for now. We've taken proactive, super healthy and smart steps to make Round 2 as successful as we can stand it to be. I'm feeling good. J's feeling good. Hopefully those eggies are feeling great!

We have exactly 47 hours until the house occupancy is tripled. Today I think I'm going to watch the birds, watch the squirrels mess with the birds & my bird feeders, and enjoy the silence. It's going to be a long, exciting, emotionally charged three weeks!

Oh the things we'll do!

I just got home, and even though I iced my bum before and after, it still hurts! Let me explain:

Last cycle I got a BFN! Are we surprised? I've just been sitting around the past 2 weeks waiting. Dr. K decided LEAP was the way to go and so I've been monitoring for ovulation with OPKs. On Friday I talked to Nurse Katie and she informed me they wanted to see me Monday (today) for an ultrasound just to check everything out. (Thank goodness I'm not working, or I'd def be getting fired for all these appointments!) She had mentioned sometimes they trigger ovulation with an injection of HCG, but I didn't think that was likely for me since I have an LH surge and ovulate on my own. Negative OPKs all weekend (I wasn't expecting a +until Wednesday anyhow).

Today the ultrasound is performed by the same doc I saw when I was cancelled. Ut lining is looking good and he sees 5 follicles measuring on track. I'm on my way out with instructions to keep using OPKs and I'll hear from Dr K and Nurse Katie this afternoon. I do a little happy dance for those 5 follies. :) 1pm rolls around and I get a surprise phone call "hey M, we want you to trigger tonite, will that be a problem?" I say no, but then realize I forgot J is CDO today. CDO is Command Duty Officer on the ship or HMFIC He is in charge of everything that goes wrong for the next 24 hours and can't leave the ship. Try as I might, I realize there is no way I can give myself The Money Shot. I frantically call a local friend who has done this, but she is out of town until tomorrow.. oh what to do! I email J... "uhhh, babe, will you have a couple minutes this evening to shoot me in the bum?" "yes, but we'll have to do it in the car." Really, in the car?? Gotta do whatcha gotta do, eh? I gather my supplies in a ziploc baggie and wedge an ice pack between my butt and the car seat on the way to see him. Driving through the gate to get on base, I feel like a criminal with my needles sweating for my next drug fix. Its 6pm, still very light out, and there are far more people walking around than I anticipated. We get some very odd looks as I mix and draw up the medication in the drivers seat. Instead of baring my behind for all of the shipyard and coworkers to see, I decide to reverse it 200 yards and park between a bunch of parked gov't vehicles and a dumpster. I hand over the syringe and hop out so J can eyeball where he is supposed to dart this thing in. I hop back in the car, crank the seat back and the steering wheel up for maximum access. For a guy who is squeamish with needles he sure knows how to stick a girl. As I'm pulling my drawers back up, the loudest loud speaker you've ever heard crackles announcing a fire drill. I steal a quick kiss and watch as J runs back to the ship hoping to not get caught outside! Talk about an adventure. I still can't believe I got a shot in the car, much less at J's work.... our baby book is going to have some amusing memories!

We don't have an "official" calendar yet for IVF #2 but it'll go a little something like this: Although today is Cycle Day 14, we are renaming it Day 0. On Day 8 I will start estrace(estrogen) pills. Day 9 I start a ganirelix injection. Do those until menses shows up. Start Follistim & Menopur CD3 until ? Trigger, +36 hours retrieval, +5 days transfer, +14 days HCG blood draw. The first and second weeks of August are going to be bery, bery busy.

As a side note, we found out we are officially moving back to San Diego! J's next job is going to start in July and will be for 3 years. According to the guy who does this job currently, he will be teaching leadership at a center for professional development and it will be cake. We are so excited! We were really worried how everything would play out and hoping we wouldn't have to move twice more before next summer... just once: from WA to Cali with the boat! A huge weight has been lifted. Everything is lining up perfectly for this April/May delivery! I think these next lil follies will feel a little more prone to grow knowing they won't be as stressed with moving and will be in SoCal for 36 months ;)

A few more tricks

I have never been so nervous for a doctor appointment as I was on Monday! I was really afraid of what the verdict would be and whether they had stronger drug protocols I could use since I had done one of the strongest. Of course, Drs first suggestion was donor egg and I said no. Maybe later, but for now I feel like we still have a chance to be successful with my own lil eggs. They can't really pinpoint what went wrong or could have caused the lack of response.... Maybe it was an off month, maybe the drug dose was too high, maybe it was the BCP.... Who knows. The good news is there are two other protocols she thinks will work well. One is a Lupron microflare protocol, which I read about and am glad she mentioned. It works in conjunction with the body's natural hormone levels to recruit follicles for the following cycle. It is one that has the most success for those who are poor responders or have low ovarian reserve, read: me. The other she mentioned is a LEAP protocol. May be similar to estrogen priming?? I'm not sure.... I haven't heard of it, google can't find me much so I don't know a whole lot. My understanding is that they make it easier to "wake up" the follicles, so during my next cycle, I'll monitor for ovulation, then start Estrace and an injection to sync the follicles (instead of suppressing with BCP) so they all start growing at the same time.

The summary of my 30 minutes in the docs office: she has tricks up her sleeve! We just need to wait for Uterine Exodus before we can proceed. I'm on CD 19, so this could be next week (if I ovulate, which I haven't yet, but hopefully will by CD22), or indefinitely if I'm too screwed up by BCP then injections then nadda. We shall see. Although there is still a minuscule chance for "au natural" this month and hubby is glad to hear this. Best case scenario, we are back to poking and prodding by mid-end July.

I've started yoga for infertility which basically involves massaging your innards through breathing... Yeahhhh..... I've also been doing reflexology, which I've found is super easy and quick. I'm still debating about acupuncture ... everywhere I read says theres no proof, but it can't hurt. It'll hurt my already empty wallet, that's for sure!

In closing, an interesting tidbit I came across: the 2nd chakra, Svadhisthana is the one associated with the reproductive system. Two ways to open up and clear your chakra: imagine a lotus flower opening and closing, or become one with the color orange. Wear it, imagine it, eat and drink it, BE orange. interesting. I swear, I picked out the background for this blog long before I knew orange and Svadhisthana were related.