Back on the Rollercoaster

After the relative calm of the last few weeks, and my so-far perfect IVF cycle that I wrote about in my last post, things got a little exciting this weekend.

I went back in on Friday for another follicle check, and was happy to finally have my husband at my side to take notes. Things continued to look good, with a total of 17 follicles in the running:

9 on the right (mostly 14-18mm, but one at 13mm)

 8 on the left (mostly 14-18mm, but one at 11mm).

My lining was holding steady at 11mm, so everything was looking good. However, we weren’t quite ready yet, so the Dr. requested I come back Saturday morning for another ultrasound. At Saturday’s ultrasound, my husband was ready to take notes again, but this time the Dr. just took a few measurements on each ovary, without telling us what they were, and then announced that all the follicles had grown.

So it looked like we were getting close to the retrieval date, but we still had one more hurdle to cross. Apparently my estradiol level was too high for us to go ahead with the hcg trigger shot yet. I ‘d already had one night with no meds, and now depending on how my levels were after Saturday’s draw, I would either get to trigger Sat night for a retrieval on Monday, or would need to “coast” (i.e. no meds again) for another night.

If we triggered while my estradiol was still high, I would in all likelihood develop ovarian hyperstimulation syndrome (OHSS), which could be very painful, quite dangerous in severe cases, and may also keep us from going ahead with an embryo transfer at this point. While OHSS sounded terrifying to me from the moment I first heard about it, to date, I hadn’t been too worried about my risk of developing it, since I didn’t meet any of the other risk factors: I was not young; I didn’t have low body weight; I didn’t have PCOS or a high antral follicle count; and I didn’t seem to be growing an abnormally large amount of eggs. However, the high estradiol was enough to put me at risk, so along with the the hcg trigger shot and all the medications I would need to take before and after retrieval, I left the Dr.’s office with some dostinex to help ward off OHSS.

That afternoon I got the call that my estradiol was still too high to trigger, so I’d have to coast again, and go back in on Sunday for more bloodwork. This news really sent my mind reeling. The first thing I thought of was that I may end up having to delay embryo transfer and just freeze whatever embryos we got. Initially, this sounded like a terrible thing. I’d been so looking forward to the high that comes with a two week wait that might actually mean something, that I couldn’t bear the thought of that chance being taken away from me. And then of course there’s all the complicating factors with our cross country move, and changing clinics and not knowing when our next chance would be.

Once I thought about it a bit more though, it didn’t seem so bad. We could go ahead with treatment at the new clinic, while knowing we had some embryos on ice for backup (or for a future child). Investing in the future gave the possibility of a delayed transfer a nice spin.

However, what really terrified me was what I thought of next: what if my estradiol levels stayed high? How many days could Icoast for, and could retrieval be cancelled?  I spent the rest of the evening worrying about the risk that we’d spent all this money and I’d injected all that medicine for nothing.

After Sunday’s bloodwork, the nurse said that depending on how things looked,  they’d either see me on Tuesday for retrieval or back in on Monday for more bloodwork. She smiled at me “We expect your levels will be down today.” This provided me with some initial comfort, but then of course once I thought about it, I got panicked again because I felt like if by today the estradiol hadn’t gone down yet, then it would be a really bad sign, and I’d be one stop closer to my biggest fear of a cancelled retrieval.

The five hours between giving blood and getting the call felt more like five days, but finally the clinic called with the good news that I would be taking my trigger shot that night!  As a precaution though, I’d only be taking 5,000 units of hcg instead of the standard 10,000 units, and would also be starting the dostinex that night. Keeping my fingers crossed that these measures will keep me from getting too uncomfortable over the next few days, but in the meantime, excited to be back on top and heading for a retrieval.

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