Life After Retrieval

I made it to the other side! Here I am, one day post egg retrieval and life is good. I’m still getting used to the new crop of medications. Bye bye suprefact, puregon and menopur, hello prometrium, estrace, baby aspirin and heparin. Oh, and doxycycline and dostinex will also be my friends for the rest of the week.

Yesterday morning was the big day. I’d read as much as I could about what to expect, so was pretty ready for how things went. We arrived at the clinic an hour before the scheduled retrieval time. First, my husband and I got to go into a room where I changed into a nightgown and he changed into scrubs, and soon the Dr. came in with some pills for me to take: 2 tylenols, 1 gravol, and 1 atavan. After that, we sat and waited, and periodically the Dr. or one of the nurses would pop their head in to check on us. The embryologist also came in to introduce herself and tell us about what her role in the process was going to be. In between the visits, we killed time and marveled at the three types of pink floral pattern in the room.

Finally it was time to go across the hall where the retrieval would take place. I got hooked up to an IV and to a machine that tracked my vital signs. We’d been in that room before for monitoring ultrasounds, and also for my endometrial biopsies and sonohysterogram, but somehow on retrieval day it looked different. I don’t know if there were additional machines that day, or if we just noticed the for the first time, but it felt much more like an “operating room” than it normally did.

In no time at all I started feeling woozy and the Dr. started the retrieval. It was uncomfortable, but not as painful as I’d feared. The embryologist had explained to us that she would periodically be yelling out numbers that corresponded to the number of eggs retrieved, so I tried to listen for that, but only remember hearing her say “8” at one point. I also remember turning my head towards the wall to look at the clock. I was amazed that the hands on the clock seemed to be zipping along the clock face at high speed. At one point I asked my husband if the minute hand was whizzing by really quickly, and he had to tell me no. Other times it looked like all three hands were falling down.

And then the retrieval was over. After the retrieval we got to go back to the room we started out in. I was pretty wobbly walking across the hall. Once in the other room, I lay down and the nurse got me hooked up to another IV to administer intralipids. Then my husband got whisked away to do his part.

I drifted in and out of consciousness, and at one point my husband came back. We talked a bit, but I was pretty out of it. Then, once the intralipids were administered, we were done! The nurse came in to report that they retrieved 14 eggs (which was very good apparently as they get 6 to 12 on average), and that we’d get a call the next day between 9:30 and 10:30 to tell us how many fertilized.

We grabbed some lunch, and then went home to rest. I slept most of the afternoon, as my husband worked on his laptop next to me. I felt quite sore (pressure and tenderness on the lower abdomen), but once I took a tylenol it felt much better. Over dinner, we marvelled that our future children (possibly all of them) might be hanging out in a dish at our fertility clinic at that very moment. Afterwards, my husband asked me about the fertilization. “What would be a really good result?” I know that typically all the eggs don’t end up getting fertilized, so I thought for a minute and said “I don’t know, 12?”

He looked at me amazed….”Really? Is that even possible?”. “Sure it is.” I said. “But it will probably be less…maybe 7 is realistic?” We decided that 7 would be great.

This morning, I was on pins and needles waiting for the fertilization call. On the one hand, I felt comfortable that by staring out with 14 eggs, we’d end up with a decent number of fertilized eggs. But then, there was the side of me that worried that very few, or none would fertilize. This fear goes back to our diagnosis of unexplained infertility. On paper, there is nothing wrong with either of us. In fact, I would even go a step further and say that on certain metrics, we even look like we would be spectacularly fertile. And yet, in three years we have never conceived on our own.

So in recent days, I started to wonder if it actually wasn’t me (usually unexplained infertility means an undiagonsed problem with the female), or even him, but something about the two of us together. Maybe his sperm just don’t like my eggs, which would result in a poor fertilization rate.

I kept myself busy this morning while waiting for the phone call, and finally it came. The embryologist started out with some niceties and talking about the process, meanwhile I sat there willing her to just get to the good stuff. Finally she said “Your eggs have done fantastic. Out of 14, 12 fertilized. One of the other eggs was immature, and the other one may have been. We’ll call you tomorrow with an update and let you know what the grades are.”

My husband was at work, so I texted him right away, and he couldn’t believe it. His response back to me consisted of a serious of quick statements punctuated by numerous exclamation marks. And finally, “Amazing! We’re the most fertile infertile couple around!”

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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.