The Never-Ending Cycle

Tuesday June 28th was supposed to be the big day when I went for bloodwork to find out if the IVF was successful. Of course, I would have done a home pregnancy test (or several) beforehand out of curiosity, and to have a heads up on the news, but regardless, the 28th was the official date. However, since we didn’t end up transferring any embryos due to OHSS, instead of finding out whether things were successful or not, I went in to the clinic for a day 2 ultrasound and bloodwork to see if we could go ahead with the frozen embryo transfer in July.

Originally, I’d thought it would be a no brainer to do the transfer in July, but when I spoke to one of the nurses after getting my period, she scared me by saying that we had to make sure my ovaries were back to a normal size before going ahead, and if they weren’t we might have to wait out a cycle and transfer next month! This totally freaked me out, because I’m moving across the country at the end of this month, and if we don’t transfer in July, I would have to wait until September at the earliest since I wouldn’t be able to take time off work from my new job in August to fly back here for a transfer.

Thankfully, the ultrasound went well, and my ovaries had gone right back down to whatever a normal size should be. However, my bloodwork still had to check out okay before we could proceed. I anxiously awaited the call from the fertility clinic, and finally got the news that my bloodwork was “good”, but I had to come back in for more bloodwork again the following day since my estrogen levels were still too high! I tried to tell myself that at this point we were just looking at a delay of a few days, rather than a few months, but the following day I was once again nervous and anxious about what the news would be. Thankfully, my hormone levels were finally acceptable, and I could start taking the estrace (to increase my estrogen levels?!)  in preparation for my transfer later this month.

For anyone who’s keeping track, I kicked off this IVF cycle with my first birth control pill on March 29th. It is now 3 months later, and while a lot has happened, I have yet to experience even the possibility of being pregnant. I suppose that technically the IVF cycle is over now, and July will be a new cycle, but to me it won’t be over until I do the transfer.

Things will be pretty quiet for the next little while as I’ll just be taking my estrace until I go in for an ultrasound and bloodwork on July 13th. If all goes well (as I think it should – the main purpose of the ultrasound will be a lining check, and my lining is always stellar), then my transfer should be around July 18th. Hopefully it will be worth the wait, but in any case I will be happy to finally have closure on this cycle one way or another!

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About that OHSS…

As I wrote  in my last post, even though everything went really well with the IVF cycle, I ended up with OHSS so we were not able to do a transfer. When my estradiol levels got very high near the end of the stims, my Dr. had warned me that I was at risk. So, we took all the necessary precautions: coasted (no medication) for two days, triggered ovulation with only 5,000 units of hcg instead of the usual 10,000, and got me some medicine (dostinex) to take every evening in the hopes of keeping the OHSS at bay.

My stomach felt quite full and bloated after  the retrieval, and on the Thursday after retrieval (2 days later) I remember finding the smell of food quite offensive (and it was pizza, which I love!), and I didn’t have much appetite for dinner. However, when I woke up on Friday I felt much better. By Friday afternoon though, I was feeling worse than before. I ate a banana at lunch time (the only thing I ate for lunch), and by the time I finished it, I felt like if I ate another drop of anything I would throw up. Again, the smell of food really grossed me out. I wondered if this was what morning sickness and sensitivity to smell feels like when you’re pregnant?

I ended up leaving work early because I was just sitting there staring at my computer willing time to tick by, but unable to actually work due to feelng horribly bloated and somewhat nauseous. I went home for a nap, and then it was time for my husband and I to go sign the morgtgage documents for our new house. The bank was next to a fast food restaurant, and again I found the smell of food just wretched. I was popping some tylenols as we went in to see the banker, and she noticed and was sympathetic that I wasn’t feeling well, so things moved along fairly quickly. I wasn’t feeling any better when we left, and within five minutes of being in the car, I could feel my stomach clenching and I ended up throwing up all over myself as my husband couldn’t pull over in time. Can you say gross?

I called my clinic’s after hours line when I got home. Ever since being told I was at risk of OHSS last week, I’d read the handout several times, but I didn’t seem to have the typical symptoms that it described. The nurse asked me questions about whether I was short of breath (no), and whether my pulse was pounding in my head (no), which I knew were symptoms of OHSS. Even though the nausea and the food sensitivity were my only symptom, but the end of the conversation when she said to drink nothing but one litre of gatorade per day, to sleep sitting up, and to come in for an ultrasound the next day, I knew that I was likely dealing with OHSS.

Sure enough, the ultrasound (on my stomach – a first!) confirmed that I had fluid in my abdomen and that my left ovary was “massive”. Saturday was the worst day of it. Thankfully I didn’t throw up again, but it was very difficult to force myself to eat anything, and I felt very uncomfortable. My stomach was also masive and felt stretched to its limits. And, I was also starting to feel overwhelmed by all the medications I was taking, especially as some of them had to be taken with food, and I wasn’t able to eat much. Between the three times a day estrace pills and prometrium suppositories, the twice daily antibiotic (to be taken with food), the baby asprin, the dostinex, and the twice daily heparin injections, not to mention tylenol for pain, and pepto bismal and gravol for nausea, I felt like my entire day was spent medicating. I even cut out the vitamins and supplements I normally take (my Dr.  even suggested it, as they can upset your stomach), and also stopped taking the DHEA, but it was still overwhelming.

We went in on the Sunday for an ultrasound, and to make the decision on whether to transfer or not. On Saturday, our Dr. had already asked us when in July we’d be moving, so we knew that we may have to hold off transferring. I felt better on Sunday as my appetite was coming back, but I still felt rough enough that I was hoping our Dr. would say we should hold off on the transfer. And strange as it sounds, when it occurred to me that morning that not transfering would mean I could stop taking all the medication, it seemed like a dream. While I’m sure lots of people would do whatever they can to transfer (even if they weren’t feeling 100%), for me the promise of no more medication was much more appealing than plowing ahead.

Due to the possibiity that we wouldn’t be transferring, I didn’t have to drink the usual 4 glasses of water prior to our appointment; I got away with 2. Sure enough, while I was a bit better than Saturday, the ultrasound showed that I still had fluid in my abdomen, so the Dr. recommended we postpone the transfer. “Can I stop the meds then?” I asked hopefully. “Yes. Just keep taking the baby aspirin, but you can stop everything else.”

Over the next few days, I slowly felt better. I had to go for bloodwork a few times, and had a few more ultrasounds, but everything showed that I was getting better. On the Tuesday (one week after retrieval), I did have some tightness in my chest, but it wasn’t too bad And then on Wednesday, I woke up with crazy hearburn (I’d never in my life had heartburn before). It was a constant burning feeling radiating out from my breastbone, and I couldn’t concentrate on anything but the pain. I went into the fertility clinic that morning to get checked out, and everything else looked good, so I got a prescription for something to helpt the heartburn, and was told to stop drinking the gatorade and taking baby aspirin which would aggravate it. Thankfully the medication fully kicked in by the afternoon.

On Thursday, I felt better, though I still had some tenderness in my pelvic area, and on Friday I think I could finally say I was 100% – no more big belly or anything! Okay, I was still up the 6 pounds I’d gained over the course of the IVF cycle, but at least I no longer looked pregnant. And then this past Sunday I started spotting, which meant my period was on its way and it was time to jump back in and get going on the frozen embryo transfer!

Into the Freezer

Wow, I can’t believe the fertilization rate was the last thing I wrote about! To be fair I did write a post on day 3 that had some updates in it, but I never posted it since I wanted to edit it some before posting, and here I am a few days later and it’s horribly out of date. So here’s the new and improved up to the minute update on how things went for our embryos. I’m going to write another post about how I’m feeling.

After getting the good news that 12 of our eggs fertilized, the next step was a call the following day to tell us how many embryos we had and what the quality was. Again, I was nervous for the call, but again we had fantastic news!

On day 2, we had 9 embryos (apparently the other 3 fertilized eggs were “multi-nucleated”). All 9 were doing very well – one was a 2 cell, and the other 8 were 4 cell, which according to the embryologist is exactly where they should be on day 2. She then went through the rating system with me. Our clinic has a 20 point rating, and all of our embryos were grade 18 to 20 (grade 18/19 being considered high achievers or “very nice embryos”, and grade 20 being the best grade, and apparently quite rare – we had two of those). So, since we had a lot of strong embryos in the running, we were probably heading for a day 5 transfer on Father’s Day.

Our clinic sets up a day 3 transfer appointment with everyone, just in case. If everything looks a go for a day 5 transfer, then you just have a consult to discuss the embryos and how many should go back in. So on Friday morning (day 3), I had to drink 32 oz of water an hour before our appointment, just in case we’d be transferring that day.

We got to the clinic and sat down in the waiting room. One of the nurses said to me “Is your bladder full?”. I nodded. “Go empty it.” she said. I happily went to the bathroom, relieved with the news that our little embryos must be doing well.

Our consult started with the embryologist reviewing where we were at. On day 3 all 9 of our embryos were 8 cell, which again was right where they should be. All were still rated 18-20, and 3-4 of them were already compacting (which apparently is a very good sign).

Then it was time for the Dr. to take over. He repeated what we all knew – that the cycle had gone really well so far and that our embryos were in great shape. He said that in terms of pregnancy rates, they see the same results for embryos graded 18,19, or 20, so from that perspective it would be hard to pick the “best” embryo. He also said that at this rate we can expect to have some left to freeze, probably around 4.

The Dr. also told us that so far based on how good everything looked, the IVF cycle had not given us any further diagnostic information about why we weren’t conceiving. He did say though that upto this point, the egg has been the dominant force in embryo development, but on day 3, the sperm DNA starts to take over. So we’d see what happened over the next few days and if things started to go downhill it could point to a sperm issue.

This stressed my husband out to no end, and he got pretty melodramatic with me and made me promise I would get a sperm donor if there was something wrong with his sperm (he’s not a typical male, in that he can get pretty emotional at times). We both nervously awaited the day 4 update. We still had 9 embryos going strong, 3 of which had developed into morulas, and all of which were now graded 16 to 19 (16 being average, and 17 being high average). The embryologist made a passing comment to the effect that “We discussed yesterday that we don’t know why you’re getting pregnant, but now we might have some more information.”, so of course I had to spend the rest of the day comforting my husband that our embryos were still doing fantastically well, and remind him that the embryologist had said that it was difficult to grade them on day 4.

Day 5 was Father’s Day and we went in for our potential transfer. As I’ll write about in my next post, due to some early OHSS, we went in expecting the transfer to be cancelled. Once again my husband was terrified to hear how our embryos were doing, but while in the waiting room, the Dr. walked by and told us “Your embryos are looking good.” “See?” I said to my husband. “There’s nothing to worry about!”. Of course he still found something to worry about “Good? Not great?” he said.

As expected, upon examining me, the Dr. recommended we freeze all the embryos we could and do a frozen embryo transfer in July, which we didn’t argue with at all. The embryologist then came in to give us the final verdict. “On day 5, we have 9 embryos.” She then went through all the details: we had 4 blastocysts, 4 early blastocysts, and one that was just past the morula stage. Eight of them were rated 17 to 19, all of which would be frozen that afternoon, and the last one was only rated a 14, and therefore wouldn’t make it to freeze. Finally, my husband was able to breathe a sigh of relief.

The rest of the day, despite having to delay the embryo transfer for a month, both my husband and I felt very positive about how things had gone. Every once in a while we would look at each other in wonder “Eight! Can you believe it?”.

And finally, for the first time, I was able to say to my husband “Happy Father’s Day.”

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.