Cycle4, IVF1, CD16 - Egg Retrieval story

05/15/12 - CD14:
Morning - No meds (in preparation for ER)
Noon -  No meds
Evening - No meds
Night -  Metformin, Inositol, Cinnamon+Chromium, Doxycycline, Cabergoline, Chlor-trimeton

We went to the lab at around 8:15am and they took us back around 8:45am. The doctor answered our last minute questions and then I was taken inside. DH had to go for sperm collection. Once inside I was given the sedative through my IV and I was in my happy place (as the doctor called it) in seconds. I remember waking up in the recovery room and the nurse told me that they got 31 eggs. The whole procedure only lasted 20minutes. That was a really good number and the doctor was able to get to my right ovary too. I came by really fast and was able to keep down water and crackers, so they kept me in recovery for about 20min and then let me go home. I was asleep for most of the way and came home and dozed on & off till about 6pm. I think because of the pain medication I was totally fine till then. At 6 I started having pain, bloating and uncomfortable feeling in the tummy. I took tylenol for it and took it easy for the rest of the day. Sleeping was hard and I kept tossing and turning. They also told me that I am at high risk for hyperstimulation and so have been watching my weight since then. The cabergoline and chlor-trimeton was added to help prevent this.

05/16/12 - CD15:
Morning - Baby aspirin, Metformin, Inositol, Cinnamon+Chromium, Doxycycline
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Doxycycline, Cabergoline, Chlor-trimeton

The nurse called me with the fertilization report. Out of 31 retrieved only 15 were mature (this was quite shocking to us) and out of 15 mature eggs 11 fertilized with ICSI. We were a little down for the rest of the day as we were expecting a bigger number and the nurse re-assured us that PCOS does produce a lot of eggs but many immature ones. The symptoms were the same with pain and bloating in the tummy and looking 5 months pregnant. Still no weight gain or breathlessness.

05/17/12 - CD16:
Morning - Baby aspirin, Metformin, Inositol, Cinnamon+Chromium, Doxycycline, Endometrin
Noon -  Cinnamon+Chromium, Iron, Prenatals, Medrol, Endometrin
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Doxycycline, Cabergoline, Chlor-trimeton, Endometrin

The nurse called me with the embryo status this morning. Out of 11 fertilized embryos 10 were still growing. We have 4 at grade 1 (excellent), 4 at grade 2 (good), 1 at grade 3 (ok) and 1 at grade 4 (not ok). She said that it was a great report and most likely I will be having a 5dt. I am still waiting for her confirmation call after checking with the doctor. Today's news has been more promising and we hope and that we have atleast a couple grade 1's to pick from for our transfer. I will be nice to have some frozen ones too. We are sure that we want to put back only one grade 1 embryo if possible.

 

Cycle4, IVF1, CD13

05/08/12 - CD7:
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/09/12 - CD8:
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/10/12 - CD9:
Ultrasound - Lining 13mm, Left ovary - 12 follicles, Right ovary - 12 follicles
Estradiol - 1339
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/11/12 - CD10:
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 150IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/12/12 - CD11:
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 150IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/13/12 - CD12:
Ultrasound - Lining 8.3mm, Left ovary - 10 follicles, Right ovary - 10 follicles
Estradiol -4298
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 150IU
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU, Ovidrel trigger shot

05/14/12 - CD13:
Morning - Baby aspirin, Metformin, Inositol, Cinnamon+Chromium, Doxycycline
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Doxycycline

Because of the number of follicles and high Estradiol values I am at a high risk for hyperstimulation. ER is scheduled for tomorrow morning and I will start additional oral tablets to prevent OHSS along with progesterone suppositories and estrogen patches. The whole process seems so much out of control and I am in a daze. I have lots of abdominal bloating and discomfort and have already gained around 2 pounds in 2 days. Hopefully I will only see the milder side effects and be OK for a fresh transfer.

Cycle4, IVF1, CD6

The second month on bcp's was pretty much the same. Headaches, nausea, tiredness and mood swings. I started Lupron 10units on 04/25/12. The shots were easy to administer and apart from some itching (for about 2min) I do not have any other side effects. I started my IVF cycle almost a week ago and it has been really hard keeping track of all the medicines and shots that I need to take everyday.

05/02/12 - CD1:
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium
Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units

05/03/12 - CD2:
Ultrasound - Lining 6.5mm and no cysts
Estradiol - 9
Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium

Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units

The nurse said that the lining was a little too thick and it would nice to have a bleed. Somehow my body listened and I started bleeding that night. I had full flow bleeding for 2 days and then it was just spotting. Also there was a confusion about my medication. Their charts indicated that I was supposed to start Gonal-F whereas I got Follistim from the pharmacy. Finally they told me that either one is fine.

05/04/12 - CD3:

Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU

Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

I am doing the Follistim and Menopur on my tummy and the Lupron on my thigh. Got my first bruise from the menopur two days ago.

05/05/12 - CD4:

Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU

Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/06/12 - CD5:

Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU

Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur 150IU

05/07/12 - CD6:
Mock Embryo Transfer 2:
         Today we tried the mock embryo transfer again. I still have some spotting but still they were able to go ahead with the transfer trial. I went with a full bladder and was extremely uncomfortable by the time the doctor came to check me. He finally decided that my uterus is not visible with a full bladder and had me empty it. Then they were able to get the catheter in with a little difficulty and with some prodding and probing the were able to see it on the screen. The doctor was happy and has made lots of notes on my chart as my transfer is going to be quite unique.

Ultrasound - Lining 10.5mm, Left ovary - 5 follicles, Right ovary - 3 follicles
(I am a little concerned about their lining measurement as it was 6.5mm 4 days ago and I have had some significant bleeding since then and was expecting it to be either less or the same).
Estradiol - 252

Morning - Baby aspirin, Dexamethasone, Metformin, Inositol, Cinnamon+Chromium, Follistim 300IU

Noon -  Cinnamon+Chromium, Iron, Prenatals
Evening - Cinnamon+Chromium, VitD
Night -  Metformin, Inositol, Cinnamon+Chromium, Lupron 5units, Menopur150IU

I am developing a mild headache in the nights ever since I started the stimulation. Also last night I was really light headed for a while. I also have my share of the usual tiredness, nausea and hotflashes that comes with going through IVF. So far it's all manageable and I am hoping it stays this way.

Based on today's results I continue the same protocol for 3 more days and go back for bloodwork and ultrasound on 05/10/12.

Preliminary blood work for IVF

Both me and DH went for our preliminary infectious diseases blood work last week. It all came back negative. In addition I had some other things checked and now I am low on vitamin D, anemic and borderline for sugar. My thyroid levels were all normal.
TSH - 1.2 (normal 0.4-2)
Free T4 - 1.09 (normal 0.76-1.46)
VitD25 Hydroxy - 22 (normal 25-80)
Hemoglobin A1C - 6.0 (normal 3.5-5.9)
TIBC - 28 (normal 28-170)
Ferritin - 5.3 (normal 11-307)
I need to watch what I eat and also eat lots of iron rich foods. I am also on supplements for vitamin D and iron. Hope the sugar thing was the side effect from eating unhealthy during the holiday season.

I finished my first month on bcp's and started my bleed over the weekend. It has been really heavy and I feel tired and drained all the time. I start the second round of bcp's today for another 4 weeks and then start my IVF cycle. I hate being on bcps's and because of the clinic's busy schedule I have to be on it for 2 months. I get crazy mood swings, I cry a lot and feel depressed and since I do not have anyone to talk to that just adds to this. The only thing that keeps me going is my daughter. She gives me such precious hugs and kisses and told me this morning that I am her baby. I hope that I don't hurt her in my quest of another child.

IVF consult & Mock Embryo Tranfer (a very very difficult one)

The mock embryo transfer was a huge disaster. My inner organs are drastically misplaced. My cervix is way high up (that's why my HSG took 2 tries), uterus is retroverted and right ovary is high up and can never be seen with a vaginal ultrasound. What fun. As if going through infertility is not enough, my body makes it even harder.
As per norm I went with a full bladder. The nurse came in to check if the bladder was full enough and decided that I need to drink another cup of water. The doctor came another 15min later and tried to reach my cervix. He had to use an ultra long speculum and after awhile inserted the catheter. They tried for about 15min to see the catheter and the uterine fundus on the ultrasound with no luck. The 15min was quite painful as they are constantly pressing and prodding and poking and pulling and pushing (all of this with a speculum, clamp & catheter inside me). Finally they decided that I need to empty my bladder. After that the doctor inserted the catheter and with a lot of difficulty and manipulation they were barely able to see the tip of the catheter and the uterine fundus on the ultrasound. So they decided that embryo transfer is going to be challenging.
The IVF consult with the doctor was about an hr long and very informative. He explained the whole process in detail and answered all my questions. With my age and AMH value he thinks that I have a good chance at IVF. But since my right ovary is high up they might not be able to harvest all the eggs from it. In the end it was decided that I am going to need another mock transfer a week before the retrieval to see how things have moved after I start the stimulation. I fall under the 0.01% of women who need to do the embryo transfer with an empty bladder.
The following sums up my whole situation:
1. Stimulation phase - High risk of over stimulation because of PCOS
2. Egg retrieval - Right ovary higher than normal and might not be able to retrieve all the eggs.
3. Embryo transfer - Cervix high up and retroverted uterus makes it real hard for catheter insertion and visualization on ultrasound.
I personally feel all of the above is going to bring my chances of success down. I have read everywhere that a difficult traumatic transfer can cause cycles to fail as the uterus starts contracting and pushes the embryo out. Mine he had to clamp my cervix twice during the trial so I guess it is considered quite a difficult transfer. Even after all that, they could hardly see the top of the uterus (fundus, which is the perfect spot for implantation). Anyway I have been on birth control pills for a month now and will be starting the second set in a week. They did not have any availability till May with their embryologist, hence the 2months of bcp's. The first week of BCP's were horrible. I had a mild headache all the time and was super emotional and cried a lot. Now my body is slowly getting used to it. I will be on the standard long lupron protocol and will be starting lupron in the end of April.
Things are getting better with DH. He has agreed to be more understanding and more helpful. But he definitely does not want me to tell friends or family. So friends from the blog world are my only vents and support system. I am a little scared about getting through retrieval and transfer and the rest without involving our friends or family. We are planning on telling our nanny so that she can do additional hours around that time. My doctor wants me to start acupuncture now and I start stimulations in May and it feels a long time from now. Hopefully I get to relax and rest a little in the next month.

Moving on to IVF

After lots of research we have decided to go with Albrecht Womens Care. I love Dr.Albrecht and the staff there. Even though CCRM has the best lab, since this is our first shot at IVF and with no previous miscarriages or genetic issues I think we do not need to spend the extra 5k to go to CCRM yet. This might change in a few months though.

So far the plan is to be on Birth Control Pills for about 2 months and to start stimulation in May. I stopped bcp's about 5years ago and being on them again has reminded me how awful they are. I have a mild headache pretty much all the time and sometimes a full blown migraine episode. I have been feeling really low and depressed and keep crying for everything. I hate being this emotional and sensitive but do not have much control over it. It also does not help that I am going through all of this alone (as we have not told any friends or family) and can't discuss much with DH as I am really scared that he might go back to not wanting another child.

We also did our infectious disease screening and some additional testing for me last week. I am low on vitamin D and iron and will have to start taking supplements for those (as if I am not taking enough medications already). I am also borderline high for a blood sugar test and have to start exercising (yeah I have so much free time between appointments, full time and looking after a very active toddler).

Infertility sucks (no matter first time or second time). Tomorrow is our IVF consult with the doctor along with consent signing, medication teaching and mock transfer. Since his clinic is 1.5hrs away from home we are trying to get as much done as possible with our visit tomorrow. I already have my list of questions ready for the consult and hoping to hear some encouraging information.