Round 1

Protocol

You can read here about different approaches to IVF.

Medicine

1 Menopur each morning and each night

225 of Folistim 900 each morning and each night

Add Ganorelix

HCG Trigger

First Injections

The first night of administration after laying out all our vials and needles and swabs and gauzes it takes us an hour before we actually give the first injection! In the weeks leading up to this point we had watched videos about injections. I *love* the series on youtube by Nurse Linda of the Sher Institute for Reproductive Medicine (SIRM). The drug manufacturer offers videos as well however they begin by detailed explanations of side effects which is not how I want to start this process!

I am not "good with needles." I was the one that would cradle my babied arm for a week after getting a shot. I would lie in bed awake the night before a physical worrying about the blood draw process. Like, as an adult. Getting several shots for world travel helped a bit but really it was mentally and emotionally preparing myself for IVF like, "Lady, if you're gonna pussy out over a few shots you have no business giving birth." And thus while it may seem harsh I don't have sympathy for women who complain about shots. Or frankly complain about anything in this process. Lots of blood draws, countless needles, bruising, pain, burning, endless appointments, vaginal ultrasounds-all without question bearable. Everyone is fully aware what this process entails when they begin.

(Steps off soapbox.)

So, back to the needles. A cinch (: Really and truly! I choose the belly. Chris is more nervous than I and it is adorable. After each needle he touches an alcohol pad gently to the injection site and looks up at me to make sure I'm ok. It's so sweet I can't take it <3

The first night we do not mix the Menoupur and Follistim as the nurse said give them a few times on their own to get used to it. We started mixing the next day. It looks like Gargamel's lab (: But it is a simple process and one the clinic laid out nicely for us. Why give myself an additional/unnecessary injection?

Here is how I set myself up each time. Wash hands. Two paper towels. One on the left is clean, one on the right becomes the dirty (trash at top, recycle at bottom) and I keep my sharps container right there in the corner of the dirty.

I use a new alcohol swab each to clean the top of each bottle and the tip of the Follistim pen (twice if I need to add a new cartridge). I mix the Follistim with the Menopur with the mixing needle, draw up the solution, change needle tips, remove air bubbles (I can't flick them out like Chris and the pros can it hurts my finger tips so I make my pointer finger flat and use the inside to smack it), and rest the syringe on the needle tip lid. I prepare any other medications (this photo is actually from round two which required additional meds) and similarly set them up then summon Chris. At first I used to have him next to me to cuckoo check my work as I mixed but eventually I begin to trust myself and mix alone.

Follow-ups

We go back to the clinic roughly every other day. We make our appointments as early as possible and can generally get to work without having to provide much explanation. (He has shared with his work, I have not shared with mine.) Each afternoon after the morning follow-up the clinic calls and based on the day's ultrasound and blood results says whether to adjust medication. My calls were always, "Keep on keepin on." I don't pour over the online forums but I did see some nurses will ask, when they look at the ultrasound "are you sure you are administering the shots properly?" Hahahaha so at least we didn't get that comment! 

Acupuncture

Chris points out an acupuncture brochure in the waiting room and...I make an appointment. You'd think my concern would be "does it hurt" but really I'm like hmm what should I wear? Sane and reasonable people I know swear by it and legit actual sciencey studies show it increases IVF success. Who knew!?!? They also offer on-site sessions immediately before and after transfer. Love that. I'll feel like a v.i.p. ha. If I can ever make it to that stage.

Last Follow-Up Appointment Stats
Lining:7.3 trilaminar (this means 3 layers, that is good)
Right: 8, 5
Left: 6, 14, 11, 4, maybe another 10

Trigger Shot

March 8. Based on this morning's ultrasound and bloodwork the clinic calls me gives me the news-trigger shot tonight! I am at work. I don't have any papers with me and I write down every word the nurse says. First and foremost I am to get home and administer my final set of stim shots. I am overcome by emotion when I hang up the phone and feel a combination of excitement and anxiety and I have to fight back tears. When I arrive home I facetime my mom who is my moral support for giving mySELF my last round of shots! Afterwards I feel if I can do that I can do anything!

Tonight at 10:00 pm we are to administer trigger shot. So this is the long scary no-joke needle compared to the dinky things we've been dealing with until now. Despite the clear directions from the clinic on where to inject we spend a solid 30 minutes discussing. I have everything laid out nice and organized. We pull up atomic clock on the ipad and watch the last few minutes count down. Me, waistband pulled down, leaning over the counter. Chris, needle in hand, looking, well, basically terrified.

Ok final 10 seconds. Things are growing tense ha. He is so much more worried than I and I feel badly for him! "I just don't want to hurt you," he keeps saying.

3! 2! 1! Injection!

I smell panic. I hear his hands frantically grabbing at things and little packets being ripped open. I look over my shoulder to the counter and see this haha:

Retrieval

March 10. My friend surprises me at the clinic with a bag of perfectly on-point goodies! I am beyond touched. Love you EGS sista!

Dr retrieves 7 eggs.

Day 1 Update

Five are mature and ICSI. Two fertilize.

Day 3 Update
Both are "thriving" on day 3; we have a 6-cell and an 8-cell.

Day 5 Update
Neither is viable for biopsy day 5; one is "compacting" so has not reached blastocyst stage and the other is still at the cellular stage and did not move much since day 3.

I am ok. I shed a couple of tears just because damn! I felt so good about it! God has different plans I guess.

I tell them: Let's move right into Round 2.

Waiting for my period.

IVF

February 16. Tonight when I pee there is a small amount of light pink blood on toilet paper. A shade of pink I've never had in a period or through this process. I assume, since it is allegeldy n its way, this is the start of my period! At dinner my husband and I discuss next steps: calling clinic, picking up meds, etc. It is exciting! But also a bit scary! I try to get to the root of why scary and it seems a mix of things, nother overwhelming just a tinge. A combination of all these things really: Medicine (I don't even take headache relief medicine), the needles, the general anesthesia. I am not a worrier by nature and these thoughts are not ones I obsess over I just think in aggregrate these things compile the bit of scary/nervousness I feel.

I wear a pad but the next morning there is only the smallest amount of blood (dried and brown by now). The next day, nothing. I call the clinic and leave a message of this as an FYI since they are monitoring me but I say don't call back unless you want to (I didn't hear back). Cramps were so bad at times. At times I doubled over in pain and once I actually grabbed my desk it was so bad. They never lasted long they came in waves.

I was afraid for the (please please) next pregnancy I might be more emotionally cautious. Not allow myself to fully give my heart. But, again, time. I'm such a sappy hopeful sucker. Tear my heart out spit on it run it over with a truck; I'll still happily hand it over fully expecting nothing but goodness in return. Dangerous but I don't know any other way to be.

Back on track for IVF.

They say I am a great candidate for IVF because they know I can hold a pregnancy (lining was good, emrbyo was attached, fetal pole had formed, baby had heartbeat, etc.) and because I am having the embryos screened and am not opposed to twins. The Dr office is of course clear to state nothing is guaranteed but they are "cautiously optimistic" this will work for me. So if they are right, I could be preg by Spring = season of new life. Maybe that is a sign!

So why undergo fertility treatment when clearly I am not infertile? IVF is the only way our embies can be screened and this is my sole purpose for undergoing treatment. I will do anything in my power to avoid losing another baby. They will biopsy our embryos to ensure there are no chromosomal abnormalities and then transfer. This is HUGE not only because we lost our first due to a chromosomal abnormality but also because at my age the single egg I produce each month has about 50% chance of being chromosomally abnormal. Fifty. Percent. I don't like those odds. AND, chromosomal losses are responsible for the majority of miscarriages. So by using IVF we produce multiple eggs in a single cycle *and* screen the embryos to mitigate the likelihood of another chromosomal loss. Both increase our chances for a healthy baby <3

And the Dr wants to transfer two healthy frozen embryos (I will call them "frembies). Because they will have been screened this means there is less chance for loss which thus means likelihood will stick. The figures for screened embryos at my age are as follows:

One healthy/tested embryo transferred 60% success of one healthy baby, 4% twins

Two healthy/tested embryos transferred 80% success of one healthy baby, 40% twins

I dont mind twins-my sister has twins. I don't necessarily "want" twins as some people do but I'm not opposed to them either as some people are. Really-I do want two kids and if this is the healthiest/best way to proceed I will do as Dr. recommends. I would not undergo IVF treatment and choose not have my embryos tested.  Too much is at risk. The additional cost is beyond worth it.

Once upon a time embryo freezing was not as sophisticated as it is today. It was a slower process that allowed ice crystals to form which resulted in a higher chance frembies would not survive the thaw. Now embryo freezing is done much faster through a process called vitrification and a thawed embryo is just as healthy and happy as a fresh. 

Step 1: IVF Orientation. We meet with a nurse and an embryologist for a couple of hours. So he can "produce a sample" they take Chris to the J.O./Porn Room which he said looks like my exam room but with a recliner, tv, magazines, and a giant fan. Next we are walked through IVF, which I mean by now I could the damned orientation I've been researching the process for so long.

I do leave the office feeling a tad overwhelmed (I know every step there could be a FAIL. It's like building a house of cards. Even if I produce multiple eggs, even if embryos are good, even if I get pregnant-one misstep along the way could send it tumbling down and put us back at square one.) but I feel I am in the most capable hands on earth.

Step 2: Hysteroscopy. Otherwise known as a camera in my cervix which PA told me "will feel similar to the D&C." Sigh. This is scheduled to take place between days 4-11 of my period but I can't be actively bleeding (very much). Because I am not doing a fresh transfer it is ok to have this procedure done during stimulation.

So waiting on my period to begin so I can go to the clinic and get baseline bloodwork and ultrasounds done and then the hysteroscopy. It will be a busy vagina day!

Baseline Bloowork and Ultrasound
Yes, you have your period when the (vaginal) ultrasound is performed. Another excellent reason to buy shares in wipes.

Hysteroscopy
Reading online, some women say this is horrible pain, some say it is a piece of cake, and most say they were under general anesthesia during (turns out this is based on the underlying reasons for performing). Ok so I know I will not be under general anesthesia and I know the PA said it will feel l ike the D&C. So I have been gearing myself up for weeks to power through this procedure mentally and emotionally. We have taken the day off work and bought a loaf of bread and planned for a nice time in a local birdpark afterwards so I focus on this as I climb onto the table.

Dr: Ok I'm threading the tube through

My head: Ok I don't feel anything the pain must not start until the tube is all the way in

Dr: Ok I'm in the cervix now...

My head: Okok I'm still ok no pain it must not start until...shit what are the parts of my body-uterus? ok pain must not start til the tube goes there

Dr: Ok looking at your right tube now....take a look at the screen

My head: !?!?!? Let's just get to the pain part!!!

Carrie: (So consumed with fear of horrific pain about to ensue voice shakes) Wow that's really amazing!

Dr: (Charlie Brown voice at this point I'm just gearing up for the pain and listening for keywords like "cancer," "death," "not conducive to bearing a child")

Dr: Ok everything looks great. I'm going to take a quick biopsy to (words fade)

My Head: Okaaaay heeeeere we go. Here is the pain. I knew it was coming. But before my brain could even finish processing that thought I saw a mechanical pincher on the screen worm its way towards a fleshy wall and close. The tiniest "nip" of discomfort but it was done before I even knew it was happening!

Then, it's over! OVER!?!? It was like a Pap smear without the awkward breast exam (so how's work? squeezes nipple).

We pick up our fertility meds from the pharmacy and wait for the clinic's confirmation call for go time!