Tuesday, November 22, 2016

IVF #1- Frozen Embryo Transfer (FET)

So we started prepping for a FET in December of 2014 for the transfer in January.

frozen embryo transfer (FET) is a cycle in which the frozen embryos from a previous fresh IVF or donor egg cycle are thawed and then transferred back into the woman's uterus.

I was on birth control from 11/14-12/29 they do that so they can regulate your body and make sure the timing of the uterus and lining is ideal for a frozen embaby to implant.

My fertility clinic also started me on lupron (to suppress my ovaries) which is still funny to me because I don't ovulate.

Started Lupron on Christmas day Merry Christmas to me with a shot in the tummy pooch! 

Here was my schedule/protocol

12/25/14- 01/07/15 Lupron 10 units
01/01/15- 01/07/15 Period
01/07 Labs and u/s
01/08-01/11 Estrace 1 mg 7AM/ 7 PM, baby aspirin, Lupron 5 units
01/12-01/15 Estrace 2 mg 7AM/ 7 PM, baby aspirin, Lupron 5 units
01/16-01/20 Estrace 2 mg 7AM/2PM/7 PM, baby aspirin, Lupron 5 units
01/21 Labs and u/s
01/21-01/25 Progesterone in oil 1ml/cc (shot in bum), doxycycline 100 mg 2xday, Medrol 16 mg, Estrace 2 mg 7AM/ 7 PM, baby aspirin, STOP lupron
01/26/15 TRANSFER DAY ---- 1 EMBRYO
About 2 hours before your transfer they have you drink 36 oz of water and you are supposed to hold it until after the transfer. They do this so your bladder is full and they can more easily see where they are placing (squirting) the embryo.  

 Having a full bladder is super uncomfortable and I swear I was going to pee my pants or dribble on the doctor but luckily after they checked my bladder they let me release some before the transfer because it was so full. Again a day of no scents, no lotion, deodorant, etc. 

I put on my gown, hairnet, socks and walk into the sterilized room, climb up on the table, stirrup up and the nurse puts the u/s on your full bladder the whole time so the doctor can see where he's placing the embryo. #uncomfortable The doctor, cleans your cervix and preps it and sticks the catheter in until you see it in the uterus, the embryologist shows you your embryo on screen and it's so tiny, like the size of a pin head tiny, zooms in and you can see the cells in it---it's amazing. He sucks the little frosty up in the straw brings it into the doctor (all while you're bum is a breezing in the air) #embarassing 

The doctor sticks the straw in the catheter and then pushes (squirts) it out and you see this little white flash and it's over. They go check the straw to make sure it's empty and say clear when they see it's empty. The whole thing probably only takes 15 -20 minutes and then they just had me walk out, finally release my pee and said no exercise, sex, or overheating  until after first pregnancy test.  They said the embryo will not fall out, it kind of just floats around until it attaches (or not) to the uterine wall. They said they used to have you lay there 20 minutes and then do bed rest for 2 days but that they have seen no extra success in this and that most patients were just more anxious.  Here's a great little read on "Will An Embryo Fall Out after Transfer?"  Of course all doctors have their own protocol and whatnot so it's fine if you do bed rest too.

I was to Continue baby aspirin , Estrace 2mg 7 AM/7PM, Progesterone shot every day until instructed to stop

THE 2 WEEK WAIT (tww) waiting the 10 days until you know if the embaby stuck or not.... tried to stay occupied and not think to much about it. But doesn't work so well. 

01/30 labs Progesterone and estrogen levels look good continue meds
02/04 PREGNANCY labs---HCG level 218 (pregnant!)
02/05 brown spotting
02/06 PREGNANCY labs to confirm pregnancy--- HCG level 723 (levels doubled still pregnant!)
02/11 u/s of baby

02/13- 02/14 brown spotting
02/15 red clots and bleeding (super emotional I was  sure I was miscarrying, we had traveled home to Idaho for the weekend and so I called my nurse LeAnn and she said to come in tomorrow to do an u/s she said it is common to have some spotting with IVF and to just wait and see tomorrow. We rushed, as in drove the 8 hours, back to Spokane for the u/s the next day. My dad and Neal gave me a beautiful priesthood blessing that everything would be fine and I felt so much comfort. )

02/16 labs and u/s --we were able to see baby's heart movement my HCG level now 19,000 and Progesterone level 25. Everything looked good. It eased my anxiety a little.

02/17-02/18 brown spotting
02/19  had more red clots and bleeding 11:45 AM to 7:30PM (lots of tears, anxiety, and feeling that I'm miscarrying again, again nurse said to come in next day to see)
02/20 had labs and u/s saw baby had grown and saw heartbeat (so much love for a little bean already--I thought once I see the heartbeat everything will be fine and continue to develop normally..)

02/21 brown/red spotting
02/23 again more red clots and bleeding  started at 10:15 PM
02/24 lots of clots and bleeding all day (Called nurse again and we decided to wait to do u/s until Friday since there is really nothing to be done either way. Emotional wreck, not sure what to think... Trying to remain hopeful because the last two u/s were good of baby even though I had been bleeding)
02/27 u/s NO heartbeat or blood flow to baby. Baby stopped growing probably 3 days prior (this was hard news and I was alone, Neal had stayed home with Grayson. I asked what next step was and decided I'd like to do a D&C so that I didn't have to wait to pass the baby and we could do another egg retrieval before moving in July...I didn't get emotional until I was in the car, I tried calling Neal to let him know on my way home and my phone was acting up and no calls were going through. I got even more emotional not being able to get a hold of him... the suck in the breath sobs. I was driving through tears and when I pulled in I got to the door and Neal was there and he just looked at me and knew...he hugged me tight and I told him there was no heartbeat and that the baby stopped growing. He held me tighter and felt so bad leaving me to go to work. It was a hard day and even now as I write this the feelings of loss are coming back, the pain has lessened of course but it's still hard to remember. 

3/2 Had the D&C  at Deaconess hospital everything went smoothly(they dilate your cervix and suck or scrape out everything inside your uterus) they put me all the way under and I didn't have any pain afterwards. I was glad we did this rather than waiting to pass on my own, I didn't want to have to see my baby as I passed it and be reminded again of the loss. 

They continued to monitor my HCG levels until they were 2 or lower
3/9 labs HCG level down to 1000 and low iron
3/24 labs HCG level 24
4/21 Labs HCG level 1.6 Started Provera to induce period for next stimulation cycle for egg retrieval
5/4-5/8 Period
5/6 started birth control
5/20-5/24 Period

Up next our 2nd egg retrieval ...

Saturday, November 19, 2016

IVF #1 --- Pre-Testing to Egg Retrieval

In August of 2014, we decided we would go to the doctor to start the In Vitro Fertilization process (IVF). Grayson was now 1 year old and I felt emotionally ready to jump in to "trying for a baby" again.

We met with Dr. Robins and went over our options and we told him we would like to do IVF. So we met with LeAnn our nurse coordinator and also Lora the financial coordinator to get things going. Before we could even begin the process we had to have a bunch of Pre-Testing done to see if there was any other cause for our infertility besides my non existent ovulation with PCOS.

My Tests, etc.:
Baseline U/S
Catheter check
Culture (gonorrhea/chlamydia)
Pap Smear
Day 3 labs/ AMH
CBC/HIV/Blood Type/Rh Factor
Prolactin/TSH/ Rubella
Infectious Disease
IVF Medication and injection instruction

Neal Tests:
Semen Analysis
Infectious Disease Testing

So by the beginning of September we had all of these things done, and Neal checked out all good, and my tests all came back good so it was just an anovulation problem. So we were ready to move forward to stimulating my ovaries and getting those eggs out.

Here are the meds we used in this cycle:

Follistim: this medication contains follicle-stimulating hormone (FSH) and is used to help stimulate healthy ovaries to produce eggs. This medication is usually used in combination with another hormone (hCG) to bring about the growth and release of a mature egg (ovulation)
Microdose HCG:   or low dose HCG is used for ovarian stimulation during IVF it helps,the smaller follies to grow...sort of tricks them into thinking it is trigger time.
Ganirelix: Sex hormone suppressor: It can prevent premature ovulation in women undergoing infertility treatment.
Lupron: new twist on the antagonist ovarian stimulation protocol for IVF called the "Lupron trigger protocol" or GnRH agonist trigger protocol has recently been used by some fertility specialists to completely eliminate the development of ovarian hyperstimulation syndrome. (OHSS):
Doxycycline; Antibiotics It can treat and prevent infections

10/20  Last day of birth control
10/21 Labs indicate ovaries are suppressed
10/23-10/27 Period
10/24 Labs and u/s
10/24-10/26 Follistim 150 iu, Low HCG 10 units (both are shots in abdomen)
10/27 Labs and u/s
10/27-10/28 Follistim 100 iu, Low HCG 10 units
10/29 Labs and u/s
10/29-10/30 Follistim 100 iu, Low HCG 10 units, Ganirelix (all 3 shots in abdomen)
10/31 Labs and u/s Neal to take Doxycycline
10/31-11/1  Follistim 75iu, Low HCG 20 units, Ganirelix
11/2 Labs and u/s No Follistim, Low HCG 20 units, Ganirelix
11/3 Labs and u/s No Follistim, No Low HCG, No Ganirelix, Lupron Trigger shot 80 units at 1 AM, Have intercousre with condom
11/4 Lupron Trigger shot 80 units at 1 PM and Labs
11/5 RETRIEVAL DAY -- Neal dropped of semen sample in morning -- 9 Eggs retrieved and placed in petri dish with Neal's sperm (which looks similar to image below)
11/6 Day 1- 4 of the 9 Eggs fertilized
11/8 Day 3- All 4 eggs still growing
11/10 Day 5- 1 Frozen embryo others still growing
11/11 Day 6 - 2 more embryos frozen

My estrogen was too high and risk of OHSS (hyperstimulation) was too high to do a fresh transfer so we did a Freeze all to do a Frozen Embryo Transfer later.

11/12 -11/17 Period and start birth control 11/14 to get ready for FET in January.

No that's just a little run down but now to the nitty gritty of it all. As you can see it's busy and every single day you have to remember your meds or are travelling to the doctor for labs and u/s. It's a bit stressful and you're hoping your body responds like it should.

The stimulation drugs are all shots given in your tummy and My Hubster really is the greatest, he squeezes that pooch of mine and sticks it right in like a pro. So on some days I was doing 3 shots a day in my abdomen. It was sore, it was bruised, and I felt like a pin cushion. As I started getting more follicles and they were getting bigger I felt bloated, and looked like I was pregnant and was a little miserable.

This is an image of what an ovary looks like when it's ready for retrieval...

On Retrieval Day you don't wear anything with a scent, so deodorant, etc. is out. They took me back and I put on my gown and hair net and socks and they hooked up my IV. They had me walk into the sterilized room, get up on the bed and then they push the anesthesia juice into the IV and I was out. Woke up in recovery room with Neal. They told me the retrieved 9 eggs and that my estrogen was too high  so risk of overstimulation was too high so I wouldn't be doing a fresh transfer on Day 6 like we'd hoped.

I went home and slept and put heat packs on my abdomen ( I mean they literally stick a needle in your ovary and suck out the eggs so of course you're sore) that night I had super sharp shooting pain up my back and into my shoulder. It hurt so bad I couldn't even breathe. I panicked I called the nurse and she said it was probably just an air bubble from the procedure and to take Tylenol.

My bloating went down after I finished my period and within a week I was feeling much better.

Next up is our first FET (Frozen Embryo Transfer)....