Tuesday, June 20, 2006

Taking the Long Way 'Round

AF arrived two days ago and a brand new cycle has begun. We continue down the long road towards Frozen Embryo Transfer #1, with the weird fact of never having tried a fresh transfer from IVF #1. We've got five "excellent-quality" blastocysts frozen in batches of two, two and one. For this I am grateful.

It's been a crazy couple of weeks. I've been to the internal medicine doc, had a Holter monitor attached for 24 hours, did a Pulmonary Function Test, and a 2D Echocardiogram (ultrasound) of my ticker. All these tests have, so far, come back normal.

I have had some intermittant chest pains, however. So the RE wants to make absolutely sure I do not have some clotting issues (which would mean, perhaps, tiny embollisms that could be undetectable on tests that scan the larger vessels). Thing is, we can't do the bloodwork that tests for clotting issues until I wait out a full "natural" menstrual cycle for all the IVF hormones to clear. There's still too much stuff in my system that could easily skew the results.

How long DOES it take for my body to "go back to normal" after a retrieval cycle? I have noticed that my bbs are still big and haven't reduced the way they normally do by CD3. Anyone?

Admittedly, I've had some nasty heartburn (ouch!) since the ER incident - which, ironically, seems like it may have actually been caused by the chalky antiseptic stuff they gave me to drink in the ER to TEST for esophogeal issues. The heartburn seemed to begin just after that! But I could be totally wrong. And I digress. The chest pains that caused me to go to the ER in the first place were different - more to the right and left - sharper, almost itchy in nature. But apparently heartburn can cause some pretty weird chest pains that can even go up into the neck and down arms. And for sure heartburn can be caused by all the hormones. Talk to a pregnant lady to confirm that one.

So, though I am not stoked about WAITING some more... priorities are most certainly in order over here. I don't even care all that much that we didn't do the fresh transfer. Basically, getting pregnant fell WAY down in the priority line when I was scared there was something really wrong with my health. I'm still waiting for the all-clear, but feeling confident that it's nothing too drastic.

Regarding OHSS... My mild case went something like this: discomfort began 3 nights after retrieval. Was pretty uncomfortable for 2-3 days, with the worst couple hours being right after a vag ultrasound to check me out. Then, most of the swelling seemed to go down the couple days following that. Discomfort would flare up sometimes in the evenings - much better if I was lying flat (less pressure on the ovaries?) I kept drinking Smartwater - making sure to have 8oz per hour. (You CAN actually get really sick from over-hydrating, so be careful, girls.) I feel very lucky I didn't get a worse case. I can't believe how brave you women are who get a bad case of OHSS and actually do IVF again. I don't know if I could do that.

Ok, so it might be a little while until I post, since I'll be like a REGULAR PERSON this month, not even on BCPs! That's actually kinda cool.

I am thinking of all of you out there and wishing huge amounts of Summer Solstice luck to those of you cycling now. I'll hopefully be joining you for FET#1 within the next couple months.

I leave you with this. As my therapist so aptly suggested: "See what happens if you concentrate on having hope instead of forming expectations."

Not sure if this speaks to you, but it sure makes sense to me.

Tuesday, June 13, 2006

The Rocky Road Detour

Today we did not do transfer. Here's the story in a nutshell: as you know, I was dealing with a mild case of OHSS. Well, yesterday at about 7PM, I had a sharp chest pain. It was shocking and really hurt. But then it went away.

Now, I had had pains in my legs all week AND my Hubs had just given me a leg massage... so this worried me. I was concerned about a PE (pulmonary embolism) - that's a blod clot that can move from an extremity up into the lungs and beyond. Can be fatal, so no messing around here. And estrogen therapy is a big risk factor. God knows I have enough estrogen in my system right about now.

I called my RE and he told me to head straight to the ER, that it was a good sign that the pain had passed, I had no shortness of breath, no dizziness. But just to be prudent it was the right thing to do. So I did. Or, rather, we did.

Spent all night in the ER getting evaluated with various tests and scans, thankfully everything came back negative for PE. Then I started having some chest tightness and burning. I still have it now. We are fairly sure it's a nasty case of heartburn or espohogeal spasm. Ouch. Pepcid not helping. Anyone experience this during IVF?? (I am going to my internist tomorrow to be further evaluated.)

The biggest surprise was when my RE walked in to the emergency room at 11:30 at night just to check on me. He does NOT live close by and he gets up at like 5AM. Of course I had spoken to him on the phone, but I was not expecting this. You should have seen Hubs' face. He was really touched.

We talked about whether we should or should not transfer today. We elected not to. I had just had a dose of radiation and was injected with dye (from the CT scan) and I was tired and it just seemed like a poor idea. I love my RE. He is prudent. He wants me to get pregnant, but he has his priorities in order.

So, this morning we found out that all of our embies have survived until day 5 - so far we've frozen 4 fully-developed, excellent quality blastocysts (in 2 batches of 2) and they're giving the remaining three a little more time to develop before freezing them as well (hopefully they will make it). This is really great news, and makes the fact that we're not doing a fresh transfer a lot easier. We still have a chance(s) if they can survive the freeze and thaw.

Anyone out there ever get preg from FET? Now would be a good time to encourage me regarding this. ;)

Monday, June 12, 2006

OHSS of the Mild Variety

Well, I wasn't supposed to go in for a check-up today but I did. Because I've been feeling some pain in the abdomen and lower back and quite bloated along with some kind of leg cramps/leg pains.

Got wanded by the RE himself and diagnosed with a mild case of OHSS. Nothing original, as you all know, but a little disconcerting and scary if you are a medical paranoid like me. (Man, I'm gonna be a real treat for whoever is my doc if I do ever get pregnant.) Upon ultrasound: ovaries are a bit swolen, and I have some fluid in the abdomen. Blood pressure was normal, urine normal, pulse a bit racy at 90. (But it's back down to 68 now, so maybe I was just freaking and didn't know it? The heart sometimes has to work extra hard when there is an imbalance with the body fluids.)

So far it's not too bad, though I have to say, when I got back in the car right after the vag ultrasound, I stared to feel quite sick - nauseated and my scalp was kinda tight and tingly - I was dizzy. I wonder if palpating the ovaries with the wand squished out some more fluid to make me feel ugh? But I made it home and after about half an hour on the couch felt much better.

I admit I was a little surprised in that after all my research and blah blah blah, I somehow missed the fact that OHSS often starts 4-5 days AFTER RETRIEVAL even though the last injection was ages ago. I kinda thought that if it hadn't happened already (like during stims) that I was in the clear. Dum dum!

Of course I am:

1) drinking fluids - Smart Water (which you can get at Trader Joe's for cheap!) which is water with added electrolytes

2)trying to keep moving/walking around because if we do transfer tomorrow I will be bed resting. One rare but serious complication can be blod clots if one gets too dehydrated, and it's good not to sit/lay in one position too long.

3) continuing with my 81mg baby aspirin for same reason

4) my awesome acupuncturist suggested lymphatic system massage on my legs. you massage the inside of the legs starting with the big toe all the way up to the groin, then massage back down on the outside of the leg from the hip to the little toe. will it help? I dunno, but feels pretty good!

So, the plan from here is to go in to the clinic tomorrow at 7AM and we will decide then whether or not to transfer or freeze everything. OHSS can be exacerbated by a pregnancy, of course, so that's a little scary. But freezing all the blasts is not the optimal thing to do on the TTC front. So, we'll see.

Ok girls, need your input here. Who has been through this? Anyone have similar experience of feeling bad after an exam and then better later? Any additional tips for feeling better/getting better (aside from getting Aunt Flo, thankyouverymuch)? Anyone have a mild case, then got preg and it DIDN'T get worse? Please, though, go easy on me - no scary stories. I can't take that right now. And I think I already know too much.

Thanks for your support and good wishes and stuff. You do know how much it helps, right?

Sunday, June 11, 2006

Quietly Dividing

Unless something changes, it looks like we're heading towards a 5-day transfer. My RE called this morning with the following news:

5 out of 6 of the embies that fertilized right away are Excellent quality (Grade 1) at the 6-8 cell stage. The other 1 out of those 6 is of VeryVery Good quality (Grade 1.5) at the 6-8 cell stage. Our late-bloomer is looking good but is still behind the others at 2-4 cells.

We are scheduled for a transfer of 2 blastocysts on Tuesday morning.

Not all of our embryos are statistically likely to make it to blast stage, so we might lose a few, but at this point (due to the good quality) it looks like we'll have enough to freeze for at least one FET. That would be really nice.

There's a lot of sensitive cell-division action that these embryos have to go through in the next couple days. They don't even check the embryos on Day 4 because they don't want to disturb them at all. Next, they'll be heading towards the compacted morula stage (16-32 cells), which I see as a kind of teenage phase - things can be kinda rough in there until they reach blastocyst.

So I am keeping calm and gentle thoughts while biology does its thing. Just think, we were all compacted morulas once. ;)

Friday, June 09, 2006

The First Phone Call

Egg retrieval was yesterday. Things went well. I got the same super anesthesiologist as I had for my cyst aspiration. Man, that guy is good. No "hangover" or grogginess afterwards, and the pain management (for whatever could be expected) has been perfect.

Hubs did his important part of the deal at home right before we left. "Oh man, I hope I got enough out," was his comment upon handing the cup over to me to keep warm. I want to shout out to the guys in our lives - they have their own pressures within all this. Props to the studs who have to do this on command at 5:30 in the morning while we "wait" on them to go have a surgical procedure. Seriously. All jokes aside, it takes a good amount of mind control and focus. I can tell you that that's the LAST thing I would want to do at that moment.

Anyway, my RE got 10 eggies out, and his comment to us a little later after I woke up a bit more in recovery was that they were excellent quality eggs. He said at that time that we were aiming at a 5-day transfer if everything continues to go well. Interesting. I didn't know they could examine the eggs alone and right away know they look good. But I'll take that. No complaints here.

Yesterday I napped and generally took it easy. My lower abdomen felt a little sore but not too bad, especially if I was lying down and taking the pressure off. Those ovaries went through a lot yesterday. Did you know that the way they aspirate the follicles on the far side of the ovary (the side furthest away from the vaginal canal where the ultasound-guided needle is) is by going RIGHT THROUGH THE OVARY? Dang. Sorry I asked.

Now it's about 25 hours since oocite retrieval. About an hour ago we got a phone call - the first of many we'll receive in the next couple days. It looks like 6 have fertilized for sure and there are 3 more that still look like they may fertilize. It's still pretty early in this part of the process. They say 60 to 80 percent of those eggs that show the first signs of fertilization will actually go on to be viable. So hopefully 1 or 2 of those questionable 3 will pull on through. If not, 6 is good.

Tomorrow we'll get another call, telling us whether we're likely to replace on Sunday (day 3) or Tuesday (day 5). In the meantime, I am so grateful that some eggs fertilized. This is a big stop along this road trip. This means that our "stuff" works together. This means that my eggs are not fried (at least as we can tell thus far). That Hubs' sperm can get in there and make things happen. This means that if this cycle does not wield a pregnancy (or a pregnancy that works) that we can try again. That surrogacy is a possibility. That IVF can potentially eventually work for us.

I will never consider this first IVF a "failed" cycle, even if we don't get pregnant. We've gained so much out of it already. This is important to those of us who are Unexplained. It gives us some answers - or I should say - eliminates some of the worst case scenarios.

Now, back in the metaphorical car (a hybrid, of course ;) ... and onward.

Wednesday, June 07, 2006

Trigger Mode

I shot the hCG trigger (10,000 USP units) last night at 7:45PM. It was no problem - I was allowed to give it sub-cutaneously in the thigh, not intramuscular, so it was pretty much on par with all the other pokes.

Hubs said from the other room, "Wait! Don't do it without me - I want to witness it." Fine with me - I thought that was cute of him. He was there for the initial injection lesson and first shots and since then, I've been taking care of all my injections without a "witness." The way I look at it, the fewer people in our little family who are wrapped up with the daily details, the better. He is sensitive and concerned and perfectly involved, but he's also really happy and not obsessed with this project. I feel this benefits both of us.

Note to self: In the past few hours I have felt really tired and bbs very sore. Makes sense with the hCG. I just want to remind myself that "symptoms" during an IVF cycle are pretty much a bogus indicator of anything. And hey, does anyone know: is 10,000 USP units a lot of hCG? If I didn't get nauseated at all as a reaction to this injection, can we assume that I would not show any nausea at an early pregnancy amount of less than 10,000 USP?

Retrieval is tomorrow. We have to be there at 6:15AM, and Hubs has to do his business (or as he so politely says it, "play the baloney banjo") right before we take off in the car. I am to keep it warm on the short drive. The nurse suggested placing it in my cleavage, until I pointed out that ... um... I don't actually HAVE a cleavage, what with my tremendous A-cups. We had a good laugh over that. Between the thighs will do. Hubs can drive.

I'll update tomorrow or Friday. Hey SuperWomen, think good retrieval and fertilization thoughts for me, will ya? Yet another important stop down this long road.

Monday, June 05, 2006

Checking the Scenery Along the Way

Still truckin' along. Had my Day 7 examination today. The follicles are still doing their thing:

now 5 worth counting on the right ovary, ranging from 19 to 9 (average is 15)

now 9 worth counting on the left ovary, ranging from 20 to 12 (average is 16)

I forgot to get my E2 number from last time, but they drew blood again today, so I know it's being carfully monitored. Endometrium thickness was 8.9-ish.

Follistim has been reduced by half to 100 IU for tonight and tomorrow night (extra day added on). Tomorrow will be my last injections of Ganirelix, Lupron, and Repronex - which has also been reduced by half to 75 IU.

Tomorrow night I shoot the hCG trigger at 7:45PM and you know that can only mean one thing... retrieval is scheduled for Thursday morning bright and early. Hopefully more of the follicles will plump up and mature to where they need to be - around 20. My RE seems pleased with progress so far.

Physically I feel pretty much normal. Maybe a bit tired but my gut's feeling good and I am thankful. Also, I think maybe the estrogen patches are having a calming effect, mentally. Or perhaps I am inventing this! But I feel pretty chill. And chill is good. Another reason for feeling relaxed is...


A few hours after my RE checkup, I went for an appointment with the acupuncturist who will be supporting me during my embryo replacement - before and after. (My regular acupuncturist will unfortunately be out of town, but it's all working out.) My "substitute" is really good and I had a nice session with her today. She works out of part of the office where my RE is located, so I saw him when I was coming out and he spontaneously gave me a hug. It was cool. He's a great doc and I know he hopes the best for me - for all his patients. Nothing wrong with a human touch in my book.

Anyhow, I asked the "substitute" actupuncturist to use bigger needles on me next time. She used really thin ones this time because it was my first session with her and she likes to go easy on people at first. But I told her that I am used to bigger needles and that she could use bigger ones during the replacement. Holy crap. I think I'm getting addicted to things being stuck in me. Seriously. It feels good. (Maybe I should report this to my therapist.)

Saturday, June 03, 2006

A Little Further Down the Road

Today is my 5th day of stims (Repronex 150 IU and Follistim 200 IU) and I added my Ganirelix (250 - not sure of the unit of measurement on this one, looks like a funky "u" - Thalia, set me striaght if you're reading :) and Luveris (75 IU). Also stuck on some estrogen patches (.1 mg one on each butt cheek).

It sounds like a lot of action, but really it's 2 injections in the AM (the Luveris gets mixed in with the Repronex and then the Ganirelix is a pre-filled syringe) and the Follistim pen in the PM. Patches, of course, are cake. LOL!

Here is my follie report as of this morning:

4 worth counting on the right ovary, ranging from 15 to 11 (most are about 13)
8 worth counting on the left ovary, ranging from 17 to 6 (most are about 14)

This is interesting because when I was checked at Day 3 of stims, I only had 3 on the right and 6 on the left. I was under the impression that what was developing at that time would continue to grow but that it was unlikely that anything else would ripen on this cycle. Even the RE seemed pleasantly surprised. Looks like a few extra follies have decided to join the party. We'll see.

Blood was drawn for E2 but I don't know the results yet. Endometrium measuring 8.6 (I think that's right. I caught the number on the ultrasound screen, I forgot to ask for a printout of that one.

Physically, I felt nothing until last night. Now, I have some fullness in the lower abdomen and some twinges in the ovaries. i would definitely not call it pain, just twinges. In fact, since you members of the Royal Court know I am the Empress of Cysts... I must say, the sensations in the ovaries are very similar to what I feel pretty much every month when I have a whopper brewing. Only this time it's in both ovaries and I feel like it's warranted.

Mentally, I have had an easier time as of late. Seeing my therapist weekly. Seeing my acupuncturist weekly. Taking good care of myself. I take no good days for granted and am thus far balanced and measured in my thoughts about this cycle. Already I feel we're gaining and gathering information. We know I respond nicely to stims and that follicles are developing. This is one good, solid step down this long, long road. From here, who knows until we get there?

One more check-up on Day 7 of stims (Monday) and if everything is going as projected, trigger will likely be on Day 8 (Tuesday) and retrieval on Thursday.