Trigger time!!!

We got the news we were hoping for this morning!!! Egg retrieval will be Monday morning at 8:45!!!! Everything is measuring brilliantly; estrogen level is 2,142 and endometrial lining is just over 10mm…super psyched about that, we’ve got about 10-14 really good follies, & most were around the 17-20mm range. In case you’re wondering, that’s about ¾ of an inch! That’s right people, there are around 14 follicles the size of small grapes on my ovaries. No wonder I feel bloated! We were given the go ahead for our trigger injection, Ovidrel, tonight at 8:45 sharp. This medication triggers the final maturation of my follicles thus preparing us for retrieval. The timing of the injection is critical it must be given 36hrs prior to retrieval in order to recover the majority of eggs at maturity. They’ve got to nab them after they’re mature but before they release into the fallopian tubes.

The retrieval will take place at the surgery center next to our RE’s office. I will be given intravenous anesthesia for the procedure, thus the usual surgery protocol: no eating, drinking after midnight, etc. For those of you who are a bit squeamish or don’t want to know the nitty gritty details, don’t read the rest of this paragraph. The retrieval is performed transvaginally under ultrasound guidance. A long, thin needle is interested through the vaginal wall into the ovaries using ultrasound to locate each follicle (pray the doctor has good aim!). The follicular fluid is suctioned to collect the eggs. Not all follicles contain eggs & not all eggs are of the same quality. We’re praying we get a least a few Grade A quality eggs (I know it sounds like I’m talking about chicken eggs here, I’ll explain more on the grade in a minute). The retrieval itself typically takes about 30 minutes & I’ll hopefully be discharged a couple of hours following this.

The eggs are then immediately transferred to the laboratory for their very important date with the embryologist to be evaluated & prepared for insemination. We are doing a specialized form of IVF referred to as ICSI in which a micro-pipette (sharp, hollow glass tube) is used to insert a single sperm directly into the cytoplasm of the egg! Amazing what science is able to accomplish, isn’t it? Sure am thankful for all those nerdy brainiac scientists right about now! The day following this the eggs will be evaluated for evidence of fertilization. The eggs that have fertilized will be allowed to develop for 2-5 days before transfer into my uterus. The nurse said that if we only have a few good eggs they will want to do the transfer earlier, if we have a lot of quality eggs they’ll likely wait a little longer to pick the best ones. We’re praying that we will have additional embryos to freeze, this drastically cuts down on the cost of IVF & would allow us to do another cycle in the future if we want to have more children. A frozen cycle is only around $1,000 vs. $12-15k for a fresh cycle.

I’ll also be started on an anti-biotic the day of retrieval in the hopes of preventing an infection. We will begin daily weight checks at this time as a precaution if any signs of OHSS begin to develop. Back to the embryo grading scale you’ll here me refer to in the days following retrieval. Our clinic uses an A-F grading scale, the best (A) being an embryo with blastomeres (the individual cells within a single embryo) of equal size & no cytoplasmic fragmentation. The reason we want a lot of eggs retrieved & the highest grade possible embryos is that by day 3-5 of development 80% of embryos typically become nonviable thus not leaving a lot of options for transfer. It’s the same as a normal woman’s egg release, only 1 in 5 are of excellent quality.

Lastly, ending things on a celebratory note one of the things I am thankful for is that through this whole process I’ve become friends with other women around the country who are going through this same process. It is a tremendous relief to have someone you can turn to who knows precisely what you’re going through & to run things by during this whole process. One of my closest IVF cycle buddies & a kindred spirit who has been with me since the beginning of this is my babycenter.com friend Mimi who I am thrilled to report found out yesterday that she is officially pregnant following IVF!! I am over the moon thrilled for her as I know the pain & challenges she has gone through to get to this point; it also makes me the least bit hopeful that maybe, just maybe this will work out for me too. 

Cultivating follicles...

I’m happy to report that things seem to be progressing well. Received more positive news at my appointment this morning; my endometrial lining is now measuring at 7mm. I also have an additional follicle in each ovary! My left ovary has 6 follicles & my right has 8, all measuring in the 12-15mm range. My estrogen level came in today at 868, so we’re moving right along. I'll be continuing with my current medication regimen & returning for another appointment on Saturday morning…early again, but this time I don’t even care because I’m so excited to almost be finished with this part. They told me today that based on how things are going they are currently estimating egg retrieval to be anytime between Sunday & Tuesday!!! The bad news: We had to buy more Gonal-f...bastard pharmaceutical companies. Thankfully we’re continuing as we should be, I’m hopeful, but cautious & realistic…we still have many hurdles to jump & a lot that can go wrong. 

Optimistically anticipating & fabulous book recommendation...

Thankfully received positive news at the RE’s appointment today & for the first time let my guard down & thought OMG this whole thing might actually work! It’s official as author Peggy Orenstein so expressively said “I’ve become hope’s bitch”. More on her & my book shout out in a minute, first as I know you’ve all been waiting in earnest the updates from my appointment today.

My endometrial lining has thickened to just over 5mm (remember 8mm is our goal)!! And as the nurse put it during my ultrasound my “ovaries have finally woken up”! She said they look much better than my last exam Saturday & my little follicles are taking their responsibility seriously & growing as they should :) I currently have about 7 follicles in my right ovary measuring at 12mm & 5 follicles on my left side measuring at about 10 to 11mm in size. She said that for retrieval to occur they want to see the bulk of my follicles measuring at 16mm or greater. My estrogen level has increased drastically from 86 on Saturday to now 432!!! They’re going to have me continue on the Lupron injections 5 units every morning & Gonal-f 450 IU every evening. The good news is it seems things are progressing well the bad news we of course had to buy more Gonal-f…ouch!!! I go back for more blood work & another ultrasound on Thursday morning…I cannot wait until we get to retrieval!

I recently started reading Peggy Orenstein’s book Waiting for Daisy: A Tale of Two Continents, Three Religions, Five Infertility Doctors, an Oscar, an Atomic Bomb, a Romantic Night, and One Woman’s Quest to Become a Mother….I know it’s a mouthful!

Anyway you have got to read this book…I LOVE it! Granted I haven’t finished it yet, only a few chapters in, but she is capturing the infertility journey so well, I highly recommend it! As her website says “Waiting for Daisy is about loss, love, anger and redemption. It's about doing all the things you swore you'd never do to get something you hadn't even been sure you wanted. It's about being a woman in a confusing, contradictory time. It's about testing the limits of a loving marriage. And it's about trying (and trying and trying) to have a baby.”

So I was cracking up last night when I read the following paragraph…I couldn’t help but think of it today when for the first time I definitely felt like hope’s bitch, although I have to say it made me smile every time I thought of it! For those who aren’t as familiar with infertility to explain this Clomid is a drug used to induce regular ovulation & yes I’ve tried this before in the past hence my relation to the following…

“Clomid was my gateway drug: the one you take because, Why not – everyone’s doing it. Just five tiny pills. They’ll give you a boost, maybe get you where you need to go. It’s true, some women can stop there. For others, Clomid becomes infertility’s version of Reefer Madness. First you smoke a little grass, then you’re selling your body on a street corner for crack. First you pop a little Clomid, suddenly you’re taking out a second mortgage for another round of in vitro fertilization (IVF). You’ve become hope’s bitch, willing to destroy your career, your marriage, your self respect for another taste of its seductive high. Here are your eggs. Here are your eggs on Clomid. Get the picture?”

I’m sure there are several of you who can relate to that, hope it made you laugh. If you’re a reader & are dealing with infertility you should definitely check out this book, she is poignantly honest…it is a fabulous memoir. For more info on the author or her book see the following website…

http://www.peggyorenstein.com/

I’m going to enjoy the rest of my evening on my fantastic high & hopefully I’ll be posting more good news on Thursday!

Life is precarious...

So my early morning appointment at the RE’s definitely could have brought better news. It was a bit disappointing & not the update we were hoping for. The endometrial lining was very thin, only about 3 millimeters, they would like to see it at about 5 mm at this point & it must be about 8 mm for retrieval to occur. They are worried at this point about it being so thin because a healthy endometrial lining is necessary in order to conceive & maintain a pregnancy. The ultrasound also showed that my follicles are measuring at only 6-8cm, which is also small at this point, although the follicles in the right ovary were measuring slightly larger. The nurse said that since my lining is very thin it makes sense that the follicles are small as they should be increasing together. As far as the estrogen count goes at least that had risen to 86. The RE decided to again increase my Gonal-f injection starting tonight to 450 IU to try & increase the size of my follicles & also thicken the endometrial lining. I’ll continue with the 450 Gonal injections through Monday night in addition to 5 units of the Lupron injections every morning & then I return to the RE’s office Tuesday morning to see how things are growing.

I put on my brave face & held it together until we got to the car, no sense in upsetting the other infertiles who are hopped up on hormones. This is just one more reminder of how precarious this whole process is. The possibility that I may never experience pregnancy is a deeply saddening realization. While Nick & I have agreed that if this is not meant to be successful we would rather that the round be cancelled or the pregnancy test come back negative than go through the additional grief of experiencing a miscarriage it is still hard to accept that IVF may not end successfully for us & that will be the end of our TTC journey. We have talked a lot about how we’ll respond if it isn’t successful. We both are open to adoption & feel that if IVF proves unsuccessful for us we are meant to become parents through adoption. I think one of the most difficult pieces of this journey for me are the many unknowns. Those of you who know me know that I am a planner & like to know what to expect, but a lot of this process is out of my control which is both a humbling & challenging thing to accept.

So as to not end this on a totally Debbie Downer moment I’d like to take a moment to focus on the good in my life. Through this whole process it is entirely too easy to let your emotions get the best of you & I believe it is important to also focus on all that I have to be thankful for. I feel immensely blessed to be married to a remarkable man & that even though this journey has been difficult it has brought us closer together. I am blessed to be the host mom to an incredible foreign exchange student who has been sharing our home & her culture with us for the past six months; opening our eyes to the world outside of us & seeing our own culture through new eyes. I have a career in social work that I believe in with all of my soul. And with all the suffering & sadness that exists in this world I have so many other countless things to appreciate. For me a healthy dose of perspective is definitely what allows me to focus on the positive at least that’s what I’m going to choose to hold onto right now to get me through. 

Sisterhood & Support...

We all will be faced with challenges in our lives, it is inevitable & part of what brings out both the best & worst in us. These trials can force us to test our inner strength & confront our previously held beliefs about the world around us. One of the reasons I am a social worker is that I am passionate about empowering others to cope with life's struggles. Infertility has forced me to really examine the aspirations I've had for my life & brought perspective that only major life struggles can bring. While I feel closer to my husband than ever before being faced with infertility can be an isolating experience for couples. As most of our friends & family have started families of their own we have been forced to realize that we will never experience pregnancy & parenthood as the majority of others do.

We have been blessed to have friends & family who sustain & support us during this time & are so thankful to have them with us on this journey. One reason I started this blog was to keep all of these people updated & because I knew that no matter how this all turns out we will need the love & support of those around us. What I hadn't anticipated though was all of the remarkable women I've come across who have struggled with infertility & are currently fighting to become parents through assistive reproductive technologies or adoption. Today I was embraced by an amazing sisterhood of women that are battling infertility right along side me. Ladies thank you for not only sharing your words of support but also your stories, allowing me to witness your strength, courage, & giving me hope that no matter where this road takes me I will never walk it alone. These women support each other through the success & devastation of infertility & I feel immensely fortunate to be a part of this group. For more information on the guru who makes this all happen & how they found me see the following blog which is coordinated by Ms. Stirrup Queen herself...
http://lostandfoundandconnectionsabound.blogspot.com/

Levels & growth...

Started off the morning with an estrogen level blood draw on my way to work this morning. Tonight I received a message with the results, my estrogen level was at 35 which is a little lower than they would like at this point so my Gonal-F is being increased from 225 IU to 300 IU & we will be doing an extra injection this evening. For the next couple days they've told me to continue with the Lupron at 5 units in the am & do Gonal-F 300 IU in the evenings. Then the part I was really excited about, my next appointment at the RE's for another ultrasound & blood draw is Saturday morning at 8am! Boo, definitely not a fan of this...no sleeping in on a Saturday, you'd think I was already a parent :)

So as far as the estrogen level being low really nothing to worry about at such an early point into stims. From what I've read it's actually normal on a Lupron cycle for the estrogen level to rise slowly. The estrogen level helps to measure how many follicles are developing & it's important for this level to also not get too high which could signal OHSS & cause a cancellation of transfer. Doctor's don't like to quote "normal" estrogen level figures, b/c what is too low or high for one person can be different for another, so I wasn't able to find exact figures. But from what I've read a rough guide is to be around 150 to 500 on the 8th day of stims (I'm only on the 3rd day right now). An approximate doubling of this level every 48hrs is considered promising as a sign of continued follicle development. We're just hoping that they don't increase the Gonal so much that we have to purchase another of those pricey little pens...keep your fingers crossed for us!

So here we go, hopefully we'll see a little growth in the next few days!

PSA...

Ah migraines...I had blissfully forgotten the discomfort you bring me, but with the intense level of hormones that are now being shot into my body on a daily basis we became reacquainted this morning at 3am. Let me be clear you are not welcome & I do not have time to deal with you! Otherwise not much new, I go into the RE's office tomorrow morning for an estrogen level blood draw & they'll then contact us in the evening to let us know the medication regimen for the next couple days based on the results.

Just in case you're wondering what $700 of Gonal-F will get you see below:

Yeah, I don't get it either...but apparently people like us are crazy enough to pay it, drug companies are bastards. We have three of these pricey pens!!!

And now for my PSA. In our society people have certain expectations regarding the order of things. The whole first comes love, then comes marriage, then comes the baby carriage, etc. And so it goes that since Nick & I have been married for almost seven years & since I'm nearing my 30's I get asked on a repeated basis intrusive & personal questions about why I am not pregnant or we don't already have children. I realize that when asking these questions the majority of people are not trying to be hurtful or bring up a difficult topic, but please think before you ask these types of questions in the future. For those of you who have never had to deal with infertility I realize that it probably doesn't occur to you that this could be a difficult topic or an emotional issue & really the fact of the matter is that for the general public its not. But for those couples facing infertility it is a deeply emotional subject & not an easy thing to discuss. Most couples like us have chosen to tell only their close friends & family what they are going through & do not want to share this information with others. Thus making it difficult to respond to these types of questions. Most of the time we do our best to laugh it off or respond with a witty come back but I can tell you from dealing with this question on a frequent basis for the past couple of years that although you don't mean for it to it reminds us of the sadness we feel. So all I ask is that the next time you're tempted to ask someone why they don't have children or when they're going to hurry up & have a baby instead try to refrain & remember that just because it was easy for you there are a lot of couples out there going through significant challenges to have what you were given so easily.