Thursday, November 3, 2016

Fertility Journey | IVF Retrieval

I have been writing about our fertility journey for quite some time now. I wrote what was happening when it was happening, but decided against posting it at that exact time. So over the last few months I have been working to publish everything we went through. If you need to catch up on anything here are all the posts I have written so far this year.
The Beginning 
First Visit with Fertility Doc
Round of Clomid
IUI with Femara
Announcement
IVF Planning

The last post I wrote talked about our decision to move forward with IVF and introduced all the different procedures and medications involved in this process. If you want to understand the medications then go to this post. Our doctor recommended that we do a frozen embryo transfer, which means that we did an egg retrieval and then froze our embryos and transferred them a few months later. The first part of our process was the egg retrieval. The way this process works goes like this. First, I had to take birth control for a few weeks to get my body calm before adding medications. Then, I started taking two different injections daily, one in the morning and one in the evening. These injections work by stimulating the ovaries causing them to produce a whole bunch of eggs, which are held inside follicles with in ovaries. The eggs themselves are microscopic, but the doctor can see the follicles while doing an ultrasound so that is how they measure when the eggs are ready. Then once the follicles are big enough, the egg retrieval is scheduled. For the retrieval, you have to go into a procedure room where they put you under anesthesia so that they can go and retrieve the eggs from inside the follicles. Once they have the eggs, they combine the eggs with sperm and let the sperm fertilize the eggs. Then they watch the fertilized eggs, aka embryos, develop over 5 or 6 days. All the embryos that survive to 5 or 6 days are frozen so that they can be transferred at a later date.

For this post, I wrote a little bit about what I was feeling or experiencing on each day. So it is a day by day account of everything that happened while we were going through the IVF retrieval process.

Written May 5 through May 24

Day 0: I had my baseline ultrasound this morning, about 4 days after I stopped my birth control pills. They did a quick blood draw and then checked out my uterus and ovaries. I was told that my lining was already pretty thin so I should not expect to get a real period. Well, she was sort of right. It was not like a normal one, but it was not light enough to ignore. So I was completely unprepared for it on our trip to Milwaukee. That night, I had to pack for our trip to Milwaukee and bringing hard core medicine on a plane requires a whole lot of preparation. Since some of my meds were supposed to be refrigerated, I had to pack a cooler with an ice pack to keep them cold on the plane. I also had to research the protocol for bringing needles on a plane and what I needed to prepare for that. I had a note from my doctor from that morning as well.

Day 1: I hardly slept at all the night before we started injections. I was worried about doing it wrong and forgetting what they taught us about mixing medicine and was nervous it was going to be painful. With the trip to Milwaukee too, I was stressing about how everything was going to go with leaving work on time, getting through security with needles and making sure I had everything for the trip. The first shot of Menopur that morning went as well as it could. I ended up looking up a video on how to give myself the injection so I had it fresh in my memory. After mixing everything together, I had Richard give me the shot because I am a complete baby and could not bring myself to give it to myself. This medicine burns just a little when it is going in, but nothing terrible. I had heard it burned going in which freaked me out, but really it was just uncomfortable while its going in and then a few minutes afterward and then I felt fine. Everything at work went smoothly and I ended up leaving perfectly on time to meet up with Richard before heading to the airport. All of my stressing about being stopped at security ended up being unnecessary because they did not even stop me or look at my bag at all. Thank goodness. Now we just had to worry about the next hurdle. I knew I needed my first injection of the Gonal-F at 8:30pm and that was the same time my flight was taking off. We decided to just give me the shot once we got up in the air. We really lucked out that our Southwest flight was not very full and we did not have to share our isle with another person. I read up on how to take this injection with their very detailed instruction booklet. It was quite the scene on the airplane and definitely the most interesting shot we have had to do. It ended up going smoothly and again I had nothing to worry about.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Pre-natal
Day 2: I again did not sleep well the night before because we had a late night talking with my cousins and I was worried I was going to sleep through my alarm and miss my morning injection. Seriously irrational, but it kept me from sleeping all the same. The morning shot went just fine after I woke up Richard to give it to me. I had no side effects from the injections except that my stomach was just a little sore at the injection site. We had a full day of exploring Milwaukee with my cousins this day so we ended up being a little late for my evening injection. My doctor told me that I had to take them at the exact same time each night, but what are you gonna do. It was not the only time we did not give the injection at the exact same time.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Pre-natal
Day 3: I slept great this night, probably because I was so tired from the previous two nights. The morning shot was not the best because Richard was still half asleep when he gave it to me so I ended up with a bruise at the injection site. I also think we injected too close to the belly button so it was more painful. Whoops. Lesson learned. The rest of the day went perfect and our evening injection was given on time.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Pre-natal
Day 4: We woke up super early this morning for our flight back to Dallas from Milwaukee. We landed in Dallas around 8am and after getting off the plane, getting our car from long term parking, giving me a shot in the parking lot of the airport, getting Starbucks and getting back to Richard's office, it was almost 9:30am. I had to go to a doctors appointment this morning for a blood draw to check my levels. It was a quick 5 minute procedure and then I had to quickly get to work, which I was already late for. I got a call from the doctor sometime in the afternoon where they told me that my Estrogen levels were 350. Apparently that was on the low end because they wanted to increase my dosage for the next day. My nightly injection went fine and then I went straight to bed after a long day.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Pre-natal

Day 5: Nothing eventful really happened this day. Both morning and evening injections went fine, although I lost track of time and took my evening injection later than I should have. Oops. I did have a higher dosage of Gonal-F per my doctors instructions from the previous day. They don't explain why they are adjusting your medicine so I just followed what they told me.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 275u 8:30 pm
Pre-natal

Day 6: I had my first ultrasound this morning since I started my injections so I was anxious to see how I was responding to my injections. My appointment was for 8 in the morning and Richard agreed to come with me for this one and as many as he could this cycle. They took blood again to check my hormones to see if they needed to adjust my medicine. My doctor then looked at my follicles and everything looked good. She measured like 8 follicles on both sides. I think some of them were repeat measurements from different angles and she said it was too early to tell how many I had. But I definitely had more than the one follicle that I produced with all my other fertility medications so things were looking good. On average, the follicles were ranging from 8mm to 11mm. They want them to be 18-20mm when they do the retrieval. We left the doctor's office and I almost forgot to have Richard give me my morning medication. I mixed it and he gave it to me while we were sitting in the parking lot of the doctor's office. I feel like we should track "the weirdest places we have done it". Friends fans anyone? Just me. Ok. This day at work was rough and by the end of it I was wiped. My doctor left me another message telling me that my estrogen level was at 931 and my doctor wanted to drop my dosage back down again. After work, Richard and I had plans to go to dinner with some friends so I ended up being late on my injections again that night. Are you sensing a theme? I also had to add another injection to my nightly routine (Citrotide) to prevent ovulation. This shot is by far the worst. I am not sure if its the needle (Richard thinks its longer) or the medicine itself but this one is painful and it leaves a large patch of redness around the injection site. The redness is itchy and it is sore to the touch for the next few hours. I was doing so good with all my shots before adding this one.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Citrotide 250mcg 8:30 pm
Pre-natal
Day 7: I had a really hard time with shots on this day. I was over it. I wanted to stop. As the week went on, the shots became more painful and I started dreading them. The morning shot burned a little more with each day. My stomach was still sore from the day before. I was tired and it had been a rough week. I sucked it up and let Richard give me my morning shot and went on my way. That night we had to do the two shots again. Usually the nightly pen shot is the best, but with the addition of the other shot, suddenly this shot was worse. When Richard gave me the pen shot this night, for some reason the needle would not go in easily and I ended up bleeding a bit and ended up with an instant bruise. Then I had to have him give me the awful injection that created more redness. My poor stomach. I was also starting to get really bloated and I could feel pressure coming from my ovaries. My follicles were definitely getting bigger and I could see and feel it.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 200u 8:30 pm
Citrotide 250mcg 8:30 pm
Pre-natal
Day 8: We had another doctor's appointment at 8:15 this morning. This time it was on a Friday and Richard works from home on Fridays so we drove together and we planned on heading home before I had to go to the Chiropractor. I was doing fine and Richard and I were laughing and then all of a sudden I was extremely crabby and irritable and everything Richard did annoyed the crap out of me. I even told him so, ha. Hormones, man, they really mess with you. By the time we pulled into the doctor's office I was on the verge of tears and I had to force myself to snap out of it. Luckily, within a few minutes Richard had me laughing again so I was fine. I had another blood draw (so much blood) from the same nurse that had drawn my blood two days previously. I don't know why but both times she took my blood, I ended up bleeding a lot after the draw and was left with two giant bruises, one on each arm. I then had another ultrasound and this time my follicles were measuring on average between 10mm to 13mm. We then left the doctor's office, ran home quick to get my car, Richard gave me my morning shot in the driveway then we headed to Starbucks for coffee and I ended up being 10 minutes late to my chiropractor appointment. Then I went to work, hopeful that the day would go quick, and waited for my phone call from the doctor. When I got off work, I listened to the message from my doctor. They told me that they wanted to increase my medication and that I was going to continue taking injections through Monday (three more days). They reminded me that I needed to check my medication stash to insure I had enough to get me through the end of my injections. They also scheduled an appointment for me bright and early Saturday morning. My estrogen levels were now at 1357. No wonder I was so hormonal. Oh and I had continued to feel bloated throughout the day and my stomach looked swollen, so much so that I had a co-worker ask me if I was pregnant. Awesome. When I got home, I checked my medicine supply to see what I needed. With the extra day and the higher dosage, I needed some more medication and I needed it for Sunday night. The pharmacy I went through before could not deliver to me by Sunday so they told me to ask my doctor if they had medicine on hand that could get me through the weekend and they could deliver medicine Monday afternoon. That night we stayed home and relaxed which was good because I felt like crap. The follicles are starting to give me cramps since they are getting so big. Three more days. I can do it. I again struggled with my injections that night and I again bled from them. Ugh. So over it. I also had to add the antibiotic to the mix which make my stomach churn and I get really nauseous. Every time I needed something and did not want to get up I would ask Richard to do it cause I am growing babies, ha. He did not like that very much but he did not argue. Smart man. It will all be worth it.
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 300u 8:30 pm
Citrotide 250mcg 8:30 pm
Pre-natal
Z-pack Double dose for day one
Day 9: We had an early morning doctor's appointment that neither one of us was awake for. Since it was a Saturday, they only see patients that they need to. But they don't want me to go too long without being monitored, so I needed a Saturday appointment. On the weekend, they have one doctor working so I did not get to see my doctor, but I saw the one that was working that day. I had blood drawn (thankfully from a different nurse) and then the doctor did an ultrasound to check my follicles. The follicles measured on average between 13mm and 15mm. At this rate, I will hopefully be ready for a retrieval on Wednesday and my last day of injections will be Monday. The nurse asked me if I needed more medication to get me through the weekend and I told her I did and luckily they had some on hand that I could borrow. I will then have to get some to replenish their stock. I called the pharmacy and set up a delivery for Monday afternoon thinking that it was the only medication I needed. I then received a phone call from the doctor's office and they told me they wanted to increase my morning dosage as well to two vials instead of one. I only have two left so they told me I could borrow some at my appointment on Monday until I could get some from the pharmacy to restock them. So I had to call the pharmacy again and they are now sending me two packages on Monday. Throughout the day, I felt like crap still so I put on the most comfortable clothes I had, even if I looked like a fool. Whatever works. My evening shots were again bad. I actually dripped blood and had a giant red mark. Have I mentioned I am over it?
Medicine:
Menopur 75 IU 8:30 am
Gonal-F 300u 8:30 pm
Citrotide 250mcg 8:30 pm
Pre-natal
Z-pack day two
Day 10: I spent most of this day relaxing. I was not really feeling up to doing much of anything. It felt so nice to just sit and not stress about anything. I remember crying a lot on this day and not being able to help it. Anything would upset me and the tears would just come. Dang hormones. My morning injections went normally, even though I had double the normal dosage. The evening shots were interesting. In an effort to save money and use as much of what I had in terms of medicine, I had Richard give me two different shots of the same meds. Because the medicine was in the pen, I had to empty out medicine from one pen and then use a different pen for the rest of the dosage. It worked out, but the extra shot was a pain. I then had the injection that sucks, the one that prevents ovulation. It was bad, but thankfully this is my last shot of that medication! Wahoo!
Medicine:
Menopur 150 IU 8:30 am
Gonal-F 300u 8:30 pm
Citrotide 250mcg 8:30 pm
Pre-natal
Z-pack day three

Day 11: I had a doctor's appointment this morning so they could check on the size of my follicles and check my hormone levels. I unfortunately did not get to see my actual doctor yet again, but all the doctors in the office know what they are doing. The doctor found out that I have a lot more follicles in my right ovary than in my left. Weird. Also, when they were checking my ovaries it was really painful and uncomfortable since my follicles were bigger. It felt like someone was digging through my insides. Not fun. I was then told that I would hear back the results later that day and they would let me know if I was ready to trigger ovulation or if I would have to do another day of meds. Around 3:45, I had to get someone to cover me in my room (full of three year olds) at work so that I could check my phone. My doctors office closes at 5 so I needed to make sure I did not have any questions for them before they closed. I checked my phone only to find they had not called yet. So I went back to my room and 30 minutes later, I called for someone else to cover me so I could check again. Thankfully, they had left me a message. I was told that I was ready to take my trigger shot and I had to make sure I timed it for exactly 8 pm since it takes 36 hours for ovulation to occur and my retrieval time was for 8 am, 36 hours later. At first, the nurse told me to take the wrong trigger shot that I did not have and I had to call back for a dosage of the correct trigger shot. Also, since I was taking a Lupron trigger shot instead of a HCG trigger, they wanted me to come in the next morning for a blood draw to make sure that the trigger worked properly. I also found out that my estrogen levels were up to 2919.  That is more than double since my last draw three days earlier. My follicles were also measuring on average 17-20mm, with a few measuring bigger at 24mm. Then that night shortly after I got home, I had to time my last shots at exactly 8 pm. We were in the middle of eating dinner when I had to pause, draw up my shots and then administer them. My last shots!!! I am definitely not going to miss those. The trigger shot is always the worst and it made my skin super red and itchy. But, it was not as bad as the HCG triggers that I took during my clomid/IUIs from a previous cycle.
Medicine:
Menopur 150 IU 8:30 am
Gonal-F 200u 8:00 pm
Lupron 50 units 8:00 pm
Pre-natal
Z-pack day four

Day 12: I had yet another blood draw today. I am glad this is my last for now. Everybody at the fertility clinic knows me by name now which is weird but it makes sense with how often I am there. They called me with the results of my labs that afternoon saying that my progesterone and LH levels look good which means the trigger shot did what it was supposed to do, trigger ovulation. Retrieval day is tomorrow and surprisingly I keep forgetting about it. I forget that I will not be at work tomorrow. So clearly I am not too nervous about tomorrow. The only thing I am nervous about is how I will react to the anesthesia. Last time I had anesthesia was when I had my wisdom teeth out and I remember being sick and tired following that. Hopefully everything will go alright. We will be at the office bright and early tomorrow morning.
Medicine:
Pre-natal
Z-pack day five

Day 13: Retrieval day! I woke up really early this morning, at like 4:30 in the morning because I was in an extreme amount of pain. There was so much pressure in my abdomen and it hurt like hell. The pain would come in waves where it would get really bad for a few minutes and then it would lessen. I also had gas (tmi I know, though what isn't in these posts) and that just made things worse because I could not do anything about it. I tried my best to just sleep through it but it did not happen so I was wide awake by the time my 6:15 alarm went off. I got up right away and dressed in comfy clothes like they told me to. I was not supposed to have any strong fragrances so I did not do my hair or makeup either. Shortly after that, I tried to make sure Richard was out of bed and he woke up so darn cranky while making some rude comments. I tried my best to just ignore him. I may or may not have intentionally left my alarm blaring while he was actively trying not to get out of bed when we needed to leave. Plus, I was still in a lot of pain and did not want to deal with grumpy Richard. We headed out the door, stopped at Starbucks so Richard could get coffee (none for me--I was food/drink free since midnight) and I tried to get as comfortable as possible. By the time we got to the fertility clinic, Richard had realized his grumpy ways and I was doing my best not to cry from the pain. We had got there with a few minutes to spare and I had to lay the seat back in the car and curl up in the fetal position to feel any sort of relief from the pain. When Richard saw how uncomfortable I was he felt really bad for being such a grump. We slowly walked up to the clinic, where we were met with an empty receptionist desk and empty waiting room. They asked us to be there at 7am, and the office does not normally open till 8am so we were the only ones there. A few nurses and doctors walked through the waiting room, yet no one said anything to us so we were confused on why we were there so early. Sitting up was extremely painful for me, so I basically laid on their chairs to make it more comfortable. Eventually a nurse came for us and took us back to their surgery suite that we have not seen yet. I told the nurse I was in pain and she said that was common after the trigger shot because all of my eggs are trying to ovulate at the same time. She brought us to a small room with a hospital bed for me to lay down on and had me change into my gown and put on a cap. It was a great look. She then went over the paper work with us, talked about the next steps leading up to the transfer and then set up my IV. The IV was painful going in and it felt like she was digging in my hand with a needle. Once it was hooked up and giving me liquids, it was still hurting. At least it was a distraction from the pain in my abdomen. My doctor then came in and talked to us a little about the process. Then a nurse came in to take me to the bathroom one last time, which was weird because I had to carry my IV bag with me. Then she walked me into the procedure room and I had to hop up on the table, which was hard since I was in pain. Are you sensing a theme? The room was full of super bright lights which was creepy, but cool. The embryologist came in and asked me for my name, date of birth and what procedure we were doing. Then the anesthesiologist gave me something in my IV that made me feel sort of groggy. Then my doctor told me where to lay and how to position my legs and then I don't remember anything else because the anesthesia kicked in. Next thing I remember is waking up to Richard and my doctor talking about what is next. Richard said I was asking questions before that and saying stupid stuff that I don't remember saying. I remember having a hard time staying awake and would fade in and out of consciousness. Then I woke up and Richard and I talked for a bit before our nurse came back in with apple juice and crackers for me. Then once I finished my IV bag, she took out the IV and let me go to the bathroom again. I was amazed how much better I felt almost immediately. I still had a little pain and cramping, but it was nothing compared to the morning pain. Then once I was feeling up to it, I was able to get dressed and get ready to go home. As we were leaving, we made an appointment to see my doctor the following week before we left for Europe. It took a while to get it booked and my doctor was reluctant to make an appointment since the only time available was the early morning and that is usually the time that people are getting ultrasounds. Once we had made the appointment and started to leave, I had started to feel a little dizzy from standing so Richard helped me out of the office and down to the car. Richard wanted to stop for donuts after leaving the office so we headed to Dunkin Donuts where he got us each a donut and a breakfast sandwich for himself that I ate half of. He says he wishes he would have got one for me but I did not know I wanted it until I could smell it. We then headed straight home even though I wanted Starbucks, but decided against it since I was feeling tired and was hoping I could sleep instead. We got home and I almost fell asleep on the couch before deciding to just go lay down in bed which was a good choice. I ended up taking a three hour nap which felt so darn good. I had to force myself to wake up because I was afraid I was not going to be able to sleep that night. Once I was fully awake, I really wanted Starbucks still so we went out to get it and I came back and watched a movie alone while Richard finished up his work for the day. Then we ate dinner together, watched more movies and went to bed early. It was a nice afternoon full of just relaxing and taking it easy after my procedure.
Day 14: I went back to work today which ended up going fine. I am still pretty swollen in the belly and the longer I was on my feet chasing three year olds, the more intense my pain got. For the most part it was not too bad, but I had to remind myself to take it easy and not lift any children. I received a phone call from the embryologist while I was on my lunch. She told me that of the twelve eggs they retrieved, 8 had fertilized over night. Our doctor predicted that 70% would fertilize and that estimate was pretty accurate. They don't all fertilize because some of them are under mature and not ready to be fertilized. We will hear how many continue to grow on day three, so in two more days. Once I got home, I had another early bedtime this night since I was still tired from the day before.

Day 15: Pain levels were pretty good again, but I am still feeling pretty bloated. I look like 4 months pregnant with my belly and I know people are noticing and wondering, but I really don't care that much anymore. Richard and I went to dinner after work and we had a really great date night together. We ended up eating far too much food and I was so full which made it harder to hold the belly in and the more I tried the more it hurt so I just gave up and had a major preggo belly happening. We had some errands to run after dinner to prepare for Europe and I was most comfortable when I was bending over a little, like leaning on the cart at Target. By the time our shopping was coming to a close, I was feeling more and more pain and discomfort which made standing straight up difficult. We finished up shopping, went home and then I went to the bathroom. I ended up finding bright red blood which really freaked me out since I was told that there would be little to no bleeding. And seeing bright red blood is not normal. Richard was a little freaked out too and was worried we might need to go to the hospital. I was not in too much pain so I just decided to go to bed and hoped it would go away by the morning. If it did not, we would call the doctor since they were open in the morning (on a Saturday). I checked my weight (gah, so much fluid retention and bloating) just so that I had a point of reference because you have to worry if you gain 3-5 pounds of fluid overnight.

Day 16: I woke up and did not have any blood anymore so I figured I was fine. I also had not gained any more weight overnight and I had even lost some so I was good. We had a lot of packing to do, but I had to remind myself to take it easy when I felt like I needed to relax. Also, I was told the swelling would go down in the next few days, but since our Europe trip is in four days, I had to start finding outfits for our cruise. The cruise has formal nights where they require you to wear evening gowns or cocktail dresses. So I figured I could re-wear some bridesmaid dresses from recent weddings. The struggle was real. I could not fit into any of my dresses that fit me just last summer. Ugh. Swelling--go away! There was only one nice dress that I could fit into and it was a lot snugger than it was last time I wore it. I called in reinforcements by asking a friend to send some of her dresses with Richard's little brother who will be watching our house and puppy while we are in Europe. Hopefully that will solve my dress issue. We also got an embryo update while Richard and I were eating lunch together on our normal Saturday lunch date. They told us that we had 6 embryos that had developed to 6-8 cells (4 had 8 cells, 2 had 7 cells), 1 embryo had 5 cells, 1 embryo had 4 cells. The more cells they have the more likely they are to make it to day 5 or 6 to be frozen.

Day 17: I started bleeding pretty heavily again, but it was more like my period was coming. It freaked me out at first because I was told I would not get my period for two whole weeks, and here I was getting my period after only 5 days. I called the nurse just to verify it was not something more serious and she told me it was normal to get it around a week after the retrieval.

Day 18: We had an appointment scheduled with our doctor for this day because it was the last day we had before we left on a two week trip to Europe. Our doctor was not thrilled about having this appointment because it was so close to the retrieval. This was only day 6 after the retrieval and usually the embryos are frozen around day 5 or 6. Luckily, our doctor was able to call the lab before our appointment to figure out that we had 5 embryos frozen, four were frozen on day 5 and one was frozen on day 6. With that information, we were able to move on to the transfer cycle. We then met with her nurse coordinator to figure out what our calendar would look like and when our projected transfer date would be. She did her calculations and told us that we could transfer on July 8th. I had to laugh because I was really hoping to do it after July 11th since I will be in Denver with my family for the anniversary of my mom. I told her I had a vacation scheduled for that weekend, but I could miss it if I needed to. She then offered to push out the transfer about 10 days to July 19th so that I could still go on my vacation. I was extremely grateful that we could push it out just a few days and not have to wait another two months to get back on the cycle. I had been waiting on more information about the transfer cycle before I booked tickets to Denver and she was able to get me a calendar a few hours later that would tell me about all my doctors appointments and medication schedule for June and July. With that information I was finally able to book my plane tickets to Denver. I then had to fill my prescription for birth control since you have to be on it for a minimum of 19 days before they start adding in other medication to prepare your body for the transfer. This was day 1 of birth control and I will be on it for a total of 26 days. This works out perfect with our Europe trip and the only thing I have to worry about while we are gone is taking my birth control consistently. That is easy enough.

Belly Pokes: 29
Arm Pokes: 7
Butt Pokes: 0





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