IVF#2: Embryo Development Day 4

Last year, this is where the major short listing happened, as we went from 11 embryos on day three to 8 embryos on day four.

Yesterday, I informed you that all fertilized embryos were still alive and kickin’. However, their grades weren’t all the same:
6 graded good
5 graded average
2 graded poor

I figured that we would probably have one or two less than last IVF make it to the day four compacted morula stage.

But I was wrong.

And I’m about to cry.

Of the 11 day three (good and average graded) embryos from yesterday….

FOUR were compacting.

How the hell did we go from 11 to 4?
Last year we went from 11 to 8!

I have made so many changes to try to produce better quality eggs (no evidence that my egg quality was a problem even) this time around, like:
– supplements
– minimal exercise
– more sleep
– Chinese herbs
– no coffee
– less sugar
– more fat

So WTF?????!

The embryologist said, “Hopefully, we will have 1 or 2 to transfer tomorrow.”

Last year we had SEVEN blastocysts.

She said that the remaining embryos are still alive, and could just be slow growers. Some could become day 6 blastocysts. There are a couple that have a lot of fragmentation, so they are unlikely to progress further even though they are still alive. She didn’t really seem to want to carry on talking to me, or giving me details like she had in previous phone calls.

I guess no one likes to be the bearer of bad news.

Please please please universe, help all four of my morulas keep growing and thriving so that they can come home where they belong. Send love to the embryos who have fallen behind so that they too, have a fighting chance.

Friends, please send me hope, peace, and positivity, as I can feel my anxiety spiralling out of control already. I don’t want to relive the hell that was IVF#1. This is my chance to restore hope in the things out of my control. Thank you.

PS- my OHSS has gotten a bit worse again. There’s no pain now, but my weight is up 2lbs, my circumference up 2cm, and I drank more than I peed out yesterday.

IVF#2: Embryo Development Day 3

So last year, we had 14 fertilized embryos on day 1, 11 of which survived to day 3.

Today, I got an update that all of our embryos are at the appropriate 6-8 cell stage, with one embryo having 10 cells already. Normal for day three is anywhere from 4-10 cells, ideally 8 cells by the end of the day, so we’re good there.

Now, of the entire batch of embryos:
6 are grade 2 (good quality, minimal fragmentation)
5 are grade 3 (average quality, moderate fragmentation)
2 are grade 3-4 (poor quality, a lot of fragmentation)

Judging by the total count of embryos here (13), I’m guessing that the single slow grower from yesterday caught up to the group.

The grading made me a bit nervous though, as I wonder why I don’t have any perfect grade 1 embryos. Is the grade 1 embryo just super rare? Is my egg quality not great, or is the grade 1 embryo a mythical creature like the unicorn?

Everything that I have read says that both the grade 2 and 3 embryos have good implantation potential. And a greater indicator of making it to the blastocyst stage is the embryo making the expected number of cells for its developmental day.

OHSS Watch:

Weight: down 1 pound
Umbilicus circumference: down 1 cm

I got out of bed today, and had minimal problems dressing myself (yesterday, DW had to help me put on my pants and socks- which was actually quite enjoyable). Peeing and pooping still hurt, but changing positions is accompanied by only mild pain now. My ovaries are still sore on palpation, but more like a sore muscle than active inflammation. The bloating is still there, much worse at night, but sleeping and peeing lots overnight seems to bring me back to a less bloated baseline.

DW and I started watching this show called “Transparent”, which has been really fantastic. It’s about a Jewish Patriarch who comes out as transgender to her family of quirky adult children. It’s got this really interesting tone to it. A humorous backdrop, with really deeply somber and tender moments. I’m loving it, and have to try hard to savour each episode rather than binge watch it.

Tonight though, is the Bachelor, and while I object to the whole premise of the show, I can’t seem to look away. Why is there always so much crying?

PS- embryo transfer is happening in T-minus 48 hours!!

IVF#2: Embryo Development Day 2

(Image from: http://www.advancedfertility.com/4cell.htm )
On day 2 of development, embryos should have 4 cells. The grading of them depends on the level of fragmentation.

Of our 13 fertilized embryos:
7 have 4-5 cells, and are graded as good
5 have 4-5 cells, and are graded as average
1 has 2 cells, but is still alive and could catch up

I asked the embryologist to give us daily updates, which they don’t normally do. I am so grateful that she is doing this for us, and appreciate the time she takes to answer our questions.

OHSS watch:
Weight: up 0.2 of a pound
Waist measurement: up 1 cm

How I’m feeling: Ovaries are still sore, especially with movement, peeing and pooping. The Dostinex is still making me super nauseous despite taking it at night and with food. DW made me a great breakfast in bed: GF grilled cheese and soft boiled eggs, with a side of Gravol.

Today, I start all of my embryo transfer meds:
– prednisone 10mg
– endometrin (progesterone suppositories)- 100mg x 3 times a day
– prometrium (progesterone orally)- 300m at bedtime
– Fragmin injections

*TMI Warning*
Shoving the Endometrin in my vagina was a real treat this morning (not!). My vagina is clearly still in the early stages of healing after all the egg retrieval punctures. I couldn’t get the suppository more than two inches inside, because everything was clenched and hurt.

I’m a little worried about the Prednisone, because last time (failed FET) it caused major comfort food cravings, as well as water retention. This time, I’m trying to stave off OHSS, and the last thing I need is to crave bad food and retain water. However, a nice therapeutic effect of the prednisone is that it made my digestive issues go away. Honestly, my usual IBS and Celiac issues seem to go away when I’m on the Prednisone, which is wonderful.

IVF#2: Day 1 Fertilization Report

So remember my post about fertilizing our eggs via conventional IVF vs. ICSI? Well last year, we had 19 mature eggs, and opted for 1/3 IVF and 2/3 ICSI. Last year we had 14 fertilize.

Today I got a call that out of our 21 eggs collected, 13 were mature, and all 13 fertilized via ICSI.

Now I’m a little upset that only 13 of the 21 were mature. I was hoping for more. However, I am so glad that I posted my dilemma about IVF vs. ICSI, and that with your support and sharing of experiences, DW and I decided to go all ICSI.

I am also glad that I spoke to the embryologist yesterday, and asked her how they select when eggs get IVF’d and which ones get ICSI’d. Apparently, they can only do ICSI on mature eggs, but immature eggs can be fertilized via IVF. So if you choose to do a “split” of ICSI and IVF, they choose the mature ones first for the numbers you’ve designated for ICSI, and the remaining (including immature eggs) are used for IVF. So if you choose to do a split, you may have a greater yield of fertilization because they can utilize those immature eggs, which are still capable of fertilizing. However, if you choose to do all ICSI, you can’t use those immature eggs at all.

OHSS update:

Weight: same as yesterday
Circumference at umbilicus: same as yesterday

I have been in progressively more pain as time passes since the retrieval. I have been popping extra strength Tylenol every four hours, which works, but wears off after about three hours. I woke up in the middle of the night with searing abdominal pain (meds wore off), and had to pee, which hurt like hell. I have been asked by the clinic to track my liquid intake and output, which has been very difficult for me. We have a measuring cup in the bathroom for that, and I always forget at the time I start to pee. Plus, the perfectionist part of me hates not having a very accurate system for measuring liquid from things like vegetables. I also dislike how I’m measuring my intake in millilitres, and my output in cups. I know it’s a simple conversion, but it still bugs me.

Things that hurt: walking (a bit), rolling over in bed, changing position, twisting, putting on pants, putting on socks.

Things that really hurt: coughing, sneezing, peeing, pooping.

So far, it just feels like my ovaries are inflamed from having holes poked in them. However, thankfully, my belly isn’t more distended than on retrieval day. From what I remember though, the OHSS didn’t really show until a couple of days after the retrieval.

Anyways, more salty snacks and soup for me!

IVF#2: Egg Retrieval Part II

So I laid 21 eggs today! At least, that’s how many the RE collected from me this morning.

The procedure went much better this time around. I pretty much told every nurse and the RE about how quickly I metabolize anaesthetic, and they gave me an extra dose at the beginning of the procedure. I felt my head get heavy, the room started to look blurry, and while I was aware of what was going on at a very superficial level. I didn’t feel any pain, which was really nice.

After the procedure, I recovered in the lounge with apple juice and the snacks that we packed: coconut water and homemade cornbread muffins. Since I had been fasting since 7pm the night before, I was ravenous. I basically stuffed my face as the nurse was trying to explain the discharge items to me. I felt a bit dazed, but then we had a chance to see one of the embryologists, as I wanted to discuss our choice of fertilization method.

We have decided to do 100% ICSI.

They will start the ICSI tonight and then we will get a fertilization report tomorrow.

After that, DW went to grab the car and came to pick me up from the front door of the clinic. I was feeling woozy getting into the car, and started to salivate. In that moment, I knew I was gonna puke, so I opened the door, leaned out, and puked all over the sidewalk in front of the clinic. DW hung onto me by the back of my jacket, and I was so glad my dreads were tied up, because I had four good barfs before I was empty. Goodbye apple juice, coconut water, cornbread muffins, and water!

On our way home, we make two stops. One at Whole Foods because all I could stomach was soup. Another at Walmart to grab some Tylenol for the post-retrieval pain as well as some Gravol because the Dostinex makes me so nauseous.

I’ve spent the rest of the afternoon lounging on the couch, binge watching Broadchurch on Netflix. DW has been taking very good care of me- unlimited fetches, making food, bringing me meds. She also took the dogs out while I vegged on the couch.

The anaesthetic wore off by the time we got home, as I have some pain with moving, but much worse with peeing. I haven’t pooped all day, and I dread having to do it. I finally pooped and while it was moderately painful, I survived. There may have been some whimpers coming from the bathroom.

I have been taking Extra Strength Tylenol every 4 hours, which has taken the edge off and made the pain quite mild. But from what I remember, the OHSS came on with a vengeance a few days after the retrieval, so the worst is yet to come.

Since we had so many eggs retrieved, they’ve already got us booked for a five-day transfer. We transfer on Wednesday! I am hoping and praying that we get a lot of good quality blastocysts over the next couple of days. I’ll post their progress along the way.

Thank you everyone for your kind words and well wishes. I appreciate all of your support. I don’t know how I would have gotten through the past two years without you all.

For now, here’s a picture of two of my cutest girls:

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Juno (the big dog) saved Clementine (the little dog) and I from a coyote that was stalking us two days ago. We were walking on a path on the side of a hill, when a coyote cut us off about 30 feet ahead. Juno chased it down the hill and across a valley, probably about 0.75 of a kilometre long. Luckily, she is bigger than the coyotes, so they are afraid of her and run away. It’s one of the major dangers of taking the dogs to this conservation area. There are deer, coyotes, beavers, and other native wildlife. We always try to go during the day time because the coyotes are more active in the evening. I feel so grateful for Juno’s protection, even though she is generally a super suck 99.9% of the time.

Anyhow, fertilization report tomorrow!

IVF#2: Egg Retrieval Part I

Last night before bed, I re-read my egg retrieval post from our first IVF. I remember most of it, especially the pain. It’s crazy to me that some women report it to be painless, as my experience was that it was the worst pain that I’ve ever experienced in my life. Now, let me explain. I metabolize anaesthetics very quickly. When I go for dental work, they always need to give me two to three times the dose of anaesthetic. During last egg retrieval, they didn’t believe me, and after seeing me writhe in pain during the procedure, the RE told them to give me “more of the cocktail”. I clenched my jaw, squeezed DW’s hand, but still, I felt every single stab into each ovary. After the second dose of anaesthetic, things just went hazy and I woke up after it was all over.

Currently, I am sitting in a medical gown, ass exposed, waiting for an IV. DW has lovingly packed me snacks and coconut water, as well as a puke bag just in case. I’ve been fasting since last night, and was up at 7am, so I’m starving right now.

Anyways, here goes round two! Wish us luck!

IVF#2: After 12 Days of Stims… We Trigger Tonight!

Well here we are, after 12 days of Gonal-F doses ranging from 200IU to 250IU, finally, we trigger tonight!

Yesterday I waited by the phone, self-soothing with spoonfuls of coconut butter (you must try coconut butter- not oil- it is so rich and creamy and delicious. It’s the only food I could really taste yesterday), for a phone call that never came. This morning I went to my monitoring appointment, had more blood drawn (so many holes in my arms now), and went for my daily meditative dildo-wanding.

These are my stats:

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As you can see, it was a good call for my RE to have me stim for one more day. A good amount of growth happened, and some of the mid-sized follicles have grown to potential maturation size. The ultrasound technician says that in her experience, the follicles 16mm and greater will probably be mature by egg retrieval. The 15mm ones are iffy, and anything smaller is unlikely to yield a mature egg by egg collection. So right now, we’re looking at 18 or so potentially mature eggs, which is great. Obviously, you never know until egg retrieval, but I love to speculate. TTC had made me a master speculator. I have self-diagnosed a whole shit tonne of things already, most of which has actually been correct.

Anyways, there’s a lot of snow around here, and I’m dying to take the dogs out, but the conservation area doesn’t get plowed, and the snow is knee-height. Juno killed and ate 90% of a raccoon a couple of days ago (we lost her in the conservation park and then found her laying in a mess of fur and blood, so we speculate (see master speculator!) that it must’ve been a small raccoon based on the fur). She has been crapping fur poops, which can’t be fun. I might throw on my gators and go for a jaunt with her. Oh, that dog… Eating things she shouldn’t eat.

Speaking of eating, I have been feeling quite a bit less bloated in the belly lately. I believe that it is due to some changes that I’ve made to my diet:

1. Cut down my carb intake a bit. Because of the amount I was working out before stims, I was eating 40-50g of carbs with each meal (so 4-5 times a day). I’ve cut that down to 20-30g of carbs with each meal, sometimes less, depending on the meal. I always feel a bit better eating less carbs. It’s not a weight loss thing, it’s an overall homeostasis thing.

2. I’m force-feeding myself protein with each meal, even with snacks. I ate a lot of protein before (at least 35g per meal x 4-5 times a day), but feeling like crap doesn’t make you want to cook or eat things that require a knife.

3. I’m consuming a lot more salt than usual. I usually consume very little salt, but thanks to some advice from this lovely blogger at Plan B Chronicles, I’m eating way more salty foods. I’m adding salt to my soups, eating more salty snacks, etc.

4. Metamucil is my friend. I’m taking two scoops of the Orange flavoured powder once a day. DW says it makes her poops “nice and fluffy”, which makes me giggle. I don’t think my poops are ever fluffy, but I’m crapping at least once a day right now, which makes me happy.

Having so many follicles, I’m aware that OHSS is quite likely on the horizon. All of the above mentioned efforts are also to prevent it. Last year’s IVF had 36 growing follicles, 19 of which were mature. I felt super shitty for 6 days after egg retrieval, and then started to feel a lot better. All in all, it took 2 weeks for me to be able to take a dump without crying alone in the bathroom (due to enlarged ovaries). I was bloated and in pain, but didn’t have nausea or troubles breathing like some women do. I definitely had ascites, and got to practice some diagnostic tests that I had learned in professional school.

Lindsey at Awaiting Autumn also mentioned taking Dostinex (Cabergoline) for OHSS, and I’ve sent an email to my primary nurse asking about being prescribed some. This study shows that it doesn’t negatively affect egg maturation, implantation rates, or pregnancy rates.

So yeah, we trigger tonight, and egg retrieval is on Friday, though I’m still waiting for a call from the nurse to find out the exact time for both events.

Last year I said that I’d never do this again (because of the pain and trauma to my insides), and here we are, doing it again. I hope that we finally get some babies out of this.

IVF#2: After 11 Days of Stims… Almost There!

I must confess that I’ve been napping lately. After lunch, I fall into some sort of food coma, and nap on the couch with the dog, or retreat to the comfort of our bedroom. I just feel so tired. I’m not sure how much energy goes into growing and developing 32 follicles, but hot damn it’s draining me. And I’m doing pretty much no exercise right now because of the wobbly wobbly going on in my abdomen. I needed assistance from my wife last night to get my underwear on after a shower. I’m sure she loved the view, but when you can’t lift your knee up and balance on one leg because it squishes your ovaries, well, it just sucks.

My breasts and nipples are super sore, and have been for three days now. Looking at my bloodwork, it seems that my LH and progesterone have increased a bit, probably because of all the mature follicles. I have read that increased progesterone levels near trigger can yield a poor prognosis for implantation in a fresh cycle, but if a woman has high follicle counts, these levels are to be expected. I am trying not to think about this too much, lest my anxiety start to soar again.

I have also lost my appetite. I’m hungry, yes, but nothing appeals to me. Our local Costco sells organic free-range whole chickens, so I bought some last week and have been eating them for almost 5 days straight, and am so sick of chicken right now. Everything tastes bland and flavourless to me. Yesterday, I polished off a bag of HardBite chips because I needed to eat, wanted the salt, but didn’t enjoy them that much. Being a person very much ruled by my stomach (and on a whole whack of injectable hormones), you can imagine the kind of existential crisis I am experiencing right now.

Today’s monitoring went well. My favourite phlebotomy nurse took my blood, I joked around lots with the reception ladies, and my favourite ultrasound technician dildo-wanded me. She even printed off a photo of my right ovary because it was pretty:

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I’ve actually begun to find the dildo-wanding rooms to be relaxing. The lights are low, it’s always warm, there’s a place to take off your clothes and lie down. There’s someone else there, but they don’t talk to you. You just lay there in silence. It’s almost meditative. I just focus on breathing in, and breathing out.

Anyways, apparently lazing around all day yesterday was good for my follicle growth. Here are today’s stats:

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As you can see, I have a total of 32 follicles (last year was 36). Of those, 17 are 15mm or larger (last year at trigger there were 18). My estrogen levels from yesterday are higher than those on a comparable day last IVF. I think trigger may be tonight, but I’m waiting to hear from the nurse. If we trigger tonight, egg retrieval will be on Thursday, which will mean a very early appointment (like 4 or 5am), because my RE has a standing OR day on Thursdays at the Hospital (he’s actually an OB-GYN so he does operations every Thursday).

So by the phone I will wait, all day. I will post again if we trigger tonight!

IVF#2: After 10 Days of Stims

Goodness! It’s been 10 days already, and we’re still not trigger-ready.

Today has been an exciting day however. At 6am, I awoke to my wife’s ecstatic giggles, as she exclaimed “It’s a SNOW day!!” Our school board cancelled all buses and closed all schools for the day, due to the terrible weather.

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As teachers, this means we do not have to come into work. It’s a safety thing really. Last year, an Ontario school board kept schools open during one of the worst snow storms, and a teacher had a fatal accident while commuting to school due to the terrible road conditions. School boards rarely call a snow day unless it’s projected to be really necessary, as they have to pay back the government for the lost teaching day.

But we woke up to our front door being snowed in. I had to go out the side door, and shovel and brush it clear to walk through. The snow was also at least three times as tall as Clementine (the dog), so DW had to shovel a path for her from the side door to an appropriate “bathroom spot” in the yard. Juno (the big dog) just loves this weather. She sat on a mound of snow in our front yard, while DW and I brushed off the cars and shovelled our driveway. We wouldn’t have been able to get to my monitoring appointment without doing so. I love shovelling. I like the physicality of doing it. But today, I got some sharp pains in my left ovary after tossing numerous shovels of snow. I guess when your ovaries are the size of oranges, you shouldn’t be twisting like that. DW made me stop, and finished off the driveway on her own.

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By the time we were done, it was time to leave for my monitoring appointment. I was hoping that my follicles would be ready to trigger today, as my beta (if we do a five-day transfer) would land on DW’s birthday, but alas, it seems we may have to wait one or two more days. I don’t know why my follicles take so long to grow. I have so many of them, but they just take their sweet ass time. I’m already half-way through my third 900IU Gonal-F pen, which costs about the same as one of my paychecks!

Anyways enough of my complaining. Here are today’s stats:

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So, we’re getting there… One or two more days until trigger.