Preparing For Embryo Transfer

(Photo from: http://m.inviafertility.com/uncategorized/drvkarande/top-10-interesting-facts-about-ultrasound-guided-embryo-transfer)

Tomorrow is our embryo transfer! So far, DW has been taking estrace everyday (beginning on day 3 of her cycle- dose decreased from 3 pills a day to 2 pills a day on the day of our retrieval). She has also started her prometrium (3 capsules orally per day) and endometrin (3 vaginal suppositories per day). She’s not particularly enjoying the vaginal suppositories, and is making her way through our stock of maxi pads and panty liners. She is being a good sport though, and in addition to the busyness of work and this drug schedule, she is still taking care of my OHSS ass.

Oh yes, still bloated and in pain. If my stats have not improved by tomorrow, I’m going to insist on having an ultrasound to see how bad my ascites is. Two days ago, a chiro friend of mine and I were playing with my belly, doing the fluid wave test for ascites, which we had learned in clinical diagnosis class back in the day. On day 4 today, my weight continues to climb by just under a pound (now a bit over 3 lbs more than on retrieval day) and my circumference remains the same as yesterday. The nurse called yesterday and implied that perhaps I wasn’t resting enough. All of this resting is driving me insane!

But exciting times are upon us my blogosphere friends. We went for sushi yesterday as one last hurrah for DW (who loves sashimi by the way). We called it the Last Supper.She is also shovelling the driveway right now too because a) I’m in too much pain right now, and b) she is on doctor ordered bed rest for two days after tomorrow.

In preparation for our transfer, I did a nice acupuncture treatment on her this morning (she played an iPhone Settlers of Catan game while her Qi did its thang), and I made her this pineapple-rich smoothy:

Mamaetmaman’s Pineapple Smoothy (for good implantation)

1/5 of a pineapple, rind trimmed and chopped but core not removed
2 tbsp coconut cream
1.5 cup coconut milk (the thin beverage kind, not the cooking kind)
1 ripe banana

Throw all ingredients into your blender and blend on high until smoothy no longer has fruit chunks in it. If it jams, add more liquid.

For a refreshing change- pre-freeze your pineapple and banana for an icy consistency .

Pour into a large glass and serve with an umbrella!

For even more fun times, double the recipe and make two drinks- add Malibu Black into the NGP’s glass!

Day Three Embryo Report

From: http://www.rrc.com/images/Early_human_embryos.png

I think I have OHSS. In fact, I’m certain I have it. In the past twenty-four hours, I’ve gained nearly three pounds, and my abdomen has increased in circumference by at least 3 centimetres. My belly is taut and hard to the touch, and it hurts changing positions, going pee (and poo), and coughing. I imagine this is how it feels to be extremely pregnant.

In other news, I received an update from the embryologist!

Of our 14 fertilized embryos:
8 of the 10 ICSI-fertilized embryos are at the 6-8 cell stage
3 of the 4 IVF-fertilized embryos are beyond the 8 cell stage and are growing fast!

In total, we have 11 embryos still in the race, on their way to becoming morulas in the next 24 hours!

Fertilization Report

So as you know, I elected for 7 ova to be fertilized the old fashioned IVF way:

(Photo from: http://m.123rf.com/photo-23226463_ovum-and-spermatozoon-fertilization.html)

And 12 ova to be fertilized via ICSI:

(Photo from: http://www.sisuhospital.org/icsi.php)

The embryologist called this morning to inform me of our fertilization results:

Of the 7 ova to be fertilized via IVF:
4 fertilized
2 were abnormal
1 had 2 sperm fertilize it –> abnormal

Of the 14 ova to be fertilized via ICSI:
10 fertilized
2 were immature
2 did not fertilize

So in total, we have 14 zygotes!

What I’m Doing to Prevent OHSS- Day One

The last 28 hours have been less than fun, given that there are holes in my vagina and ovaries. We have been doing our best to stave off ovarian hyper stimulation syndrome (OHSS), which has felt like a full-time job.

Things that we are doing to prevent OHSS:

– I have been downing coconut water, which is a good electrolyte
– I have been eating salty things like soup
– I made myself a big pot of congee (a savoury Chinese rice porridge), which is salty and very easy on the digestive system
– I am trying to maintain my protein consumption at every meal even though I don’t feel like eating it when I’m not feeling well
– I am not exercising, even though it usually makes me feel better when I’m feeling gross
– I am weighing myself and measuring my abdominal girth daily
– I am doing acupuncture on myself (I have advanced training in this) to prevent ascites
– I am trying to relax and enjoy my 2 days off at home

So far, most of my discomfort has to do with any movements that engage my pelvic floor: getting up/down from sitting/standing, rolling over or changing position on the couch/bed, coughing (still have that damn cold from my MIL!), urinating, defecating, sitting.

This morning, the acetaminophen had worn off and I had major problems trying to pee. I could not bear down, and could only “open the flood gates” and let the natural pressure differential aid in excretion. I sat there for minutes as my urine “drip drip drip drip dripped….”. It was frustrating and sad as DW stood there and stared, feeling helpless and sorry for me.

However, I’m not feeling overly bloated. Just a little maybe. I have read that the bloating gets worse with time, which scares the shit out of me because I was hoping to play hockey on Monday, and am playing in a tournament during the weekend of the 30th.

We’ll see how it goes. Will update more on this as things progress.

Egg Retrieval!

So at 5:35am, we rolled into the clinic parking lot, Black Eyed Peas blaring in the car, us bouncing to “Pump It Harder”.

We were immediately escorted downstairs to the recovery room, where I was asked to change into a gown and undress from my waist down. I was also given little disposable slippers and a hair net that didn’t fit over my dread bun.

Then the nurse asked me some questions and put an IV in my arm. The doctor was running late, so we just waited for a bit. Below is a picture of DW in her outfit for the retrieval, as well as the recovery area:

We were then led to the treatment room, where I was asked to lie down and place my legs in a strange contraption. DW was in the room with me, as were two nurses and one of my favourite ultrasound technicians.

Three different drugs, which the nurse kept referring to as the “cocktail” were injected into my IV line, and within a few minutes my body started feeling heavy. The doctor came in just as the drugs were starting to set in. He inserted a speculum, ‘prepared’ my vagina, and then began the retrieval.

I felt the needle as it poked through each ovary, and as it was maneuvered to access each follicle. I got to watch it in the tv in the room as well. It was over just as quickly as it began, and I don’t remember about two-thirds of it presumably because if the drugs (at some point the doctor asked the nurse to give me another dose of the “cocktail”).

In no time, it was over. It took about an hour and a half for the drugs to wear off though. In that hour, I was very sleepy, we hit a grocery store, and I puked in the car (thank goodness for doggie poop bags in the glove compartment).

Once we were home, DW pampered me with unlimited fetches, and hit up three more grocery stores to get things that I wanted/needed.

The pain has been on and off since we’ve been home. Mostly a stabbing pain that comes on randomly, but it also hurts a lot when I pee and poop. Sudden movements are risky as well. So today, I’ve been a couch potato, and have run out of PVR’d shows to watch.

Here are today’s stats:

21 mature eggs were retrieved (they didn’t bother with the smaller ones).

7 will be used for old-school fertilization (put egg and sperm in a room and see if they hit it off)
12 will be used for ICSI (intracytoplasmic sperm injection)
2 were deemed low quality

Tomorrow we find out how many fertilized!

Egg Development Thus Far

I am going to keep a running account of my egg developments as they occur. This is mostly for myself, but if others can be comforted in having an example of what my body’s journey is, that is fantastic.

CD 3 baseline (on 20 units Lupron, no Gonal-F yet): 7 follicles on the L, 6 follicles on the R

[start 200 units Gonal-F on night of CD 3, continue 20 units Lupron]

CD 6 (after 3 days of 200 units Gonal-F): 8 follicles on the L, 6 follicles on the R, all itty bitty

[CD 6 (stim day 4) doses adjusted to 250 units Gonal-F, and 10 units Lupron]

CD 8 (stim day 6): 12 follicles on the L, 6 follicles on the R, all still small (2-8 mm)- things are starting to feel really swollen in there.

CD 10 (stim day 8): 12 follicles on the L, 8 follicles on the R, all still small (4-10mm)

CD 12 (stim day 10): 25 total follicles, 6 about 12mm.

CD 14 (stim day 12): 30 total follicles, 20 of which are over 10mm. Lead follicle is 17mm

CD 15 (stim day 13): 38 total follicles, 15 follicles on the R, 23 follicles on the L. About 21 are 12mm or bigger.

[Gonal-F dosage reduced to 200 units]

CD 16 (stim day 14): same as previous day, with follicles in the middle range growing by about 1 or 2mm .

[evening at 6:45- HCG trigger]

After Fourteen Days of Stimulation

After Thirteen Days of Stimulation

Dear Ultrasound Sonographer

I created my own e-card today!

598 and 1069 Mean Nothing to Me

So after the tactless voicemail I received from the RE’s nurse last week which included both: abnormal cortisol levels and cancelled IVF cycle, the nurses did not return my emails nor voicemails for a week! Normally, they reply within a 24 hour period, but this time it took me writing an angry email to coerce a reply.

I had asked to see a scanned copy of my lab results, but instead, she just gave me two values for my cortisol levels which mean nothing to me without reference levels or even UNITS! Sometimes the results are given in mcg/dL and other times it is in nmol/dL, and the conversion factor is somewhere around 27.59 to go from the former to the latter.

The upper range of normal is from 5 to 23 mcg/dL, which converts to an upper limit of 635 nmol/dL. This puts me within the normal range for my first result (pre-Marvelon).

My second result, was taken after I had started Marvelon, which can significantly increase serum cortisol levels anyway, so I’m skeptical of how they feel my second cortisol level is data they can even consider to be reliable.

I asked two other questions in my email, which she didn’t address at all.

For partially privately paid health care in Canada, and for a treatment cycle that costs 11 000 not including the cost of fertility drugs, I was expecting better care.

I’ve been shopping around for different RE clinics, but the reality is that they’re all the same: one doctor, 5 clinics, and a bunch of nurses who have been trained not to think for themselves.

My beef is not with the nursing profession- but rather with how these clinics are run- and how it makes me and other patients feel like we are nothing but a file number with a dollar sign.

Oh- and I’m STILL waiting to hear from the endocrinologist. Argh.