Alrighty friends. My initial plan was to update the blog as we were going through the process of IVF. Truthfully, there is simply NO time for that along the way! Allow me to explain...
This is our first cycle with IVF, and I didn’t know what to expect prior to starting, but let me tell you I was just blown away by how much work goes into this process. I just assumed it would be similar to the process of IUI’s, with having a day 2 baseline sonogram and then meds for 5 days, and then your day 12 sonogram to check your lining, trigger, etc... BOY WAS I WRONG.
Honestly, so many people said the same thing to me: they had no idea what to expect with IVF so I’m just going to lay it all out on the table and be as descript as possible. Hopefully this will help some people understand the process a little better and therefore know what they’re getting involved in. :)
So cycle day 1 came pretty early for me, or at least I felt it was early. I called my RE and they had me come in for my baseline ultrasound on cycle day 2. On this baseline sonogram, the team is essentially looking to see how your uterus and ovaries look prior to starting. Are there any cysts? Growths? Areas for concern? Etc. They also draw baseline labs (estrodiol level) at this appointment. After the doctor reads the results of the sonogram and labwork, they’ll give you a call to give you instructions on dosing for your medications, which typically start that night. Note to self: definitely stay by the phone that day, these instructions are important and so is the timing of medication! Not a phone call you want to miss.
The medications that were started for me were Gonal-F and Menopur. Both of these are subcutaneous injections that are administered every 24 hours. Gonal-F is a follicle stimulant (follitropin alfa). You got it: it causes the eggs in the ovaries to develop at a faster pace than usual, and basically kicks your body into overdrive on egg production for ovulation. Menopur is also a follicle stimulant, but it contains luteinizing hormone (LH) in addition to follicle-stimulating hormone (FSH). These are typically used in combination for fertility treatment.
I injected these bad boys every night at 6 PM, and oh wowzers the SIDE EFFECTS. Honey. I don't even know how to describe what I was feeling during this time. I imagine it's what menopause must feel like. I had the worst hot flashes--to the point that I felt like I was going to faint--, vertigo and dizzy spells, nausea (likely from the dizzy spells), and headaches. I didn't notice it at first, but I also bloated like crazy. I stepped on the scale the morning of my retrieval and I was literally shocked at the number I saw.
I will say, injecting yourself is a weird phenomenon. It doesn't hurt, at all. I mean that needle is so dang tiny you can barely see it lol, but there's something that just makes you hesitate every time you go to stick yourself. That may or may not have had to do with the Menopur burning like a ~BIOTCH~ upon injection. Oooof, the burn is definitely noticeable. It goes away relatively quickly, but I did take my fertility sister's advice and use cold packs she sent me. That helped right away. It's also a large volume of diluent, so it's not a super comfotable injection. The Gonal-F I never felt and it's also super small. The Menopur was 2 mL of fluid. NOPE.
Around day 6 (I believe), I was instructed to add on another injection: cetrotide. This medication is brought on board to basically prevent premature egg release or early ovulation. Because IVF has to be timed just right, all of the timing on this has to be absolutely controlled. This is why it's so important that you're seen in the office for labs and follow up sonograms every 1 to 2 days. Your team needs to evaluate your results and make sure nothing needs titration.
My estrogen was climbing pretty quickly. My baseline was 69, by the time I was told to trigger it had already reached 3,000!! That number really scared me so I looked it up to be sure that was acceptable, and apparently it is, but it had me shaking in my boots. I have not only read so much about OHSS (ovarian hyperstimulation syndrome), but my friend went through it and it is definitely scary! OHSS is actually most common in younger women, those who suffer from PCOS, have rapidly rising estradiol levels, a large number of follicles and/or large sized-follicles, and also have a high AMH. Side effects to look out for with OHSS include rapid weight gain, excess bloating, urine retention or a significant decrease in your urination frequency, nausea/vomiting and shortness of breath. OHSS can actualy cause you to throw clots, so PLEASE pay attention to these side effects. It's extremely rare, but it can be fatal.
Anyways, my follicles were growing FAST and LARGE. Which you would think is good, but looking back, I think it was a sign that I was at risk for OHSS. I only did about 5 days of the cetrotide before my office called me and told me I was ready to trigger. I had a lot of follicles on both sides that were greater than 17 mm, and I was only on day 10 of medications! I was instructed to take my trigger shot that night (Ovidrel, which is another injection), and then 36 hours later, BAM, we were suiting up for egg retrieval!
The egg retrieval is quick, but can cause a lot of painful cramping, so you're completely anesthetized for it. Trust me: it's the best nap of your life! You care team uses a long needle/catheter to access the ovaries, and this is how they "retrieve" the eggs. The catheter is inserted vaginally, it's not through the abdomen. A few people had asked me that so wanted to make sure that was understood!
After my procedure, my RE came to my recovery room to tell me they retrieved 32 EGGS, which is CRAZY. (ya think I was hyper-stimulating...?) They did give me a warning that most patients lose approximately 50% of their egg count, but it was still an excellent number to start with. Some people are lucky if they get 10 eggs initially, so I was feeling ultra blessed to come out with 32. An angel or two was certainly looking out for us...
The embryologists call you on days 2, 4 and 6 to give you updates on how your eggs are progressing. I think by day 4 they typically want to see the embryo's reach a 4-cell count (meaning they're dividing appropriately), and by day 5 or 6 they should be blastocysts, which is once the embryo has formed separate cell structures and a fluid cavity. According to the literature, only 20 to 30 percent of embryos become blastocysts, and they also have a higher implantation rate.
My final embryo counts were as follows: of the 32 eggs retrieved, 26 were mature enough to fertilize. 22 of those 26 were successfully fertilized. Of the 22 fertilized, 14 became blastocysts and are currently cryopreserving!!!
Because I was borderline hyperstimulating, it was recommended we wait until next menstrual cycle to do a frozen embryo transfer. So, we'll be calling the office again on my next "cycle day 1" aka the start of a period, but this time we won't need those crazy injectables! Those are only utilized to assist with egg production and retrieval.
This is one heck of an update, and I feel like I just went on lots of tangents throughout, but I really wanted to be as specific as possible for people who have lots of questions! I'm an open book, so if there's anything I wasn't clear on, feel free to ask. Otherwise, be on the lookout for an update in a few short weeks! **crosses fingers and toes**
