Pulling the Trigger

A ton has happened since I last posted.  I had blood work and ultrasound appointments on both Friday and Saturday.  You know it's getting close when they make you come in everyday.  As you know, they had just decreased my dosages of medication to make sure things didn't progress too quickly.  Unfortunately, that slowed things down so much that it pushed back the schedule.  On Friday, my estrogen level was 2, 470 which is not quite double what it was on Wednesday.  (Double is the mark they are trying to hit every 48 hours.)  At the Friday appointment, the nurse let me know that they would probably have me taking stimulation medications for a few days longer than they originally thought.

Being the planner that I am, hearing that we were deviating from the initial plan really upset me.  Having unnatural quantities of hormones floating in my body also probably contributed to my overreaction.  I basically pouted the whole way home, but that wasn't the bad part.  My first official IVF meltdown came that night when I was giving myself the "big" shot.  As per usual, it hurt as I was starting to put in the needle, so I proceeded to pull out the needle, kick my flip flops to the ceiling, yell a few choice profanities, and heave the needle across the kitchen.  After that, I melted into a puddle of tears.

I think what upset me the most is that I had originally thought I only had one more day of shots left and then was told that I had to keep doing this for an undetermined amount of days.  There was no light at the end of the tunnel anymore.  They shut it out.  Lame.  I did eventually scrape myself off of the kitchen floor, pull down my big girl panties, and give myself the shot.  But all of the accolades I had given myself thus far about keeping my cool through the process melted into oblivion.

The next morning, I went back in for my blood work and ultrasound and was given the same vague "a few more days" answer when I asked about the schedule.  Not only that, but they added another shot to my daily routine.  Yes, that's right, more shots.  Ugh.  Fortunately, that afternoon when they called to tell me the results of my blood work, they also told me that Sunday night (that's tonight) I was to take the "trigger" shot.

The trigger shot is taken exactly 36 hours prior to the egg retrieval.  That means that the end is in sight.  Finally.  I'm so tired of being bloated and feeling full all of the time.  I'm ready to get these eggs out.  Basically, the shot triggers the oocytes to go through final maturation to prepare them for retrieval.  I am scheduled to take the shot at 11:00 pm Mountain time.  This is the last and largest shot of them all.  I've made it!!!

I go in tomorrow morning for blood work to make sure the shot took properly, then I go in at 9:15 on Tuesday morning for my egg retrieval.  After that, they fertilize the eggs and we watch the embryos grow until it's time to put them back in.  Almost there.  Can't wait to have a munchkin of our own.  Here's praying!

Practicing baby-holding with our niece the day she was born.

Moving Right Along

Prior to my ultrasound yesterday morning, I asked the nurse what she was looking for.  She said she was hoping to see the largest follicle at 14 mm.  Out of the 19 that were measurable (others may catch up later), two were measuring 13.5 mm.  That's very good.  If they develop too quickly, they may mature too much by the time of egg retrieval, or it may be a sign that they are not of particularly good quality.  Mine appear to be moving at a slow but steady rate.

Yesterday afternoon, they called with the results of the blood work.  My estrogen level was 1570, which is slightly higher than they were hoping for.  They would have liked to see it closer to 1400, because that would have been about double in 48 hours.  Since I'm progressing just a tad faster than they want, they decreased the dosage of one of my injectable medications (Follistim).  I don't love that because it still means I have to stick myself with a needle three times a day.  I would like them to have told me to skip the shot in the buttocks.

Tonight I was about three hours late with my medications.  (I was in Denver picking up our new kitty...more to come on that soon).  I'm not sure if that is going to throw things off or not.  I will let them know when I go in tomorrow and see what they say.  From tomorrow morning until the egg retrieval happens, I will have blood work and an ultrasound everyday.  I can't wait until the procedures are over so I can rest a little bit.  I am so worn out lately. Not to mention, my stomach is uncomfortably bloated.  I've really been struggling to eat lately, which is probably contributing to my fatigue.

I have been out processing at work all week.  (For those of you not in the military, it basically means I have to run all over the base tying up loose ends and getting things signed before I leave.)  I am not ready to leave Peterson and go to the Academy.  It would be nice if I had been able to stay put.  With all of the changes going on in my life with IVF, I would have enjoyed having the stability of my job and the support of the friends that I've made there.  Tomorrow is my going away luncheon, and I am certain that my hormones will take over and I will shed some tears at some point.  I just hope it doesn't happen in front of anyone.

Sorry for the lackluster report, but it's all I have in me tonight.  I will do better next time.

Polka Dots

I had a blood test and ultrasound yesterday morning.  The ultrasound went really well.  My follicles are growing at a very reasonable rate.  My lead follicle (that's the one that gets the biggest first) is 10 mm which is exactly what they would have expected.  A fully mature follicle is 18-20 mm, so when the time comes for them to retrieve the eggs, we are hoping that the majority of the follicles are within this range. 

The blood work from Saturday came back with my estrogen levels being at 252.  Ideally, those levels double every 48 hours.  On Monday, the levels should have come back around 500, but instead, they were at 699.  According to the nurse practitioner, this is not a huge concern.  However, they decided to have me skip one night of the Menopur stimulation medication in an attempt to slow things down.  That's the super long needle, so I was totally stoked to skip out on it for one night.  I was in such a good mood, I think it confused Ryan.  

Lately, I've been noticing that I bruise much easier than I ever have before.  I think that it is likely a result of the 81 mg aspirin I take daily.  (Aspirin is a blood thinner, so bruising is a common side effect.)  I am basically covered in bruises.  It seems like everything I touch leaves a purple spot on my skin.  That includes the three needles I use daily.  I wish I could have gotten a clearer picture of it, but my stomach looks like it's covered in purple polka dots.  This picture doesn't do it justice, but to give you an idea of what I'm looking like these days, here is my super bloated non-six-pack.  There are probably five or six more needle sized bruises you can't see.  The buttocks looks worse, but I will spare you the torture of that photograph.  

Tomorrow I am going in for more blood work and an ultrasound.  They will measure the follicles again, let me know how my estrogen levels are progressing and adjust my dosages accordingly.  Also, tomorrow, they are doing something called a trial transfer.  That means they are taking the same catheter that they use on the day they put the fertilized embryos back inside of me and they are placing it through the cervix into the uterus so they know exactly how long that catheter should be.  This keeps them from risking hitting the lining of the uterus with the catheter on the day of the transfer.  That is important because that lining needs to be intact for the embryos to implant into it.  

As we get closer and closer, I am getting more and more nervous about things.  I can handle the needles, the surgeries, the procedures.  What I am most frightened about, is going through all of this and having the result be a negative pregnancy test.  Granted, things will change as we find out what egg quality and embryo development brings, but currently our Reproductive Endocrinologist (RE) is advocating that we place only one embryo because our statistics are looking very good.  In the average woman going through assisted reproductive therapy, there is a 30% chance of one embryo implanting and a 60% chance of ending up with at least one child if you place two embryos.  If you place two, there is also the risk of twins which increases the chance for preterm birth and risk to the mother.  However, we are still going to push for two embryos.  I don't care if my odds "look" good.  I would much rather deal with the risk of a multiple pregnancy than the defeat of no pregnancy at all.  Not to mention, with the expense of this process, we would have to wait 2-3 years before we were able to attempt it again financially.  By that time, our chance of success would decrease simply because of our age.  I am hoping that the doctor sees our point of view when the time comes for transfer next Saturday.  But, I suppose I am worrying unnecessarily now.  These things won't become sincere issues for another 11 days if everything goes according to plan.   

Bloated Belly

Early Saturday morning I had my first of a series of blood tests leading up to my egg retrieval.  The blood tests measure varying hormones, but the one that they are looking at most closely is the estrogen level (also called E2 or estradiol).  This hormone is important because it gives an idea of how the follicles that house the eggs are developing.  Each follicle produces estrogen as it grows, so the E2 levels will vary based on the number of follicles that a lady has present.  As a general rule of thumb, if the level doubles every 48 hours then everything is progressing as expected.

Saturday afternoon, they called to let me know that my E2 level was 252. Dr. Magarelli is very happy with this number and decided to keep all of my medication dosages the same.  If the levels jump dramatically, it can be a sign that you're at risk of developing Ovarian Hyperstimulation Syndrome (OHSS) which is a very serious condition that can lead to hospitalization and causes the cycle to be cancelled.  When this happens, the lady produces a high number of low quality eggs, so the chances of fertilizing and freezing them to use later is very low.  

Tomorrow, I have another blood test and an ultrasound.  They are going to be counting and measuring the follicles in my ovaries.  I think they are looking for several small follicles at this stage, but I will ask more questions about it at the appointment.  In the afternoon, they will call me with the results of the blood test and we will be hoping for a number somewhere in the ballpark of 500.  If they don't see that, they will likely adjust the dosages of my medication.  

Honestly, I am hating all of the meds.  I know no one likes them, but I am so frustrated by all of the side effects.  Right now, bloating tops the list of most hated side effects, followed by feeling tired all of the time and crying about nothing tied for second place.  Throughout the process, your ovaries grow from the size of walnuts to the size of oranges and your stomach bloats.  When I look at my belly sideways in the mirror, it looks like I'm already about three or four months pregnant.  If I keep growing at this rate, people are going to be asking me when I'm due by the end of next week.  And the last thing you want when you're going through all of this mess to get pregnant is to look like you're pregnant already.  

The only good thing about all of this is that I have such a loving and supporting husband.  Ryan is always telling me how beautiful I am even when I look in the mirror and see a potbellied chick with dark circles threatening to swallow her tired eyes.  He goes with me to every appointment and asks questions to clarify things.  And, most admirable of all, he listens attentively when I ramble on and on about the whole ordeal.  I am so lucky to have Ryan as a partner in all of this.  He is amazing.  

I love this picture of Ryan.  Such a beautiful smile.  

The Calm Before the Storm

Tonight I began my first full day of stimulation injections.  Most of the shots were alright, but the Menopur shot was very uncomfortable.  It was the shot that went into the behind.  I administer shots multiple times per day at work, but putting a needle into yourself is an entirely different thing.  And this shot is three times as long and more than twice as thick as any of the others in this process.

The shot itself stung quite a bit, but I've only got to do it 10 more times after tonight.  Unfortunately, it looks like I'm going to have to do them all myself because I'm married to Mr. Shakeyhands McScaredofneedles.  I swear he was more traumatized by the shot than I was.  He was still recovering about an hour later.

I'm in the midst of the calm before the IVF storm.  Starting Monday, I will be in a flurry of ultrasounds, blood tests, and acupuncture appointments for two full weeks.  I think I will welcome the four days of bed rest at the end of this process.  I will have earned it.

Already Losing Steam

Yesterday was my baseline ultrasound and blood work.  The ultrasound went really well, they were looking to make sure that I had several follicles (little sacs that hold eggs) and that the lining of my uterus was nice and thin.  They called today with the results from the blood test and all of my hormone levels are exactly where they should be.  Also, today was acupuncture appointment number 8 of 12.  I'm already weary of appointments and I haven't even gotten into the meat of the IVF process yet.

Tomorrow, I begin what is known as stimulation.  It adds two more injections to my once daily injection regimen.  These injections are hormones that help eggs to form and develop.  Normally, each month, a lady only has enough fuel in her body to allow one egg in one ovary to develop.  With stimulation, all of the eggs in both ovaries will develop.  From what I understand, this is supposed to make my ovaries feel "full and heavy" and I may even have some visible swelling in my abdominal area.  

The medications I begin tomorrow are called Follistim and Menopur.  They both help the follicles in my ovaries to develop, but while Follistim contains only FSH (Follicle Stimulating Hormone) which helps stimulate egg production, Menopur contains both FSH and LH (Luteinizing Hormone) which helps the eggs to mature and release.  I'm not so worried about the Follistim.  It's a subcutaneous injection in the stomach just like the Lupron that I've been taking.  I've kind of gotten used to that.  However, I'm terrified of the Menopur that I will be taking in the evenings.  It is a serum that I mix myself with a powder and a liquid and I inject it intramuscularly into my bottom.  And, for my dental friends who can visualize this easily, I will be using a 25 gauge  1 1/2 inch long needle and I have to bury it to the hub.  Scary.  

The Menopur I have to mix myself before I inject it my bum.  Here is a YouTube Video of how that works.  Menopur Mixing Video .  Tomorrow I'll include some actual pics of the mixing process and the needles that I'll be using.  

So, my schedule has been updated some: 

Thursday, August 2nd:  Stimulation Start

Saturday, August 4th @ 8:00:  Blood Labs

Monday, August 6th @ 8:00:  Blood Labs and Ultrasound

Monday, August 6th @ 4:30:  IVF Protocol #8 (Acupuncture)

Wednesday, August 8th @ 8:00:  Blood Labs and Ultrasound

Wednesday, August 8th @ 4:30:  IVF Protocol #9 (Acupuncture)

Friday, August 10th @ 8:00:  Blood Labs and Ultrasound

Saturday, August 11th @ 8:00:  Blood Labs and Ultrasound

Monday, August 13th @ 7:00:  Egg Retrieval

Saturday, August 18th @7:00:  Embryo Transfer

August 18th-August 22nd:  Bed Rest

August 28th:  Pregnancy Blood Test

August 30th:  Pregnancy Blood Test Recheck (if positive)

The list is looking much more manageable.  However, I get more and more tired every day.  The medications are really starting to take their toll.  I dread the next two full days of work.  I'm like a zombie at the office.  A crying zombie.  

Crazy Town

Yesterday morning, I woke up a little nauseous, so I ate some spelt toast and headed outside for a leisurely walk with Ryan and the dogs to get some fresh air.  It helped tremendously.  Thinking I was over the worst of the side effects, I decided to settle in on the couch with a few magazines while watching the Olympics.

After a little exciting competition, a commercial break interrupted my perfectly pleasant morning.  A commercial came on about the dangers of texting and driving that showed a young man who had gotten brain damage while texting "Where r."  I totally lost it.  Not just crying, but sobbing and wailing to the point that I couldn't breathe.  Completely crazy town.

I wish that I could say it was an isolated incident, but I've been crying with very little provocation since I began the injections.  I'm afraid that attempting to see patients this week at work is a mistake.  I just know that someone is going to walk into my treatment room and say, "I hate coming to the dentist," and I am going to scream-cry in their face.

Besides being incredibly emotional and slightly nauseous, I've spend a lot of time thinking about what is yet to come.  Today, we are two weeks away from the egg retrieval procedure.  After that, depending on the number and quality of embryos that are created, we have to decide how many to transfer back to me.  Likely, it will be one or two.  Right now, our doctor is leaning towards one.  I'm scared of putting in just one.  If it doesn't work I don't know if I'll have the emotional capacity to go through this too many more times.  We are leaning towards two.  It's not that we want twins, but we would rather have two (or more if they split) than none.  So much to consider, and until we create the embryos, it's all just conjecture.

If you are reading the blog, and you are interesting in helping us out, Misty Alvarez is hosting a Celebrating Home party to help ease some of the financial burden of the process.  Celebrating Home is a collection of gifts, home accents, and gourmet foods that can be ordered online and sent to your home no matter where you live.  So, if you feel like doing a little shopping or getting a jump on the holiday season, check out Misty's Celebrating Home Party and buy yourself something nice.  A warm thank you to Misty for offering to do this for us.  It means so much.