Five Snowflakes

The thing about IVF is that it's relatively unpredictable. Most people who haven't been through it don't realize the combination of steps and gambles, twists and turns, along the way. We just had one of these happen to us. Fortunately, it may be a blessing in disguise.

First of all, I've mentioned before that I was overstimmed during my first IVF, which was likely the cause of my low egg maturity rate, and that my stim dosages were decreased this time, in an attempt to avoid overstimulation. Well, it seems to have worked! IVF #1: 21 sizeable follicles, 19 eggs retrieved, 8 mature, 5 embryos after fertilization with ICSI. IVF #2: 9 sizeable follicles, 11 eggs retrieved, 7 mature, 5 embryos after fertilization with ICSI. So you can see that the success rate at each step has been higher.

Today was the third day after egg retrieval (which by the way, was curiously more painful this time). We learned from the Embryologist that all 5 embryos are still growing, although one is slacking. A healthy embryo should be 6 or more cells by this point. Today we had a 9-cell, two 8-cells, a 7-cell, and a 5-cell. If my memory is correct, with IVF #1, we had an 8 cell, three 6-cells and a 5-cell. So the theme of higher success rates at each step of IVF #2 is continuing!

This IVF cycle has been more complicated because we want to do preimplantation genetic screening (PGS) at the day 5 stage, instead of day 3 like last time. In IVF #1, we had a single-cell biopsy done of our embryos at day 3, to test them for a severe chromosomal abnormality, and hopefully prevent another miscarriage. The results came back on day 5, and we had one competent embryo. Two tested as incompetent, and two were inconclusive. Unfortunately, the two that were inconclusive had already ceased growing on their own, or we would have given them a try.

A day 5 biopsy collects more than one cell for testing, and it takes longer to get the results. But it's also more accurate. However, it does require freezing. So our first plan for IVF #2 was to do a freeze-all cycle. But then, considering that we could easily end up with only 1 or 2 embryos to test at day 5, and that the 5-day growth process culls some of the genetically incompetent embryos anyway, we decided to have a back-up plan of preparing for an embryo transfer. In the case that we ended up with only 1 or 2 embryos at day 5, doing PGS seemed pretty pointless. But the result has been that I have had to prepare for both circumstances - a freeze-all, and a day 5 transfer. Having to explain this over and over again to confused nurses was no picnic.

Today, when the Embryologist called with our day 3 results, I was so relieved when she said we still have all five. If we had already been down to 1 or 2 poor-grade embryos, we would have gone in for a transfer today, and I am still in pain from my egg retrieval on Thursday, so I really don't feel ready to get pregnant. I was already getting worried about the very realistic possibility I would need to do a transfer on Tuesday, wondering if I would still be in pain. But, she also had some surprising news.

The Embryologist told me that they always grow a batch of mouse embryos to test the culture medium and lab environment, and that all her mouse embryos had just died. She needed to pull all embryos out of culture. In other words, they all had to be either transferred or frozen. So we froze all five of our embryos. The more accurate term would be "cryogenically preserved", but "froze" is easier to type.

Of course, the idea of something being seriously wrong in my embabies' first nursery concerns me, but I couldn't be happier with the Embryologist's response time, and her focus on saving them. The amazing part is this feels like a blessing. My body does not feel ready to become pregnant right now. This will give me a few weeks to feel completely healthy again.

So when will we get PUPO (pregnant until proven otherwise-describing my state after an embryo is transferred)? Probably anywhere from late September to late October. Vague enough for you? I'll write more about what that part will entail in a later post. For now, we have five snowflake babies resting peacefully. Please pray for them and for us!

As always, please feel free to ask any questions. This often seems like science-fiction to me, but at this point I've probably become so familiar with it, I brush over some points that need explained. No question is too simple.

Friday Freakout: IVF Meds

I’m calling this post a “Friday Freakout” as a tribute to the fact that my greatest psychological challenge is anxiety. It rots my gut on a regular basis.

So guess what? We’re there. Where? IVF number 2. I started my morning injections of Lupron on Thursday, and start stimming next Thursday night. My protocol is 10iu of Lupron daily until next Thursday, then drop it to 5iu, and add 225iu daily of Follistim. My last birth control pill is tomorrow, so CD 1 should be about next Tuesday. I’m also taking Metformin, prenatal vitamins, DHA, CoQ10, and extra calcium and vitamin D, but these are all oral pills. Only the Follistim and Lupron are injections.

On August 26^th I’ll go in for a monitoring ultrasound, and my RE will decide whether to schedule me to trigger, or have me continue on Lupron and Follistim longer and return for another ultrasound before triggering. Our first IVF, we had a low percentage of the total eggs retrieved that had triggered properly. My understanding of the trigger is that it tells the eggs it’s time to go from 46 to 23 chromosomes, so they can be fertilized. My RE thinks it didn’t work on a lot of them because they had grown too fast. In other words, I was “over-stimmed”.

Even though we had a single, genetically competent, girl embryo that made it to transfer, since she didn’t implant and we didn’t have any others make it to blastocyst stage for freezing, that cycle was a total bust. The only thing it did was give us very expensive clinical data showing we end up with a lot of chromosomally abnormal sperm and eggs, thus conceiving chromosomally abnormal embryos. That is, when they are able to actually conceive.

This time, my dosage of Follistim has been decreased, and an additional stim dropped entirely, with the hope that this will allow more of my eggs to mature a little slower, and properly trigger. This is what we are now hoping and praying for virtually every day.

I’ve also decided that I’m going to learn how to give myself the injections this cycle. That does not mean I will actually be doing them all myself. Nurse Stepmom is again generously giving me my injections, but I’m going to have her teach me how. I’ll do a couple under her tutelage, on the off chance I get stuck having to do it myself. But until that happens, I’m having her do it! I haven’t had pain or a bruise from any of these injections yet, and I firmly believe I owe that to her expertise and skill! This process is stressful enough without having to stab myself every day.

And no, the Wacky Wicketeer is not allowed near my shots. You see, my big, strong husband is afraid of needles. Despite this fact, he grudgingly said to me one day, “I guess I could try giving you a shot.” I replied with a firm, “no way!” I love him for wanting to help, but what I don’t need is a husband passed out on the floor and me still standing there, having to stab myself.

Finally, I promised my tweeps (friends on Twitter, for those who aren’t) that I would share another use for the insulated bags Dove gave us at BlogHer ‘11. Here it is: Transporting our IVF meds that are supposed to be refrigerated! Hey, if it’s good enough for ice cream…

If you have any questions about anything I’ve discussed in this post, please don’t hesitate to ask!

The IVF Experience: Through Trigger

Here's where I start to give you the details about what this IVF cycle entails. At the moment, I'm frankly a little buzzed on a prescription painkiller my RE gave me after egg retrieval, so please, bear with me!

The first part of preparing for IVF is down-regulating. Particularly with PCOS, the woman's hormones need to be under control prior to starting stimulation. To accomplish this, Dr. Analytical had me go on birth control pills (BCPs) in December. On a Wednesday in mid-February, I started daily injections of Lupron, which does a lot of things, but mostly suppresses estrogen production. Thus, side effects are like a mini-menopause: hot flashes, fatigue, headaches, etcetera. At the same time as the Lupron, I started taking Dexamethasone, to help suppress my immune system. The next Monday, I stopped BCPs, and Aunt Flo officially began my cycle that Wednesday.

I had to get my estrogen level tested the next day to make sure that I was properly suppressed, which I was, with estradiol at 25. So I was on course to start stim injections the following week, which included Follistim and Luveris.

You might be noticing that there are a lot of injections involved. Most women either do these themselves, or have their husband or partner do them. However, the Wacky Wicketeer has a tendency to faint at the sight of needles, and while he nonetheless offered to try, I decided that I did not want a passed-out husband on my hands while going through this. The idea of doing them myself totally stressed me out, but I'm fortunate enough to have a Stepmom that is a nurse! So, she was kind enough to arrange twice-daily injections with me.

After a week of stims, I had my monitoring appointment, which included an ultrasound and another estradiol test. My estradiol was 3500, my uterine lining was 9.5, and I had 21 follicles ranging from 12 to 21 mm, with most of them in the 15 to 18 mm range. Dr. Analytical said I responded perfectly to the stims, that it looked great, and we should stop stims, trigger, and schedule egg retrieval for Wednesday - 2 days ahead of schedule!
So we did.

We had to administer the trigger injection - Human Chorionic Gonadotropin (HCG), a.k.a. the pregnancy hormone - at 1:45 in the morning! So, Stepmom stayed overnight, and we got up in the middle of the night to get it done.

Next up, the scary part: Egg Retrieval!