Day 12: Stims, Ultrasound, Trigger...Oh, My!...

So, yesterday we went for my ultrasound and oh, boy...did I grow!  I still have 22 follies but 14 of them were over 17mm, 4 of them were 15-16mm, and 4 were 11-14mm.  That is crazy growth from the day before.  My doctor said she was going to wait until my E2 levels came back but she was positive the trigger was going to be that night.  My E2 levels came back at 2888 which is beyond perfect (it should double every 48 hours) and the nurse gave me instructions to trigger last night!  She said I was going to trigger at exactly 8pm and that I was to have nothing to eat after midnight on Friday.  I am also to start the antibiotic Friday night and Michael should take his last on Saturday morning.  My retrieval is set for Saturday morning at 8am and we need to show up at 7:30am.  I will be given an IV and sign paperwork and Michael will umm...do his business.  We are out of our minds excited today.  Work has been pretty tough for Michael lately and he called me on his way home, after I told him we were trigger last night, and his voice was so different.  He was still tired but I could tell he was so happy that this is actually happening.


We got everything ready for the trigger shot and just waited until the clock said 8pm exactly.  I was so nervous.  Michael has never given a shot like that before and it is not fun to think about a gigantic needle being shoved into your hip.  I, personally, hate giving those kinds of shots because I am always afraid I'm going to hit bone even though that is very difficult to do, but still...I was not excited even knowing I knew that anticipation was much worse than it was actually going to be.  He counted to three and it was over.  The HcG stung a little going in but it was not bad at all and I barely felt the needle.  I have been told that it gets worse though.  I start taking Progesterone the day of the retrieval and you eventually run out of places on your hip that are not sore after a couple weeks.

I feel like everything is falling into place.  We have all confidence in our doctors but this last week, we questioned whether they maybe have been too conservative with me since I am, as they say, still so "young".  We have said, "do they really know what they are doing?"  Well, they absolutely know what they are doing.  Going an extra day made me nervous because I felt like that was "not normal" but it was 100% the right decision.  I've got so much potential with these eggs and I am even starting to think that we might have a few good ones to freeze.  We just want to get one healthy baby but having embies to freeze would be gravy.
We are just excited that it is actually to this point in the process.  We get a call tomorrow letting us know how many eggs were retrieved, how many were mature, and how many fertilized and then it's just a waiting game with daily updates about how our embies are developing.  Oh, gosh...I'm getting anxious.  Prayers are welcome.

56 needles...

Day 10: Stims, U/S, No Trigger...

Day 10...I can't believe it! Yesterday's appointment was weird. I wasn't paying attention to the growth I had over the past day and left feeling very confused. I felt like I hadn't made any progress and that it was going to be forever until I was ready for retrieval. They had me order another days worth of meds (a precautionary $230) but when I went home to dose myself for the day I realized I had enough on one med to last me through Thursday. The injection pens have over-fill in them so I got a free dose and didn't have to pay for all of the meds. Pheww! I called the nurse to tell her this and also asked her to go over the numbers with since I left feeling confused. I actually had quite a growth spurt. I had 8 follicles over the 16mm range, 6 over the 11mm range, and 6 under 10mm.


Today.

I have 10 in the 16mm-22mm range, 6 in the 11mm-15mm range, and 6 still under 10mm. My RE said I had a 75% chance of triggering tonight but wanted to wait until the my E2 (estradiol, a form of estrogen) levels came back. My E2 level came back at 1800 which is good but the nurse said the doctor thinks I still have room to grow. I'm fine with that. One more day of growth is one more day of growth. She didn't have me order more meds so most likely my retrieval will be Saturday morning. This is good, I will not have to miss school or work next week since the transfer will be on Thursday instead of Wednesday. I go back again tomorrow morning for more blood work and another lovely ultrasound. I feel so bad for Michael. I've spent a week in his shoes having to drive the 30 miles to the U every morning and it totally blows. The traffic is horrible and the rising sun is blinding and it is SO early! I made our appointment for tomorrow a little later (8:30am instead of 7:45am) but Michael said with the time difference, the traffic is even worse so we will basically have to leave at the same time. Ugh.

Ahhhh! I'm getting super nervous. I hope my ovaries kick it into high gear!


Caution: Science ahead...ignore the information below if you don't care why the estrogen levels are so important.


Estradiol is a hormone that stimulates the lining of the uterus, causing the lining to grow, and to make itself ready for embryo arrival. (This is not estradiol's only function, but for us, it's the important one). Estradiol is tied into pregnancy by it's method of production: oocytes (eggs) contain follicles. These developing follicles contain 'granulosa cells'. These granulosa cells synthesize the estradiol and release it into the blood circulation.


 This means that more follicles produce more estradiol. This helps measure how many follicles are actively developing. The longer they continue to develop, the longer the estradiol level continues. As they develop, the level continues to rise. This rise can further indicate that the oocyte within the follicles is reaching its maturity.


 An example of the use of estradiol level is when it is measured during down-regulation cycles. In down-regulation we expect low levels of estradiol: below 30pg/ml. If levels are not this low, this suggests that the ovaries are not yet suppressed, and that the down-regulation should continue a little longer, until they actually are suppressed.


 Estradiol And Ultrasound Scans
Blood estradiol is also used in combination with ultrasound scans. Taken together they help indicate how (and if) the ovaries are responding to stimulation. Is there a response? Is it adequate? Is it excessive? To tell us this, the blood level has to be viewed in relation to the stage of pregnancy and the day in the cycle in which the level is being taken.

 For example, a level of 1500 pg/ml on day eleven might be considered acceptable in a stimulated cycle, as reflecting the presence of a reasonable number of mature follicles. However, if this level were present on day eight, it would be considered unacceptably high. It would almost certainly reflect the presence of an excess of follicles. At this stage (day eight) they would still be Immature ones. Their quantity, however, would suggest that continued stimulation would carry an unacceptable risk of developing OHSS-- ovarian hyperstimulation syndrome.

 Don't Expect Easy Comparison
Before we continue, one important point: levels of estradiol are not the same from person to person. They cannot simply be compared from one to another. People vary-- everyone is slightly different, and everyone responds to a different degree. Some more so than others. A level that is dangerously high in one person-- or dangerously low in a second-- might be normal and healthy for a third. This is why blood levels can't just simply be compared. It's also why blood levels can't always be interpreted with complete certainty in the first cycles. Without prior cycles to 'calibrate' the levels, the meaning of a level can only be determined as to what it usually means-- what it 'probably', or perhaps even 'almost certainly' means.

 Despite individual variation, estradiol level does provide very useful information.
 A Rough Rule-of-Thumb for Good Estradiol Levels.
Exact figures are not possible. As a rough guide, however, a level in the range of 150 to 500 pg/ml is generally considered reasonable for the eighth day of a stimulated cycle. An approximate doubling of this level every 48 hours is considered promising, as a sign of continued good follicle development.


48 needles! My belly gets a rest in a couple of days and then the butt gets all the abuse!

Day 8: Stims & Ultrasound

Quite of bit of growing in the last couple of days over here in the Hall house.  I went from 13 follicles to 20 follicles and from only 4 being over 10mm to 11 being over 12mm!  Yay!  I am very happy.  I found out today that they like to see a good number of the follies measuring 16mm or greater to be ready for retrieval but they again reassured me that I am right on track.  If I have as much growth in the next two days as I did from Saturday to today, I think I will be ready to trigger on Wednesday night.  The trigger is a shot of Hcg that ripens the follicles so they can retrieve them, exactly 36 hours after the shot.

The ultrasounds are getting really uncomfortable.  They aren't all sunshine and rainbows to begin with, but I was told my left ovary is twice the size of my right one and when they scan the left...OUCH!  Me no likey!  Okay, so fingers crossed and lots of prayers I will be ripe on Wednesday for retrieval on Friday!!

40 needles (I got an extra one yesterday since my fancy injection pen ran out of meds so I had to replace it and stick myself again), 37 days.

Day 6: Stims and Ultrasound

I guess we got good news today.  I'm not exactly sure what I expected from our ultrasound?  I knew and hoped that I wouldn't be ready for retrieval in the next day or two.  I knew that I would still have some cooking to do but I left our appointment today a little disappointed even though they said I was right on track.  So, my AFC was 15 (I said 16 before but I guess I remembered wrong).  Today they saw 13 follicles and they measure the follicles to see how mature they are.  Anything over 10mm is great.  Well, I had 4 that were over 10mm, 4 that were very close behind, and 5 that needs some catching-up.  Hmmm.

I admit I was really sad but they said I shouldn't be, I should be happy because I'm right within normal range for being on the stims for 5 days.  I still have about 5 days to go and I was told that others will probably pop up as well.  I asked a couple for fellow IVFers for a number comparison and they both only had 1 that was over 10mm at this point so I guess I'm doing okay.  I can't wait to go back on Monday, hopefully there will be a big change.

I'm starting to get anxious about all the variables in this process.  What if they don't get a lot of eggs? What if they are not mature?  What if they don't fertilize?  What if they don't continue to grow after they are fertilized?  There are so many major daily milestones.  I guess we just have to take it one day at a time.  I just want everything to go well and on transfer day, I want a couple of great embryos to snuggle in and few great ones to freeze.  That would be the ideal situation.

Day 5: Stims

Nothing much new today.  I've realized that my decreased appetite has not normalized yet.  I planned on eating a yummy lunch today but could not even begin to finish it.  Five bites and I was done.  You would think a pretty side effect from that side effect would be weight loss but no, I have managed to gain five pounds, regardless.  I'm pretty sure it's just water and fluid because I am so bloated.  But, really...I feel good.  I'm excited to find out how those little suckers are growing tomorrow!

Day 4: Stims

27 needles.  Still feeling pretty good.  The Repronex is getting on my nerves.  It's pretty difficult to draw up in the syringe.  I'm supposed to mix it first and draw up the solution that is supposed to equal 1mL.  It always ends up being a little less than that.  You think this would be somewhat easy for me since this is what I am going to be doing for living.  I'm hoping I'm not completely screwing it up.  And yes, Michael was right.  The Repronex does get worse as the time goes on.  Everyday it stings a little more going in and it gets more sore as the day does on.   Just two more days until our first ultrasound.  Fingers crossed that those suckers are growing!

Day 3: Stims

24 needles down...approximately 21 more to go until retrieval and about 100 more after that...hopefully.  I feel very good today.  Still very aware of the egg machines but not nearly as uncomfortable as Monday.  My belly is really sore today.  I accidentally bumped it at work and oh, man!  That nasty Repronex is a killer!  The days are dragging because I count the hours until I can give myself the next shots.  Hopefully, a week from now I will have already been given my trigger shot (Hcg) and I will be done with the belly shots.  Michael and I can't stop asking eachother if the other can believe we are actually here.  It still seems so surreal that we are to the point of injections and less than 10 days away from the harvest!

On a non-IVF note...I started school again today.  My hormones are a little out whack these days and I teared up while watching an orientation video of Primary Children's Medical Center that was made in the early 90's.  I'm afraid OB will have some stiff competition because I think I'm going to love Peds.  I'm not so psyched for Psych (haha..get it?).  I'm going to have to use what brain power I have these days and refocus my attention on school.  I haven't wrapped my head around the fact that I'm back in it for 16 weeks of tests and clinicals and studying all the time.  I'm glad the IVF hoopla will be over in just a couple of weeks so I can be less consumed by what my ovaries are doing and more with what the kiddos and the crazies are doing.  I am quite excited to get another semester under my belt.  I have a feeling it will fly by.  Fall semester always does with holidays approaching and all.  By then I will have only two semesters left and be half-way through  my pregnancy...now that's crazy!

FOR MY OFFICIAL RECORDS, IT'S ACTUALLY DAY 32.  I DON'T KNOW WHY I STARTED NUMBERING THE STIMS AS DAY 1.  OH, WELL.

Day 2: Stims

Well, I guess this is technically day 31 in the entire process but it's day 2 of the good stuff.  Okay, yesterday kind of sucked.  I felt really crappy just a couple of hours after I took the stims.  I really could feel my ovaries growing and I was cramping all day into the night.  I just felt very fragile.  I got a wicked headache, possibly from the sudden cessation of caffeine intake or the meds, I don't know.  It was so bad I felt sick to my stomach.  I am only allowed Tylenol right now which I was surprised to say it actually worked.  It didn't fully take the headache away but at least I stopped feeling sick to my stomach and it dulled the cramping.  I came home early from work and took some Tylenol P.M. and Michael and I were asleep by 10:30pm.  It was bliss!

It's been a couple of hours since I took my second dose.  So far, not as bad as yesterday's...so far.  I found out why everyone has been telling me the Repronex sucks.  Because it does!  It stings going in but the worst part is that it kills afterward.  The place where I injected yesterday is still so sore.  My belly is definitely beginning to show signs of wear.  If I get brave enough, I will post a picture.  I'm hoping today is better and I don't feel like I'm going to pop.

21 needles down!

Day 1: Stims

We are to 3 shots a day now!  Woohoo!  I am actually excited!  I woke-up and Michael was still here so he got do my shots with me.  He even mixed one of the meds because I was having trouble drawing it up.  I was using the wrong needle!  There are over 80 needles so it's all little confusing still.  I saved the Repronex shot for last because everyone says it awful but it wasn't as bad as I was expecting.  It did sting when it went in and ached for a while after.  Not too bad...yet.  Michael reminded me it was only the first one and to give it time...thanks, baby.

Side Effects.


Oh, man.  I want to preface by saying that this all totally worth it and I'm loving the drama of it all...really.  I wasn't expecting any side effects from the Lupron and truthfully, if I wasn't paying attention, I would probably not even noticed them or chalk them up to something else.  The biggest one, I'm not sleeping!  I have NEVER in my life had trouble sleeping.  Anyone that knows me real well knows I can sleep anywhere, anytime and it takes a lot to rouse me.  I have not had trouble falling asleep but I wake-up on average 10 times a night.  I took an anti-nausea pill the other night that is supposed to knock you out...I only woke-up twice (and I slept in until 9:30a).  I woke-up a few mornings ago with more than a few lovely red spots all over my face...another glamorous side effect.

The hot flashes, oh my!  I will be fine one minute and next I can feel sweat streaming from every pore in my armpits...I know, gross.  Michael thinks I'm being dramatic (how do you stick out your tongue on a blog?).  It really is all not that bad.  The sleeping thing is bothering my though.  People tell me it's just preparing me for motherhood.  No, thanks!  I am fully aware that my nights of good sleep are numbered and I am supposed be enjoying every good night sleep I can have.  I'm going to call and ask about a sleep aid.  I'm generally against it but I have GOT to do something.  Last night I woke-up 7 times.  Ughh!

And all of this was just with the Lupron!  I am expecting some side effects with the stims (stimulation medications), but I was surprised by the Lupron.  On stims, the ovaries literally grow to the size of grapefruits so you can imagine how uncomfortable one can get.  One being me.  It's been a couple of hours since the shots and I don't know if it's in my head but I think I can actually feel my ovaries now.  I asked my friend, Karen about it and she said she could feel hers all the time, so maybe it's not in my head.  Starting today, I am not allowed caffeine (sniff,sniff), only mild exercise (no twisting, no heavy lifting, no crunches, heart rate not to go above 140bpm, nothing that targets the belly area), basically nothing you would do if you were already pregnant.  I have my first ultrasound on Saturday to see how the follicles are developing.  I'm just crossing my fingers that things go well and that I don't under or overstimulate.  Michael's little problem is taken care of the day of retrieval so everything is kind of up to me now.  No, I don't have any prior known issues but the doctors have no idea how I will respond to the medication.  It's a very delicate process.  Literally, we are putting all my eggs in one basket!

A visual of how big the ovaries can get.  No wonder I can already feel them!

Big Box o' Meds

That is 101 needles, people (I won't have to use them all, though). 18 down!