Cycle Day Twenty-Five: Trigger Shot

I went in for another round of ultrasound + blood work this morning. Instead of my favorite nurse, an ultrasound technician performed the ultrasound. She did not seem to do as thorough of a job with the ultrasound. She found 25 follicles in just a few minutes. Normally ten to fifteen minutes are spent on the ultrasound.

I received the call late in the afternoon. Time to trigger ovulation (and undo the actions of the "follicle glue"). The timing on this is a tricky thing. If you trigger too early, all the eggs will be released and all the money washed down the drain. I was told to specifically trigger at 9:00 pm. It brought back the first two times I have used this injection. I was slightly terrified the first time I saw the supplies because of the size of the needle.

It is so thick and long. Thankfully, it is only the needle to withdraw the fluid. The injection needle is as tiny as all the other needles I have been using.

The other important information that was revealed? Drumroll, please...
I am at a high risk to develop ovarian hyperstimulation syndrome (OHSS). When I have my blood drawn, they measure my estrodiol level. Whenever that number gets over 3000, there is a risk of OHSS. I was measuring just under 5000 today. Other causes for OHSS? Having a large number of follicles (check), having a low BMI (check), under 35 (check), PCOS (nope). I fit most of the qualifiers.
What are the funs symptoms that I might enjoy? Rapid weight gain (such as 5 pounds in a day or 10 pounds in three days), severe abdominal pain, severe and persisting nausea and vomiting, decreased urination, dark urine, shortness of breath, tight or enlarged abdomen, etc. (Many women that have OHSS look as though they are several months pregnant-not really fair.)
I will know less than a week after the egg retrieval if this will plague me. Some women receive it within hours of the procedure.
I am not terribly worried about this, but if I do receive OHSS, we will have to cancel the embryo transfer and instead do a frozen transfer in a month.

Cycle Day Twenty-Four

We had a doctor's appointment today. (Today? On a Sunday?) Yeah, it was today. It makes sense if you think about it. I am dealing with time sensitive things here. If they took the day off, we could miss something.

I felt slightly bad because I had it in my mind that the appointment was at 8:45. 8:28 rolled around and I picked up my phone in time to see a calendar notification. "We need to leave. Now!" And of course the road was closed in front of our clinic so we had a four minute detour.

Today they were able to find 27 follicles. Most of them look like they are growing nicely. The largest follicle is at 19 mm and we have several that range from 16 mm to 18 mm. Because I have only been stimming for eight days, the nurses were unsure if I would trigger today. (They want at least three at or above 18 mm, so if you only look at that qualifier, I would have done my ovulation trigger shot today.) I was pleased with my 27 follicles. From my perusal of the Internet the past couple months, it sounds like doctors can often retrieve more follicles than they can see on the 2D ultrasound scans. Not all the follicles that are retrieved are mature enough to be fertilized, and not all of the eggs that are fertilized make it to the five day mark (a blastocyst). I am hoping that I end up with at least ten embryos that become a blastocyst.

When I was done with the ultrasound, I had my blood drawn with the sweetest phlebotomist. He kept asking me if I was comfortable. It was the most pain free blood draw ever (except for the time they forgot to swab me with rubbing alcohol).

I got the call at around 3:30. Even though I have some good looking follicles (I mean, if the follicles are mine, they definitely would be good looking), my doctor wants to wait at least one more day. We are reducing my gonal-f injection from 175 IU to 75 IU. That's a huge decrease.

Tomorrow I will go in for (probably) my final ultrasound to check on the growth of the follicles. I will most likely do my hcg shot to trigger ovulation tomorrow evening and do the egg retrieval on Wednesday morning. It's weird to think I probably only have four more shots to do for this madness.

In terms of how I feel physically: I feel slightly bloated. (I have 27 growing objects inside me that range from 10-20 mm.) I feel slight twinges in my ovary area, but the feeling is more uncomfortable than painful. I am not supposed to engage in any high impact exercise for a couple weeks. As of a couple days ago, I have not gained any weight. (I keep forgetting to weigh myself in the morning. The last time I weighed myself was at 3:00 in the afternoon and it was less than a pound more than before I started the injections.) My stomach is slightly tender from the injections with slight bruising.

I reported to my father that I had not had good days on Friday and Saturday, so he dropped by with these beautiful roses on Saturday afternoon. He is amazing and extremely supportive.

Cycle Day Twenty-Three: Emotions Lately

I have been taking my injections for seven days now. If you're counting along at home, that makes 16 injections. I believe it is safe to say that I have graduated from a beginner to an intermediate drug user. I should make myself a ribbon that proudly claims "Intermediate Drug User," but I think if I wore it in public, mothers would quickly usher their children away from me.
Drug stats lately:
My stomach strangely looks like there have been needles thrust into it. Thankfully, I only have little red dots where the needles have gone in. We switch sides everyday so depending on the day, either the right or left side has dots that are slightly more red than the alternate side. The injections are administered on my stomach, approximately 1-2 inches below or slightly to the side of my belly button.
My emotions were fun yesterday. Husband and I watched the USA women's olympic trials and I randomly started crying. No devastating back story about an athlete was being shown. The tears just decided to start pouring during a floor routine. (It wasn't even a breathtaking showstopper.) It was weird. I am normally an emotional person, but I can always peg what makes me cry.
Today I am going to get an entire week's worth of homework out of the way so that during egg retrieval (or harvest) week, I can be a little more lazy. To offset the unexciting nature of completing assignments about curriculum, I will also be dabbling in the arts by attempting to make an awesome painting. We'll see how it goes.

Life

Life. I loved it as a kid. This is not me being a depressed woman on hormones. I'm talking about the game of Life. It was one of my favorite games. We did not own it until I was a bit older (at least I am pretty sure we owned it for a brief stint). When I was young, I can recall going over to a friend's house to play it. It was the best kind of friend's house because I was between two of their girls in age. That automatically gave me two friends.
One of my favorite games they owned was Life. I always had the same habits while I played the game: 1. Get a college degree. 2. Get married. 3. Buy the coolest house I could afford. 4. Rake in as many kids as possible. Try to exceed car slots to require second car.

Number four was crucial. If I could have skipped the first three steps and gone straight to four, I probably would have. Big secret: Sometimes I cheated. I hardly ever cheated in games as a child, but I would cheat as often as possible in the game of Life. Not to get more money. Not to get a better career. I cheated by trying to change the number I received on the spinner to land on more baby squares. At the end of the game when the total was calculated, I was perfectly happy losing as long as I had a decent number of peg children. I considered myself the winner if I had the most kids.
I haven't played the board game of Life in years. Now I'm in the middle of the real deal. Numbers one and two on my list for success are checked off. Number three will come someday. I just need to land on the baby squares and start filling up my plastic car with peg babies.

I have been pretty lucky in terms of insensitive people asking unintelligent questions. My students and nieces/nephews occasionally ask when I will start having kids. I usually give them a little hug and tell them I don't know. Then they run off and forget they ever asked.
I do not get offended if someone asks if I have children unless there is a follow-up question. I'm sure that I have had a few questions of those types, but I usually put them out of my mind. Two of the worst stories remain. One is kept private because it happened at school with one of my student's moms. The other one is your regular run of the mill insensitivity story.
I was visiting a lady in my neighborhood with another woman. Small talk ensued. The kid question came up. Nope. No kids.
"Oh, you just don't want them yet?" Punch to the gut. I'd just had my first miscarriage. I was still bleeding from my first miscarriage. I always think of many answers to the dimwitted questions. I consistently answer with the one that gets me in the least amount of trouble.

No matter how long or short someone has been married (or in a relationship), never follow the kid question with anything else.
You don't know their story.

Cycle Day Twenty Two: Ultrasound

I have mucho to write about today. Yesterday was a bad day because I had my class and I worked on school stuff, but I am ready to dish right now.
Yesterday we talked to our Endocrinologist. We asked her several questions such as:
Q: Because we are using frozen sperm (that we banked back before radiation for cancer treatment), do we need a backup?
A: Nope. The frozen sample is just fine.
Q: If we move across the country eventually, would we be able to have our embryos shipped to another clinic?
A: Definitely. Some people keep coming back to Utah to have the transfer, but we can definitely move embryos across country. (Overseas is a little more complicated though.) Some people get nervous because of the minuscule possibility that there will be a fault in the transfer and the embryos will be ruined, but she has never heard of that happening.
Q: What is the shelf life of frozen embryos?
A: Just about as long as we would want to have them frozen.
Q: If this IVF cycle fails, how soon could we begin again?
A: As soon as my period starts, we can begin another round.
Q: Should we try one or two embryos?
A: This one is a little more complicated. I do not want to be the next octamom and transplant twelve embryos. (Shortly before my mother passed away, I asked her if she would have rather had all eight of her kids at the same time instead of over a span of 15 years. I believe she rolled her eyes at me. Granted, this was when verbal communication was getting hard for her to do.) Our endocrinologist prefers to only transfer one. She said she will let couples do two if they are set on that number, but she would much rather transfer one. Here are our odds: 60% chance of becoming pregnant with one embryo transferred. 2% chance of having twins. 70% chance of becoming pregnant with two embryos transferred. 50% chance of having twins.
That was the end of our conversation. She did chat with me for a few minutes about our trip to Europe and how awesome it was. She really is a great doctor.
After the phone call, I had a slight meltdown (husband would claim it was more than slight) about the 60% she gave us. If one of my students had a 60%, they would fail. 60% sounds like basically 50/50 to me. I do not like those odds. I do not think we will make a final decision about that until we get closer to transfer day.
Today I had an ultrasound. Every follicle was measured on both sides (at least all that they could see). Our largest follicle is 19 mm. That is pretty big. The average woman ovulates when her follicle reaches 18 mm. I also have four follicles at 14 mm. I will do an hcg shot to trigger ovulation when at least 3 follicles are over 18 mm. The original estimated date for the "harvest" was this upcoming Thursday, but our nurse today thought it may happen as soon as Tuesday.
She measured 22 follicles today, most of them growing at a pretty steady rate. She said we looked great. I go back in on Sunday for more blood work and another ultrasound to see how close we are. If it is decided that they are not quite ready by Sunday, I will go in daily until it is time.
Because I do have a follicle over 18 mm, I added another shot to my daily routine. I now get to take Ganirelix (pictured below). Ganirelix is a "follicle glue." It prevents me from ovulating until I take a trigger shot. I am used to the daily fun of Gonal-f and Menopur, but Ganirelix is different. As soon as the needle hit my stomach, I felt an uncomfortable stinging sensation. (As opposed to a comfortable one?) It stung for a few hours and it has made my stomach slightly more tender, but not too bad.
I do feel slight discomfort in my uterine area. Something about growing 22 follicles that are around 14 mm. That's huge.

In other news, husband and I discovered something delicious. We froze half a watermelon and then stuck it in the blender along with some water, lemon juice, and a touch of sugar. It is extraordinary.