IVF #1 (October 2014)

Super-Secret Post
Concerning month 37 (approx. October 2014)

tl;dr is at the end (if your instinct is “too long, didn’t read”, there’s a summary)

Day -1 : I’m so nervous about pinpointing day 1, although I got a lot of sympathy from the doctor for that anxiety, and I am fairly confident about not calling today day 1. Hopefully tomorrow is not ambiguous.

[Day 0: There’s no day 0. Normally the math major in me would want there to be but it just doesn’t work in this context.]

Day 1: It was easy to determine that I should label today Day 1 and call the clinic before the 3pm deadline. So there’s that. It’s the only time I’ve been right on schedule in recent memory, and it makes the clinic’s job easier since they had penciled in many of my appointments based on today being Day 1.

The trickiest part was remembering I can’t take ibuprofen this cycle. Ow. Oh, and not being able to triple-check the credit card balance since the site is down for scheduled maintenance… but that’s why we got the limit upped.

I want to warn friends I’ll need to purposefully obscure details starting now, and beg them not to read into Facebook posts about sushi or skiing, but I want to wait until after my first appointment. Who knows what tomorrow’s bloodtest could reveal that could screw up all of my plans?

Now it’s back to trying to live life like normal in between phone calls and needles and appointments. One more (possibly the last of the season) bike trip for groceries this afternoon, hopefully getting to have a friend over in a couple days, and keeping on top of cooking, dishes, and laundry too. You know, living.

Day 2: Bloodtest to see where my hormones already are, and medication pickup so I can start whenever they say “jump”. (Except that’s funny, since I’m not supposed to do any jumping once my ovaries are all stimulated and swollen.)

When we were trying to decide where to live in Ottawa, we could have factored in the clinic’s location. It didn’t seem as important as the day-to-day considerations of being handy to major transit routes and grocery stores and the like, though. It turned out to be even less of a factor than I anticipated as I’ll be traveling to the clinic for approximately half the appointments I expected based on my last clinic’s protocol.

Anyway, day 2 was a breeze. The medication is handled by an in-house pharmacy and the pharmacist knows the process inside out and backwards and was also really kind, reminding me to keep busy if I wasn’t working and insisting I call if I’m in a lot of discomfort. I also had a nice conversation with the nurse who took blood and we laughed about giving ourselves needles versus our partners doing it, and also whether we’d be able to stick them if the tables were reversed.

Later in the day, I got a call to schedule the next few days. My hormone levels indicated that I shouldn’t start the first medication until Day 3, and therefore my follow up bloodtest and ultrasound after four (evening) injections would be on Day 7.

Day 3: First injection. During the day, I sorted out everything I got from the pharmacist: alcohol swabs and needle tips for each day with the pen, and alcohol swaps and Q caps (for reconstitution) for each of the syringes. Now at a glance I know if I need more of any of those pieces next time I’m there for medication (I overheard the pharmacist asking other patients).

I managed to move my next appointment from 8:10 to 8:30. That’s lucky since literally the earliest I could get to the clinic on a Sunday [on the bus] was 8:16 and I don’t like to have plans where I know ahead that transit won’t get me there on time.

The first kind of medication is in the evenings. We were carefully following all the instructions when I sneezed downward, aka all over the site I had just wiped down with the alcohol swab (it’s a subcutaneous injection into the belly). Oops. Luckily I didn’t sneeze on the pen. Aside from that and small room for improvement of technique, it went fine.

Day 4: More pre-crastination wherein I moved everything for injections to another room so we could have all the supplies better-laid-out and would be more comfortable sitting together.

All set up to do the pen injections. Don’t mind the electronics;
that table is in front of our media centre.

(If anyone wants me to expand on how the injections work, I wouldn’t mind at all.)

Although the injection itself went more smoothly than the first one, it was still more uncomfortable than the test needles, leading me to believe the injection itself carries discomfort separately from the needle.

Day 5: Saw the counselor in the morning. I had requested the appointment the week before when I was at the bottom of a deep, dark hole, but by the time the appointment actually rolled around, I felt fine.

The injection that night went really smoothly and I was feeling good so I even posted about it to Facebook. That’s what I do when I’m feeling good so if the good feelings continue it will be hard to keep radio silence.

Day 6: Group therapy today. Even though I was supposed to have a 4 day reprieve from going in to the clinic, therapy and group are back to back followed by my Day 7 appointment Sunday so I have to go three days in a row.

I had another “feeling good” moment this morning while doing my hair. I am starting to feel a little bloated (whether it’s all in my head or not) but my abdomen doesn’t look any different, and my hair is cooperating today, and I had one of my favourite nice t-shirts on, and I just felt good. I relished in that feeling for awhile and then went and found my husband to show off to and share the good feelings with and have a little cuddle. I said “We’ve got to enjoy this while it lasts” and he said “You’re right; I probably only get 30 more years of this.”

Unfortunately I’m not a great fit in this support group. Just on different wavelengths somehow. I’m not planning on going anymore but if things are really bad I won’t have a choice. Luckily the therapist had just validated my day-to-day life and routine the day before so I was less vulnerable to someone crapping all over it.

I did realize today that I think the least-stressful outcome of our IVF cycle would be a straight up negative test, an hCG level of zero. Anything else will just carry the terrible stress of not knowing what happens next. (Note: least-stressful outcome is not the same thing as best outcome.)

Day 7: First bloodwork and ultrasound since medication was started.

The monitoring appointments during an IVF cycle at this clinic are less-frequent and less-invasive than the monitored cycle I did in Kitchener so it’s not too hard to get up and go. I only started scans today and they are only every second day. The crazy routine of appointments before 8:15 every day (and in the snow and sleet of December) meant that of course it was harder in Waterloo. Well, except for the fact that that cycle didn’t end in an egg retrieval…

The ultrasound technician I had today volunteered less information than yesterday’s but, given that I have my own screen to watch during the procedure, I gleaned at least one amazing thing — the follicles she measured were around 12mm wide. I had no idea things were on that scale! No wonder my abdomen was starting to feel a little crowded. This was not happening at a microscopic level.

I also thought I caught her type in “25” for my left ovary which sounded good.

Then back out to the waiting room, then in for bloodwork, then back out, then wait in another room for the doctor (I’m glad this isn’t every day!).

The doctor reviews the scans with me to decide if my medication needs tinkering. In this case, it was time to start the drugs that prevent me from ovulating on my own, and I am to keep the stimulation drugs at their current levels. She gave me a small fright when she said I had four follicles, but she must have meant mature ones since she followed that up with “and you’re on your way to 40, more than you had when we monitored you last.” 40! I suppose my discomfort is likely to increase.

Then a nurse ordered enough medication for me to last until my next appointment and scheduled the appointment.

As soon as I got home, we did the new shot. It has to be taken within 24 hours so we started it mid morning today and will do it immediately upon waking up from tomorrow onwards so that my husband can do it before he goes to work.

I feel bad for our friends who came over for a visit later that day. Not only was I all bloated and my husband had to keep chasing me away from tasks, but I was really eager to share the details of my cycle and it doesn’t make great conversation.

I even uttered the phrase “I’m trying to stay chill, but it’s hard!”

When we went to do the evening shot I realized I had hives at the site of the first shot. It was too late to call the clinic so we decided to wait until after the next shot to worry.

My husband and I were talking about pants (his old pair are fraying and need replacing) and I gestured at my pants with the intent of saying “These are my normal jeans. They will be the benchmark post-baby to determine if I am the same size again.” But as I tapped them I realized they didn’t feel right, and I looked down to find myself wearing yoga pants. Because I had been too bloated to continue wearing my normal-fit jeans and had surrendered to the yoga pants already. Sigh.

Day 8: in-between day, now on both medications.

My ovulation-suppressing shot only bothered me for 45 minutes today and with no hives. The clinic said that yesterday’s reaction was noteworthy but since today’s wasn’t, I could just keep an eye on it.

Today it’s not hard to slow down; it’s hard to get back up to find something to eat, let alone finish the dishes.

I wonder if my extreme discomfort is a) normal, b) a consequence of the number of follicles being so high, or c) not extreme at all and I’m just having a negative emotional reaction to a small amount of discomfort. Certainly I can’t imagine being able to perform well at any job right now, let alone one in childcare (my new profession). Or performing in a musical, as was supposed to be the case last year. Yikes. I’m lucky no one talked me into doing this over top of my work placement.

It’s also making me really worried I will have OHSS after retrieval. So much for having post-retrieval as a reprieve.

Must continue to drink fluids. But they’re all the way over there…

Day 9: oooooh here’s the irritability.

I wonder how much of it is really a pharmaceutical effect and how much of it is the fact that my husband has to stab me in the abdomen as a wake up call every day. The morning shot is a lot more uncomfortable and bigger and not a great way to start the day. Luckily today I couldn’t surrender to the self-pity because I had to leave the house in less than an hour to go to another blood test /ultrasound.

At least I am not feeling as bloated yet today. I even managed real pants!…. Their button may or may not be done up.

I got to see the fellow we really liked from our first consult — he was the one who looked over my chart today.

The news is a silver cloud with a black lining. I have tonnes of follicles. 20 are notable (ready?) now; no update of what the total could be. Now they have to worry about too many follicles. In fact, when the doctor saw for the first time my age and the number of follicles from my test cycle (31), he just assumed I had PCOS. For a second I thought this meant he had found something new, but, it is just that those are usually indicative if PCOS but don’t define it (since I have regular (enough) cycles).

One option would be to reduce the amount they stimulate me but then I could start to lose follicles — they say my cycle “crashes” (and the doctor pointed out that that never means anything good). The other option is to prep the eggs slightly differently to retrieve them, grow out and freeze all of our embryos, then not transfer any back and give my body a cycle or two to reset itself before putting any in.

The reset cycle is necessary when the drugs they use do a really bad number on my endometrial lining, making an unwelcome environment (irony! The fertility drugs often make a less-fertile environment for the final step). There’s some indication that even on an IVF cycle that goes completely according to plan, transfers aren’t as successful versus the embryos being frozen and then thawed and transferred into a uterus “at rest”.

(The thing about frozen embryos is that, as long as they survive thawing, they are just as likely to make it as fresh embryos. Except actually what happens is that they are slightly more likely to make it, and it’s thought that it’s due to the uterus being at rest (although I wonder if it’s (also) because they’ve shown themselves to be very hearty indeed). )

I got my next appointment scheduled for two days from now and picked up the next round of meds (same doses for now). I was feeling up for some errands on the way home so now I have some nice cozy slippers for relaxing in.

(Oops — a 90 minute nap might have been overkill. There *are* productive things I can do that don’t interfere with taking it easy.)

I didn’t realize how scary the OHSS prediction would sound to others, but given that I am so risk averse and sure that I would have the worst case happen to me, it seems normal for everything to go wrong. Of course I’m at risk for it — most of the criteria which raise the risk apply to me. “I told you so” does have a certain autoschadenfreude after all.

And hey, having an 8 week delay while waiting to reset me would be perfectly in line with our history of hitting all the delays possible. Because nothing goes according to plan for us except the worst case.

Day 10:

I spent some time with my mom today, grabbing the last couple of things from the house I grew up in before the new owners got it and taking some photos of the yard to compare to some pictures I found in a box from over twenty years ago.

After dinner I passed out on the couch for awhile; maybe I actually can blame the medication for the tiredness.

Day 11: bloodwork and ultrasound

This morning they needed three tries to get my blood drawn which is really odd. I guess I can’t skip my regular smoothie breakfast. The scans are also getting more uncomfortable as I get more bloated.

Verdict: I’m a little shy of ready so instead of waiting two days for my next appointment, I’m going in again tomorrow. One more of each shot, and then I should be switching to a whole other set of goodies to get ready for retrieval / transfer. Oh, and those might be completely normal too since today’s doctor didn’t mention a thing about OHSS (and I didn’t ask).

It’s so frustrating not being able to make plans more than a day away, but I think the Thanksgiving weekend is salvageable. It’s not like I committed to *making* dinner, at least. But there’s a trip a few weeks from now and we’ll be in the dark for a while longer about that.

After our last regular evening shot, while my husband was putting the cap back on the removable needle tip of my pen injector, the needle went right through the cap and stabbed him in the finger. Yikes. I looked at it and wondered if 100% correct procedure would mean holding the cap differently in order to avoid that eventuality, but the pamphlet showed it being held the same way.

We don’t have any cross-contamination reason to worry, but it’s still really freaky.

Day 12: supposed to be the last bloodwork/ultrasound

Having appointments every second day instead of every day was definitely so much easier logistics-wise. In that regard IVF is easier here than Kitchener. But the anxiety and build up and everything for 8 months probably made it net worse.

The doctor today (someone different again) said we were ready to schedule our retrieval for two days later and didn’t mention anything about needing the alternate “trigger” medication for OHSS reasons. When I asked, she left it to me if I was ok taking extra risk. I must have been really really eager because I said “if you think it’s ok, let’s proceed with the fastest course.”

I’m still so tired. I totally zonked out on the couch for a good chunk of the afternoon.

Day 13
Complete notes stopped here until Day 23. I’ve written out some stuff based on point notes and memories.

We had the regular “trigger” to do ourselves at home, the shot that quickly matures the eggs so they can be removed. Fun fact: the trigger is a dose of hCG, also known as “the pregnancy hormone”.

“For my next trick, I will pee on a stick and it will turn blue even though I have not even ovulated, let alone been knocked up. Tada!”

(If home pregnancy tests were cheaper, I totally would have done this.)

Day 14: Egg Retrieval

Here’s the thing about the egg retrieval. They stick a needle through your vaginal wall to reach your ovaries to aspirate the contents of each of your maturing follicles, and they don’t do it under general anesthetic.

And it was less fun than I was expecting.

Although parts are hazy in retrospect, I felt very aware at the time. They’d given me something to take before I left the house, to relax me, and then gave me a half-dose of something before the needle. I describe this as being aware enough to be panicked, scared, and in pain, and out of it enough to not fight with them that I’m not medicated enough. During the retrieval I kept saying “Why does it hurt?! I need more!” since they had said that the nurse would take my cues as to whether I needed more or not. She did give me the second dose but it didn’t seem any different.

Everyone said I did fine. Maybe I was asking a lot if I was doing stuff right because I didn’t want to get in the professionals’ way. They always said I was doing great, but who knows. They were probably just being nice; it’s a better tactic than “You have to CALM DOWN” which I totally had them tell me once at a radiology clinic while getting an extremely painful scan.

Afterwards I told the doctor I was sorry and that I had wanted to be more stoic. He said I did fine; hey, some women panic and try to sit up and get away!

Um, what? WHAT? And your response to that is not to MANAGE THE PAIN IN A DIFFERENT WAY? You may be able to imagine how mad I was a few weeks later when I heard a radio ad for a dentist’s office who offer knock-out service; I can’t get knocked out for my transvaginal needle but you can get put to sleep for a goddamn filling?!

(Good thing I recently watched a lot of Grey’s Anatomy and their constant talk of the dangers of general anesthetic, or else I would have put together an organized revolt of the clinic’s patients demanding reform.)

Curled up in the big comfy recovery armchair, I bawled like a baby. “Please don’t make me do it again,” I told my husband. They had retrieved 13 eggs. “It’s a bakers’ dozen. We have all we need. I never want to do this again.”

My parents, who had to drive us home, met us in the recovery room. I’m glad, because the sight of me on an IV and in a hospital gown helped my mom understand how this procedure was far more involved than the IUIs I had brushed off as easy.

That night when my husband asked me what I wanted for dinner, I realized there wasn’t anything prepped for me. I had spent some time at the end of the last cycle stocking prepped stuff for him in our big chest freezer, and forgotten to make some of my own freezer meals. Self-care: it’s a thing.

Day 15

Early in the morning we heard the fertilization details. 11 eggs were mature. 9 had been successfully fertilized. We had an appointment for Friday to transfer a Day 5 embryo. If there were any problems, they would call us early and a Day 3 embryo would have to be used.

We talked about how, as far as price-per-embryo went, we’d gotten a great deal. I thought about making notes for next time to remember details I could
smooth over, only to realize, oh, interesting: I’m thinking about next time. (A significant portion of that, though, is just my desire to always do better next time, no matter if that makes no sense, like at my wedding.)

Then we went to Thanksgiving dinner and settled in to wait for Friday, keeping an eye on my weight for signs of OHSS.

… Day 24

Everything has gone to shit. I have spent a week on the couch fighting nausea, hyperstimulation syndrome, and an opportunistic infection (whose treatment interferes with the tonnes of fluid I am supposed to drink so I don’t stroke out due to hyperstimulation).

And not only was our embryo transfer cancelled and all our embryos frozen, but they didn’t make it to Day 5. As of Day 3, only 2 of the 9 that had fertilized were still scoring high enough to bother freezing, and they had to be frozen now. Each has a 30% chance of taking, if they survive thawing, way down from the average success rate of 60% the clinic carries.

In the few moments of lucidity between doses of Gravol I am panicking about what it means that 77% of our embryos were crap. Is there a genetic incompatibility after all? Will repeated trials even help? Will we end up with a much smaller family than we wanted or an awkward mix of biological and foster kids? Or is it just a fluke and we should continue to drag ourselves through more hell for a tiny chance at what we originally wanted?

Good thing I don’t have a job to show up to or a play to act in, though.

But I skip ahead. On Day 16 (embryo day 2), the clinic called. They said “Hi, how are you?” I said “Well you’re calling me on day 2 so I guess I’m not doing so well.”

“We need you to come in for the transfer tomorrow.” “What happened to them?” “All I can say is that they have us make this call if you are down to 5 or fewer.”

It’s really hard to call my husband with bad news like this. He came home right away.

The next day I woke up with thrush. The antibiotics, combined with passing out after drinking juice (fluids are important!) without brushing my teeth, meant I grew myself a yeast colony in my mouth. Ugh. Well, at least I haven’t gained any telltale weight. Then we get to the clinic and they tell us we have 2 embryos left and they aren’t great quality. Would we like to transfer both of them? Hang on, what? After the scare tactics you used re: multiples? No thanks. Ok, come this way. Feet in the stirrups. We’re just going to check for fluid in you abdomen to check for OHSS. Oh there’s a little. Let’s find your pre-stimulation scans. There’s a little there too. Did you gain weight? No. But there’s more fluid there than before. I’m canceling this transfer. Go wait in the recovery area. Go home and rest and we’ll monitor you from here via phone. Here’s a diary to track important symptoms and your fluid intake. Here’s a tool to measure your fluid output. Here are the things you can take to try to feel more comfortable. Here’s a prescription for the thrush. See you in 4 weeks.

I was deeply uncomfortable or in pain for 6 days. The abdomen distention, which worsened considerably until it got better, looked like a pregnancy belly. I had to carefully time the different medications and try to offset all the fluids I was taking with the medication for thrush that couldn’t allow me to drink after taking it, and I had to force down the fluids around the nausea. It’s mostly a blur thanks to the Gravol, Candy Crush, and Cracked articles that kept me dazed and unfocused.

After a couple days of feeling less bloated and back to 80% energy levels I was declared “better” by the doctor over the phone.

Final notes

The day the transfer was cancelled, there was one nurse with a lot of the wrong things to say, but one important action which spoke louder: she got our follow up appointment moved way up. It’s initially set in relation to the transfer so that it falls in a certain week of pregnancy in the case of success, and acts as a debrief in case of failure. But it doesn’t actually need to be X weeks in the future to act as a debrief, and moving ours up meant less wasted time. We were pretty desperate to learn what had happened to the embryos that didn’t make it.

tl;dr

I had a bad reaction to our first IVF cycle after they had extracted my eggs. We have to wait before they can actually put an embryo back. Moreover, out of the 9 embryos from successful fertilized eggs, none were going to make it to the gold-standard of 5 days of growth, so the ones worth freezing were frozen on day 3, and there were only 2 of them. We had to wait 4 weeks to find out why any of this happened.