IVF Update | Cycle Progress, 9 Days of Stims

My three-shot cocktail.

Work and a general feeling of fatigue have kept me from posting an update here the last few days. But I'm off work today and there is quite a bit to report!

We started our IVF cycle on Feb. 13 and I have now had nine days of injections and four monitoring appointments. 

My medication dosages have remained consistent; 300 units of Gonal-F (FSH, a follicle stimulating hormone) and 150 units of Menopur every evening. As I mentioned in my last post, we added a third injection, Cetrotide, which I began taking on Feb. 18, the day after my first monitoring appointment. I didn't expect to begin taking the antagonist (to prevent premature ovulation) that soon, but one of my follicles in my left ovary was growing much larger and faster than the rest, and we wanted to give the other follicles a chance to catch up.

So for the last four nights the hubby has mixed and administered three injections and to say we are both a bit over it would be an understatement. My belly is so, so bloated from all the hormones — Greg, thankfully, gave up the sweet husband act of trying to say it looked fine and normal — and I feel like I'm running out of new places to be poked. But we persist because we know it is all worth it. Every single prick, every scan. Every cramp, every headache. It will all be worth it in the end.

IVF may take the mystery out of baby making, but it doesn't steal the love.

Things are progressing well, it seems. Each monitoring appointment has shown my follicles are growing. (And my estrogen levels have increased, as they should, along with my follicle size.) A sixth follie popped up in my left ovary at my second monitoring appointment, giving us 10 total follicles. And we still have one large, overachiever on the left.

These are my numbers from this morning's scan:

On the left: 

26mm, 24mm, 15mm, 12mm, 11mm, almost 11mm

On the right:

two 16mm, 13mm, 11mm

Endometrium (uterine lining):

About 10mm, which is good. The doc likes to see it above 8mm for transfer.

When I was able to check my phone at lunch yesterday, I had several missed calls and messages from my clinic. Even my doctor had called! (Normally I just get instructions from my nurse or, if it is the weekend, the nurse case manager on duty.) Because of my large, overachieving follicle on the left, they are planning to move up my retrieval. As much as you want your follicles to grow, you don't want them to become too big. It's a balancing act. Initially the egg retrieval was tentatively scheduled for this Saturday, but now we are looking at Friday, Feb. 24. 

A chart at my clinic that illustrates just how big my follicles have grown, and why my tummy looks so huge.

The final word will come when I get my instructions this afternoon, but it seems most likely that I will be triggering tonight! (During IVF, you take a final "trigger" shot of hCG, human chorionic gonadotropin, which completes the final maturation of your eggs prior to retrieval. The trigger shot is usually administered 36 hours before the retrieval.)

The past 10 days have been a little surreal and I could hardly believe it when I heard we were already at trigger day. I told my nurse I was excited and nervous and, unsurprisingly, she said that is a common response. When I got home from work yesterday, Greg greeted me at the top of the steps all wide-eyed. He's excited, too.

I'm trying to hold onto the bit of excitement I have as well as stay calm. This message from Dr. Willman provided reassurance that my cycle is progressing positively, and that gives me some comfort as well as the strength to keep going:

"I'm thinking we'll get about 7 or 8 eggs, which is a nice normal number. It's not high but it's not low either, so I think you're in good shape. You're young, we should have good egg quality, so I think you're doing just fine." 

-Dr. Willman

(IVF card by Levi & Roen In Print, via Anchor of Hopes)

When you have diminished ovarian reserve, you are expected to be what they call a "low responder," so Greg and I knew going in that we wouldn't get a ton of eggs. (I wouldn't be getting the 15-20+ that other women without DOR might get.) But we are pretty happy with our team of follies and we hope that once retrieved that a high percentage of the eggs will be mature and fertilize normally.

My prayer for now, though, is that God will continue to protect these little (and kinda big!) follicles that are growing in my ovaries for a few more days... That the stragglers and intermediates will continue to grow and that they'll be in prime, embryo-creating condition once retrieved.

Prayers for His protection and my health (this cold is lingering...) in these last few days before retrieval are so very much appreciated!

My prayer.

P.S. If you don't already, follow along on Instagram @dreamingoflullabies. I tend to post updates more frequently there!

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Making Baby Thilgen: IVF #1

Greg diligently mixing my medications the first night of IVF.

We started our first round of IVF this week. After having to postpone our cycle in January, the weeks of waiting felt like forever. And yet, of course, when Aunt Flo finally returned, I suddenly felt unprepared. Suffice to say, things have not gone quite as expected.

Per usual, following a couple days of spotting, my full flow arrived right on time, in the afternoon on Saturday, Feb. 11. That is the date my period tracker gave me and that is the date I gave my nurses to build my IVF calendar around. Based on that date, my calendar said I would need to come in Monday, the 13th, for my baseline sonogram.

I had to work on Saturday, so I didn't get a chance to call and report CD1 until my lunch hour around 3 o'clock. Unfortunately, my clinic was closed and I had to leave a message with an answering service. They said someone would call me back the next day with instructions. Since I also was scheduled to work Sunday, I decided to be proactive and call back before my shift that morning. And it's a good thing I did because after putting me on a brief hold, the nurse informed me that I needed to come in ASAP. 

I was still in the bathroom, finishing my makeup, about 10 minutes from leaving my house to drive to work. And they wanted me to come in now? What happened to coming in Monday? I was instantly frazzled, tears were shed. I called work and quickly got dressed while waiting to talk to my manager. I apologized profusely as I told her I would be an hour or two late. She completely understood, of course, and told me to stop stressing, but I was upset. This was the exact thing I wanted to avoid. I work retail, I work shifts, I have bridal appointments to attend to. It's not as easy for me to come in late, take a long lunch, or call out sick. I didn't want IVF to affect my work.

So much for that.

The good news is, the baseline appointment went well. I didn't even need to have blood work done because my lining and ovaries looked good. I arrived to work just an hour late and all was well. I later received an email that I could start my FSH (follicle stimulating hormone) injections the next evening.

While I felt nervous about the injections, the busyness of work fortunately kept me from dwelling too much on what awaited me at home. And then, toward the end of my shift, I felt it — DUN DUN DUN — a cold coming on.

Seriously? Yes, seriously. I came down with a cold hours before my inaugural injection. At first it was just a sore throat. I tried to kick it with lots of fluids and Vitamin C. But I woke up Tuesday feeling dead on my feet; foggy-headed, low energy and completely exhausted. I couldn't tell if it was from the cold, the injections, or both.

I worked Tuesday, pushing through the fatigue and trying to stay as upbeat as possible for my brides. Luckily I was already scheduled to be off Wednesday and I did my best to rest up and get well. I emailed my nurse case manager to tell her about my cold, hoping for reassurance that it wouldn't negatively affect my cycle. But she did seem concerned. She said as long as it stays mild (no fever) and I get over it quickly, then it shouldn't be an issue. She just doesn't want me to be sick too close to the egg retrieval. This terrifying thought then popped into my head: Oh crap, don't get your husband sick!

Because he's a player in this game, too. We need his swimmers strong and healthy.

So the poor guy got booted out of our bed last night, just to be safe. And on the advice of my coworker and mother, I did the thing I never do and hate to do: I called out sick from work today. There comes a time when you just need to put yourself and your health first, and what better time than when you are paying boatloads of money to try to get pregnant?

I'm feeling a bit better today. I'm going to keep resting and guzzling fluids, per my nurse's orders. I'm off Friday too and my goal is to be all better by then. Especially since I have my first monitoring appointment in the morning! I'm hoping that this cold will have had no negative effect and we'll see some growing follicles on the ultrasound monitor.

All in all, this week has been a bit surreal. I might not believe we were actually doing IVF if not for all the dots on my belly from the needle pricks. My best friend asked if I felt any different and I haven't noticed anything out of the ordinary. No mood swings yet. Only a little bloated. Tired, yes, but that could just be the cold.

Loved ones have lots of questions about the process — how long do you do the injections? when is the retrieval? when is the transfer? how many are you going to transfer? — which I totally understand. It is a confusing and complicated thing, IVF. But right now I'm just trying to stay calm and take it one day at a time. And I'm getting a strong sense that God is trying to use this cold to break me down. He's telling me to take it easy, to care for myself, but also to realize that I'm not in control and I can't do this alone. Sure, I have my friends, my family, my husband and my doctor. But I need Him.

I cried in my pillow last night as I prayed to God. I asked him to heal me of this cold, to not let it thwart our efforts. I told him that I know He cares for me and knows our desires to grow our family, and I asked him to help me trust Him and His plan for us. It is so hard for me to trust sometimes. I prayed that his hand would be in this IVF process, that his hand would guide my husband's as Greg gives my injections, and our nurse's and doctor's as they perform the retrieval and hopefully a transfer. I asked that Greg would be protected from this cold and I prayed for peace in my mind and heart. We don't know how long our journey to baby will be, we don't know where the path will lead, but God knows and I just need to have faith and patience along the way.

My first injections: Gonal-F and Menopur.

Stay tuned: I'll be back tomorrow with an update after our first monitoring appointment!

Swabs, Syringes & Gonadotropins, Oh My!

This is what $3,200 worth of medications looks like.

My husband came home Wednesday to this sight  and joked, "Let's open a pharmacy!"

Almost looks like we could.

And don't worry, eagle-eyed IVFers, I only pulled half of my Cetrotide kits out of the fridge for two minutes to take this photo :)

It took a lot of back and forth — many phone calls and emails — with two different pharmacies to get this loot ordered. We applied to two discount programs and priced out the meds multiple ways (with insurance, without insurance, with discounts applied, etc.) in order to find the best price. Our fertility clinic estimated that the medications for one round of IVF would cost somewhere between $3,000-$6,000. The initial estimates we received were near the upper end of that range, about $5,500. I still can't believe how much we were able to get those first quotes down and I'm honestly thankful for my nagging annoying tenacious personality, that I continued to check every option and take copious notes. I actually asked the pharmacy rep to check the final total three times because I was in such a state of disbelief. Suddenly the more expensive pharmacy (by $300) was the cheaper pharmacy (by $400) and it was like I was at an auction; I didn't want to lose the bid! $3,200 going once, going twice, and SOLD to the surprised infertile woman on the phone! While we didn't plan to order the medications that day, Greg agreed we needed to get while the getting was good.

As I unpacked the huge box Wednesday morning and took an inventory of what I'd received, everything began to feel incredibly real. My stomach turned as the thought crossed my mind: All of this is going into me. Three different injections (well, four if you count the HCG trigger shot), a couple kinds of pills, and progesterone to insert, uh, vaginally. (Thrilling!)

I knew what IVF entailed, I'd attended the injection training workshop, I'd reviewed the prescription. But seeing it all sprawled out on a table in your living room is a whole different thing.

As nervous as I am, I'm trying to feel excited, too. At the very least, I feel more prepared to start our first round next month. And with all these boxes of medications and packages of syringes staring us in the face, we surely won't postpone again. Fingers crossed!