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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IVF Update | 1st Monitoring Appointment, 4 Days of Stims

Looking at the monitor during my first monitoring appointment.

After four days of stims (that's what we call injections in the IVF world), I had my first monitoring appointment this morning. While I've managed to stay relatively zen this week, likely in part to focusing on self-care and kicking my cold, I did feel a bit nervous as we neared the clinic and I wondered what the monitor would show. Fortunately, my husband was able to come with me to this initial appointment. I know he won't be there for every ultrasound and blood draw, but it was nice to have a little extra moral support this morning!

There was an immediate sense of relief when the ultrasonographer very quickly found my left ovary. Typically, my left ovary is very difficult to find and it can be quite the uncomfortable search on my end. But there it was, clear as day. We knew that must mean that follicles were growing inside.

The technician continued to scan around, left and right, measuring the diameters of the visible follicles as well as the thickness of my uterine lining. Normally looking at the screen gives me the heebie jeebies (I'm not sure why!) but I decided I needed to watch today. And I honestly don't know how they can make heads or tails of the blurry mess on the screen. Good thing that's not my job! The sonographer informed us that I had four follicles in the left ovary and five in the right. Most were generally around the same size except one large fella in my left ovary. And my endometrium measured at about 7mm, which the tech said was good. She couldn't speak to whether or not the number and size of the follicles was good or bad; every woman and every cycle is different. And, of course, she doesn't know the details of my specific case, either. She printed out a copy of the results and I figured I would have to go home and Google.

Follicle count during my first monitoring appointment, four days into stimming.

Luckily, my nurse case manager, Valeri, called me before I had a chance to fall down an Internet rabbit hole. (Though, I did find this informative article about monitoring from a reputable source.) I told Valeri that I had my results from my monitoring appointment but that because I wasn't sure what the "goal" was today, I wasn't sure how well I was doing. First, she said that my only "goal" is to take my medications correctly. As long as I'm doing that, I'm doing everything I can, and how my body responds is not really up to me. So true! And a good reminder. Second, my nurse echoed the tech's comments that every woman and every cycle is different. But, given that I was worried I wouldn't respond well, she thinks that I am "off to a good start" and that the number and size of the follicles is average. I told Valeri with a laugh: I'll take average!

Obviously, the more follicles the better, and she said that a few more may crop up between now and the egg retrieval. Plus, when I am under anesthesia and the doctor can do a bit more digging, they might find follicles not visible during the ultrasounds.

For now, we're happy with and optimistic about my progress. I've been instructed to continue taking my FSH (follicle stimulating hormones) at the same dosage, and to add my antagonist (Cetrotide) tomorrow night. That injection is used to prevent premature ovulation. Since one of the follicles in my left ovary is substantially larger than the rest, Valeri said they want to hold that guy back a bit while giving the other follies a chance to catch up and "join the party." 

You hear that ovaries? Grow, follies, grow!

My next monitoring appointment is scheduled for Sunday morning and then I'll be back in Tuesday for another ultrasound and blood draw as well as a pre-op consult. Egg retrieval is about a week or so away!