An IVF Update

It’s been a while since we’ve done an IVF update – so let’s do it!

About three weeks ago we kicked this thing off. To catch you up to speed after our failed frozen embryo transfer in March 2021, we decided to do a full round of IVF again. That means going through the whole process to grow eggs, retrieve the eggs, fertilize the eggs, genetically test any embryos that result, and then if we are fortunate enough, transfer any genetically normal embryos.

To get everything started about three weeks ago, I went into the clinic to do a pretty routine blood draw and ultrasound. They just have to make sure my baseline looks good before introducing any new medications etc.

Unfortunately, the ultrasound showed two fairly big ovarian cysts. This was a brand new thing for me. My bloodwork also showed an elevated estrogen level of above 700. So this means the cysts are also hormone-producing. The biggest thing is this obviously delays the timeline. Because they cannot stimulate your ovaries to produce eggs if there are cysts that are in the way of that. So they decided to keep me on birth control-which is supposed to help them decrease, and bring me back in a week to see if the cysts decrease in size.

I went back a week later, to find that they were the same size. But the good news, my estrogen came down to 30. So the birth-control did its job. And because time is of the essence for me this round, with a low AMH, my doctor decided to go ahead and schedule a cyst aspiration surgery, instead of trying to wait for them to decrease in size over time. This just means they put me under anesthesia, put a needle into the cysts, and aspirate the fluid.

CYST ASPIRATION SURGERY

On July 9, 2021, I arrived at the clinic early in the morning. Loren had to wait in the parking lot because my clinic still does not allow support or friends or spouses to come in with the patient.

They put in an IV and brought me back to the surgical room. I started breathing in oxygen and that is the last thing I remember until I woke up in my recovery room.

For me, this experience was really low-key. I had zero pain and only felt slightly foggy after recovering from anesthesia. I never had any cramps or an ounce of pain. But I know some people have very different experiences. I was really thankful for mine.

OVARIAN STIMULATION PROTOCOL

The next day, July 10, I began what is called the Ovarian and Stimulation phase of IVF. This is the period of time where you are injecting medications to help stimulate your ovaries. The goal is to stimulate enough to have a few (or more) eggs in anywhere from 9 to 14 days typically.

I documented this entire process on my Instagram. You will see a highlight called LAST IVF Round, and it has the whole journey saved there.

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DAY 1: July 10 – Started STIMS

Gonal F 300 IU SQ in PM
Menopur 150 IU SQ in PM

DAY 2: July 11th

Gonal F 300 IU SQ in PM
Menopur 150 IU SQ in PM

DAY 3: July 12th

Gonal F 300 IU SQ in PM
Menopur 150 IU SQ in PM

DAY 4: July 13th

Then I had my first monitoring appointment. This is just where I go into the clinic early in the morning, have my blood drawn to test for hormone levels, and have another ultrasound done to see if my ovaries are starting to develop follicles. Within the ovaries are the follicles, within the follicles are the eggs. An exception to this rule, not all follicles contain eggs-but that is ideal.

The nurses also measure the hormone levels in my blood to make sure they aren’t too low or too high. They measure each follicle within my ovaries to see if they are growing at the rate that my doctor wants. I go into the clinic every other day for this monitoring routine in case any medication dose adjustments need to be made. The goal is that my body will respond to the dosage and stay on track for an egg retrieval target.

On this day my estrogen level was right on track. I had six follicles in each ovary, a total of 12. The largest follicle was measuring 13 mm and every other follicle was less than 10 mm.

Although my body is responding, my doctor feels this is a little too slow. He decided to increase my Menopur and also add in a new medication, Cetrotide, starting the following day.

My side effects so far are a headache every day since day two, as well as pelvic fullness.

Tonight’s dose stayed the same:

Gonal F 300 IU SQ in PM
Menopur 150 IU SQ in PM

Day 5: July 14th

Cetrotide 250mcg SQ in AM [first day of new medication]

Gonal F 300 IU SQ in PM
Menopur 225 IU SQ in PM [increased dose]

DAY 6: July 15th

Cetrotide 250mcg SQ in AM before appointment.

I returned to the clinic for another monitoring appointment. My estrogen again was within the range they want it to be. However, my ultrasound wasn’t showing the follicles had grown the rate my doctor would’ve liked. He decided to increase my Menopur dose to 300, which is four vials every night.

I was a ways away from my house hosting a work event. It was the absolute worst time to have to go into the clinic every other day for monitoring. But, in IVF, you don’t make the schedule. You bend your life to fit the IVF schedule. I missed some of the event, drove out to the appointments each time, and came back to my hotel room early to do my night injections on time. It’s never convenient – but it is always possible. Life doesn’t just stop to make room for the needs of IVF – but, I want you to know – you can do it – you will find a way.

Gonal F 300 IU SQ in PM
Menopur 300 IU SQ in PM [increased dose again]

Day 7: July 16th

Cetrotide 250mcg SQ in AM

Gonal F 300 IU SQ in PM
Menopur 300 IU SQ in PM

Day 8: July 17th

Cetrotide 250mcg SQ in AM

Gonal F 300 IU SQ in PM
Menopur 300 IU SQ in PM

DAY 9: July 18th

Cetrotide 250mcg SQ in AM before Sunday monitoring appointment.

Another monitoring appointment. They wanted to give me a couple of days on the increased dose to see how my body responded. It feels like we have some good growth happening so they kept me on the same doses.

Day 10: July 19th

Cetrotide 250mcg SQ in AM

Gonal F 300 IU SQ in PM
Menopur 300 IU SQ in PM

Day 11: July 20th

Cetrotide 250mcg SQ in AM

I headed back to the clinic today at 7am for more bloodwork and another ultrasound to measure these follicles.
They kept me on same dose and want to bring me back again tomorrow to check everything again.
I made a critical IVF mistake and shared all about it on my Instagram.
I miscounted my medications and was unable to get the dose in time for tonight. A fellow IVF woman reached out to me on Instagram and gave me her left over meds from her recent cycle. An absolute angel. Go check out the whole story when you have a chance – she saved me.

Gonal F 300 IU SQ in PM
Menopur 300 IU SQ in PM

Day 12: July 21st

Cetrotide 250mcg SQ in AM

Back to the clinic for another appointment. When my nurse and I spoke yesterday – we were both assuming I would go another day or 2 on current medications before doing the trigger shot to help the eggs enter the last stage of development before egg retrieval.

At my appointment they measured 17 follicles, the largest one being 22.4mm in size, and 5 of them being “mature”. My doctor decided to have me stop all meds and do the HCG trigger shot tonight at 7:45pm.

We had plans to spend the evening with another family & do dinner at their house. So, we just packed up the meds, set my alarm on my phone, and got it done.

Novarel HCG Trigger Shot 10,000 IU at 7:45pm – intramuscular injection

Stop taking all stimulating medications and continue prenatal vitamins.

Day 13: July 22nd

Return to clinic in the morning for bloodwork to confirm my body is absorbing the trigger shot medication.

Bloodwork confirmed the trigger shot is being absorbed so the eggs within the follicles can finish the last stage of development before retrieval.

Take Zithromax 500mg – 2 tablets with dinner before tomorrow’s Egg Retrieval.
Nothing to eat or drink after midnight tonight in preparation for tomorrow’s procedure and anesthesia.

Day 14: July 23rd

Egg Retrieval Day!!

Arrive at the clinic at 6:45am.
Egg Retrieval under anesthesia is at 7:45am.

I tried really hard not to have any expectations yesterday. I tried to just go into this egg retrieval with the assurance that I did what was in my control and the rest was out of my control.

For the most part, I did that – but I had a hope in the back of my head.

At the time when my clinic decided to schedule my trigger shot & my egg retrieval- I had 5 mature follicles and a few more that could catch up after the trigger.

So in my ‘no expectations’ mind, I thought wow, wouldn’t it be great if we had at least 7 or 8 mature eggs… especially with my low AMH. This process is really not as much about the quantity as it is about the quality of the eggs. But the attrition rate is so high in this journey : when you start with more – the likelihood of delivering a healthy babe feels bigger.

Well : they retrieved 14 eggs! 👏🏼

Way more than I hoped for and I truly felt my first breath of relief when my nurse told me as I woke up from anesthesia.

I was groggy almost all day. Very little pain from the procedure –  but very foggy from the anesthesia. I was uncomfortable – but not in pain. (They gave me pain meds when I was asleep)

Got something to eat.
I wanted to work from bed, but my head did not feel clear enough for productive thoughts or reading.
Slept for a few hours.
Spent time with my miracle babe.
And then felt good enough to go to small group with some of our friends.

As the procedure pain meds wore off, I got more and more uncomfortable and that lasted most of the night. If I were to describe the discomfort, it would be an intense pulling feeling, mixed with a severe cycle cramp.

Day 15: July 24th

Early this morning the lab called me to tell us how many of those retrieved eggs were mature and how many fertilized properly.

After the retrieval: it’s typical for 80% to be mature.

Out of the 14 retrieved … and 13 were mature!

Then there’s another drop off for fertilization.

As of early Saturday morning, 6 fertilized properly – but a few more were just a little behind & may catch up

So now we wait a few more days to see how many become 5 day embryos (usually 30-50%)

… and if we have any 5 day embryos – we then send them off for genetic testing / which of course will have another drop off.

So, we are praying for these little embabies and their development over the next few days – then we will take it from there.

I appreciate all of your prayers and support during this journey. As many of you know IVF is confusing, expensive, and incredibly challenging. I hope these updates help paint of picture of the journey for others going through it — you’re not alone! Sometimes, reading other people’s journey gives you a little sturdy spot to stand as you embark on your own unique journey. My only hope is to encourage & to help others feel less isolated.

If you have any questions – please feel free to ask in the comments! I do my best to share whatever I can. And if you know someone going through this – please feel free to send them here to read and connect!

The Lord is good. And at the end of the day – if your story isn’t good yet, He just isn’t done yet. Have faith!