Rough day

Sunday morning I had another scan and more blood work done.  Spencer got to come with me this time since it was a weekend.  Blood work went fine.  The scan was fine too. Spencer got to see all of the follicles.  They were measuring a little bigger than Friday at 10-13mm, which the nurse said is excellent progression.  She said that the doctor would make the call for Monday or Tuesday as my next scan and blood work.  The call in the afternoon confirmed that I’d be going in again on Monday.  My estradiol levels were at 2794 and they told me to continue my dosages as usual.

Monday was rough.  My appointment started out ok, or so I thought.  I decided to switch up the arms for the blood draw and go back to the right arm. The nurse couldn’t find a vein.  So we went back to the left arm, where she still couldn’t find a vein.  Sigh. She went and got someone else, who came over and prepped me a little more thoroughly, then found the vein in no time like an old pro.  She bandaged me up and showed me to the exam room.  The scan went fine again.  The nurse said my ovaries are kissing; they are so enlarged they have come together inside me and are way closer to each other than usual.  The follicles were measuring up to about 15mm with many stragglers around the 11mm mark.  The nurse measured about 10 follicles from each side and there were still plenty of smaller ones she ignored.  She said that the doctor would either want me back Tuesday or Wednesday for another scan to see if it’s time to trigger.  If it’s Wednesday, I need more of the Ganarelix; I only have the dosage through Monday night.

The call from the nurse today set off a whirlwind of emotions in me.  My estradiol levels are great, in the 3000s at 3517.  She said that the doctor would like me to come back on Wednesday.  Well crap.  This pushes back the retrieval to Friday, not Thursday like I’d been mentally preparing for.  And I have to order more Ganarelix, so more money and a scramble to locate some.  I need the Ganarelix to be over-nighted or available for pick up.  The nurse gave me the names of a few pharmacies, and I called around.  The first one was going to charge 20 bucks to have it shipped over night, so I said I’d wait and shop around.  I called several pharmacies before finding one that has it and will over-night the medication for free. I called the nurse back and told her where to send the RX. Then I took a break and went for a walk because all of this really upset me.  Pretty sure it was just the hormones and the stress of trying to find the medication I need in such a short window. 

After a few tears, I went back to work. Work in itself is becoming tougher because it hurts to sit down.  My ovaries are so big, they make everything hurt. The ovaries are crampy because they are growing. I’m bloated because of this and the medications.  I’m thirsty all the time, so I down water like no one’s business.  This means my bladder is always full and pushing on much more crowded pelvic cavity.  It feels better to stand but that’s difficult without a standing desk.  I use two boxes to raise my keyboard and mouse then angle my computer screens upwards more.  This works ok, but my feet start to hurt after a few hours of standing.  Driving is worse because I can’t move around and the seat belt pushes on my belly.  I’m also hungry all the time; eating large meals is uncomfortable, so I have to eat a little at a time, but then I feel like all I do all day is eat.  I know most of this is temporary but it’s harder to deal with because of the hormones.  Today I think it was worse because I have to put up with it all for another day. Before this afternoon’s phone call from the nurse, I only had to make it to Tuesday when we trigger, then Thursday for retrieval.  Now I won’t trigger until Wednesday at the earliest and retrieval won’t be until Friday.  I can do this. Suck it up and get through it, is what I keep telling myself.

In the meantime, I haven’t felt like doing homework, so I starting to stress out about falling behind in my classes.  Just a lot of overwhelming feelings right now.  Most of it self-inflicted because of my procrastination.  Here’s to hoping this is all over soon and we get enough eggs to not have to do this again.  I have no idea how some women stand doing this for three or four rounds (let alone fund that many attempts). 

Shot/blood draw counter: IIII IIII IIII IIII IIII IIII II

Symptom tracker: ovaries feel like they are each the size of melons (hyperbole I’m sure), bloated, thirsty, lower back pain, hormonal/stressed out, tired, hungry, acne, some insomnia

The one week mark

The Ganarelix I added on Thursday is not good at all.  The first time I used it I had all kinds of issues.  There was a bunch of air bubbles in it that just didn’t want to come out.  I finally got those out and prepped my tummy for the shot.  The needle gauge is in between the two that I’m already using, so I figured it’d go in easily.  NOPE! I ended up pricking myself twice before I finally got it to go in all the way.  Then it burned! I had a red splotch on my belly for over an hour, which according to Google searches is a normal side effect the first use.  And it continued to burn for a while after the shot too.  I’m glad this wasn’t included since the beginning, but sad that I’ll probably end up using all 5 of my doses of it.

The appointment on Friday went well.  I asked about why my nurse appointment was changed to a doctor’s appointment and the doctor just mentioned that they were going to a conference and wanted to see me one last time so my case was fresher when doing the phone consults over the next week.  So no problem with me, just a routine appointment.  The nurse had trouble drawing blood out of my right arm, so we had to switch to the left arm.  This one worked and I guess I’ll lead with it next visit. The scan went well too. The doctor said that my lining was looking good and measured my follicles again.  They were up to about 10-11mm.  The doctor said I have a good number of follicles and will be very full by the time of retrieval.  Oh boy!

The nurse called earlier in the day and said that my estradiol level is 1176, which is great.  She said to continue doing my same dosages for the next two nights and they’ll see me on Sunday morning for more blood work and a scan.  I should learn more about when my next appointment after that is, Monday or Tuesday, and hopefully get a better idea of how the next week will look with retrieval. It’s getting so close yall! The shots went ok Friday night; the Ganarelix was a little better, but still stung for a bit after it went in. 

Shot/blood draw counter: IIII IIII IIII IIII II (as of Saturday night)

Symptom tracker: Bloated in evening, ilioscaral joint aches, thirsty

Things are speeding up!

Tuesday was my first blood draw after stims had started. I got to the doctor’s office first thing at 7am and had to wait a little while before they called me back.  She drew my blood and that was it.  I made sure to drink lots of water before this appointment so the blood draw would go easily.  I also asked the phlebotomist if it was normal for one side of my belly to hurt more with the shots than the other, thinking about how much more the left side hurt the second night compared to the right side on the first and third nights.  She said that was normal and that I could do all of my shots on my right side if I wanted to.  I’ve decided to give the left side a second chance; that perhaps I was just doing something slightly wrong. 

By the afternoon, the nurse called back with my estradiol level – 406.  She said this was excellent and to keep my dosage the same that night.  She also said that they wanted to see me Wednesday instead of Thursday for my first scan.  I made the appointment with one of the physicians doing the scan since the nurse I spoke with wasn’t available.  It got me really nervous that my scan was moved up and that my numbers were so high already.  My mind started jumping towards having too many follicles growing already and that I was headed for a difficult experience. 

Shots Tuesday night were done at my parents’ house because we went over there for my dad’s birthday dinner.  I tried it in my left side again and it worked okay.  I think I wasn’t darting the needle in quick enough the second night.  I still don’t like the Menopur needle because they are slightly bigger than the Gonal-F pen.

The appointment this morning went a long way towards easing my mind.  I got my blood drawn after I got to the office. Then I was shown to an exam room and got undressed from the waist down.  The doctor came in and asked how I was feeling.  So far my main symptoms have been bloating/gas and a bad back ache, which I told her.  I guess those are normal, because she didn’t really have much to say about that.  Then she proceeded with the ultrasound, measuring my lining and the largest follicles on each ovary.  She said my lining looked great. I have 3-4 follicles on the right ovary measuring about 7-8mm each, plus lots of smaller ones that ought to catch up.  My left ovary had 2 large follicles each measuring 8-9mm, plus many smaller ones.  My cyst is still there, but is small and didn’t seem to worry the doctor.  She said I’m progressing just fine and is exactly what they want to see.  I mentioned to the doctor that I was worried about my exam being moved up and she said it’s normal; they are just trying to figure out when to start the antagonist (Ganirelix in my case; this is what keeps me from ovulating on my own).  That put my mind at ease.

I got the phone call from the nurse later in the afternoon. She said my estradiol level is at 592.  I’m supposed to start the Ganirelix on Thursday.  The part that makes me more nervous again is that she wanted to change my appointment so that a doctor does the scan, not a nurse.  I’m sure it’s nothing, but it seems like maybe I could be kind of high risk if the doctors have to keep doing my scans and not just a nurse.  I’m probably worrying too much.  But I’m actually surprised at how zen I’ve felt about most of this experience.  I expected to be much more anxious about every little detail.

Shot/blood draw counter: IIII IIII I

Symptom tracker: Bloated, slightly crampy, ilioscaral joint (where hip bones meet the back bone) aches, hungry

Pokey pokey

Yesterday morning was an appointment for a blood draw.  They were testing the LH levels in my blood in order to confirm the dosages I should inject myself with starting that night.  We got there just in time for our 8:15 appointment, even with stopping to put a few gallons of gas in the car because I forgot how low it was.  We had to wait for nearly 20 minutes before the nurse came back to grab me. She asked on the way back to the phlebotomy lab if I’d had any water today. I hadn’t because I was in such a rush to get out of the house.  She gave me a water bottle and told me to drink it.  After drinking about half the bottle very quickly, she started to look at my arm to see if she could see a vein.  She poked my arm but didn’t think it was going to produce enough, so she took the tourniquet off to start a new poke. That sped up the flow and she got what she need without poking me again. Yay!  That was everything for the appointment; they will call with the results that afternoon.

First of many early morning appointments

I got the call in the afternoon that my LH level was just above 1, which is what they want to see.  So my paper with the dosages that I’d gotten earlier in the week still reigns true and I was supposed to start those that night.  We had already made plans to go over to Bill and Rachel’s Saturday evening to watch the new season of Dr. Who premiere.  I took everything I needed for the injections over there so I could do them at the right time.  I decided 7pm ought to be a good time for the next few weeks. So around 7, I got everything out. Spencer helped me with the directions and I prepped the injections.  We took everything one step at a time.  I did the Gonal-F first; I just dialed up the dosage and put a needle on the pen.  Then pushed the needle in and pushed the button. The pen did all the work. After I the pen finished the dose, I pulled it out and capped the needle.  That shot didn’t even hurt.  I was kind of excited.  The menopur was more complicated because I had to mix it myself.  I got out the new syringe and put the mixing needle on it.  I used it to draw out 1cc of the sodium chloride solution and inject it into the powder.  I swirled it around and then drew it out of that vial and injected it into the second powder vial.  I took two doses of menopur; so once I was done with the second powder vial, I changed out the mixing needle for the injection needle.  I felt like a lost a little bit of the dose because of my inexperience with the syringe; I think I got enough of it though.  This needle was slightly bigger than the first one, but it still didn’t hurt going in.  Once I started to push the plunger down and insert the menopur, that burned a little.  I read somewhere that it burns because the sodium chloride, but who knows.  This shot wasn’t too bad either.  Once I was done with it, I capped the needle and threw it out in my sharps container.  That was it. I cleaned up all the wrappers and was all done.  Time for ice cream, which is my reward for needle pokes.

My daily medications

 

Today’s injections were a tad different.  Now that I had done it once, I felt more comfortable prepping the injections.  I feel like I did a better job of that.  But the left side of my belly doesn’t like the needles as much.  I felt the needles going in today. L The medicine burned still going in too.  I hope this was just a fluke and they go back to being nice and easy like yesterday.  I was so pumped at how easy it was yesterday, but I’m starting to lose the excitement and confidence since today’s shots were worse.  I guess I’ll know more tomorrow.  Maybe I’ll get some numbing cream or ice my belly first.  I do more shots on Monday, then go back for another blood draw on Tuesday, where I get my new dosages depending on how I’m responding.

And so it begins...

We had our baseline appointment today; the only directions were to arrive with all of our meds and a full bladder.  They started by drawing blood to send to the lab, then put us at a table in the coordinator’s office to wait for everything to be ready, because apparently we were early.  We got moved to an exam room where I was told to undress from the waist down and sit in the exam chair under the orange blanket.  I had to pee so bad this whole time, which I was hoping would be the worst part of the whole process.  The nurse checked my bladder to ensure it was full enough.  Then the doctor finally came in to do a mock transfer.  He put a speculum in to open me up (it was really cold); the nurse used the ultrasound equipment to show the doctor what he was doing as he inserted a few more tools.  After “tickling” the top of my uterus, which felt more like cramping than tickling, we were done.  It was uncomfortable for sure, especially with the cold speculum and the nurse pushing on my full bladder; but it wasn’t unbearable.  The doctor said when we do the real transfer I’ll have some valium so I won’t be as nervous.  Haha, can’t wait! After that, I cleaned up, got dressed, and finally got to pee! 

Then we met with the IVF nurse to go over medications.  She double-checked to make sure we ordered everything we needed.  Then she showed us how to do the injections.  The Gonal-F seems rather easy; I just dial the pen to the dosage required and then poke it into my belly, an inch away from my belly button.  Hold the button for 3 seconds and pull it out.  Recap it and put back in the fridge for the next day.  The menopur seems a little more complicated.  I use one vial of liquid and two vials of powder and have to mix it each night.  I take 1 cc of liquid out of the vial and throw that out.  Then inject the liquid into the first vial of powder, swirl it around until the powder is all dissolved. Then I pull the liquid out of that vial and inject into the next vial. Repeat process and then draw it back into the syringe. I change out the needle and inject this into the same spot as the Gonal-F.  I am supposed to alternate sides each night to keep the bruising and discomfort to a minimum. I’m also supposed to take the meds at the same time every night after 6pm. I think we decided to do 8pm so I will probably be at home each time and so I can have ice cream afterwards. Ice cream is going to by my treat after each poke in this whole process. These are the only meds I’m using for the first few days. I go in on Saturday for more blood work and then they will tell me what to take.  This whole process is planned out tentatively up to the trigger day, but could change as we move along and blood work and scans come back.  Everything is spelled out in detail and the nurse is only a phone call away.  Hard to believe that the time has finally come! I probably won’t write again until the adventure of Saturday and my first injections. 

Here is a shot of my meds from when I unpacked them:

 

What is PCOS?

PCOS, or polycystic ovarian syndrome, is a hormonal imbalance that affects 5-10% of women of childbearing age.  It messes up a woman’s period and causes infertility, as well as changing one’s physical appearance and possibly leading to diabetes or heart disease.  Most women with PCOS have many small cysts on their ovaries, hence the name; these cysts are not usually harmful but cause hormone imbalances. Ovaries of women with PCOS make too many androgens (or male sex hormones).  This causes irregular ovulation, acne, and extra hair growth on the face and body.  Women with PCOS often have a problem using insulin, or insulin resistance; this leads to elevated blood sugar level and increased risk of diabetes.

Symptoms of PCOS begin mildly and only a few at a time. They include acne, weight gain, extra hair on the face and body, thinning hair, irregular periods, fertility problems, and depression.  [I had almost all of these within six months of going off of birth control.]  Diagnosing PCOS involves a health history, physical exam, blood work (to test blood sugar and hormone levels), and a pelvic ultrasound to examine the ovaries.

Regular exercise and healthy foods are the key treatments for PCOS.  Birth control pills can reduce symptoms. Metformin, a diabetes medication, can help regulate your blood sugar levels and help encourage a much more regular menstrual cycle.

Some websites with good information about PCOS that I used after my diagnosis:

• WebMD – Polycystic Ovary Syndrome Topic Overview (http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-topic-overview)

• What is PCOS- PCOS Foundation (http://www.pcosfoundation.org/what-is-pcos)

• Polycystic Ovary syndrome (PCOS) fact sheet (http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html)

So what is In Vitro Fertilization?

After talking with the doctor and learning about all of my issues, we decided to proceed with IVF once we got the funds together.  Our post-op appointment was a lot of paperwork signing and questions answering.  Doctor said we have about 46% chance of success with a single embryo transfer and 57% with two (however, this also comes with almost 40% chance of twins compared to about 2% with one embryo).  So we are electing to go with just one for now.  I guess if the embryos don’t look as perfect as we want, we can always bump it up to two at once.  IVF uses medications to stimulate the egg follicles in the ovaries and encourage them to grow.  Some women with PCOS already have lots of follicles, so there is a chance that they will become over-stimulated and develop OHSS (Ovarian Hyper Stimulation Syndrome).  The doctor said that I would have a low chance of hyperstimulation because of the protocol they are going to put me on, but this is something that worries me a bit.  If I were to get OHSS, then we would most likely have to freeze all of the embryos and do a frozen transfer later.  

Basically, they will take me off birth control pills, and four days later start injections.  After 10-12 days of hormone injections and lots of scans and blood work to monitor the growth of my follicles, I will trigger the eggs to release. Before my body actually releases the eggs, they will do the retrieval and fertilize the eggs.  About 5 days later, they transfer the embryo into me.  After that, I have to wait almost two weeks to find out if the embryo implanted or if it was a failed cycle.  Hopefully we get a quite a few eggs.  The odds are that you lose about half of the eggs retrieved between retrieval and transfer/freezing.  Our hope is to get several embryos, transfer one and freeze the rest for future frozen rounds.  The frozen round costs quite a bit less money, so hopefully that’s how we can get baby 2 and 3 if it’s in the cards.

How this crazy journey all began...

Hubby and I have been trying to make a baby for over a year now. I think it’s safe to say that both of us thought it would be quick and easy to get pregnant since we are both rather healthy and young. After nine months of trying and increasingly erratic cycles, I finally went to see the doctor after my period was late but pregnancy tests were still negative.  2 doctors, lots of blood draws, a 24 hour urine test, and two ultrasound scans (one thyroid and one pelvic) later, I finally had some answers: PCOS (polycystic ovarian syndrome).  The pelvic ultrasound also revealed that I had a cyst in my left ovary and my right fallopian tube was blocked.  I decided to have surgery to remove the cyst and fix the tube so that we have a better chance of conceiving.  This surgery was much shorter than planned since once inside he found that I have stage IV endometriosis and closed me up instead of proceeding.  So basically, with both endometriosis and PCOS, IVF is likely our only option for getting pregnant; because of this we got a referral to a fertility specialist to find out what they suggest.

Dr. D is who we picked for our fertility specialist. Our meeting with him in mid June was a whirlwind.  We discussed my background and infertility, then he did another pelvic ultrasound, which was uncomfortable because of my endo. He definitely confirmed PCOS since I have about 30 or more follicles on each ovary.  He also informed us that the cysts were actually endometriosis on the ovary, forming “chocolate cysts”. These are basically pockets of blood in my ovary that have no way to drain, so it’s just nasty old blood trapped in my ovary. Gross!

After the exam, we went back to his office to talk.  Dr. D said I have lots of eggs, so that is good.  In order to remove the endometriosis more permanently, he’d have to take out a chunk of eggs as well, so he wants to wait on that.  He said with the tube blockage, the cysts on my ovaries, and my PCOS, about our only chances for pregnancy is IVF. I have both the hormonal and structural problems that are associated with infertility; luckily, hubby has good sperm.  He recommended the option that requires less egg stimulation since I have so many follicles. The doctor also recommended optimizing my plumbing before starting IVF.  This involves removing my right tube and draining the endo cyst on my right ovary.  This will prevent complications during the IVF procedure and pregnancy.  Apparently my tube drains into my uterus because it cannot go out the normal way into my pelvic cavity.  This can cut my success rate by 25% for IVF/pregnancy.  With the endo cyst, removing eggs could puncture the cyst and cause bacteria-ridden old blood to leak into my ovary, infecting it.  We opted for the surgery, especially since I’ve already met my out-of-pocket max with the insurance which means it’s free.

The surgery went ok. My recovery was a bit tougher than the last time, dealing with a few complications like constipation from the pain meds and my endo flaring up later in the week.  I started birth control pills so that I won’t have a period for a while; the nurse told me I could just skip the sugar pills and go straight to another package, so that’s what I did in order to avoid the endo pain associated with my period.   The next step is to get our IVF scheduled and paid for, but I’ll save that for another post.