It’s been only a few days since my last post describing the process of being approved to move forward with IVF and the first few steps of the whole shebang. This week, week 2 of stimming (Stimulation/injectables) I have been closely monitored due to concerns regarding potential OHSS. Yesterday, I got the phone call I have been dreading… My progesterone levels sky rocketed from my last blood test and we no longer would be able to do a fresh IVF transfer. I tried really hard to be optimistic when I received the phone call as I knew in the back of my mind this was always a possibility. But once I had to break the news to Jason I totally fell apart. It’s so hard to keep getting your hopes up and trying to be consistently optimistic and then receive not so great news. For those of you who aren’t familiar with IVF let me explain what this all means.
For a normal IVF cycle you go through five not so basic and certainly not easy steps:
(#1) Suppression aka birth control to calm everything down in your uterus and ovaries.
(#2) Stimulation aka all the oh so fun injectables usually involving FSH (follicle stimulating hormone), LH (luteinizing hormone) and some form of an antagonist (a drug that stops your body from spontaneously ovulating before its time).
(#3) Egg Retrieval which involves a carefully timed ‘trigger shot’ protocol (mine involves a co-trigger) and then a surgical procedure exactly 36 hours later to retrieve all of your eggs from your swollen mature follicles. Then comes the big step…
(#4) Transfer aka the day they take your healthy mature embryos or blastocysts (depending on which day they are transferring them) and put them back inside your lovely cozy uterus. Lastly its time for the dreaded…
(#5) Two Week Wait where you get to pump yourself with loads of other fun medicines like progesterone and estrogen in hopes that your little embryo is a ‘sticky bean’ and you get a positive beta pregnancy test.
Throughout this whole process you have loads of early morning doctors appointments and are poked and probed more times than you care to count to ensure all your hormone levels are where they need to be, that you are progressing not too little/not too much (sounds like a Goldie Locks story) and of course that your little follicles and future little embryos are doing what they should and that is grow! Amongst of these daily injections, almost daily doctors appointments, filled with blood work and the ever so pleasant vaginal ultrasound, your job is to remain cautiously optimistic that everything will turn out A-OK.
Welp, I’m here to tell you that in my experience, both personally and in hearing from others who have or are currently going through this process that just isn’t likely! As fun as IVF and infertility already are with all their heartbreak, plot twists and turns… You don’t get to get off the roller coaster of emotions until your little bundle of joy (I know, I know, the puns are ridiculous) is safely in your arms.
Keeping all of that background info in mind, lets talk about what is happening in my first IVF cycle and where it went wrong. It’s probably easier for me to show you with a day by day run down of my doctors appointments so here goes nothing!
Dr’s Visit 1 – Suppression check (12/22)- Following 14 days of birth control pill. All looks good! You can barely see any follicles as they are currently suppressed and my uterus lining is falling somewhere in the broad range of average though it was somewhat on the thinner side. I was told my period would likely start in the next few days but I no longer needed to call with day 1 of the cycle. I had blood work done following my ultrasound which confirmed I was sufficiently suppressed and ready to start my first stimulation medications on December 24th! (Early Birthday present?)
Dr’s Visit 2- Initial STIM Check (12/28 STIM Day 5) – Supposedly all looks good, though I was slightly disappointed to see how small my follicles were. So small that they only counted them, rather than bothering to measure them which is what I thought they would do. Doctor said not to worry at all, young people are like an airplane, they start off slowly down the runway and then take off like crazy out of nowhere. Suggestion was made to stay on current doses of meds and come back in a two days (Menopur 75 IU, Gonal-F 150). FYI- not really feeling any symptoms of the medications yet just bad headaches at night. For a frame of reference: My blood work showed my estrogen to be in the 200’s and my uterine lining was 6.9mm. Luteinizing and progesterone were both in the 0’s range.
Dr’s Visit 3- Second STIM Check (12/30 STIM Day 7)- Things are still slowly progressing, you can see more follicles but they are still very small some wheres in the range of 5 – 8 mm’s. Given the fact they need to be 18mm and above to be considered mature we have a long ways to go! Mind you it’s only been two days since my last ultrasound/blood work appointment. Patience is a virtue I still hope to one day achieve 😉 My estrogen level is now at 649 thats a jump of around 449! All in less than 48 hours, isn’t it crazy what our bodies are capable of ??? Anywhoo, the science nerd in me digresses. LH and progesterone were still very low which is a good thing! I am now told it is time to start my antagonist protocol in combination with my STIM meds. That means keeping my two shots in the evening the same (Menopur 75, Gonal-F 150) and adding in a lovely early morning shot of Cetrotide! The enthusiasm is real! I mean if I wasn’t a morning person before, I’m sure dragging my sleepy butt out of bed at 5:30 a.m. to ice my sensitive tummy, mix medications and inject myself will definitely do it!!
Dr’s Visit 4- Third STIM Check (1/2 STIM Day 10) – Grow follies grow! Follicles have gotten a bit bigger but still have a ways to go as they were ranging from 10-17mm. Still nowhere near were they need to be, making me somewhat anxious. Doctor mentions briefly that we will want to keep a close eye on my estrogen levels moving forward due to concerns regarding potential OHSS. Let me state clearly that true OHSS can be mild but is typically severe and has levels of estrogen somewhere in the range of 8,000 -10,000! My doctor already warned me that she would not let me get anywhere near that level especially if we wanted to continue with a fresh IVF transfer. I left the appointment feeling cautiously optimistic and headed to work.
If anyone hasn’t told you yet, waiting for the phone calls from the nurse with follow up directions is like waiting to here if you one the lottery.. you can’t think about anything all day until you get the call, and then after you get it, you still can’t think straight! So much for being productive at work. It’s hard to keep your head on straight when you are constantly running scenarios, dates, timeframes, and medication protocols through your head. (I can just imagine that as the new poem for “T’was the night before Christmas” except it would be “T’was the start of IVF”). Anyways, when I finally got the call regarding my blood work I got a bit concerned, my estrogen had jumped up to 1,689 and my progesterone was now at 1.3). I was told not to worry but they wanted to see me again in two days. Cue the automatic worry that occurs when you are an IVF patient with anxiety!
Dr’s Visit 5 – (Fourth STIM Check – 1/4 STIM Day 12) Do I get frequent flyer rewards for this? It feels like deja vu every time I park my car, ride the elevator, stop at the restrooms (cause obviously this is a necessity before being probed down there) and head into the office. I’m becoming such a regular that they now recognize my voice when I call to confirm appointments, don’t ask for my name when I arrive, and carry on conversations where we left off the day or so prior like old time friends! This time my follicles are somewhere in the range of 13- 18mm but once again still not mature enough for trigger shot. The doctor mentions I may likely need a few more days of meds to let them grow bigger. This immediately freaks me out as I know I only have enough medication left at home for one more round of shots. I needed to know if I should order more or not.. Not to mention it was the beginning of the bomb cyclone – 2018 blizzard and now I was full of worry over follicle size, medications, snow storms and yet again more injections! I tried to relax and enjoy the rest of my snow day but it that just wasn’t going to happen.
And then I received the phone call… It went something like this “Hi Joy, its nurse Karen, I have your blood work results. Your estrogen level is at 2,266 and your progesterone level is at 2.09 so we are going to have to cancel your fresh cycle and do a ‘freeze all’.”.. And just like that my hope of having a smooth first round of IVF were gone. I’ll admit that at the time of the phone call I was so taken aback by the seemingly sudden turn around I honestly didn’t know how to respond. The nurse told me the doctor wanted to see me first thing in the morning for another ultrasound and blood work. I knew it didn’t sound good. I spent the rest of the night worrying what it all meant.. would we cancel egg retrieval too? Was all of this a big waste? Do I have OHSS? Should I be worried? Am I going to be ok? What if I don’t have mature enough follicles? When will the frozen transfer happen? IS THIS EVER GOING TO END…
And thats when it hit me that I should be thankful, and that all of these thoughts are selfish. Yes, my journey has yet another unexpected turn in the road. When has that ever stopped me from going after what I truly want? It hasn’t… Also, its times like these where I once again thank god we are covered fully by insurance. For someone else, or I should say for most people. That phone call would mean not only more heartache, for all the what if’s, but also a bigger financial burden. I can’t even imagine that kind of stress. If you are reading this right now, and that scenario is you, I want you to know that I am praying for you. I am praying that things turn around, I am praying your journey get’s easier not harder. I am praying that you have the strength to keep carrying on.
Dr’s Visit 6- (Fifth STIM Check – 1/5 STIM Day? or Trigger Day?) I was up bright an early to take what might be my last antagonist shot. I was nervous as I dug my car out from the blizzard the night before and drove carefully towards my clinic. So many thoughts where racing through my head so I did my best to relax and remind myself that what ever happens is meant to happen (totally easier said than done right?). I got to my clinic and parked in my favorite spot (yes, I now have a favorite parking spot). I made my traditional walk to the elevator, then up to my floor, and to my now ceremonial bathroom visit before entering in the clinic doors. I sat in the waiting room with bated breath. They quickly called me back for my blood work and then sat me in the ultrasound room for what felt like 45 minutes (in reality it was probably closer to 10).
The doctor came in all dressed and prepped for surgery (clearly someone else was having their lucky egg retrieval day). She took her time to explain what was going on and why we would have to cancel the fresh cycle. She completed the ultrasound and I was pleasantly surprised to see that my follicles had magically grown overnight and were now in the 17-23 mm range. (Silver lining people!). She told me she would double check on my hormone levels but I would likely trigger tonight, come in for more blood work in the morning and then have my egg retrieval on sunday…. Let me repeat that… I was still able to have my egg retrieval!! and my follicles were now suddenly mature!!! (god does have a plan for me).
Then came the second blast of not so great news.. if my egg retrieval was on sunday my doctor would not be the one performing the procedure. I know that probably doesn’t sound like a big deal, but trust me, it is to me. I have built up significant trust in my doctor. Her approach is one full of calm, and sensitivity, and egg retrieval is an incredibly sensitive procedure! I know the other doctor is just as smart and talented as mine, but the relationship is different, the trust level is different, and heck the approach will likely be different (each doctor has their own style after all). I know this is all out of my control, but as I’ve mentioned before, that certainly isn’t easy for me. To top it all off, having my procedure sunday means I would have to miss one of my best friend’s weddings. I felt awful breaking the news to her.
When I finally left the doctors office I went home and took a nap. All of this stress is trying to take it’s toll on me and I am determined not to let it happen! Plus we got a bonus snow day thanks to the bomb genesis storm so why not? Later on I got the call from my nurse, Karen. My estrogen level was at 2,511 and progesterone was at 2.39. Due to my levels, tonight was going to be the night for my co-trigger, followed by a second trigger antagonist in the a.m. and blood work to ensure everything was working correctly. I am now scheduled for my egg retrieval on sunday morning at 6:30 a.m. I will write a new post updating the process of the co-trigger, blood work and egg retrieval day. Until then, wishing you and yours lots of love, luck and baby dust!