2 Days Down, What Feels Like a Century to Go!

How many days left until the pregnancy blood draw? A whole week you say?? I don't think I will make it...already going crazy waiting and wondering! Even though my RE doesn't require strict bed rest following the embryo transfer, I've definitely been taking it easy. If I had to describe my state the past couple days it would be "movie watching and laziness to the extreme." Hubby even unloaded the dishwasher, swept after dinner, and boiled water for his tea last night. Gasp! haha! Speaking of hubby; What a sweetheart. He surprised me last night with a card that make me bawl and these...

From my sweet hubby. :)

Seriously though, it's weird not doing chores or anything that involves lifting and core strength, but I've been really careful just to be on the safe side. I have read stories from women who didn't even shower for 3 days following their transfer, staying on complete bed rest, but that is a little beyond what I personally think is necessary in order to achieve a state of rest....no offense to anyone who has adopted that regimen. I just think the mental state of taking it that far would outweigh any physical benefit in my case, but that's just me. Instead, I'm just keeping my pace at a mosy, while still continuing to cook, eat, drink, and bathe as normal. No gym time whatsoever either of course.

I'll venture out into the real world again tomorrow for my volunteer shift downtown. I'm also taking a lot of time to just meditate, listen to soft music, and trying to envision what amazing things could be going on inside of me right now. I was actually having a little trouble even knowing what should be going on in there in the days following an embryo transfer until I found this cool little chart...

Source: NYU Fertility Center @ http://www.nyufertilitycenter.org/ivf/embryo_transfer

So, now instead of just picturing something random, I have a little more direction on some specific visualizations. Seeing this also got me a little antsy to want to do some HPT's at home, before the actual pregnancy blood draw. I am not a Pee-On-A-Stick-aholic by any means. I actually detest taking HPT's at home, because seeing a negative result just affects me in such a bad way. Major mood killer! However, I also know that a pregnancy could be detectable days before the RE has me scheduled to do the blood draw.

After my 2nd and most recent pregnancy loss, I was made aware through more extensive testing that I happen to have 4 blood clotting/autoimmune disorders, which absolutely have the potential to cause miscarriages. That is why I already have a prescription sitting here from my hematologist for Lovenox, ready to be filled the moment I found out I'm pregnant. I have been ordered to take these daily blood thinner injections (in addition to the daily baby aspirin I'm already taking) once I am pregnant next time around. This will help to prevent my blood from clotting and causing any complications. It's for that reason, that I really do want to find out if I am pregnant ASAP.

I went ahead and ordered some Wondfo HPT's last night. They should arrive tomorrow, which means I can begin testing on Saturday morning. By then I will be 5dp5dt (5 days past 5 day transfer). I have never used an hCG trigger shot before either, and now I'm thinking I should have started testing sooner to truly "test out the trigger." For anyone who doesn't know, you can get a false positive pregnancy test if you've used the Ovidrel trigger shot and hCG from it is still in your system, so what many women do is take a pregnancy test every day following an IUI or IVF transfer and watch the pregnancy tests go from + to - first. This confirms that the trigger shot is out of your system completely. Then if any subsequent tests return to a +, you know it's the real deal. Sounds like a lot work, but really it only requires about 2 minutes each morning to pee in a cup and dip a stick for 5 seconds.

I've never tested out a trigger. Will it be too late to even do that if I don't start testing until 5dp5dt? I am thinking I should have started this whole testing process much earlier now unfortunately! I guess if it's negative, I'll know the trigger is out of my system for sure. However, if it's + can I assume it's still the trigger or is it possibly the real deal? I am already confused and haven't even started testing yet! ha! Any advice or feedback on when a trigger shot should leave your system is welcome!

5 Frosties...and I Don't Mean the Chocolate Kind

Our embryologist just called with an update on our potential "frosties." I was hoping he would say we had the 3 we expected make it to freeze quality today, but to my surprise he said we actually have FIVE frosties make it so far! And no, I'm not talking about these...

Oh, what I would give for A) something chocolate and B) something ice cold and sugar laden! Oh well,  I will still take my frosties over this one right now.

The IVF process is so incredibly nerve racking, and any small piece of extra insurance just helps the couple going through it know they won't be left with nothing if it doesn't work. For my hubby, one of the biggest "pros" for him in us choosing doing IVF was the prospect of having frozen embryos for back-up or for a later time. While I always appreciate his glass half full outlook, I also kept reminding him that frozen embryos are not a guarantee in this process, especially for someone diagnosed with DOR. I just didn't want him to expect all these frozen embryos and then us not have any.

Even at the group IVF meeting we attended, the embryologists stressed more than once that "Having frozen embryos is a privilege, not a guarantee."  I think that has just been drilled into my head so much that I've tried to keep my expectations low and my hopes high regarding cyropreservation....and more specifically vitrification, which is the latest and greatest type of rapid freezing used in most labs.

We are very grateful. I feel like I can breathe easier just knowing that we have a plan B if needed. If we do ever need to do a FET (frozen embryo transfer) later on, success rates are almost comparable to fresh cycles nowadays, because of the rapid freezing process used in vitrification.

Plus, having frozen embryos for use at a later date means if we decide to have another child 3 years from now when I'm 38 for example, our embryos will still be made with eggs that were only 34/35 (I turn 35 less than 2 months from now). Using these frozen embryos later could reduce some risks associated with AMA (Advanced Maternal Age) that increase sharply at age 38. In case you didn't know, pregnancy risks are defined by the age of the eggs used to make the pregnancy, and not necessarily the woman herself when ART (assisted reproductive technology) is involved. This is why a 42 year old doing IVF with donor eggs from a 22 year old would still have extremely low risk for things like Downs Syndrome...because her egg age is only 22.  Not saying this theoretical procreation timeline is part of our master plan. I'd love to actually become pregnant on my own at some point without using science, but I'm just saying it's an added benefit of having frozen embryos available for later if we did happen to need them.

Just a little frozen embryo humor for you. :) One of the other great aspects of doing an FET if needed, is that it is waaaaay cheaper to transfer a frozen embryo than to do a whole fresh IVF cycle all over again if needed...like $3-$4K vs. $15-20K+. Yeah, BIG difference.

Without further adieu, here is today's freeze report:

2 embryos frozen yesterday (BC quality)
3 embryos frozen today (2 BB quality, 1 CB quality)

I am perfectly happy with B and C quality! From what I'm told, my lab is super strict as well, so I don't even know how often they dole out A's to be honest. Plenty of B and C embryos become healthy happy babies, so that's all I care about. We also still have 5 embryos growing in incubators right now. We will see if they reach freeze quality by tomorrow. The embryologist said it's pretty rare for an embryo that hasn't reached freeze quality by Day 6 to then reach freeze quality by Day 7, but anything is possible. They will call with a final report by tomorrow, and we'll know if any of the remaining 5 fresh embryos stepped it up a notch overnight. Either way, we are ecstatic with the 5 frosties we have already. We will take it!

Two Little Embies Transferred

I've been trying my best all weekend to have faith our embryos would be strong and ready once we arrived for our transfer today. I kept having those pesky thoughts creep into my head that we would arrive and they'd say, "Sorry, we regret to inform you that none of your embryos survived." GASP! I know I know....stop worrying so much! I can't help it though. We have so much riding on this IVF, and I don't think I'm totally abnormal for wondering "what if." Needless to say anytime I had those thoughts, I immediately stuffed them deep down into oblivion where they belong. Rightfully so, because there was no such bad luck today...quite the contrary.

After my pre-transfer acupuncture session we made our way to the fertility surgery center, the same place we had our retrieval done. The best part of the appointment was seeing my husband in this...

That's the spirit!

They also outfitted me with these fancy shmancy skid free socks...

Safety First! haha!
Totally saving these for my 91 yr old grandma.

I don't know about you, but I have never seen such fancy hospital socks before, and I appreciated the effort from the facility to give us a good laugh with our ridiculous apparel.

The embryologist then came in with a report on our embryos and asked us to confirm how many we wanted transferred. I am not the most knowledgeable on the whole "embryo grading" thing, but the embryologist seemed very happy with their progress. He brought in pics of the strongest embryos; Ones which were already "freeze quality", meaning that if we wanted to cryopreserve them today, they were developed enough to do so. To explain...Just as an embryo is stronger at Day 5 than it is at Day 3, it's even stronger once it reaches freeze quality. Typically they give extra embryos about 7 days max to develop after they are retrieved to reach freeze quality and have a chance at cryopreservation, so the fact three had reached their benchmark at Day 5 is good news as far as we're concerned.

We discussed number of embryos to transfer once again with Dr. Vaughn before making our final decision, and we went with two. However, Dr. Vaughn felt the top two embryos we'd be transferring today were strong enough that he put our risk for twins around 30-40%. Even though the twins rate at my clinic for women ages 35-37 is only 19.4% according to the clinic's 2011 SART data, he felt that the quality of our embryos were pretty strong, so that alone increased the chances of twins occurring in his eyes, should we become pregnant. Still, this is a risk we are willing to take.

The risk of transferring only one embryo would have simply been less chance of us becoming pregnant at all. The thought of that was enough to make us choose two to be honest. Remember, we were given only a 40-50% chance of this IVF working. We didn't come all this way NOT to get pregnant. Of course, there are women of AMA (Advanced Maternal Age) who transfer 3+ embryos and still only have one baby or no baby at all. The embryo grading process isn't all that predictive either. There are AA embies that don't end in a baby, and then there are BC embies that do. It's all a big fat game of roulette really, and no one can predict what will happen. We've done all we can, and it's out of our hands now!

We had an ultrasound guided transfer done, where the RE uses ultrasound to visualize the catheter with the embryos going in and shows exactly where the embryos are deposited in the uterus. Very interesting process! We watched on a large flatscreen as the embryologist in the adjacent lab retrieved our chosen embryos into the catheter. He then brought them to Dr. Vaughn, who explained exactly what he was doing with each step as we watched on a different monitor. Just me with my legs in the air, hubby in his sexy hopsital garb, and about 3 other people positioned straight beneath my hoo-hah....soooo romantic. I dare anyone to say this child wasn't conceived out of love!

We also got a pic of the two embryos that were transferred...

Our best embie: BB quality embryo (150-200 cells)

2nd best embie: BC quality embryo (150-200 cells)

The embryologist was confident about both of these embryos, because of the differentiation between the trophectoderm cells (outer cells along the perimeter which become placenta) and the inner mass cells (separate cell mass inside cell that becomes baby). In fact 5 of our embryos in total were showing "distinct differentiation."  Two shown above we transferred, one is being frozen today, and the other two embryos we anticipate may be freeze quality by tonight or tomorrow. Here is a rundown of all 12 embryos' progress as of this morning:

3 embryos freeze quality (2 were transferred, 1 frozen today)
2 embryos approaching freeze quality (hoping for freeze tonight/tomorrow possibly)
4 embryos still developing...wait and see if they reach freeze quality by Day 7
3 embryos not doing much

The way it's looking so far, after the two we transferred, we are fairly confident we'll still have 3 more for cryopreservation. The embryologist couldn't guarantee anything, but he said he didn't see any reason why we wouldn't have at least 3 make it to freeze. WOO HOO! This is fantastic news, and we are extremely grateful for the prospect of this happening. Not only because it will give us a Plan B if this fresh IVF cycle doesn't work (for a cheaper second try with FET/frozen embryo transfer), but even if this fresh cycle does work, we can always use the other embryos later for potential siblings if we have difficulties conceiving on our own again. Having frozen embryos is basically like an extra layer of insurance for infertile couples...at least that's how we look at it.

I had a second acupuncture session following the transfer, and hubby chauffuered us home. Now my only orders are to laze about. I figure there is no better way to do that than to snuggle up in bed and watch Sex and the City re-runs on E!  I will say, the other good thing about having a 5DT is that you wait less time until the pregnancy test. Ours is scheduled for Wed. 4/17, so nine days from now. Please, please, please Lord, let this work!

5 Day Transfer Confirmed for Tomorrow...It's Really Happening!

Got the call bright and early yesterday (Day 3 following retrieval) telling us that we would NOT be doing a 3DT.  As you probably know from my previous post, this was welcome news. As long as our embryos are progressing well, it is more beneficial to wait and see which are the strongest contenders on Day 5. And while my nurse didn't lay out the exact number of cells visible in each of our 12 embryos, she did say "You just have so many beautiful embryos growing so nicely, that we see no reason to do a Day 3 transfer."  Nurse Pam also gave a cliff notes progress report:

10 embryos are growing "really well"
1 embryo is growing "well"
1 embryo is a "slow grower"

I can only assume that the questionable 13th egg we had waiting to possibly fertilize late had not, or she probably would have mentioned it. I completely forgot to ask about that one.  Still, we are very happy with the progress. We remain in the double digits as far as strong looking embryos go, and only one runt out of the bunch is not too bad as far as I can tell.

In addition, this means I can discontinue my "hatching meds" which were an additional 6 pills per day (4 steroids and 2 antibiotics). My clinic strongly recommends using assisted hatching with all 3 Day Transfers, but since I'm not doing a 3DT, assisted hatching will not be utilized. I asked if it's beneficial to go ahead and add assisted hatching to a 5DT just to make sure the embryo doesn't have a hard zona pellucida (outer shell) and won't resist hatching or something crazy and I was told, "No. Day 5 blasts will hatch on their own." Alrighty then! Just happy I can stop taking the steroids and antibiotics for that now. I will take one more antibiotic tomorrow right before the transfer and then I'm done. I just hate taking antibiotics, because I'm always scared of getting a YI. Um, that is the last thing I want right now.

We received our transfer apt. time, and I've schedule pre and post-transfer acupuncture sessions accordingly. Unfortunately, my acu cannot do my sessions onsite, but luckily her office is not too far from my fertility clinic, so we'll just drive there before and afterwards. Hubby will be driving Miss Daisy after the procedure of course. This is what our transfer day looks like:

9-10 AM--Pre-Transfer Acu
10:30 AM--Arrival for Transfer
11:30-12:15--AM ET procedure
12:30-1:30 PM--Post-Transfer Acu
2 PM--Resting at Home

My RE does not mandate complete bed rest for 3 days like some RE's, but I won't be allowed to do anything strenuous, including simple things like vacuuming or lifting anything, so we're going to devote some time today to make sure things are in order before the big day tomorrow...grocery shopping, steam cleaning our carpets, and cleaning the rest of the house. If I'm on rest orders, I need my house to be clean and to have healthy food on hand!

We are extremely hopeful that we'll be met with a fabulous embryo report upon our arrival to see Dr. Vaughn tomorrow. Now, I know from experience that having a picture perfect cycle does not guarantee a successful pregnancy. This cycle seems to be picture perfect so far, and I am very grateful for that, but I am also aware that can mean something or it can mean nothing in the end.  There are never any guarantees in this process, but I'm trying my best not to imagine worst case scenarios right now and just have complete confidence that everything is going to go exactly as planned; That we will have 2 of the most beautiful 5 Day blastocysts ever seen to transfer back into me, that my body will accept them with open arms and provide the perfect environment for the next nine months, and that we'll even have some embryos left over to freeze for use at a later date. 

If you are the praying type, we can use all the prayers we can get. Thank you in advance if you have a couple minutes to bow your head and pray for us that this will work!

Fertilization Report Is In

So far this morning, I've received a phone call from the embryology lab, the IVF surgery center, and Dr. Vaughn himself, all making sure we received our fertilization report and that I'm doing OK following yesterday's egg retrieval. I know I've said this before, but my clinic really has their stuff together. I am never left wondering about anything, and they are just so on top of it at all times. I honestly don't even know how they stay so organized, and that says a lot coming from someone as Type A about organization and communication as I am.

The best part is that our fertilization report brought more good news. Here are the results:

17 eggs retrieved
14 mature eggs
12 fertilized normally
*(1 fertilized abnormally, 1 did not fertilize at all, and 1 may still fertilize)

We have a full dozen fertilized eggs hopefully starting to grow and divide right now! That is a 70% fertilization rate, so exactly as we had hoped for. They have one egg they think might still fertilize but aren't sure. They will basically just let that one simmer in the petri dish and wait some more to see what happens. If it hasn't fertilized by Day 3, they will just discard it.

We won't know if we're having a Day 3 or Day 5 Transfer until the actual day of transfer. Early Saturday morning we will get a call telling us if we'll transfer that same day (Day 3) or if we'll be waiting until Monday (Day 5) for the transfer.  I am hoping for a Day 5 transfer. Pregnancy success rates are typically higher when using Day 5 blastocysts. Waiting until Day 5 gives the embryologists more time to differentiate between the developing embryos and gain a better picture of which ones are truly the strongest contenders. Only the strongest ones last until Day 5, so this allows for an extra element of natural selection to enter the decision making process regarding which ones will be transferred.

Of course, plenty of couples have Day 3 transfers which result in successful pregnancies and healthy happy babies. In fact, my clinic has a Day 3 transfer rate of about 60%, meaning most of their IVF cycles do in fact use a Day 3 transfer. I am content with whatever Dr. Vaughn's recommendation is, and I trust the decision made jointly by he and the lab. I am just here to follow dr.'s orders!

In other news, I'm doing pretty well following the ER. I became super uncomfortable the second half of the day yesterday. It is the strangest feeling following that procedure...almost like you're walking around with a huge bag of marbles in your abdomen. It feels weird to walk, like a heaviness with each step, hurts to get up from a chair if you don't take it slow, and feels really strange and uncomfortable to even go pee. It's really hard to describe. I took extra strength Tylenol twice which helped, and luckily I woke up to seeing most of the severe bloating gone. I think the really bad part of the bloating happened early for me and I'm already over that hump. Still taking it easy today, because I'm just moving around so slowly and would rather not granny it into public if I don't have to. I'm sure I will be back to normal tomorrow and plan to go downtown for my weekly volunteer shift as usual.

So, that makes one more successful step completed in the process. Hopefully no surprises to come, other than maybe that additional egg fertilizing. We'll know in less than 48 hours when our transfer will be!

Egg Retrieval Complete: Make that 17!

The past 48 hours have been unfolding as well as we could possibly hope for.  My estradiol came back looking great on Monday (3681), so we triggered at 7:45 PM that evening and scheduled our egg retrieval for exactly 36 hours later-this morning (Wednesday) at 7:45 AM. I had to laugh when it was time to do the Ovidrel trigger shot. I remember a day long ago when we first started fertility treatments and I was told I may have to do a trigger shot. I remember being so freaked out at the thought of injecting myself. At that time, I was so relieved to get a +OPK and forgoe that trigger shot altogether.

Fast forward to many months and cycles of TTC later, and being faced with this tiny little trigger shot now seemed like a breeze compared to the rest of the shots we've been doing. So funny how your perspective can change right? We were thrilled to get the news we had no more stims left and only one little Ovidrel shot remained. Thank goodness, because finding any unbruised real estate on my belly has become quite impossible at this point.

I was also told to do a pre-IVF "clean out" using magnesium citrate. I had never heard of this stuff, but apparently it's used commonly pre-surgery. If there is anything in your bowel at the time of egg retrieval surgery, it can interfere with the RE's ability to aspirate all of the eggs from the ovaries. My RE is adamant about having all of his patients do this the day/night before ER. After visiting my second opinion, Dr. Google, on this previously undiscovered substance, I basically spent the whole day yesterday afraid of what might follow drinking this prehistoric sounding solution. I basically slept with one eye open, just waiting for the dreaded mad bathroom dash, which did not even end up occurring until 12 hours after I drank it @ 4:30 AM. I won't go into the details, but rather I'll just chalk that one up to yet another ahem, "learning experience." Whatever. I will follow dr.'s orders if it means helping him get more eggs!

Luckily I've been in a pretty nice state of zen over here this week to balance out all the craziness leading up to the ER. I had one of the most amazing acupuncture sessions to date yesterday. I actually fell asleep on the table and then drove home with blurry vision for part of the drive I was so out of it. Probably not too safe to be in that state while driving, but I didn't care; IT FELT SO GOOD....exactly what I needed.

We arrived at the surgery center this morning at 6:30 AM, the procedure was performed, and I was released about 2.5 hours later. I was most worried about the IV needle, but it wasn't bad at all. It just went into my arm and not the hand thankfully. I seriously LOVE anesthesia. I was knocked out instantly, like in less than 15 seconds and woke up after the procedure feeling perfectly fine, like nothing even happened!

Our initial report from Dr. Vaughn was that we had 12 eggs retrieved, but he said the embryologist would have the final report after he checked all of the tubes containing follicular fluid. A short time later our embryologist, Tom, gave us our final report.

17 eggs retrieved
Total Sperm Count (pre-wash)= 298 mil., 50% motility, 21% morphology
Total Sperm Count (post-wash)= 31 mil.

I guess the motility of the "final cut" sperm also increases once they add it into their special solution, and they start moving really fast at that point. Tom said the sperm motility increased to about 80-90% once they did that and he said all things on the sperm front looked "spectacular." I'm a little foggy on the rest of the details, but that's what I do remember. We are not being indicated for use of ICSI at this point, and we are thrilled with our total egg count.

This is one more step of the process successfully completed! The sperm aren't added to the eggs until about 6 hours post retrieval, as the eggs are also placed in a special medium to allow them to stabilize first. As I'm writing this at 5 pm, I'm assuming the sperm have now been added to the eggs and they are hopefully beginning their best Michael Phelps butterfly stroke towards my eagerly waiting eggs!

Tomorrow, we will receive a call from an embryologist with a more thorough report on the eggs: how many were actually mature and also a fertilization report, which tells us how many actually fertilized on their own and/or if there are any problems with fertilization requiring other measures. My clinic has an average fertiliation rate of around 70%, but the more the merrier of course. 

I'm doing fine physically. I napped for 4 hours straight today, and since waking have gotten considerably more uncomfortable as they day has gone on. I'm becoming bloated. It feels weird to walk, and I am expecting to be even more seriously bloated tomorrow per the nurses warning. Just popped some tylenol and snuggled up with a heated blanket at home. It's rainy out, and hubby is picking me up a Chelsea Handler book on his drive home to keep me occupied and smiling. So far so good! Still praying for everything to keep going smoothly. More on our fertilization report tomorrow!

Easter Egg Forecast: Trigger Tomorrow!

I'm happy to report that our Easter egg hunt went very well this morning.  As predicted, the smaller follies we saw two days ago have caught up quite nicely and are appearing more mature and closer together in size. Here's what we ended up with in our basket today:

right ovary: 16, 15.5, 13.5, 13, 9 mm
left ovary: 18.5, 15.5, 15, 15, 14, 13 mm
uterine lining: 9.3  mm
estradiol: 2814


If the general rule for follicle growth (1-3 mm) per day continues over the next couple days until our anticipated ER (egg retrieval) I think we'll be in really good shape to retrieve some nice ripe eggs for fertilization. Dr. Vaughn is predicting that we'll possibly be ready to go ahead and do our hCG trigger shot (Ovidrel) tomorrow evening, which would put our ER Wednesday morning. Looks like we are perfectly on track with the calendar that I was given before we even started stimming. That is some damn good egg forecasting right there. Kudos Dr. V! I have a feeling things are about to begin moving pretty fast from here on out!

Our meds have been reduced yet again. Here is the schedule for the next couple of doses:

Tonight:
10 units Microdose Lupron in PM
150 iu Gonal F in PM
2 Dexamethasone in PM

Tomorrow Morning:
10 units Microdose Lupron in AM
150 iu Gonal F in AM
75 iu Menopur in AM


Tomorrow, I'll go in for estradiol AND progesterone blood tests first thing in the AM. Then we go back for yet another ultrasound in the afternoon and further instructions. The earliest I could possibly do the trigger shot will be 6:15 PM tomorrow, but we won't know until our 3 PM appointment when we're given clear instructions based on my bloodwork and ultrasound findings.

Please keep us in your prayers; That my eggs continue to grow slowly and steadily in perfect unison (without ovulating of course!) and that everything falls gently into place for a picture perfect egg retrieval!