Testing

hCG levels vary greatly from woman to woman. You cannot really measure yourself against another because the hormone levels can be on opposite ends of the spectrum but you can both still end up with a take-home baby, or the woman with super high results might miscarry and the one with low results may have a healthy baby or vice versa. You can check a chart to make sure you are in the normal range but it is best if you wait until you have had two beta tests and then calculate the doubling time. Your hCG should be doubling every 48-72 hours. That is the best indicator as to if your pregnancy is heading in the right direction. Here is a chart showing the normal range for a beta test. 

The day after I took my pregnancy test I went in for the beta test (blood pregnancy test). I stopped by the clinic first thing in the morning and then sat around waiting for the entire rest of the day constantly glancing at my phone to see if the clinic was calling yet. Let me tell you it is quite nerve wracking even though I had a positive HPT the day before. I prayed and prayed that the number would be high enough. I waited and waited (seems to be quite the theme for those of us in the IVF circuit). Finally around 2pm my phone rang, it was a 626 number, the clinic was calling. I picked it up and stepped outside. I held my breath.

Did I hear that right? I asked her to repeat the number again. Nope that was what I had heard the first time. Wow! Is this really happening? The lab tech congratulated me. I was in shock. I immediately called Paul who was also waiting on pins and needles for me to call (he had already texted hours earlier asking if they had called yet). About an hour and a half later Dr. W called to personally congratulate us and noted that the number was high. He even said "what have I done to you" at one point during the call. Our number of 846 falls during the 4 weeks LMP on the chart above. We were almost double what the high end of normal is.

Our second beta was scheduled for 1 week after the first, and we knew that we needed that number no matter how high it was to be doubling every 2-3 days. So we entered the next phase of the waiting game.

Resistance is Futile

I am weak. I gave in the day before my beta. I did it. POAS. While Paul was still in bed I quietly got up and went to the restroom. It was premeditated, I did not have any tests at home. I drove to a store with the intent to buy a pregnancy test the day before. I executed the purchase of said test, I took it home and shoved it in the bottom of a drawer. I tried to wait until the beta, but I couldn't. This is one of those things that I didn't want IVF to take from me. I wanted to be the one to POAS and tell Paul the news either way. So that we could celebrate together or grieve together. I didn't want a phone call while I was at work that could knock the breath out of me or be fantastic news that I would immediately want to share with Paul who would also be at work.

So I took the test. 

I sat. 

I stared. 

I waited.

And waited. 

And waited. 

And then when the result popped up I kept staring and waiting. I kept waiting for the NOT to show up. I was in shock. You know like back in the day when kids would say stuff like "You are the coolest.... NOT" how they waited a beat to knock you down to size. That is what I was waiting for. The punchline. It never came. The word PREGNANT just stared back at me. My heart was racing and the rush of adrenaline was crazy. I didn't just want to go running out into the bedroom like a crazy person waving a pee stick so I quietly got dressed and went to pick us up some coffee. Paul was awake in our room when I got back. So I handed him the cup and waited for his reaction. Then I thrust the pee stick towards him as further proof since of course it was possible, and maybe he was thinking she must be hopeful about the beta test. I practically shouted WE ARE PREGNANT at him. We hugged, we kissed, I shed a few tears (happy happy tears). 

For IVF patients we all know that it is best to wait for a beta test to confirm a pregnancy. If your beta number is too low it can spell trouble. If your beta number isn't doubling every 48-72 hours there could be a problem. So of course as happy as we were in that moment I knew that we still needed to see what those numbers were over the next week. If they are high and doubling that is a great thing. 

Anticipation

This may involve some rambling -- be forewarned. 

So many women who do IVF have an obsession with POAS (peeing on a stick aka a pregnancy test). Some of these women start POAS starting at just 6dp5dt (six days past a five day transfer) and continue to do so all the way until they have their beta test (blood pregnancy test) which is usually done about 2 weeks after transfer. They analyze and scrutinize photos of these tests trying to determine if the lines are getting darker, honestly a lot of the time I cannot even see a second line on them. Occasionally they will even invert the colors so that you can make out the test lines better. I know I may be in the minority here as so many ladies do this, maybe it helps them get through the 2 week wait but I think if I had done that I would have driven myself nuts.

Read those sticks carefully too, many of them tout that they can tell you 6 days before your missed period on the ads that are run on TV. Once you get that box home read the instructions as it will lay out what the odds are each day for how accurate their test is. Here is the info from an e.p.t. test. Notice that they don't even give you accuracy rates for more than 4 days before your missed period! Who knows exactly what these percents represent, are those women who do not get a 'pregnant' result not pregnant or are they pregnant and they took the test too soon? I'm just saying don't drive yourself nuts taking these tests if you have a regular cycle and you know about when your next period is due. The tests claim 97 - 99% accuracy but that is not until the day of your missed period! Many tests even say to wait until a week after you have missed your period.

A few friends asked if I would take a pregnancy test as it got closer to beta day but then if you get a light line or no line at all it could send a gal into a panic. Plus if you wait until your beta you get to be PUPO (pregnant until proven otherwise) longer, you get to keep that hope alive. On the other hand, if it was positive you would be able to have more of a special moment between you and your spouse when you tell them or if you do the test together, than going in for a blood draw and getting a call while you are at work later in the afternoon when the clinic gets the results. One thing is for sure I will not become a POAS professional, I couldn't take staring at a test and trying to decipher what it means, in my opinion just test once, a day or two before your beta and please give me the stick that has a happy or sad face just so there is no confusion.

Days 12 through 18           

                    - Progesterone lozenge: 3x a day

                    - Endometrin insert: 3x a day
                    - Estradiol tablet: 3x a day
                    - Vivelle Dot patch: day 12 and day 15 time to stick on a new one

And of course I am still taking these once a day

                    - Prenatal vitamin

                    - Folic Acid

                    - DHEA

                    - Fish Oil

                    - Baby Asprin

More of the same

Days 7 through 11
                    - Progesterone lozenge: 3x a day

                    - Endometrin insert: 3x a day
                    - Estradiol tablet: 3x a day
                    - Vivelle Dot patch: day 9 time to stick on a new one

PUPO

In the IVF community once you have transferred embryos you are considered 

PUPO or pregnant until proven otherwise. 

Day 6 - Progesterone lozenge: 3x a day

           - Endometrin insert: 3x a day
           - Estradiol tablet: 3x a day
          - Vivelle Dot patch: time to stick on a new one

This medication contains Estradiol, it is just in a different delivery method than the pills I take. Vivelle also helps make sure I have enough estrogen in my system. The medication is slowly released over a 3-day period. Side effects include: skin redness/irritation at the application site, breast tenderness, nausea/vomiting, bloating, headache. It is rare that any serious side effects occur but if they do you should contact your doctor immediately. 

Transfer Day

2 of our 6 littles did not make it to transfer day. 

I was given explicit instructions to make sure that when we showed up to the clinic that I had a FULL bladder. Since I didn't plan on getting up any earlier than I really had to I figured I needed to start drinking like I was in the desert from the time I got up till we arrived at HRC. I drank a 16 oz bottle of Gatorade and approx 750 ml of water! At first I was really worried that I wouldn't have enough liquid in my bladder and that it could cause problems. Then as the minutes ticked by and it was 15 minutes past our appointment time I started to feel like there was a good amount of liquid, then we hit 20 minutes and I started to think "uh-oh" I may have had too much to drink, at 30 minutes past I looked like a little kid doing the potty dance... finally at 45 minutes past I began to feel like my bladder would actually explode! I kept squirming in my seat telling Paul I didn't think I could wait any longer, that it was painful to sit there with a bladder so full. I walked up to the counter and explained how long it had been and couldn't I use the bathroom to release just a little bit of the pressure, I was given the ok and told to count to five and then stop. I ran down the hall to the bathroom just in the nick of time. As soon as I got back out to the lobby they called my name to get ready for the procedure at which point I started to wonder if I had enough in my bladder again. 

We found out later that it was because 8 of us patients all belonging to Dr. W were having our transfers done. One of the other patients had blood in her uterus which cancelled her transfer (any blood in the cavity  can mean the demise of any embryos and Dr. W will not waste any embryos with that possibility), because of this it took a little longer for the doctor to get her situated and move on to the next patient. 

My nurse got me all set up with my gown and booties and asked us to verify some information. I got situated on the table and then Dr. W came in to discuss the littles and how they were doing. We were told we had the best looking embryos out of all of the 8 patients. Fantastic news for us to hear. The lab guy who cultured our littles for the last week brought them up and took one last look under the microscope and signed off on them. Dr. W got all of his tools set up and the embryos set for transfer. The nurse got out the ultrasound wand and started pushing around on my belly to get a good picture up on the screen which is very important because this is how the doctor sees where to put the embryos, and placement means a lot. Paul stood by my head with a hand on my shoulder and our eyes were transfixed on the monitor. I had very minor discomfort due to the tools he used for the procedure, the ultrasound wand being pushed into my bladder was more bothersome. 

We watched as the catheter moved in so it could be seen on the screen and then as Dr. W pulled it back slightly you saw a bright dot emerge, then it pulled back again and a second bright dot emerged. There they were, our babies. The reason we decided to transfer two is because of how long it has taken us trying to conceive we wanted to give ourselves better odds of having one stick. After the procedure I laid on the table for about 15 minutes before being taken to a recovery room where I laid flat in a mostly dark room listening to music that was being  pumped into the room to help relax the patient for another 30 minutes or so. I was finally allowed to use the restroom, I went only after I asked for assurance that they weren't going to fall out or anything. Then we signed some final paperwork and headed home with instructions for me to lay with my feet up as much as possible though I was allowed to sit up to eat. Then I was told to just take it easy for a few days before resuming light activity. Then begins the long wait before you can go in for a blood test, the dreaded two week wait (sometimes longer if your clinic doesn't do blood tests on the weekend). 

We even got a picture to take home

Pill Poppin

Day 5 - Progesterone lozenge: 3x a day

           - Endometrin insert: 3x a day

           - Estradiol tablet: 3x a day 

Estradiol is simply estrogen. During the early part of the menstrual cycle, estradiol levels remain nearly constant. This is followed by a rapid increase reaching a peak the day before or of the LH (Leutinizing Hormone) surge, also known as ovulation. It is generally believed that the rise in estradiol is the factor which triggers the LH release. Following ovulation there is a drop in estradiol followed by a second rise which corresponds with the formation of the corpus luteum. Some REs (Reproductive Endocrinologists) prescribe estrogen supplements to help support the growth of the endometrium.

Our Littles

Many clinics (including ours) have begun favoring a 5-day transfer with the thought that those who make it that far are stronger and more likely to implant. A clinic will wait to make the choice between a 3-day and 5-day transfer because if there aren't enough viable embryos on day 3 to risk culturing to day 5 then it could result in the loss of a cycle. For example, if only two embryos are present on day 3, one or both, could stop growing by extending the culture to day 5 or 6. However, if six good embryos are available on day 3 (which was us), the chances are very good that 2 or more will survive to day 5 making blastocyst transfer feasible. 

The ones who look like they are "two", are not. Those ones have begun hatching, which is a really good thing! Hatching is when the cellular blastocyst hatches (breaks through) from the zona pellucida. This has to happen before implantation can occur. 

Day 3/4 - Progesterone lozenge: 3x a day
             - Endometrin insert: 3x a day
             - Estradoil tablet: 3x a day (photo and info to come)
Day 4  - change Vivelle Dot patch (photo and info to come)

Thrice

These medications are started from the day after egg retrieval so that your body begins to develop the best environment possible before transfer day. 

Day 2 - Progesterone lozenge: 3x a day

Endometrin insert: 3x a day

Endometrin is a vaginal insert containing progesterone 100mg. This is the same active ingredient as the progesterone lozenge, just administered in a different way. As noted yesterday it helps make your lining more receptive for a fertilized egg to attach at the beginning of a pregnancy. It is utilized because of the lack of natural progesterone in the body when a woman uses ART (assisted reproductive technology). Endometrin has its own list of side effects including: mild nausea, vomiting, stomach cramps, bloating, constipation or diarrhea, dizziness, drowsiness, joint or muscle pain, increased urination etc. and of course if you experience any severe side effects you should immediately seek medical attention. 

Estradiol tablet (photo and info to come): 3x a day

Update: I have a 4th medication I forgot to mention Vivelle Dot Patch which is applied once every 3 days

The Call & New Meds

 Six out of eight eggs fertilized. 

New medications for the next phase of our treatment:

Day 1 - Progesterone lozenge 

Progesterone is a hormone that naturally occurs in the human body, levels rise after ovulation to help build and sustain a lining in the uterus. This lining is where the fertilized egg will implant. The ovaries will produce progesterone during the first trimester, until the placenta takes over this function around the 9-10th week of pregnancy. Doctors will prescribe progesterone supplements for women who have undergone ART (assisted reproductive technology) such as IVF. One of the reasons for this is because the woman did not ovulate (the eggs are taken from the ovaries before ovulation occurs) so she may not produce enough of the hormone to sustain the pregnancy. 

This medication tastes terrible. I have to place under my tongue and wait for it to dissolve which takes about 15 minutes but sometimes up to a half hour. I received grape flavor (though I recently found out they have cherry, chocolate and mint -- don't know if those would taste any better) which is just gross. The fact that it is in the shape of a square isn't helpful either, it is pointy! Why not make it round?

          

Endometrin insert (photo and info to come)

Estradiol tablet (photo and info to come)

Each of the 3 medications above will be taken 3 times a day (every 8 hours)!

Still taking these once a day

Prenatal vitamin

Folic Acid

DHEA

Fish Oil

Baby Asprin

Egg Retrieval Process & My Procedure

The Process

The process of egg retrieval is known as follicular aspiration. Follicular aspiration involves inserting a hollow needle through the top of the vagina and into the ovaries. This needle is then used to suction out any eggs that may be present. In order to guide the needle into the appropriate area of the ovary a transvaginal ultrasound is used. This allows your doctor to insert the needle into your ovary at just the right place. 

Immediately following this procedure the eggs will be examined under a microscope to ensure that the egg is mature and viable. They are then placed in an incubator. Depending on the age of the patient and the effect that the fertility medications had it is normal to see between 5 and 20 eggs. The entire process takes about 30 minutes. 

My Procedure

We headed to HRC first thing in the morning on egg retrieval day. I was given my lovely bracelets, signed the consent for anesthesia, and then got dressed up in my hospital gown and fancy socks. 

I was taken back to the procedure room and waited for the anesthesiologist to get set up. The guy doing my anesthesia was sadly not the same one I saw for my surgery. It took this guy multiple tries in 5 different areas to get my IV set up! Ouch! He was finally able to get it going in my wrist. Last time the guy had no trouble getting it done on the first try. 

After all that Dr. W came in and we exchanged pleasantries while he made sure everything was set up. I do not remember anything beyond that point until they woke me to tell me they were all done.  I was taken to recovery where Paul was able to join me and given some juice. Dr. W came in to tell us that everything went smoothly and that he was able to get 8 eggs! If you remember we were worried that often times you will end up with less mature eggs than you had follicles so it was great news to hear. He said that we would need to wait for the lab to confirm that they were all mature and of good quality but he was quite pleased. Yay!

We had a celebratory breakfast and then I took it easy the remainder of the day. I was told there would be some discomfort and  possible bleeding from the procedure.

Beginning the day after an egg retrieval a whole new regimen of drugs will begin and you will find yourself (if you are like me) staring at the phone waiting for it to ring with news from the clinic as to what is happening. This is because a few hours (this varies clinic to clinic) after the egg retrieval process the lab will allow the viable mature eggs and your partners sperm to meet. They will be cultured overnight until they can be checked for fertilization.

Last injection of the cycle!

Paul was the lucky one this time around as he only had to give me 1 shot (with the IUIs he had to administer every single shot). This was the big one, intramuscular in the back of my hip, the trigger shot. 

Novarel contains human chorionic gonadotropin (HCG) which is a hormone that supports the normal development of an egg in a woman's ovary and stimulates the release of the egg during ovulation. Side effects can include headache, feeling restless or irritable, mild swelling or water weight gain, depression  pain or swelling at injection site and OHSS. If any side effects are severe in nature medical attention should be sought. 

Novarel should be given approximately 36 hours before an egg retrieval takes place (the doctor will give you an exact time of day this medication should be given). I was injected with 10,000 units. This medication is mixed in the same manner as Menopur. 

Checking the Follies

Had another appointment with Dr. W to check and see how things looked internally. He seemed surprised that we were down to 8 follicles though they were measuring at a good size and told me that I had a muted response from what he was expecting. Generally less than 6 is considered a poor response and more than 20 is considered hyper-stimulation. So most doctors would like to see you somewhere in that range. In addition each follicle may contain 1 or more eggs or it could contain NO eggs! Also not all eggs are of good quality which means they may not fertilize or could fertilize abnormally. This is why I believe Dr. W is showing concern. We are praying that each follicle contains at least 1 egg. 

Here is a close up of the above screen the larger the number the bigger the follicle and closer to maturity it is. My ovaries are still even showing 4 follicles on each side. 

Last day of this drug regiment! 

Menopur Day 7: 1 ml saline solution dissolved into 2 vials of Menopur powder (150)

Follistim Day 7: 300 iu injection

Ganirelix Day 3: 1 syringe (.5)