CD3 - Blood work and Ultrasound

Alriiiiighty. Blood work and ultrasound are done. I asked Dr. K about my thyroid level from the first blood panel(4.5) and she said that was too high and she wanted me on medicine starting now and throughout pregnancy to manage my thyroid level. *sigh* The thought of taking more medicine makes me cringe. She said thyroids are very important in pregnancy, but I haven't read up on that yet so I will do that shortly.

She did a vaginal ultrasound and saw only 7-8 follicles on each ovary. This can be considered normal since I'm only on cycle day 3 - but they will continue to measure the count and size of my follicles throughout this entire process.

In other news, the nurse called shortly after my appointment to tell me that my blood work and hormone levels were fine, and to go ahead and start the birth control pills tonight. So, this is it. Once I pop that pill in my mouth I'm officially on an IVF 'regimen'. I must admit I'm a bit nervous, a bit burnt out by everything, a bit fearful, and a little lost.

It's like..... being excited that you got a new bike without training wheels for Christmas, and then realizing you have to learn to ride it. The task ahead seems big and daunting.

They messed up my IVF schedule (again) and didn't update it with my new cycle start date, so now I need to wait until the other nurse comes in tomorrow to confirm and send me my new schedule.

Next Steps:
Start BCP tonight Dec 30
Needle Class on Wednesday Jan 2

Period Arrives! Cycle Day (CD) 2

Yesterday my period arrived and I was super excited. M and I even gave each other a high five because this is the official start of the IVF cycle. I called the fertility clinic to let them know of my period start day, but no one answered! I was so frustrated! I called during business hours but kept reaching the 'after hours' line. Arrrrrrrgh. I left voicemail for the pool of nurses and for Nurse S. No one called me back yesterday.

So today I woke up knowing the clinic is only open from 7-11am - I called at 8:30, same after hours line! Poop! I was NOT going to let their responsiveness affect my first cycle, so I emailed Doctor O and let him know I had not heard from anyone and was now on cycle day 2. Shortly after the email, Nurse L called and scheduled me an appointment for tomorrow Sunday at 8:45am. They will do a vaginal ultrasound to measure how many follicles I have on my ovaries, what size they are, what my uterine lining looks like, as well as do a blood panel to check for my estrogen levels, my TSH, LH levels and make sure nothing looks out of sorts. If all goes well, I will start taking the suppresion hormones (BCP) starting tomorrow night. (omg!!!! this is it!)

Shortly after the BCP are the first injections of Lupron, so we also have scheduled our needle class for 1-2 to make sure we know how to stick me! I've been watching tons of videos and reading the needle manuals though. I separated all of my needles and meds into plastic bags and labeled them all. I don't know how we're going to manage all of the injections with all of our work, school, acupuncture, therapy and kid obligations, but we'll have to manage.

In other news, M got me the cutest baby slippers for Christmas. They are in the shape of flippers, are light sage green and the left one says "flipper", the right one says "slippers". It's the cutest thing, and I almost cried when I saw it. We hung them on our large kitchen magnet board so we can see it every day and "keep our eye on the ball" as it were.

Since my period came 6 days sooner than they had projected, I need to get an updated IVF schedule as well.

Next Steps
-Blood work and ultrasound tomorrow 12/30
-Start BCP tomorrow 12/30
-Needle Class on 1/2

Medications Arrived

Well, all my IVF meds arrived today in a big brown box. I was excited to open it and we broke out the video camera to capture the event.

Sitting in my pink pajamas talking to the camera, I pulled out box by box by box, and then needles and more needles and more everything. I couldn't help it and broke into tears. It's so overwhelming. I know once I get the habit of all of this I will look back and chuckle at my naivete, but right now I have much fear.

Fear about the injections, the pain, the sense of mortality, the hassle, the hormones, the emotions, the needles, the bruises, the what if I don't do it rights, the what if he doesn't do it rights, it all hit me at once and I wept. All I could muster to say was "I'm scared."

Because I am, I'm scared of this process though I know I will proceed with it, I'm scared of becoming pregnant and scared of losing that pregnancy, I'm scared of becoming a mother and not being a good enough mother, I'm so very conscious of the transition my life is in right now that it feels like the emotions will just bubble right out of me. The fertility acupuncture treatments help to relax me but they are still more appointments, more 45 minutes drives, more being social when I feel everything but social, sometimes this process is so overwhelming it just feels like a battle.

When I have more resources, I can plow through this without blinking, with a steel and stoic face, only focusing on the goal. But it's times like this that I have to take a step back and remind myself of why I'm doing this. The goal is not just to get through the injections. The goal is not to be avoid being crazy under the hormones. The goal is not just to get pregnant. The goal is to create our child. To be able to feel our children in my womb, to combine the love for my husband and create a being of our own, parent that being with love and all the experience we have in the hopes he or she will be loving and happy. There are so many moments waiting for us out there, that ultimately this will be only a blip on the radar, but damn if this isn't a mission.



A picture of the meds that arrived today:



The pharmacy also let me know they made an "oopsie"and rather than $1085 for my meds, it was actually $2,322. Yeah, oopsie! :-)

Ordering Medications

The "Fertility Pharmacy" called me today to set up my order and make payment for my medications.

Below is what will arrive on Saturday, "signature required":

Leuprolide 1mg/0.2 2-Wks Kits
Doxycycline 100 mg - Tablets
HCG 10,000 U Vials 10,000 units - Injection
Medrol 16 mg - Tablets
Tranxene 7.5 mg - Tablets
Syringe 3cc 18g 1.5 in
Syringe 3cc 22g 1.5 in
Needle 27g 5/8 in
Needle Disposal System
Cycle Kit
Loestrin 1.5/30 1 Tablet Tablet - Tablets
Menopur 75 IU - Injection
Needle 25g 1.5 in
Syringe Insulin
Prometrium 200 mg - Capsule
Gonal-f RFF Pen 900 -- IU - Injection

Total Bill For Medications: $1,085 $2,322. Thank god, I'll get reimbursed by my god-send benefits.

Instructions: Upon receipt, go through each medication and compare it to the above list, call if something isn't there or something doesn't seem right with my order. No item needs to be refridgerated.

Trial Transfer Complete

Wow. Just wow. I don't think I've been as excited and overwhelmed as I am today after our appointment.

M and I met up in the same ole parking lot we're getting accustomed to, and headed to the clinic. I wasn't as nervous as last time (which wasn't as nervous as the last, last time) and began nursing my 24 oz water bottle. They said I needed A LOT of water for my transfer, so chug a lug it went. (it almost felt like back in my 'younger' days when it wasn't water I was drinking, ya hear.)

After arriving, I really had to pee. I mean really. We made our brief movie that we do, and headed into the clinic. Shortly after my name was called a tech (whom I've not seen before) led me back into the rooms I'm getting used to, and had me undress and redress with the infamous paper gown. Into the ultrasound room we went. I told M that I remember my prior surgery that required a 'full bladder' and I bet I was 'going to fail the full-bladder-test' based on their standards. Sure enough, she lubed up the ultrasound, put it to my belly and said "Nope, not full enough." She showed me where my bladder was on the monitor, and showed me my uterus, and told me what it SHOULD look like. Ok, so I was no where near where I needed to be. Clothes back on. Another 24 oz of water in my hand, and into Dr. O's office we went to have our consultation. She said that after the consultation, we would redo the ultrasound and trial transfer once my bladder became more full.

Into Dr. O's office we went: We had written down a list of questions that we wanted answered this time around (pre-ordering the meds, the needle injections classes, statistics etc etc)

He answered all of our questions while I sipped, sipped, sipped my water and M did well to keep us on track with the questions as my need-to-pee was growing stronger.

Some facts told to us by Dr. O:

- One embryo has a 55% chance of implanting with a 55% chance of pregnancy

- Two embryos have a 55% chance of implanting with an 80% chance of pregnancy

-With my age and the fact that I don't have any fertility issues, he'd feel comfortable placing our chances of one embryo implanting up to 70%.


HOLY CRAP!! Here we've been thinking that each embryo had a 35% chance, and thus we've always assumed we would transfer over two, but by transfering over two, we'd have greater than a 50% shot of having twins. Yikes.

Of course all of this is dependent on the quality of our embryos, which we won't know for several weeks, but it's important that M and I have these discussions now so we know what to do when we reach our transfer dates. Dr. O said we would get our IVF schedule today (!!!omg!!!!) and gave us the info we needed. I started to fade at the end of our meeting because the need-to-pee became so strong I started seeing dots.

"Um, ya'll, I really need to pee."

Dr. O jumped up and led us to the ultrasound room, and they began the trial transfer procedure. The nice and lovely tech (my fave so far) made a comment that my bladder was definitely fuller as my stomach was protruding, and in Dr. O went with the empty catheter. I could barely focus on the screen this time, because the need-to-pee was so strong I wanted to do anything but THAT at that moment. All I wanted to do was pee. Sounds crazy, but try it and get back to me.

M was smart to ask the doc if we could get images and videos of all of the procedures there have been thus far. They said sure! The tech then did a movie of the trial transfer and saved it. Next time, Ill go in with a flash drive and save it all. (not sure who would want to see a movie of an empty catheter going into my uterus, but I sure do!)

Then Dr. O said what I was dreading. "You know, your bladder could be a little more full for the actual day of the embryo transfer."

"More full?!!?" I barked. (I tried not to bark too much as I'd probably end up doing a pee-bark)

They ultimately said they don't want me TOO uncomfortable or in pain, but that yes, it would be best if I drank more water for the 'real day'. Immediately after the trial transfer, I threw on my pants and ran to the restroom. Ahhhhhhhhhhhhhhhhhhhhhhhhhh. I bet you know how that was.

Dr. O was attending another poor-gotta-pee-now lady and we talked to the receptionist about getting my IVF schedule, scheduling my needle injection class and ordering my hormone injections. We waited in the waiting room and a nurse came out with my IVF schedule. This is it! This is it! She calculated all of the tasks for the next month, based on my next cycle. My chart says I should get my period around January 2 or 3rd, so all dates are based off of that. If indeedy I go over or under, then the schedule will be re-adjusted to accomdate. Ok, you ready? Are you really ready?

Here goes:

• 1/3/08 - Period Starts


• 1/4/08 - Go into the office/ baseline ultrasound/blood work


• 1/4/08 (same day) - Start Birth Control Pills and low dose of aspirin


• 1/13/08 - Begin injecting myself with Lupron/ keep taking the BCP


• 1/19/08 - Stop taking the BCP/ Keep taking the Lupron injections


• 1/24/08 - Go into the office /ultrasound/blood work/ reproductive suppression check


• 1/25/08 - Reduce Lupron amount/ Begin new injection of Gonadotropin (each morning from 6-8am and night from 4-7pm)


• 1/27/08 - Go into Office / Blood drawn


• 1/30/08 - Go into Office / Blood drawn/ ultrasound


• 1/31/08 - Blood and ultrasounds every 2 days until follicles are mature


• 02/03/08 - "Trigger Date" (subject to change depending on how I'm doing on the meds)/ Inject myself with HCG hormone


• 2/04/08 - Go into Office / Blood drawn


• 2/05/08 -Egg Retrieval Day / Begin new progesterone injections


• 2/06/08 - Fertilization Report - Office will call me and tell me how many of my eggs fertilized


• 2/08/08 or 2/10/08 - Embryo Transfer Date (3 or 5 day embryos based on quality)


• 2/19/08 - Go into the Office /Blood Drawn/ Pregnancy test

WOW!! Holy appointments and needle injections batman!!They almost need to use the back of one piece a paper to capture all of the must-dos. So, now we wait until my period. If it so happens that I get my period while visiting family over Xmas, I have a couple of options. To go get an ultrasound in that state's hospital, or to wait another full menstrual cycle. Ugh. I would hate to do that. I think I would instead go to the hospital and get an ultrasound and blood work done, before waiting another 40+ days.

Next Steps:

• Wait until my period comes and go in for my baseline ultrasound and bloodwork - Scheduled right now for 01/04/08.

HSG Complete

Ahhhh...no more diagnostic procedures.

Ok, one more - but it's not so much diagnostic as it is a "test run" as my husband calls it. Today was the HSG appointment - and I was a bit nervous, not as nervous as I was before though.

We arrived bright and early at the hospital and they immediately saw me upon sitting in the waiting room. M stood up to escort me back (it's becoming quite the habit now) and Nurse C said "She'll see you in about 20 minutes." He quietly sat down, I gave him a kiss and I walked back with Nurse C.

She led me to a "women's changing room" and on went the infamous paper gown. She then led me to an "x-ray room" and asked me to lay down on the table. She wanted to take a baseline picture of my uterus and this very big machine slid over my body, and snap goes the picture.

"Woah, what's that!" she said. (You NEVER want to hear this in this situation, seriously.)

She pointed to the left side of the X-ray (right side of my body) and asked "what I had done in that area". I looked at the X-ray and lo and behold, my sutures from my previous hernia surgery were shining pretty in the x-ray. She remarked how "strong" they were, and indicated that I would never have another hernia with those strong sutures in there. I was a little proud. I'm getting very proud of the weirdest things. (I do still need to ask Dr. O what the possible impacts of two hernia surgeries could do in labor and birth).

Dr. O was about 7 minutes late, so I stared at the monitor, the florescent lights, the bandaid weirdly placed on the big machine.....in he walks, hair cut and all, shaking my hand like he always does. Nurse C scooted me down to the end of the table and propped a pillow under my head (thanks, C!). As usual, Dr. O walked me through each step and inserted all the machinery into my cooch.

On the screen I could see the catheter once again, but this time it was a black dye. I also saw my little fallopian tubes and I do mean little! I've always pictured this Dodge Ram uterus image in my head, but it was so delicate and fragile. After the dye was pushed, it was very clear it was going through my left fallopian tube. But not my right.

Hmm, he says, the dye isn't coming through that right side. My proud uterus self froze for a moment and alas, the dye started spilling out of the right fallopian tube. He mentioned that there still could be adhesions or a blockage on the right side, but that it wouldn't affect my IVF treatment (as we won't be using the fallopian tubes for conception).

I asked a couple times "Are you sure that's ok? Are you sure nothing's wrong?" He assured me that all is good and that the X-ray machines aren't 100% accurate anyway. He said everything was fine and right on track.

I thanked him for being my doctor, got dressed, got lost finding my way back to M, and then finally found him. We made our quick movie (we've taken videos of this entire process from the beginning) and headed back to the car.

I decided to go into work today (I was going to "work from home") but I started noticing that I was having some harsh cramping on my right side. (the "defunct" side). It's still there, kind of like a pang, an ache, a sharp icky feeling. The cramps are different than menstrual cramps and instead kind of feel like a sharp dagger. I'll see if I feel any better tomorrow, and if not, I may call Dr. O to see what he thinks.

I'm not as excited over these results as I was my SHG, but I think that's to be expected. I can't always have a perfect uterus and tubes, I spose.

This picture is NOT mine, but this is basically what I was looking at today:


Next Steps:
My Trial Transfer on Monday. Immediately after the transfer, we have a consultation with Dr. O to go over all of my blood work, all of my procedures and generally talk about the start of the BCP and hormone treatments.

SHG Complete

Whew. The SHG procedure is complete.

I was super nervous - M and I walked in, there were more people in the waiting room than normal. It's funny - the waiting room - it's all these anxious couples that give you empathetic looks if you happen to catch their eyes. I wouldn't say there is a theme, it's never older women, older men, young women etc etc - it's always a nice mix which is comforting.

The lab tech asked us back and told me to strip waist down and cover myself with the infamous paper gown. I did so. M and I chatted off an on - mostly M - I was so nervous I kept putting back on my pants and running to the restroom, coming back in, undressing, then putting back on my pants and running to the restroom. It's how I deal with nervousness, my body is trained that way.

Finally, after the third run to the bathroom, I was ready. Lab tech came in and brought us into the ultrasound room and Dr. O came in. He had gotten a haircut. I know it's strange for me to notice such things when I'm about to have a catheter through my cervix, but I thought it made him look nice, younger or something.

He did an excellent job explaining exactly what he was going to do and put me at ease. He made a couple jokes which made it all go smoother as well.

On to the stirrups - I scooted to the edge of the table and in went the speculum. Similar to a pap, this stage didn't phase me (although I hate the feeling of a speculum - it's like a tire jack for your hoo-ha) - up he cranked me - and inserted the very bendable tube into my cervix. There was a slight pinch, but nothing like I'd expected. Taking the speculum out, and leaving the catheter in, he then put in the vaginal ultrasound and up pops my uterus! I'm so fond of my uterus now. I love seeing it on the screen, like a little oven it is, just waiting for baby(ies).

He pushed the saline through and we watched a black puddle forming in my womb. Pretty soon, the saline disappeared and he was surprised it had gone away so quickly. He remarked that my fallopian tubes must be 'very open' for the saline to disappear like that to which I asked "is that a good thing?" It's a very good thing he said. As he was moving the ultrasound wand, he kept remarking how he saw no lesions, no polyps, no blockages, no nothing. He then said he thought the IVF cycle was going to work out "very well".

I had a shit-eating grin on my face. I couldn't help it. Yes! Yes! Yes!

"You've got a great home for your little embryos" he said. Me, I've got a great home!!

He then checked out each ovary to see how many follicles I have growing. The more follicles the better because this is eventually what they will 'harvest' when it comes time. He counted 1,2,3,4,5,6,7,8 - as he kept counting higher my grin got bigger and bigger - 9,10,11,12,13,14,15 - I was ecstatic! Same amount of the right ovary. As quick as it started, it was over and he said he see me on Monday morning for my next procedure, HSG.

I did a little dance in the office when everyone left and high fived M.

Things are looking up, things are definitely looking up.

Next Step:
HSG appointment on Monday.

And more appointments!

More Appointments:

Trial Transfer now scheduled for Monday 12-10

Consultation with Dr. O to go over HSG, SHG, and blood work, same date 12-10

Final Summary For This Week

• Acupuncture Appointment on 11-28
• SHG Procedure on 11-30
• HSG Procedure on 12-3
• Acupuncture Appointment on 12-3
• Trial Transfer/SHG/HSG/blood work results and consult with Dr. O on 12-10
• Acupuncture Appointment on 12-14

Appointments, Appointments, Appointments

I called today and made the appointments, holy batman there are a lot of appointments.

This Friday 11-30 will be the SHG procedure. This will be at my normal fertility clinic performed by Dr. O.

Information about the SHG (sonohysterogram):

• Evaluates my uterine cavity (my uterus has a cavity!)
• The procedure will introduce a small volume of saline into my uterus while looking at my pelvic organs via an ultrasound. They will image my cervix, uterine cavity and ovaries.
• Must be performed in the first half of my cycle because they want my uterine lining thin.
• It will take 45 minutes to an hour for the whole she-bang, including walking into the doors.
• They insert a speculum (similar to a pap) and and "clean my cervix" with betadine - they insert a catheter into the cervic/uterus and inflate a small balloon to keep it in place (there will be a balloon in my cooch!)
• Saline is then flushed into the uterus and an ultrasound captures 3d images of my pelvic organs.
• "This is usually painless." (I love how they use the term "usually".) (As in, if it's painful, you're a chump.)

Then, on Monday December 3rd, I have to go to the hospital for the next procedure, called HSG (Hysterosalpingogram). I must admit, this is the procedure I am dreading. This is the one they keep saying things like "This one may hurt", "Take 3 Ib Profens before you come in", "It may pinch a little."

Note: Any time a doctor tells me something may be "uncomfortable" or "may pinch" - I know not to screw around.

More about this HSG procedure:

• HSG is an x-ray examination used to determine whether the fallopian tubes are open and if the inside of the uterus is normal.
• They insert a small tube through the cervix so that dye can be pushed into the uterus.
• This must be done on cycle days 5-12.
• They recommend taking at least 800mg of IB profen (say what) as "this procedure may be uncomfortable". (uh -huh)
• They say that M won't be able to come with me during the procedure because they don't want others exposed to the radiation. (um, whattaboutme)

Trial Transfer

• This will be the same procedure done the day they transfer the embryos - but without the little embryos. They do this to make sure there are no problems getting the catheter into my uterus and to make sure there are no unforseen issues.
• An "empty" (embryo-less) catheter will be inserted into my uterine cavity. They use a transabdominal ultrasound to help guide the catheter through the cervix.
• This will be done in the fertility clinic and not the hospital and hopefully by Dr. O.
• The shit part of it all is I have to have a FULL BLADDER for them to do this procedure. For those of you who have had to go through the hellish process of drinking tons of water for this type of thing know that this is SOOOOO uncomfortable! I remember doing this with my hernia and I had to pee so bad I was willing to pee in my pants just to let it all out. I hopped off the table and told them I needed to "let out just a little or I'd go everywhere". I never forgot that day. :-) But yeah, I do that here too.
• They want me to drink 24 ounces or more of water a half an hour before the transfer.
• This process takes only a couple of minutes and is "usually painless" (I love that!)

Next Steps:

• Schedule appointment for the Trial Transfer in between Dec 10-20th. (will do tomorrow)
• Schedule appointment (hopefully the same day for bob's sakes) for a consult with Dr. O to go over the HSG and SHG results and blood work.

I keep telling myself this will be all be worth it, and I know it will be. This is only the beginning and only the onset of appointments and chaos. I'm taking it in stride and although I'm balancing full time school and work, the outcome will make it all worth it.

I decided to keep a journal to bring in with me to appointments to document what is said, what procedures are done when, the timelines associated to all of it - yes I am a Type A control freak, whatttyagonna do about it?

Summary for the next week:

• Acupuncture Appointment on 11-28
• SHG Appointment on 11-30
• HSG Procedure on 12-3
• Acupuncture Appointment on 12-3
• Trial Transfer/Consult 12-10-20
• Acupuncture Appointment on 12-14

Baseline Scan and Bloodwork

Today was four vials of blood drawn and a vaginal ultrasound to determine how thick my endometrial lining is, as well as capture measurements of my uterus and ovaries. The doctor who did my US wasn't Dr. O so I was a little uncomfortable. I haven't let a male doctor anywhere near my girl bits for over a decade, but I quickly got over that when I got to see my uterus on the monitor.

Although there's no fetus in there, it made the experience so much more real to see a couple of follicles in my ovaries as well as the lining in my uterus. M seemed to get excited as well as when I glanced over to him he had a big grin on his face and was staring at the screen. It made me happy to think this experience would be very similar to the experience we will go through when we do egg retrieval and transfer and baby check ups.

Next Steps:

• Call tomorrow and schedule the HSG and SHG procedures. These have to be done before I ovulate which won't happen for another couple of weeks.
• Have both procedures done and schedule an appointment with Dr. O to discuss the results.
• Schedule the trial transfer.
• Relax, Relax, Relax

In other news, I LOVED the acupuncture!! She was super rad, super open minded and I really trusted her. I've noticed the past two nights I've slept REALLY well, and I totally attribute it to the acupuncture. She started me on a Cinnamon D herbal supplement and I have at least one appointment a week until I start the hormones.

IVF Update and Acupuncture

Our fertility clinic highly recommended fertility acupuncture. This is right up my alley.

So, today at 3pm marks my first fertility acupuncture treatment. I'm nervous but looking forward to it.

I got my period today, which is what we've been waiting for to truly start the diagnostic process -so I have an appointment scheduled this Sunday at 745am to go in and have a vaginal ultrasound and blood work done.

In other news, I found this AMAZING show on TV called "The Baby Lab" on the Discovery Health Channel. It walks through many stories of couples going through IVF - we've seen two episodes already and I've cried both times. Good crys. Not bad crys. It's good that they show you the experiences with failed IVF so I'm still feeling optimistic, just not unrealistically so, if that makes sense.

We'll see how Sunday goes.

What is In Vitro Fertilization?

For those of you who don't know what IVF is, I've documented this below. I've captured "my version" and the medical version.

There's even a cool virtual tour here.

My version:

• They first run me through many diagnostic procedures to ensure my uterus and 'girl bits' are working as they should. Two of these procedures are called SHG and HSG. I've heard these aren't the most pleasant things in the world, but are neccessary to make sure my bits are in fine working order. They are very specific about when these tests can take place, the vaginal ultrasound needs to be 3 days after my period. The other two need to be 5-12 days after my period and so on and so on.
• Then they put me on fake hormones - birth control pills - to "suppress" my natural reproductive system. They basically wanna be in charge, they wanna run the show.
• Then more hormones - these are hormones I will inject myself with every day - to stimulate the shit out of my ovaries in order to get as many egg follicles growing as possible.
• They will monitor me often - checking to see how my follicles are doing, whether or not they are getting to the "ripe" old age of maturation.
• When they're ready, they suck those little puppies out. I hope to get 15-20+ eggs. Women normally produce ONE a menstrual cycle. :o
• The day of my "egg retrieval", M has a sperm aspiration as well.
• They take one single sperm and inject it into each good quality egg. This procedure is called ICSI.
• The lab fertilizes my eggs with M's sperm. The little cells start to divide, forming what will later be known as 'baby'. They grow those little kiddos out to 3 days or 5 days depending on their quality. These are called embryos. Some survive. Some don't. Some are good 'quality', some aren't.
• For those that survive, we decide how many to transfer into my uterus. A couple days later, I go back in and those little suckers are dropped into my womb and I take it easy for a couple of days, hoping those little guys implant themseleves nice and happily.
• 8-12 days later I come back into the clinic to see if the embryos "stuck" (implanted) aka, if I'm pregnant. If so, they will monitor my HCG levels to see if there is more than one fetus in there. (!!)
• Boom bang bam, we're pregnant. But it doesn't always work. This is to be expected. If it doesn't, we do a second IVF cycle. And third and so on. Of course, this is leaving out a lot - like the injections I'll need to give myself, the emotional strain, the weird doc hands in my cooch and all the lovely things that come with vaginal scenarios.

Now for the Medical Version:

IVF Process
The following text outlines our process for an IVF cycle:

Suppression of the reproductive hormone system: We must suppress the natural hormones in order to allow multiple follicles to develop (normally, only one develops) and to prevent spontaneous ovulation of the oocytes before we can retrieve them for our purposes. We use several medications such as oral contraceptive pills (OCP), Lupron (GnRH agonist), Antagon or Cetrotide (GnRH antagonists) in various combinations to achieve suppression.

Stimulation of the ovaries: We use gonadotropins (FSH, LH) in high doses to stimulate the ovaries to produce a large number of oocytes. Women differ widely in the number of oocytes their ovaries will produce but we hope to retrieve between 5 and 20 oocytes with each stimulation cycle. We monitor the progress of the stimulation with blood hormone levels and vaginal ultrasound measurements of the ovarian follicles.

Retrieval of the oocytes: We plan for retrieval of the oocytes when the hormone information and follicle size indicate that the oocytes are mature and ready for fertilization. Our staff instructs our patients to administer the hormone HCG about 35 hours before the planned retrieval. This initiates the final steps of oocyte maturation and allows the oocytes to be removed from their follicles. With the woman under conscious sedation and using ultrasound for guidance, we pass a fine needle through the vaginal wall into each of the ovarian follicles and aspirate its contents. The fluid obtained from the follicles is transferred directly to the IVF laboratory where the embryologist identifies the oocytes under the microscope and places each one into its own dish containing special culture medium.

Fertilization of the oocytes: Usually, while the ovum retrieval is underway, the woman’s partner provides a semen sample from which we isolate sperm to fertilize the oocytes. Other possible sources include sperm obtained previously and frozen, donor sperm from a sperm bank and sperm obtained through aspiration of the testis for men with obstructive azoospermia. The sperm sample is prepared in the andrology laboratory (see below for details and variations) before being added to the dishes containing oocytes. The oocytes and sperm incubate overnight to allow fertilization to take place. In cases where impaired fertilizing ability is suspected, we directly inject a sperm into the oocyte to achieve fertilization (ICSI). Successful fertilization is determined the next day by locating two nuclei within the oocyte ("2PN stage"). The fertilized oocyte is now called a zygote.

Embryo Development: Each zygote is placed into fresh medium and incubated further to allow cell division to occur. Once cell division begins, the zygote is now called an embryo. The embryonic cells ("blastomeres") remain contained within the egg’s outer coating, called the "zona". By the 3 rd day after retrieval, most embryos will have reached the 8-10 cell stage and may be ready for transfer. After another 2-3 days, the embryo has more than 100 cells and is called a "blastocyst".

Embryo Transfer: Selected embryos are returned to the uterus through a procedure called an "embryo transfer". This is a painless procedure involving the introduction of a thin tube (catheter) into the uterine cavity through the cervix. The embryos are passed from the catheter into the uterus where implantation takes place. The embryologist guides us in selecting a limited number of the best embryos for transfer. Selection criteria for embryo transfer are designed to maximize pregnancy rates and minimize multiple pregnancy rates. Whenever possible, we freeze the remaining embryos for future use. The number of embryos to transfer is determined by the anticipated implantation rate. Implantation rate refers to the number of implanted embryos per total number embryos transferred as determined by the number of gestational sacs visible by ultrasound 4 weeks after transfer. Implantation rate is determined mainly by embryo quality which in turn depends largely on a woman’s age. Embryo quality is also dependent on the conditions within the embryology laboratory.

Luteal Phase Support: The ovary produces progesterone after natural ovulation and after IVF oocyte retrieval. However, during the course of ovum retrieval, we remove a large number of the progesterone producing cells along with the oocytes. Consequently, some women may not produce sufficient progesterone themselves to support a new pregnancy. So, we supplement all IVF cycles with additional progesterone during this critical stage. Progesterone supplements may be administered by injection or by the vaginal administration of tablets or gels.

Pregnancy Test: We test for pregnancy using a blood test about 14 days after egg retrieval. By that time, the HCG administered to trigger the retrieval should be out of the system and any HCG measured in the blood will be from a new pregnancy. Some pregnancies last only a few days ("biochemical pregnancy") but most progress to at least 6 weeks when we can see them with ultrasound ("clinical pregnancy"). It is at this point that we can determine how many embryos have implanted.

How it all started....

We've been talking about children for a long while now. But M had a vasectomy almost a decade ago. We knew it was going to be a long journey, we just didn't know how long or how tough. :-)

In September, M got a vasectomy reversal. We were told to wait 6 weeks to get the analysis back - which we did - it was a failed reversal, aka no sperm. And by no sperm, I don't mean low sperm, I mean NO sperm.

Devastation hits, we grieve, we progress, we move on. We meet with a fertility specialist who recommends IVF (in vitro fertilization). And that brings us to now.

This journal will document all of our journeys, our appointments, our ups, our downs, everything. Because it is public, names will be removed, some posts may be ambiguous, but the purpose is to share with YOU our family and friends, everything we're going through in order to create the child or children we want so badly. I started documenting this in another journal so some posts will be backdated to capture the steps we've already taken.

So let the journey begin.