The Magic Number

Six is the magic number.

As you may recall, we did CCS genetic testing on 11 blastocysts 2 weeks ago at CCRM. We have been waiting for the results ever since, with no small amount of crying and cuddling my small dog like the baby substitute he is.

Wednesday night we got the call from Dr. Surrey. We have six normal embryos! Of the 11 blastocysts tested, four have genetic abnormalities incompatible with even a positive pregnancy test, and one is still a question mark. And six are normal and of "more than high enough quality to result in a live birth."

We are relieved.

FET approximately September 27.

A Hypothetical FET

Sometime next week we will get the big news about our blastocysts. The doctor has not given us an appointment, so it could be anytime and anywhere: 9 a.m. at the kitchen table, 2 p.m. at the grocery store, or just before the first class I teach this semester. It could very well be the good or bad news that will make my birthday complete.

If there is one thing I have learned in the past two years, it is to prepare for the worst. That said, I have started the meds for the next possible Frozen Embryo Transfer (FET), and I have the schedule for the rest of the protocol.

I am going to share this protocol now, in case it is of use to someone else. If I don't have normal embryos, I suspect I will not be in the mood to type this up later.

So here it is:

August 18: begin birth control pills
August 30: start Lupron 10 units per day.
9/3 last birth control pill
9/6 new cycle begins
9/8 1 Vivelle patch
9/10 1 Vivelle patch
9/12 1 vivelle patch
9/14 1 vivelle patch
9/16 2 Vivelle patches
9/18 3 Vivelle patches
9/20 4 Vivelle patches
9/12 ultrasound
9/22 4 vivelle patches, endometrin 3 x day, stop lupron, tetracycline 4 x day, medrol at night
9/23 endometrin 3x day, tetracycline 4 xday, medrol at night
9/24 endometrin 3x day, 4 vivelle patches, tetracycline 4 x day, medrol at night
9/25 endometrin 3x day, tetracycline 4 x day, medrol at night, Travel to Denver
9/26 endometrin 3x day, 4 vivelle patches, tetracycline 4 x day
9/27 Embryo Transfer: endometrin 3x day
Strict Bed Rest 48 hours
Return home.

In addition, I will need to do electro acupuncture 2x week for 4 weeks and give up decaf coffee and chocolate.

DH calls it the Scorched Earth Protocol.

The Idea of Eleven

Longtime readers of the blog may recall that during my second IVF cycle, my Reproductive Endocrinologist described me as a "woman committed to the idea of eleven" because I had about eleven follicles developing on either ovary.

Well, my current embryologist agrees.

To review, of the 32 eggs retrieved, 28 were mature, and 26 fertilized normally.
Of those 26, 18 developed normally to Day 3.

Of the 5 embryos who journeyed to Colorado in a tank, all 5 survived the thaw.

Day 6, yesterday, the CCRM embyrologist call to say that of the 18 from the fresh cycle, 9 embryos grew to good-quality blastocysts and of the 5 frozen, two continued to develop to blastocyst.

So that makes 11 blastocysts total.

Committed.

These blastocysts are now made up of about a hundred cells apiece and have already differentiated themselves into the fetal pole and trophectoderm, or what will be the placenta. The embryologist biopsied 2 or 3 cells from the trophectoderm and sent those off for the Comprehensive Chromosome Testing. (They do this with PCR at CCRM.) The embryos themselves have been vitrified.

So now we wait.

The good news is that I have lost four pounds of water weight since I came back from Colorado, so I think am safe from the dangers of hyperstimulation.

Fertilization Report

I got the call from John Stephens, the director of the lab, this morning.
of the 32 eggs, 28 were mature, and of those, 26 fertilized normally, with ICSI.

Now, on to eat more salty foods, as prescribed by my doctor.

Retrieval Day or 32 Eggs and Then Some

I'll write down a bit of what I remember from today, since I hear I have one or two readers new to IVF.

I got to CCRM at 8 a.m. and a very nice nurse named Jennifer set me up in a room to change into a gown and start an IV. I have had some bad experiences with IVs, so I was nervous, but she used all the tricks I have heard of, including wrapping my arm in a warm moist towel and injecting lidocaine under the skin of the back of my hand before putting in the actual IV. Close to painless.

Jennifer let my husband into the room, and soon after, the anesthesiologist came to talk with my and have me sign the consent for general anesthesia. (Note that I had been fasting since midnight.) For this procedure, I was not intubated, but they put in a device to keep my airway open. My only moment of nervousness was when the doctor told me that since they were running short of Versed, they were trying to conserve it, so I might remember being scrubbed in preparation for the procedure.

A few minutes later, Dr. Minjarez came in. My main doctor at CCRM is Dr. Surrey, but I have only met him once, during my day-of-tests. Various nurses convey all of his instructions. I technically have one main nurse at CCRM, but I have only seen her once since I arrived in Colorado. All of which is to say that I did not have a real relationship with any other medical professional, and thus was not disappointed to see a new doctor. I liked Dr. Minjarez immediately, especially when she said, "I go by Deb."

Dr. M instructed me to come back for an ultrasound tomorrow, and then to drink lots of water and eats lots of salty foods for the time being. She also said that I should avoid exercise for at least the next week, and that my hyperstimulation symtoms should go away completely with my next menstrual cycle.

After Dr. Minjarez left, the anesthesiologist came back in and turned something on in the IV, and that's the last thing I remember. I guess she found some Versed.

While I was in the retrieval, DH went off to do his thing.

I awoke to the sound of beeping. I looked up and saw that my heart rate was 46. I wanted to go back to sleep, but the beeping continued, so I could not. Jennifer brought DH to the recovery room.

32 eggs retrieved. Jennifer was impressed. It was nice to feel like I was good at something related to fertility. DH has been referring to me as the ovipositor, which, thanks to Google, I learned is both an organ used by some insects for laying eggs and also an ongoing experiment in groove versus dissonance. So the lab will work with these 32 eggs, and they will also defrost the 5 embryos I had shipped here. Before anyone gets too excited, the number of embryos that fertilize AND make it to blast AND test normal will be a good deal smaller, like one fifth of that at the most.

But back to retrieval day itself.

Before I left the surgery center, I had 2 extra strength tylenol and one can of ginger ale.
I slept for most of the rest of the day, and I am ready for more sleep now.

Tonight:
Tetracycline
Dostinex
Cetrotide by injection

Triggers and Bonus Medications

Yesterday, at 5, I got the word that I would need to take a trigger shot that night.

The nurse confirmed that I was still hyperstimulated, and that my estradiol, at 6,774, was too high.

So last night, in addition to lupron, dexamethasone, and, and the intramuscular trigger shot, I also had to stick a pill called dostinex up my vagina. I will have to take this for 8 nights. (This is exactly what the nurse said, "Stick it up your vagina,")

Starting tomorrow, I will also have to inject myself with cetrotide.

If you are scared of having your loved ones give you intramuscular injections, note that you can pay an RN to drive to your home, or, in my case, your hotel room, where she will mix and provide the injection.

My retrieval is with Dr. Minjarez at 9 a.m. tomorrow.

If you happen to be reading this at 9 a.m. Mountain Time, send thoughts of quality embryos.

A Different Sort of Two Week Wait

Today we spent the morning at CCRM. I had my IVF physical at 9, and then ultrasound and bloodwork at 9:30.
At 10, I had an excellent massage right in the clinic.
At 11, we met with a new genetic counselor, Mary. (She is not to be confused with Danielle, who helped me through a misunderstanding during our last consult.)

Our meeting lasted an hour, and, because my brain is not working, I am not sure I remember everything she said, but the big news is that on July 1, CCRM has changed its method of Comprehensive Chromosome Screeing from CGH (Comparative Genomic Hybridization) to something called PCR. While the CGH testing would have taken 6 weeks, the PCR testing will only take 2 weeks. So we will know whether any of the embryos are normal in 2 weeks!!

To review, CCRM will let all the embryos grow to blastocyst, biopsy them for testing, and then vitrify them. I will go home to Oregon and wait for the results. If there are normal embryos, I will come back for transfer at a later date.

This afternoon, the nurse called to tell me my estradiol level, at 7200, was too high, so I need to "coast" for another day with no stims. According to various sources on the internet, my estradiol should be between 200 and 600 per mature follicle (those over 18 mm). I think the ultrasound tech said that I have around 27 follicles nearing that size.

This explains why I feel so nauseated and bloated.

Good times.

Tonight: 5 ml Lupron! Trigger tomorrow.

Another Reason to Move to Chicago

For the past few days, I've continued on the doses of 75 Gonal-F, one ampule of menopur, and 5 units of lupron, along with dexamethasone, folgard and prenatal vitamin. I am starting to feel nauseated and uncomfortable. The good news is that when the nurse called this afternoon, she said I did not have to give myself any stimulation shots tonight or tomorrow morning.

This morning, when I went in for my ultrasound, there was a new tech, and she gave me the option of guiding the transvaginal wand myself. Now, if you having done a few rounds of fertility treatments, as I have, you may be tired of having people poke things in your vagina. It is actually nice to be given the choice to do it yourself.

The tech told me that she can always tell the patients who have traveled from Chicago, because they always reach for the want themselves. Apparently, this is standard practice at a few major clinics in that fair city.

Tomorrow:
9 a.m. IVF physical
9:30 Ultrasound, bloodwork, and meet with nurse
10 massage (!)
11 genetic consult