And on the Third Day....

Today's big thing: our first IVF appointment!

The day began with another billion inches of snow that fell overnight and continued to fall. We thought we'd be late to the appointment at the fertility center, but we were only a few minutes late, and pretty much everyone else was running late, too.
First, we met with my doctor. Since we have done several rounds of IUI (intrauterine insemination), a lot of the things about IVF (in-vitro fertilization) are the same - like the shots and monitoring the cycles with ultrasounds and blood tests. For IUI, they stimulate the growth of my eggs and inseminate with sperm directly in the uterus. For IVF, they remove the eggs, fertilize them, and then watch them grow for a couple of days before placing the best ones back into the uterus.

Today's appointment was a long one - almost 3 hours - so they could go over everything with us and do tests. In the consult part, Dr. G. went over my chart, how my eggs developed during the IUI, Sean's sperm count, how I responded to the shots, etc. He went over the risks, of course, including ovarian hyperstimulation syndrome, and the risks that come with the egg retrieval. Even though the chances of these things are slight, they have to tell you.

Dr. G. wanted me to get a pap test and mammogram in the next month or so, and wanted to make sure my A1C number was under 6. Since I've had insulin resistance issues in the past (daignosed PCOS), and recent trouble with my blood sugar, this is important to get in line before I get pregnant. When my A1C was taken in October, it was 8, which is high. Since then, I've been much more careful about my sugar and carb intake, and I've started on a new medication to help keep it all in control. I'm hopeful that the A1C number will come back low.

I asked about the incompetent cervix, and Dr. G. said that my OB/GYN Dr. K. would for sure do the cerclage early on once I was pregnant. Dr. G. did not feel that the incompetent cervix would affect my chances with the IVF. He did feel, however, that, even though they usually implant 3 embryos in women over 35, they would only implant 2 or maybe even 1. I would be high-risk carrying just one baby, and two would be very risky. Three would likely be impossible and Dr. G. said if I were to become pregnant with triplets, that I might need to make a difficult decision early on. I think Dr. G. and I agreed that we would be more comfortable with implanting 2 embryos. Of course, this is also something we will decide once we see how they grow.

We also had to sign a bunch of releases, stating that we understand the risks involved in the procedures. These were very similar to what we signed for IUI. We also had to sign forms indicating what we would want done with the embryos if something should happen to us or we got divorced. We had to spell out what we would want done with the frozen embryos if I was to die, if Sean was to die, if both of us died, and if we got divorced. Any extra embryos that look good will be frozen in case we need them later.

Since I've already done many of the fertility tests like ultrasounds, hysterosalpingogram (HSG), ultrasounds, endometrial biopsy, etc., we are kind of ahead of the game on some things. So, next I got to "undress from the waist down" (Sean laughs at me because I always ask if I can keep my socks on because my feet get cold!) get into the stirrups, get the dreaded speculum, and Dr. G. did some swabs of my area to test for STDs and did a mock transfer where a thin catheter is inserted into the uterus to measure its depth and to determine how to insert the catheter with the greatest ease during the real embryo transfer. This was not any more uncomfortable than the inseminations I'd already been through.

I got dressed, and we went back to the waiting room until we were called by the fertility nurse. She sat down with us to tell us the expected protocol that we would follow and when we wanted to start after all the test results came in. She set the orders for the blood tests we would need and how we would have to pay for them. We went back to the waiting room until called in for the blood draw.

We decided to test for Cystic Fibrosis, so they test one of us for that. If one of us comes back positive, they will test the other person. I offered to be the testee for that, so they drew about 5 vials of blood from me, 2 vials from Sean I think. What they will test for from both of us: HIV, Hepatitis B and C, and syphilis. From me, they will also do blood typing and the A1C test for my blood sugar. From the swab they took from my vagina and from Sean's urine sample, they will test for chlamydia and gonnorhea. So, our bases should be pretty much covered!

Back to the waiting room, then we were called back to the fertility nurse, who went over which shots we would get and when. More on that later.

Back to the waiting room again, then Sean was called to give his semen sample. He goes into a private room (it cracks me up that they tell you that the door locks and everything! I would hope so!), they give him a beaker (and they always say that you are NOT expected to fill it!), some surgical-grade lube (so as not to contaminate the sample), and there are some Playboy magazines in a drawer.

While I was waiting, the nurse came out and said she forgot to have them do the Rubella test for me, so I would need to come back some time, and I said I wanted to do it today. They test for Rubella immunity to prevent birth defects in case I become pregnant and was exposed to Rubella. The nurse was very apologetic and felt bad that I'd have to give more blood, but it wasn't THAT much. I was a blood donor, this doesn't even come close to that. So, I went back to get the blood drawn and when I came back out, Sean was back from doing his sample and we were free to go.

As for my protocol, I am to call when I get my period, and then on day 21 of the next cycle, I will start on Lupron, which I take with injections daily. When I get my next period after that, I will continue on the Lupron and will add the Follistim (to help more eggs grow) that I did with the IUI. At that time, they will start monitoring the cycle with blood work (to monitor hormone levels) and ultrasounds (to check follicle growth on ovaries) every 2 days or so. When they get a few mature eggs, I will do the trigger shot exactly 36 hours prior to coming in for the egg retrieval.

For the egg retrieval, I will be sedated (very similar to when I had a colonoscopy). They use an ultrasound to guide a needle through the vagina to reach the ovaries and draw the fluid from the follicles into the needle (and with the fluid, the eggs). They like to retrieve at least 10 mature eggs. My first IUI I had about 10 mature eggs, but the second was a lower number, so we'll see.

Next, they will take Sean's semen (usually given that morning) and, similar to IUI, remove the seminal fluid and any inactive sperm. They put the sperm and egg together (about 50,000 sperm for each egg) and let them get to know each other for about 18 hours. Hopefully at this point, one sperm will be a good match for the egg and they will join in fertilized bliss. Then, the fertilized eggs will be moved and left to grow for 48 hours or so until the egg is in the 6-8 cell stage.

The quality of the embryos is determined and then the "good" embryos are transferred within 3-5 days after fertilization. The transfer is much like the IUI insemination, where a thin, plastic catheter is inserted through the vagina and past the cervix. Several embryos may be implanted to improve the chances, but for me it will likely not be more than two embryos. After the transfer, they want me to take it easy, laying down for an hour or so before going home, and then taking it easy for a few days. He said, "No strenuous exercise" to which I said, "that shouldn't be a problem!!!" hahaha

For now, I wait to get my period, get a pap test and mammogram, and wait for the test results (which I expect should be fine, just a bit worried about the A1C).

So, another big day in my world! Keep sending those happy thoughts. Today I thought, "Wow! I just might have a baby THIS YEAR!"

KEEP HOPING!!!!

(Note: image above is entitled "Fertility" by Keith Haring)
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