I'm an Over Achiever

Monday was the egg retrieval - and it went great! I have never been a patient in the hospital so I was nervous - never sat on a hospital bed, never had an IV, never had anesthesia (more than wisdom teeth removal) and definitly never been in an operating room. I was pretty uneasy the whole morning, unsure of what would happen. So when it was time for the procedure I had Todd give my swollen belly a little pep-talk and then I was rolled away to the OR. In the OR there were a few nurses and the embryologist right there to look at the eggs that were extracted right away. I said a prayer as the room started spinning...and then 45 minutes later I woke up in my recovery space with some horrible abdominal cramps. The doctor came by and said they extracted about 30 eggs - I didn't know if that was good or not so Todd did a little google search and found out it's REALLY good, normally no more than 20 are extracted. The rest of the afternoon I was in a lot of pain, a lot of discomfort so I stayed in bed.

Tuesday was the fertilization results. The embryologist called and let me know they extracted 29 eggs on Monday, 23 of which were mature and usable eggs. So they then performed the ICSI (intracytoplasmic sperm injection) procedure on all 23 eggs Monday afternoon and then on Tuesday 18 of them were fertilized and growing strong! I'm still in disbelief that we have 18 embryos now. The embryologists will monitor those 18 eggs for the next few days and identify the best and strongest ones to transfer and implant on Saturday. The remainder will be frozen for future use.

ICSI procedure. 

5-day embryo stages

So we're all set for Saturday, received the pre-op instructions and now it's just the waiting piece. This one isn't an actual surgery, more of a routine gynecological procedure and no anesthesia, just vicadin to keep me calm during the procedure so really nothing to worry about. I think one of the best parts about Saturday is that Todd can be in the procedure room so he can be a part too. Yea!! I just hope my abdomen swelling and pain goes down by Saturday so the procedure is easy and I feel good- mental prep is important too. It will be a week where I wear dresses all week - no constricting waistband for me!

Countdown T-minus 60 hours!

Today's appointment went well - Todd was able to go to the appointment and experience what a sonogram entails. It was nice to have him there so he could see what the procedure is like but also I couldn't look at him out of fear of bursting out in laughter as I was in the uncomfortable gynecological position...so our egg retrieval date is officially set as MONDAY, 11/28 at 9:00am. Dr Mayer said I would have been OK to go on Sunday but he'd prefer to have one more day of growth to really get those borderline follicles up to 16mm. I got upset with the day delay but Todd said that it's nothing to be upset about - Dr Mayer is being "greedy" and "greedy is good for us!" which is an interesting spin on it. So one more night of FSH injection and that's it!

Egg retrieval, or "egg aspiration", is a minor surgery but involves no cutting. I'll "assume the position" and then a needle with an ultrasound will go in and lightly suck out each egg from a follicle. From that the eggs will go directly to the embryologist where Todd's swimmers will be thawed and waiting. The procedure is done under full anesthesia at Tampa General. I can do normal activity that afternoon, there is only an hour recovery time. Pretty minor procedure with pretty major results. This website has a pretty good step-by-step of what happens. http://www.floridafertility.com/floridafertility/IVF/Tour.aspx

The "operation table".

This isn't me - I don't think I'd sign the consent form to allow this photographed!!

So, not a big update but there are dates and times set in stone which is a good thing. And my wonderful sister's 30th birthday is on Monday so that MUST be a good sign that it will be a great success - the best sister in the world was born that day, no reason why a great number of healthy eggs wouldn't be retrieved that same day. And not having on Sunday is actually a blessing in disguise because we got new puppy Macy this weekend and now we'll have the full un-interrupted weekend to spend time with her and make sure she's acclimated to our house.

So cheers to the LAST Menopur shot tonight! Cheers to the LAST Lupron injection in the morning! and cheers to the VERY LAST injection of them all Saturday night at 9pm!!

The Home Stretch

We officially are in the home stretch - less shots to take than are left (possibly only 7 more - we started with 41!). While at dinner last night Todd and I were in awe of how fast this process went - it feels like just yesterday when we had the injections class and I was terrified to give myself the first shot. And now, here we are, possibly ready to go for egg extract on SUNDAY 11/27!

Yesterday I had my first sonogram after the stimulants - they went in to count the number of follicles on each ovary and what the size of each follicle was. If you've never thought into detail about the female reproductive system - the follicle is the home where a single egg grows. like a little den. Each month a females body releases usually 1 egg (meaning 1 follicle really grows)  IVF and other infertility treatments try to get the body to mature multiple follicles (hence, multiple eggs for better chances of success). So at this sonogram appointment the nurse found  19 follicles that were bigger than 12mm which is good progress after 5 days of stimulant shots! Once the follicles are 16-20mm that indicates the eggs are "mature" and can be taken out. Being that many of mine are > 12mm and my estrogen level is near the top, we don't have too much longer to go really!

Now, just because there are 19 follicles does not mean there will be 19 happy healthy eggs that they retrieve. Sometimes there are more, sometimes there are less. Sometimes a follicle is empty. Sometimes an egg isn't fully mature. So I've still got my hopes on getting lucky number 9. We have another sonogram appointment on Friday morning where they will recheck the number and size - at that appointment they'll decide whether we're retrieving on Sunday or not. I hope we are - then I don't have to use a vacation day at work and I won't have any more shots in my belly!!

I haven't really had any terrible side effects that I was anticipating. I've read other blogs and listened to the nurse and was expecting intense pain, severe bloat, and battle wounds from the syringes. While I don't fit into my jeans (sadface), I don't feel terrible which is good. I haven't had hot flashes, I haven't had mood swings (anymore than usual). It's dangerous to do too much internet reading and research - that's when I get scared and nervous about long-term side effects of the medicine, or Over-Stimulation, or other terrible side effects. But USF is very closely monitoring everything so I'm not worried. I am 27 after all which is the perfect age still :) 

...And We're Back!...

Blood work on Friday - lovely results!  We're back in the game, so only a 3 or 4 day delay in our calendar. Whoop!

I have done 2 nights now of the "stimulant" shots - there are 2 shots each night that are intended to get my insides going as much as possible so they can extract as many mature eggs as they can in one surgery. The medicines now are called "FSH" or "Follicle Stimulating Hormones" - Gonal F and Menopur. My friend Beth had the pleasure of getting the Injection 101 class last night and watched the injections. I tried to keep my brave face as much as possible but the Menopur stings so bad! The worst part about Gonal F - it's a self contained medicine that is in a pen-like dispenser. NOT and easy syringe to depress at all - you have to push really hard and hence leave a bruise. Menopur takes a little self-mixing but at leas uses a normal syringe set up so the medicine is injected with simple pressure - although it stings so bad!

Anticipated side effects of medicines are severe bloating and fatigue. The doctor explained this part of the process to us like this: normal ovaries are the size of a walnut. We're trying to make both of mine the size of oranges...so it's not going to be comfortable, it is most definitely going to be noticeable, and will be  uncomfortable. Looks like I'll be wearing dresses and elastic band skirts because my pants already don't fit from the weight I've already gained.

But the most "real" part of this IVF adventure has just started...I officially have to be alcohol free and limit caffeine consumption! For those of you that are familiar with "Kelly The Tank" or my regular 3pm Diet Coke breaks- this is a major milestone. I tried to ween off of alcohol since our Halloween party so it wouldn't be such a shocker - but it's for real now. And I was an idiot and bought 4 12-packs of delicious soda at publix the other day on a great sale with coupons so now I just have to sit and look at it longingly. On the bright side, I'm officially off of litter-box duty so that's not such a bad thing!!

I go in for lab work/sonograms every 3 days for the next week to check on the progress of these new medicines. If everything stays on track, we should be having the extract surgery the first week of December.

11/15 Update

We've hit a small speed bump on our fast road to IVF. I had my first bloodwork/sonogram appointment on Tuesday to check to make sure my ovaries were "resting" and that we had a clean canvas before we started the stimulants. As uncomfortable as the appointment is (pictures to come!), it was a GREAT appointment! The doctors and the nurse said I looked great, no cysts or other abnormalities in the ovaries that would prevent a successful cycle. I also have 6-8 follicles on each ovary which is a healthy producing ovary (I am 27 after all, who would doubt that!) Matter of fact, Dr. Mayer even gave me a high five on the way out! If that doesn't boost your spirits, I don't know what would!

To push my excitement along even further, the nurse said, "the next step is to recruit, recruit, recruit!" [the eggs]. and I'm thinking in my head...that's fantastic! I recruit for a living so I should be great at recruiting my own eggs! Then we'll go through the interview and selection round and I know how to interview so i'll select the best and brightest...and then to push it along even farther i'll put the eggs through some pre-employment testing and make sure we're really top notch. Quite geeky to align the IVF cycle with my profession, but I thought this was a good sign that I'm making those connections.

Well, then the 3pm bloodwork results come in and turns out the Lupron isn't working well enough to bring my estrogen levels down to where they need to be. In doing some research i don't think I'm too far off, but it's not where it needs to be. (I guess i'm a more "girly-girl" than I thought since I'm estrogen filled). So we've postponed the calendar a few days and I'm continuing on the Lupron to see if we can bring those levels down. Since I'm not as low as I need to be, maybe that's why i'm not getting any adverse reactions to the medicine that I thought I would have? At the start of the stimulants I should have an estrogen level <70. At the peak of the stimulant cycle I should have an estrogen level around 3,000!  Since I'm at 102 now, I don't think I have a terribly far way to go since the range is 70-3000 in a matter of 2 weeks! See the chart:

 

So for now, we're a few days behind the published calendar which messes my brain all up because I have a mental picture of the previous calendar. Now I'm even more lost on dates. I just hope it's not pushed back too much - timing was working out perfectly with the holiday breaks and downtime in work; my absences for the surgery wouldn't have impacted much at all (and holiday weight gain will be masked with IVF weight gain...excuses excuses). 

But in the spirit of having spirit and hope - our calendar wasn't stopped. My sonogram was great. I'm 27 with healthy ovaries. The doctor gave me a high-five. I've gotten a lot of support from friends and family. It's still a favorable time of year to do the procedure. Still need to stay positive, we're still just in the beginning stages.

It's Not All About Me...

As much as I'm thinking about myself in this process, it's not all about me (bummer!!) I have to give credit to Todd who underwent some significant procedures to get where we are. So some additional history to how the IVF process started.

In 2010 after a year of trying to get pregnant my doctor said we could start infertility testing. The first test that is always done is a semen analysis - easiest test to do and usually the most telling, and this was no exception. So Todd was a trooper and did his test and the results came back as "AZOOSPERMIA", which means zero count. Not slow swimmers, not a low number, but absolutely zero. Once we overcame the shock the doctor had Todd go through a second test with the exact same result. He had multitudes of blood work done - testosterone is fine, all other blood indicators say there isn't a problem. So Todd was referred to a urologist to check out what's going on because it could be either a diagnosis of 1) blockage or 2) he doesn't create "swimmers". A blockage would mean we could have biological kids through IVF; the second diagnosis is the end of the road.

The first procedure he had to undergo was a biopsy, where they go into Todd's manhood, take each one out, take a syringe of fluid out of each one, and then put it all back and sew it up. I'm sparing the technical terms and more graphic details, but for men that have heard the story I think they immediately grab their "areas" in pain just thinking about it. There is a YouTube video of the testicular biopsy procedure, for those interested. 4 days of waddling and an immense amount of pain for Todd (I think his exact words were "it feels like I've been kicked in the balls or my balls were used as punching bags") the results were in. Me, being the skeptic that I am, assumed the worse and we'd get the 2nd diagnosis that has no hope for fixing. Todd is the hopeful one and his hope won - the urologist said it was healthy and good and usable swimmers that are just blocked so our hope was restored knowing that IVF was an option! The only downside is that procedure needed to be done a second time to extract swimmers for the IVF treatment.

Once we figured out how we were going to make the IVF work out financially, it was time to schedule the procedure and send Todd's "area" through turmoil again. On 10/10 we went to Tampa General and got him ready to go. Funny part of the story - since it's for IVF treatment Todd was treated in the "Women's Center"! LoL! We were both prepared for the full biopsy surgery again with the painful, lengthy recovery time. When his surgery was over the doctor came and found me in the waiting room and said they were able to retrieve with just a syringe - so NO cutting, NO lengthy recovery, and NO pain! Instead of waddling around for a week, Todd and I went shopping for new flooring that afternoon. They were able to retrieve and freeze 4 vials of usable "swimmers" for IVF procedures (each procedure takes 1 vial).

All in all, Todd's part of the procedure restored our hope in many ways. Against nature and with the help of modern medicine, they were not only able to retrieve healthy swimmers, but they were able to do it without pain and 4 vials of it. It really couldn't have gone any better in this retrieval situation. And, it looks like Todd's Cigna insurance is picking up some of the tab for that so his $2,200 procedure has only cost a portion of that. Positive, Positive, Positive! I think this is reason for my hope in this procedure - I've been given nothing but opportunities for hope along the way, when my heart was sunk little nuggets of joy kept coming up to restore my spirit.

Next Tuesday 11/15 is my next appointment to check on my body and to check if the Lupron medicine is getting my body into "dormant resting" mode before they kick it up into overdrive. Since I'm not having ANY negative reactions I'm skeptical that it's actually working - but maybe it's just another positive sign that this is going our way...

Pictures

Pictures of what the next month looks like for us:

These are all of the medicines that will make their way in over the next month.

The syringe is so small, nothing to be afraid of!

 To give a scaled comparison, 10cc's of medicine is really a tiny amount.

Just a little pinch of the mid-section and a quick pop! (No, it doesn't get injected into my butt!!)

I'm being dramatic...it really doesn't hurt Todd.

I LOVE ORGANIZATION, and I LOVE USF!!! (Bulls 4 Life!)

My Personal Pharmacy

My benefits at work are great - I'm not going to even try to pretend the medical coverage for the cost of procedures isn't competitive. However, prescription coverage is unfortunate. As most insurance companies, IVF procedures aren't covered - it is $15,000 after all for just 1 shot at it. But at least they could cover the medicines to help get us there! I've got a total of 44 shots lined up over the next 4 weeks; some I have to mix myself, some are refrigerated, some are in kits. Either way, I have my own personal cash-bought pharmacy that is supposed to send my body into turmoil the next few weeks. The drugs I'm on are called:

• Lupron (it's supposed to suppress my ovaries and put them in "resting" phase so the stimulants can really kick in. The nurse said I will feel like I'm going through menopause)
• Gonal-F (it's a stimulant to excite my eggs)
• Menopur (another stimulant to excite my eggs and mature >1 in the cycle)
• HCG (this is the "trigger shot" to mature the eggs right before extraction)
• Crinone (this is pure progesterone - so much is lost during the IVF process that the womb physically could not support a pregnancy without it).

once I picked up all of these medicines, it really hit that this is REALLY happening. When you have your own personal 'Sharps Disposal' box and you understand the different gauges of needles in syringes, you know it's for real.

So day 1 of the shots - terrified out of my mind to give myself an injection. Todd and I were going to wake up early and he was going to be the strong man to make sure we didn't wimp out. After a back and forth of about 5 minutes of "you do it", "no you do it", 'no i can't do it, you do it" i finally said OK and took a deep breath and stuck myself. And you know what? It was NOTHING! I felt nothing, it didn't hurt, it didn't bleed, it didn't sting. Totally doable and now it's second nature to stick a needle in my belly.  If you're interested in seeing someone do it, do a YouTube search for a girl doing a "Lupron Injection".

Side effects after 1 week of shots? Nothing really yet. I've had a terrible headache for 4 days straight but no hot flashes yet, no mood swings (although I'm moody enough on my own...). I'm waiting for this misery to kick on that I keep reading about on other blogs but as of yet I've just gained about 6 pounds. So other than being miserable about weight, I'm hanging in there. But there's another 22 days of shots to go...when I get home from travels I will take a picture of my pharmacy so you can really appreciate the process. Every time I look at the boxes of medicine I can't help but think of the miracles of modern medicine and how fortunate Todd and I are that we can financially handle this journey and also emotionally handle the journey. It can be overwhelming to look at and think about - staying cool is key to success.

Decisions Decisions

One of the biggest, most unnerving parts of the process was the "decisions" we have to think through and make. As with any good research institute, USF does their due diligence in educating their patients and making sure they understand all of the implications of the medical procedures and the "what-ifs". Our first big decision making session was called the "Consent Signing Appointment". During this appointment, Dr. Mayer outlined all of the risks, decisions, and outcomes that could happen with IVF with ICSI. If you're interested in seeing a blank Informed Consent and what we went over, visit http://www.usfivf.com/ and click under "Patient Forms". 


My biggest concern with the procedure was the long-term, and unknown effects, of injecting hormones and stimulating ovaries. There's a reason the human body has a certain chemistry - and as we mess with it, I'm afraid of the long-term risks. You hear of many stories of women who got cancer or other terminal illnesses from IVF stimulants. Our doctor showed us the research, showed us the data. We walked out of the appointment knowing that I won't be over-injected to cause any problems. After all, I'm the "perfect age of 27" for IVF (no joke, EVERY doctor has commented how 27 is the PERFEECT age for this! I've never felt more special!)

The next decision factor was what to do if it doesn't work. Many couples have a sperm donor on the side - so if Todd's "stuff" didn't thaw correctly, we could still have a baby and use the eggs that are retrieved. Todd and I both agreed that it's either our baby together or we would adopt a baby together. I'm not the type of girl that needs to be pregnant, that needs to experience the miracle of birth. I've seen people have babies - I don't need to get fatter, my boobs don't need to get bigger, and I sure don't need to go through the pain! So that was an easy decision for us - it's ours biologically, or ours adopted but not a combo. Even though Todd's friends offered to have a "mystery donor bank" -appreciate the thought guys, but we'll pass!

Finally what we have to decide on (and i'm still not certain) is how many to implant. Because of my perfect age of 27, at most they will do 2 embryos.However, for medical research they want to do some research with implanting only 1 embryo to see what success rates are (currently 50/50 for implanting TWO). I've always wanted to be  medical research, and the thought of twins is terrifying! So we have up until implantation day to think through if we want BOGO babies or not. No way will I be the new Octomom or "Kelly Plus 8". We'll follow the doctor's protocols. As much fun as the Burchell's are, I don't know if we're cool enough to have an audience for a TLC TV show to help cover the expenses of that baby drama.

In The Beginning...

After much reading about the adventure that Todd and I are embarking on, and after my selfish jealousy of others who "accidentally" get pregnant or say "we weren't even trying!", I realized that there is a lot about this journey that is new and exciting that others should be envious over US. Majority of couples won't have the pleasure of going through an adventure of this magnitude together - the physical and emotional journey of assisted reproduction is a test of strength, faith, and completely losing any sense of self. 

Long story short, we are going through InVitro Fertilization (IVF for short) with Intra-Cytoplasmic Sperm Injection (ICSI for short). What does this actually mean? Well, the doctors have taken a syringe of Todd's "stuff", they will extract my "stuff", force them to be happy in a test tube together, and then put the finished product back inside of me. And of course, hopefully 9 months later there will be a baby born. All of our "stuff" is completely normal and healthy, they just need some help meeting. Much like Todd's personality, his "stuff" is very introverted.

How did we get started on the  process? We first started with a doctor's group called the Reproductive Medicine Group based out of Tampa, FL. Everything started out fine, we completed our tests and consultations; but something just didn't feel right about the process. We felt rushed, and almost swindled by them. Of course to this group of specialist doctors it is common day occurrence to ask couples for $15,000 for a procedure that has a 50/50 shot of working. But for us, it was a big decision we wanted to have our timing on, be talked to like patients that had a decision, and have all of our questions answered before signing on the dotted line. So we switched doctors and now are working with the University of South Florida and their reproductive group. AMAZING! Dr. Mayer is fantastic, thoughtful, educational, and most importantly makes us feel good and comfortable about the process. Still the same cost, still the same statistics, but we feel good about it. If Todd didn't already have a name picked out for our imagined baby boy, I would name him James after our doctor James Mayer.

So after we were re-tested, have any and all possible medical tests done to make sure we are legitimate to procreate, the official process began on October 10, 2011. I still don't understand how stringent the government rules are on assisted reproduction...but in spirit of being hopeful, I'm goign to forget about that piece and how I used to perceive it as unfair. This has really encouraged me to be more hopeful and faithful in God. Everything really happens for a reason - there's a reason we're going through this, there's a reason we have the resources to do this, and there's a reason that it will or won't work. It's now like a little mysterious puzzle of what's in God's greater plan and what exciting things will be in our future.

My main purpose for writing and posting is to educate, entertain, and hopefully gain support. At first I wanted to keep the IVF process a secret in fear of it not working or others judging me or Todd for our election to do this over adoption. But now  I'm realizing the more people that know, the more fun this journey is and the more support Todd and I will have whatever the outcome is.