Well, I guess we’re (maybe, please let this happen, body don’t fuck with me anymore, seriously did I say “please” yet?) getting this IVF show on the road. My period arrived late last night, my baseline appointment is scheduled for bright and early on Wednesday, and this better damn well finally be happening.
(But, again, you notice all the apprehension above? The near compulsive need to use weak words and not express any sense of certainty? I’ve ridden the chair lift to the top of “OMG We’re Doing IVF!” Mountain before, and I’ve still never been skiing. I’ll believe this is happening when they’re knocking me out to retrieve my eggs and when I’m handing over that mighty-sized check. Until then, we’re maybe doing IVF.)
I’ve kept things pretty much geared to the battle-hardened IF foot soldier around these parts. Half because I’m a big, pompous jerk. I tend to hate it when I go read IF blogs and they’re spending their time teaching me about cervical mucus and temping. (“No shit, Sherlock. Temping is sooo 2009!”) And, of course, half because, in addition to being an arrogant busted-uterus bitch, I’m also about as lazy as my ovaries when it comes to going that extra mile. I dumped way too many years of my life into explaining newbie shit to newbies on FF, so, yea, when I finally get it together to write a post here you can be sure that (most of the time) I’m diving straight in. Don’t get me wrong, I love it when I get questions or comments at the end of my posts asking for clarification or more info because 1. that means you are reading (yay!) and 2. it gives me something specific to direct my response to. In case ya’ll haven’t noticed I tend to struggle with brevity. If you leave the entire wild world of IF writing to me to tackle in a given day I will try to tackle it fully and completely (and terribly). Ain’t nobody got time for that (least of all me).
Ok, so, anyone still reading? Have I insulted you all sufficiently that you’ve huffed on off to greener, rainbowier, unicornier pastures? No? Well, hello my masochistic ilk. How the hell are you doing?
All that was a long-winded (told ‘ya!) way of saying I’m about to do a little IVF 101. While I know the bulk of my audience are folks that have been or currently still are in these bloody trenches with me, it also warms my heart to know that a few amazing real-life friends have found and follow me here. And, while these friends with normally functioning lady-bits and man-parts have been truly remarkable in their support of me and Mr. But IF over these past many years, fact remains you really can’t know much about IF until you’ve lived it (and I hope to God none of them EVER have to live it). So, here’s the only things I hope you ever have to learn about IVF in general and my unique IVF in particular.
Now that my period has started (and, might I add, not on its own but thanks to yet more pills… stubborn MTHFR-er… hehehe <IF insider joke>), I’m set to go to my first appointment of this IVF cycle. This appointment is called the baseline appointment, and it usually occurs on day 3 of a woman’s full flow menstrual cycle. For me, that is 7:15am on Wednesday. At the baseline I will have bloodwork drawn to measure my hormone levels and I will have a trans-vaginal ultrasound performed to check the state of my ovaries. (Oh, and yea, remember that “full flow” comment before. That ultrasound probe is one damn lucky piece of plastic, eh?)
Assuming all checks out with this first appointment (hormones that should be low are low, hormones that should be high are high, all the ultrasound shows are a bunch of immature egg-containing follicles, etc.) then I start the injections. Everyone’s injection schedule is different depending on their IVF “protocol” (and, in fact, some protocol’s would have called for me to begin injections before the start of my period), but I’m going to focus on what I’m doing – the “flare protocol.”
Beginning on Wednesday I will inject 225IU of Gonal-F, 75IU of Menopur, and 50 Units of microdose Lupron nightly. In other words, and I’m totally not exaggerating here, that’s 225IU of follicle stimulating hormone (FSH) derived from genetically modified Chinese hamster ovary, 75IU of a FSH and luteinizing hormone (LH) mix derived from the urine of post-menopausal women, and 50 Units of menopause-in-a-bottle. You know how the mass market media always makes IVF and other assisted reproductive techniques sound all high-tech, sciencey, and fool-proof? Yea, somdays I think it would be better if I just ate some hamster ovary, let some grandmother’s pee on me, and called it a day.
The act of doing daily timed injections is far from new. I’ve done the Gonal-F and the Lupron before; the Menopur will be new. What is totally new is the high doses. In all of our previous cycles we were shooting for one strong, healthy-looking, egg-containing follicle. Rupture one good egg, have sex (or an intra-uterine insemination, aka IUI), wait two weeks, positive pregnancy test, wait 9-months, healthy baby But IF. But, yea, that never happened. And, since that never happened we are now moving on to IVF where all sex is taken out of the equation. Gone is the 1-egg goal, now I want enough of those suckers to field a pro football team. More eggs means more drugs. This is where things get new.
Thing is, you can have too much of a good thing. Over-stimulation and ovarian hyperstimulation syndrome are real risks. The possible negatives range from me feeling like a bloated uncomfortable piece of shit, to me entering liver failure or rupturing an ovary. Put simply, bad things can happen. But, Mr. But IF and I are so very hyper-aware of those bad things (and our clinic’s apparent blase attitude toward those bad things) that we’ll stay on top of it. No worries, dearies.
During the days of these injections I’ll return regularly (about every other day) for more bloodwork and more ultrasounds. This is called monitoring. We’ll watch as the follicles grow and mature, a process that hopefully occurs at an even-pace across all the follicles. If I develop a “lead follicle” – or one follicle that seems to be growing faster than the rest – that may threaten the entire IVF. Remember, the goal here is to retrieve as many mature (meaning similar in size) eggs as is possible without subjecting me to any unnecessary risk.
Once the ultrasounds start showing a bunch of follicles in the 18-20mm range and my bloodwork (primarily estrogen levels) suggest a number of healthy, mature follicles, I go in for egg retrieval (or ER). There is no way to know for sure when this will happen, but typically it’s about 10 days after starting stimulation meds. That puts us at about September 28, give or take a few days. Retrieval is much like many of the other lovely procedures I’ve already subjected my lady bits too in the past several years. I will strip down, have a needle passed through my vagina and into the ovarian follicles, the fluid from each follicle will be extracted to look for the tiny eggs, and then I’m done for the day. Oh, and yes, I will be mildly sedated. Woot!
Once free from my shitty body, the eggs will be injected with DH’s finest swimmers via a process known as intra-cytoplasmic sperm injection (or ICSI, pronounced “ick-see”). Hopefully, my eggs love injections as much as I do and the egg/sperm combos get down to the business of becoming embryos. Each day after retrieval we will get a call telling us how our microscopic children are doing. Many won’t make it, many won’t fertilize, many will appear abnormal. These things happen to all normal people and are the reason why even the fertilest of Myrtles only have about a 20% chance of achieving pregnancy each month. By doing IVF with ICSI I’m just kinda getting to live through about a year’s worth of “tries” all at once.
Depending on how the embryos are developing, we will prepare to put one back anywhere between 3 to 5 days after they were retrieved. This step of the process is called the embryo transfer or ET. It’s actually not that much different than the IUI I’ve done before. No needles in the hoohah, just my old friend the catheter. Catheter in, push of the plunger, catheter out, and I’m what we IF lot call PUPO – Pregnant Until Proven Otherwise.
I get to start a whole new batch of lovely meds after the ER, continuing through the ET, and up to my pregnancy test. None are knew. Vaginal progesterone (aka cottage cheese I squirt “up there” daily), intramuscular Progesterone (aka big fucking needle Mr. But IF sticks in my ass), HCG booster injections (aka stuff that fucks with home pregnancy test results and means I can’t use them), and steroids (aka I haven’t gained enough weight with all these other drugs so why not add some more?). I’ll also be repeating my Intralipid IV infusions. Both the Intralipids and the steroids are being done under the advice of our Reproductive Immunologist who believes my immune system has contributed to my miscarriages and general inability to get and stay pregnant.
Then, finally, it’s the big day. The pregnancy test day or beta day. This will be about 10-14 days after the embryo transfer and will involve yet another trip to the hell on earth that is my local hospital lab. After that? Well, either we’re pregnant (“How long will it last?”), we’re not (“Where’s the whiskey and the cheese curls?”), or we’re a little bit of both (“Inconclusive results AGAIN? FML!”). If the answer is ultimately bad we turn back to the embryos we have left (if we have any left) and go through another transfer called a frozen embryo transfer or FET. Basically, we do the transfer and the post-transfer meds, but not everything leading up to that point. We do that as many times as we can, and then start from the very beginning all over again. We’ve paid for two “fresh” IVF cycles (with the requirement that we use any frozen embryos before moving on to our second fresh attempt). On one hand this means it can be a little overwhelming to realize how huge a part of the next 6 months to a year of our life this process might become; but, on the other hand, there is a lot of peace to be found in the fact that we know we’ll have a second chance if things don’t go smoothly the first time.
So, in a nutshell, that’s where we’re at. Oh, and we’re never going to be able to have sex again (it’s verboten throughout most of this process).
“Hey, honey, let’s make a baby. I’ve got my needles, and here’s your cup!”