Finally... In Vitro!

Well, kids, I must say, I am much more excited since my last post and I'm in much better spirits overall.  A bit of a break was exactly what I needed and after 58 days worth of screwed up cycle, I finally got AF!  More importantly, I was finally able to start birth control.

"WHAT?" you say... well, it's all part of the protocol.  I shall explain.


Suppression Stage:

First, in order to quiet your ovaries to prepare them for stimulation, reduce/diminish any cysts that Clomid may have triggered and make sure they're able to time your appointments appropriately with their office, you go on birth control for a specific amount of time (you'll also start a baby aspirin regimen that will last throughout your cycle).  Usually, this is 2-4 weeks.  Lucky me, I got in on the 4 week slide.  Regardless, we're three weeks through now and this Friday will be my very first shot of Lupron... but I'm getting ahead of myself.

During this 2-4 week period, you and your dude will both have infectious disease labs drawn and be scheduled for an injection class to teach you both how to handle the meds.  You may sign all of your consents at this app too but that will depend on your RE.  Your man will then repeat his sperm analysis where they'll do a 24 hour test (to see how many survive the day in the lab).  You'll go in for baseline ultrasound where they'll make sure you have no fibroids to be concerned with and that you have no cysts to prevent egg retrieval.  I did but it was a small one and the doc said that the birth control should suppress it completely.  Then, a saline infused sonogram (SIS) or a saline sonohysterogram (same difference) which will be done both to map the uterus and as a mock transfer, to help the doc with a plan of attack since the embryos need to be jostled as little as possible during transfer.  They'll also check for polyps and such here.  This is not the most comfortable thing and, much like the HSG, I cramped like a sonofabitch when he inflated the balloon on the catheter to hold it in place but it was also over quickly.  A bit if an added insult was when he went "all in" with the dildo cam while the catheter was still in place but again, it was over quickly.  The ruling here though was that I had no polyps and everything looked good.  The cyst from earlier had shrunk to the point where it looked more like a follie and he cleared me for starting Lupron.  Adam's sperm analysis also came back very well with 80% survival over the 24 hour term.  He was, as always, proud of himself.

Stimulation Stage:

My new pharmacy sends its regards.

We're currently approaching the stim stage.  This Friday, I'll start with an ovulation supressant called Lupron and continue it through the cycle until just before the egg retrieval.  This will prevent by body from releasing the eggs I'll be working so hard to grow.  A few days later, I'll stop taking the birth control and then go in for another baseline ultrasound to make sure that everything is sufficiently suppressed.  Then, (about I'll start the stims.  I'll be on a Bravelle (300) and Menopur (75) protocol, which will be one shot each night (so two total for now).  This will go on for 10 days (or thereabouts depending on my reaction) and I will be monitored throughout to make sure I'm progressing nicely and don't need my dosage changed.  Ovarian Hyper-Stimulation Syndrome (OHSS) is also a concern during this time.  A very wise friend of mine mentioned shit-tons of water to prevent this so I'm going to try my best.

Once the doc says we have a bunch of follies up and they're of good size and maturity, we'll take the trigger shot, Ovidrel.  This is a pre-filled syringe that has to be refrigerated and I've heard it's best to let this warm up for a bit before injecting to prevent sting.  Now this shot is very important!  It has to be administered at a very precise time as the eggs need to be as ready as they can get for retrieval without being released.  From what I've been told, we're looking at like a half hour window or less to get it right so I'm really hoping I don't' fuck that up.  You'll also take some antibiotics to prepare for the retrieval here as well.

Egg Retrieval


This is, by far, the part that I'm most apprehensive about.  Not only will it likely be painful, but it will also determine how many embies we have to work with and if we can freeze any for the FET if the fresh cycle fails.

This is an outpatient procedure but you are under sedation (and thank fuck for that).  Basicly, they strap a needle onto the dildo cam and proceed to puncture your vag until they get all the mature eggs they can reach.  That sounds like at least the first circle of hell to me so I'm glad I'll be asleep for it.  The good news is (besides the pain meds) that they will be able to tell you as soon as you wake up how many eggs they've retrieved.

Over the next 24 hours, they'll fertilize the eggs either naturally, by introducing sperm and egg, or they'll use the ICSI procedure (IntraCytoplasmic Sperm Injection), depending on your personal circumstances (whether you're dealing with MFI, poor egg quality, etc).  Since we're unexplained, they will be doing half and half for us.  They'll call us with info regarding how many eggs were mature, how many fertilized and how many started to grow over the next few days.  They said I'll get calls daily, letting me know how many cells they've divided into and so forth.  Apparently, our embryologist also sings to the embies.  I found this surprisingly comforting as after all, these are our children... the makings of them at least.

Embryo Transfer


And we've reached magic time!  Assuming I have a decent amount of embies to work with and they seem to be of good quality, we'll go in for a transfer five days after retrieval.  Lower quality/fewer numbers means a day 3 transfer, which we don't want because they're not in the blastocyst stage yet and they aren't developed enough to implant immediately.  However, they'll do this if they worry that we may not have enough eggs to transfer so they have the best chance at survival.  So... fingers crossed for a 5 day!  Anyway, this procedure is very much like an IUI.  You decide how many embies you want to transfer (we chose two if we have that many) and the doc inserts them through a catheter into the top of the uterus.  You hang out for 45 minutes or so and take it easy for a few days.  They generally make the beta appointment for two weeks after retrieval (what they consider ovulation to compare it to a typical cycle), but of course you're free to test at home before then.  And I'm quite sure I will.

Well... there you have it.  IVF in a nutshell.  I'll go into more detail about all this as stuff happens but here's what we'll be doing.  If everything goes according to plan, they'll be doing my retrieval on either the 2nd or 3rd of May.  This means a HEDD (hopeful estimated due date) of either January 1 for twins or January 23rd for a singleton.  I should find out if I'm pregnant mid-May.  April can't go by fast enough!