Let’s put the important part first: the outcome. We successfully completed our second round of IVF, and now we have a total of four embryos frozen. It’s crazy to think about, but according to our doctor, the embryos can stay frozen indefinitely without it harming them. I guess these freezers are a little more sophisticated than the one we have at home, and freezer burn won’t be an issue ;)
If there is one thing I have learned through getting to know other people’s IVF stories and comparing them to ours, it’s just how different each individual story is. Which combination of drugs you take, the doses of drugs, the number of days, the number of eggs you get, the quality of the eggs—it all varies from person to person, and it’s completely unpredictable. Once you decide to go ahead with IVF, you’re along for the ride and just have to be ready for what comes—and it’s best to do away with any expectations or preconceived notions, because they’re sure to be dashed before the process is over!
We started our second round feeling hopeful. Having gotten three eggs, two of which successfully fertilized and became embryos, we got decent results from the first round, but my doctor felt that because I am relatively young (37) I should still be able to produce more. So, she decided to start me on a different drug regimen including Menopur, a medication that acts on the FSH receptors (and which, by the way, is derived from the urine of women going through menopause—no really, it's true!), in addition to massive doses of FSH (the same as last time). My protocol was 150 units of Menopur and 300 units of Gonal F per day. I ended up taking these for a total of 13 days, and then partway through the cycle added Cetrotide to keep me from ovulating (that would be bad… the eggs need to stay in the ovary for them to be able to find them and extract them).
Like last time, I had monitoring visits twice a week, but I really didn’t pay too much attention to what the ultrasound was showing. After all, last time around we thought we had 10 eggs, but the majority of those turned out to be endometriosis that was showing up on the ultrasound with a similar appearance to an egg. I knew we wouldn’t really know what we were dealing with until the doctor got in there and saw for herself.
We faithfully administered shots twice a day (my husband gave me most of them but I had to do it a couple times myself and managed to do so without passing out, even though I was shaking profusely), and for the most part things weren’t that new or different. The Menopur and Cetrotide added a new wrinkle because they are delivered as powders that you mix yourself before injecting, so all of a sudden there were a few steps added to the process that just felt like additional opportunities for something to go wrong… and eventually this did happen one day.
One morning, Sean was mixing the Cetrotide by our bedroom window and I heard him curse. Not exactly what you want to hear come out of your husband’s mouth when he is mixing an expensive drug and you are already running late for work… It turned out he had somehow lost about 20% of the dose. When you turn the vial upside down to draw the liquid (with powder mixed in) back into the injection needle, normally it’s formed a seal and the liquid stays inside the vial until you draw the plunger back to draw the liquid into the needle. For a reason we still don’t understand, some of the liquid leaked out through the hole in the vial lid around the outside of the needle. Fortunately we still had one more fresh box of Cetrotide left; we quickly called my doctor’s office to ask them whether 80% of the dose would be enough to keep me from ovulating, or if we were better off using the new box and discarding the partial dose. We didn’t get a call back right away and I had to get to work, so we used the fresh box but refrigerated the one Sean had been mixing, just in case there was a chance we would be able to use it the next day. So, I did end up getting the full dose, and when my doctor called back, that was indeed the advice she gave us—that you don’t want to mess around with having less than the needed amount. Still, it wasn’t the answer we wanted to hear because it meant we would need to buy another dose that night at a cost of more than $200. It seemed like a lot to spend, until the next day...
The next morning, at my monitoring visit, our doctor made a decision to push us out one more day from what had originally been planned. Since last time one of the eggs retrieved wasn’t fully mature, she wanted to make sure not to pull the trigger too early. So, we had to get one more day of drugs. This was the night we dropped a cool $1,500 at Costco.
The dose of drugs we were on cost $300 per day when purchased from an online mail-order pharmacy (Mandell’s—highly recommended, by the way; they apply all applicable discounts without your asking and submit all applicable manufacturer rebates on your behalf so you don’t have to do anything). But on this short of notice, even the pharmacy’s standard overnight delivery wouldn’t do. We were told in the morning that we needed the meds by that evening. So, we were stuck paying over $1,300 for one day of Gonal F and over $200 for another day of Ganirelix (the Cetrotide equivalent carried by Costco). See what I mean when I say once you decide to commit to one round, you have to be ready for anything?
By that point in the process, I was just tired of it all and wanted to get it over with. I was hopeful and excited about the prospect of growing our family, but there were still so many steps that needed to happen in between for that to become reality. I was on my special pre-surgery diet again, and had been sticking to low-impact exercise for months and even paring back the yoga poses I was doing just due to the size of my ovaries as they swelled up from all the meds and growing follicles.
I didn’t have any major side effects from the drugs this time. Lupron had given me anxiety last time and the Cetrotide seemed to be better. I experienced some nausea from it, but it peaked about three hours after taking the medicine and I just had to be sure I had eaten enough and I’d be fine. I also noticed I was especially irritable but it really wasn’t more severe than a normal day when I’m tired ;) This time around, we were used to the routine of injections. I had my ice pack ready to go and Sean had the technique down. It just felt like much less of a big deal than the first time around.
We went in on Saturday, September 10, for egg retrieval. I had to arrive at the clinic by 6:30 a.m. I had given myself the trigger shots (two doses of Ovidrel) at 8 p.m. the previous Thursday because Sean wasn’t home from work yet. Things were much less emotional for me in pre-op this time because I was no longer having flashbacks to my surgery from two years ago. I also knew that the drugs would work well for me and I wouldn’t feel or remember anything, so I was much calmer all around this time.
I remember being wheeled into the operating room, scooting down to the stirrups, confirming my name and birthdate, and hearing the doctor say out loud the dose of meds I’d be receiving. After that, I don’t remember anything until I was in the recovery room, being told between naps that they’d retrieved a total of six eggs.
After a couple of hours I was allowed to go home. (Because you’re so loopy as the drugs wear off, you need someone else to drive you.) Just like last time, the meds wore off in waves. I would be feeling fine one minute and then fall asleep for half an hour. Just like last time, about four hours after the procedure start time was when the nausea and clammy sweats hit. If the drugs affect you like they affect me, I would advise you not to eat anything until you get through this phase! At this point, I just went to sleep and when I woke up 2-3 hours later, I felt great. My appetite was back and we went out to a late lunch at the Indian buffet down the street.
Because my retrieval was on a Saturday, I didn’t end up having to take any time off of work. I was able to get back to some very gentle yoga the next day, and gradually increased my activity level day by day. Each time, it has taken me a good week or two to feel normal again.
Even though the procedure affects a very small part of your body (the ovaries and a small hole in the vaginal wall on each side where the needle pierces), I really did feel like my body was undertaking a serious recovery. I would sleep long and very deep, and my appetite increased hugely during the week after the procedure. I found myself craving fatty foods in large quantities, which really is not typical for me! I indulged a bit in things I wouldn’t usually eat, but then tried to get back to my regular diet of vegetables, high-quality protein, and healthy fats by about a week later.
A common question I get is how soon after this procedure I got my period. My doctor said it varies quite a bit from person to person, due to the hormones and just everything in your body being out of whack, and can be anywhere from a day or two after, up to a month. It took me about two weeks each time. That probably also explains the fatigue, bloating, and cravings during the week after the procedure… After those massive doses of hormones, it would make sense to get the world’s worst case of PMS!
The day after the procedure, we got the call to tell us that three of the six eggs had fertilized. This number was actually on the low side because we had ICSI done, in which they inject sperm directly into each egg. Last time two of three eggs fertilized and they could see during the retrieval that the third egg was not mature. This time it looked like they had six mature eggs, but as I’ve said before, absolutely nothing is predictable when it comes to IVF (except for when your retrieval will be, assuming you’ve administered the trigger shot correctly).
Because of the small number of embryos we had, on Day 2, the doctor told us she’d be recommending to freeze all of them like we did last time, and we agreed with that. When you have more eggs, they let them grow out a full five days in the lab to see which of the bunch are the hardiest. Some of them don’t make it, but that’s OK when you have more embryos than you would want to use anyhow.
There is some disagreement in the medical community when it comes to Day 3 embryos. Some recommend growing all embryos out to Day 5 because if they don’t survive to Day 5, they wouldn’t have made it in the womb either. Our doctor said she believes that the embryos have a better chance of surviving inside the uterus than in a dish in the lab, and that some that don’t make it to Day 5 would have made it if they had been transferred into the body at Day 3. There’s really no way of knowing for sure. Plenty of transfers of Day 3 embryos fail, and of those that succeed, it’s impossible to say whether those same embryos would have lived to Day 5 in the lab or not.
It made sense to us to go ahead and freeze them on Day 3 just so we wouldn’t run the risk of losing them. But then, when the doctor called on Day 3, she said the embryologist felt ours were looking especially good this time and he thought he would get at least one blastocyst out of the bunch. (This is the stage the embryo reaches on Day 5, when it’s a bundle of more than 100 cells.) She wasn’t recommending one way or the other, just offering information, but still… it meant something that she was calling to ask instead of just proceeding as planned.
Fortunately I had already planned to see Sean for lunch that day. We only had about an hour to make a decision. It was a really tough one since the “safe” thing to do would have been to freeze all three of them on Day 3, but at the same time, we knew that if we could get a blastocyst, we would have a 60-75% chance of a live birth from an embryo transfer, compared to a 25% chance for a transfer of Day 3 embryos. (Keep in mind that those numbers include embryos of all quality levels; our own personal odds might be better if our embryos were good quality, but who knows?)
We made the decision to leave the embryos out. It was intense nail-biter for a couple of days until our next embryo update. On Day 5, we got the call that we had one blastocyst that was ready to be frozen, and another early blastocyst that they would leave out for one more day and then freeze it if it expanded like the other one did. It was good news again on Day 6 with the call: the other one had expanded and we now had two blastocysts frozen. Our third one from this round did not make it, and I have to hope that means it wouldn’t have made it either if we had frozen it on Day 3.
Throughout this all we have learned that my ovaries don’t work that well for my age (many women’s would have produced several dozen eggs even at a smaller dose of medication than I took, and with fewer days of meds). However, the eggs they do produce were good quality, and together my husband and I made some good quality embryos :)
I don’t think we would do another round… The financial risk is just too great, with not knowing what the drugs are going to cost at the start of the round, and just having to pay whatever it is because you have no other choice. But never say never. We do believe a higher power is in charge and we are praying for God to bring our babies to us and to lead us to the children we are supposed to have.
For now, though, we are taking a break before getting ready for an embryo transfer hopefully sometime in 2017. My kidneys still need to recover more (they still aren’t back to 100% after my complications from surgery in 2014) and I need to have a fibroid removed to improve the quality of my uterine lining and improve my chances of a pregnancy taking. There are also financial considerations, since just like all other parts of this process, embryo transfer is not covered by insurance.
We are anxiously waiting for the day when our family will be complete, whether it be by these embryos or by adoption. Anything can happen in this process, but we already feel we have experienced a miracle to have those four precious embryos waiting for us.
If you know someone going through IVF or thinking about it, please share this blog if you feel it would help them to have a better understanding of the process. If you yourself are undergoing IVF or considering it, please don't hesitate to reach out to me. I love connecting with other women who are wishing and working to grow their families against the odds, and I am always happy to answer any and all questions.