IVF Primer-- part deux

For the IVF Primer--- part 1, click HERE

TRIGGER TIME:
When the doc decides that your eggs are fully cooked, you get the trigger shot instructions. This is a nerve-wracking portion of the process because you're always paranoid that you're going to miss your "shot window" and mess up your whole cycle. This is an HCG shot (another lovely intramuscular shot in the bum) that you have to mix yourself (powder and some liquid) and then have a specific time period that it has to be administered, which usually ends up being some time in the middle of the night. This shot gives all those eggs the final push to maturity and makes them ready to be harvested. The egg retrieval takes place 34-36 hours after the shot, so if you miss your time or sleep through your shot, you're all messed up. If you don't make it to the doc on time on retrieval day, you run the risk of ovulating all on your own and losing all those valuable eggs that you have been growing. It is a delicate timing issue that always made me paranoid. I would always set double alarms to wake me up because I didn't want to miss my shot and had nightmares about getting in a car accident on the way to the clinic for the egg retrieval and ovulating all on my own. My last fresh cycle, I had Mark give me the shot at what I thought was the proper time and then didn't realize until we had driven down to Vegas for the retrieval that the time they gave me was Pacific Standard Time, not the Mountain Standard Time I was operating on at home. I about FREAKED OUT because that meant I had the shot 1 hour too early. Luckily, they were running ahead of schedule that day and they got me in, no problems.

EGG RETRIEVAL:
This is probably the yuckiest part of the whole process, but I never really minded because egg retrieval is done under anesthesia and I am completely out for the whole process. Plus there are good pain meds for after the surgery, so it is hard to worry about how man-handled all your delicate parts were when you're floating in a happy cloud. Egg retrieval is a surgery--- it is done via needle aspiration through the vaginal wall and probably takes about an hour. The doc locates each follicle (on the ovaries) via ultrasound and using the needle, aspirates the fluid out of the follicle. They then flush the follicle with additional fluid, to catch the egg if it was a little stuck to the follicle. Then they examine the fluid with a microscope to see if they picked up the little eggie. And rinse and repeat, for all the follicles, until they have harvested all your mature eggs. During this process, your lovely husband is required to provide a sperm sample and then wait for you in doctor's office, thoroughly embarrassed at having to participate in such a process, but unwilling to complain too much because his wife will callously respond to such whining with "DO YOU KNOW WHAT THEY JUST DID TO ME?? AND YOU'RE COMPLAINING ABOUT YOUR PART???" You then wake up groggy and in a little pain (enter the percocet) and have your husband drive you home, where you wait between 3-5 days for the embryo transfer.

EMBRYO TRANSFER
The 3-5 day wait is a little weird, because in the meantime, you know that the lab guys are busy conceiving and growing your potential babies for you, which is a little different than nature's way. Despite the visual picture of all the little embryos happily hanging out in a petri dish together, they are each fertilized and placed in a culture medium separately. My second clinic used ICSI on all embryos, which is where they force fertilization by injecting an individual sperm cell into the egg. This part was always strange to me, because that meant the lab guys were personally picking the chromosomes that would become my future children--- no 'survival of the fittest' or random luck. The Mr. Wizard's of the lab would be the ones matching the egg and the sperm. Odd, if you think about it. So it is kind of their fault that I have all girls.

After 3 days, they 'grade' your surviving embryos and (at least at the SIRM clinic) do some extra testing to decide which ones have the markers to go the distance. All my fresh cycles were done with 3 day embryos, where they are most likely 8 cell embryos at time of transfer. They often do 5 day transfers too, but the embryos are then called blastocysts because they have reached blastocyst stage at that point. Transfer is not really a big deal. You take a couple valium an hour in advance (to calm both you and your uterus) and the then the doc inserts a catheter through your cervix, into your uterus, and then uses ultrasound to place the embryos in a nice soft spot. You then stay put for a good 30 minutes and then head home for a day or two of bedrest.

If you're lucky, you have extra embryos left that are frozen and can be used for future cycles. Most of the time, these are cultured out until they are day 5 and frozen as blasts.

MORE MEDS; MORE LUMPS:
I don't want to forget the additional meds that are involved. These start after the egg retrieval and continue (in the event of a pregnancy) until you're 8-9 weeks pregnant. Dexamethasone is a drug of the devil, at least according to me. It is a steroid that helps your body not reject the embryo, but what it REALLY does is increase your appetite and cause weight gain. I swear that was what it's main purpose was in my case. I hate dex, almost as much as I hate progesterone shots. Progesterone is given in the rear end, with a super long, super big needle. The reason for such a needle size is because the progesterone is suspended in oil. So what you are really doing every night for about 6 weeks is injected 2 cc of oil in the same 2 inch diameter area of your buttocks, the result being multiple knots the size of hard-boiled eggs in your muscles that just don't go away. In fact, even after discontinuing the progesterone shots, it takes a good 3 weeks for the knots to disappear. What is even worse is the fact that additional shots often have to go right through the old knots, causing vocal outbursts from the inject-ee and profuse apologies from the inject-or. Mark hated giving these shots; I hated receiving them. There are some more shots involved, usually just estrodial (estrogen), and even though these are also given in the muscle, they seem like cake after the progesterone.

2 WEEK WAIT:
This is the difficult part. You now have to wait. In the meantime, you notice and evaluate every twinge or sign, wondering if it means you're pregnant or not. SIRM lets you test on day 11 (which is 8 days after a 3 day transfer or 6 days after a 5 day transfer), so it is technically not a "2 week wait", but believe me, it drags on for what seems like months. To test, you go to a lab and have your blood drawn for what is called a "Beta". It measures the amount of HCG in your blood, which is indicative of a pregnancy. Anything over 5 means 'technically pregnant' and if you get a positive number, you don't get to rejoice yet, all you do is get to wait another 2 days to test again to see if your beta numbers are doubling. Some women have nice clear cut beta numbers; mine are always low, sometimes don't double, and end up leading to 6 or 8 beta tests before we know if the pregnancy is really taking.

A LITTLE BIT PREGNANT:
And here's the kicker, after all that, even with a positive beta, it is still common to end up with what is called a "chemical pregnancy". A chem pregnancy is where you're pregnant, but it just doesn't stick. It is a pregnancy that most normal women would never know about and might not have even registered on a drugstore pregnancy test. You can also have your great betas turn into not-so-great betas and end up with a blighted ovum (an embryo that attaches, but does not develop), and ectopic pregnancy or a miscarriage. All those results are still up for grabs until you have waited another 3 weeks for an ultrasound. If at a 7 wk ultrasound, you are able to see the gestational sac, the yolk sac, the baby and a heartbeat over 110, you are probably going to do OK. But not quite yet, you still have to wait 2 more weeks for another ultrasound at 9 weeks, at which that time, if the heartbeat is there and strong, you are down to a 5-10% chance of miscarriage, just like any normal woman who experienced this whole nerve wracking process as an "I think my period might be late . . . . maybe I'll pick up a Clear Blue Easy at Target tomorrow" (I don't hate women like that, I just have lost my girlish opinion that anything involving getting pregnant and staying pregnant should include the words Clear, Blue, or Easy. More like "Painful", "Expensive" and "Crap-shoot")

31 WEEK WAIT:
And if luck will have it, you will then have 31 more weeks to worry about every possible thing that could go wrong with the pregnancy. But most likely it won't, and you'll have a beautiful baby at the end of it all.

MY CONCLUSION:
I will never do IVF again. I did 4 fresh and 2 frozen cycles and it pushed the limits of my own and my family's resources, including emotional, physical, and financial. But I am so grateful for it. Without it, I wouldn't have Janie or the two new little girlies joining us in just a few weeks. I think it is an amazing process that (at least for me) put in to perspective just how much we are willing to sacrifice and give for the blessing of children. It is science, but it is also a miracle. I don't forget that.