BEFORE egg retrieval

AFTER egg retrieval

Yesterday was the big day for egg retrieval.  9 days of medications and 30 needle sticks later (most self inflicted)!  We arrived at the hospital (my hubby and my sister) around 8:30 for my 10:00 surgery.  Strangely, it was pretty anticlimactic; funny since I've waited 30 long months to get to this point.  I checked in and waited for a bit to be taken back to change into my hospital get-up.  My sister and hubby had to wait in the waiting room while I had the nurse take my vitals, start my IV (ouch!) and for the anesthesiologist to talk to me and take my history.  I was in the room with another woman but she was behind a curtain....There were 3 egg retrievals scheduled that day and I was the last.  After all that was finished, my other half and sister were allowed to come into the room to help me pass time.  I waited for about 45 minutes or so until the lady that was next to me was finished in the OR and for my antibiotic to drain into my IV.  It was nice to have my big sister there for moral support, otherwise I'd probably let my mind get the best of me and would have been a basket case.  I figured that nothing could be worse than the hysteroscope I had....(and it wasn't!)  Surprisingly I wasn't nervous about the pain, but more the outcome:  would they be able to retrieve enough good eggs to make this work?  Just because the ultrasound shows nice follicles, doesn't mean they all contain good quality usable eggs.  Until now it was a mystery if I even HAD good eggs.  About every other day while taking the injections, I had internal ultrasounds to check the size and number of follicles.  Here's what it looks like:

Each black circle is a follicle:  a fluid filled sac that contains an egg inside.  At the time of egg retrieval, each is about 20 mm in diameter.  

my stomach after injections

At 10:00 it was my turn and I said my good lucks and good byes and walked myself into the OR.  I did some more waiting, lying on the table (staring at the weird machines). I was waiting for the anesthesiologist to finish her prep and had to wait for the doctor.  It wasn't my usual reproductive endocrinologist but another doctor in the practice that I've never met.  That made me a bit nervous but I had to deal.  I saw the infamous "window" they spoke of.  There is a window pass through (like a drive through window!) that connects the OR to the lab.  After each egg is collected, it is immediately passed through the window, to the lab, for them to work more magic.  I was SO ready to have this done and over with since my ovaries were about to explode and were killing me.  After the doctor arrived I was asked to assume the usual position for all these procedure:  in stirrups...that's the last I remembered.  I was given the MJ cocktail of propofol, benzodiazepine and maybe something else.  

Every woman's experience with infertility and egg retrieval is different.  We all have different journeys but share a common goal.  I've read reviews of horror stories with egg retrieval as far as pain is concerned.  Others barely feel it.  I was somewhere in the middle I suppose.  I was in the OR about an hour but the actual procedure itself is only about 15 minutes.  I woke up with moderate pain but it was helped once I filled my Tylenol with codeine script.  My stomach was sore and it was very painful to sit for obvious reasons.  Walking was also a challenge. Occasionally I'd get super sharp pains but they didn't last long.  On the way home I was a little nauseous but this passed quickly and I was even able to go to a restaurant to eat.  After I got home I slept most of the day and woke up this morning at 8:00.  Today is much better as I only have a little soreness. Tomorrow I return to work.  

So you may be wondering, how they collect the eggs? A large needle is attached to an internal ultrasound probe.  Once they find a follicle, the needle is inserted through the vaginal wall (ouch!) and into the follicle.  Once the needle enters the follicle, suction is applied and the fluid in the follicle is aspirated, taking the egg with it.  They repeat this for each and every follicle.  

After the eggs are collected, they are passed through the window and into the lab.  Since we have male factor infertility, letting the sperm and egg do their thing alone in the petri dish is a bad idea.  Our sperm can't seem to get it together enough to do the job. We opted for another procedure called ICSI (intracytoplasmic sperm injection)....the embryoloist takes a small needle and manually inserts the sperm into the egg. This alone added another $1500 to our bill

OUR RESULTS:  We retrieved 14 eggs (a good number is between 8 and 15)!   As of yesterday that's all I knew.  It takes several hours for the lab to do their thing and call back with results.  I received the call this morning that 10 of the 14 eggs were mature and usable.  7 were able to be fertilized.  Each day until the transfer I will receive a call from the lab to learn how our embryos are doing.  Usually not all survive and not all may be good quality.  I am hoping for the best.  I should have the transfer Friday or Sunday and am hoping all embryos survive.  We will only transfer 2 and hope to have some leftover to freeze in case this fails.  If not, our journey may be over and we will have to consider living childless.  

Almost there!

Steps of IVF:

  1)  Control ovarian hyerstimulation (taking hormones which produce eggs)

  2)  Egg retrieval 

  3)  Fertilization

  4)  Embryo Transfer

I'm still at stage 1.  Today is "stim day" 10.  I started Gonal F and low dose HCG (injectable hormones that help produce lots of eggs) last Friday.  Being a needle phob I am quickly getting over this fear.  I've learned to stick myself in the stomach....so far 20plus times in one week.  I had follow up with the doctor last Monday, Wednesday, Friday and yesterday for ultrasound monitoring and bloowork.  My arms are toast.  Thursday I started the third kind of injectable medication (Ganerelix), which prevents premature ovulation so you don't lose the eggs.  It also keeps them around longer so they grow into mature eggs....immature eggs are incapable of being fertilized.  I had good news at all follow ups that my follicles (the thing that holds the egg) are growing nicely and steadily.  At my last appointment I had about 10 to 12 follicles around 17mm (average is 8 to 15 follicles).  By now each ovary is the size of a grapefruit whereas normally it's between 3 to 5 cm.  Needless to say I've felt quite uncomfortable the past few days!  The first 6 days on hormones I felt great....no side effects at all.  However since Thursday I have become increasingly uncomfortable (bloating and weight gain) and am having mood swings.  The injection sites are also sore and bruising.  Tonight I will take my last shot called a "trigger shot".  It's a medication called HCG which will help the eggs to undergo final maturation.  Timing is vital.  If the shot is given too early, the eggs will not be mature and are incapable of being fertilized.  If given too late the eggs are "too old" to fertilize.  Egg retrieval MUST be completed precisely 34 to 36 hours after the HCG shot is administered for viable eggs.

Tuesday is the big surgery date for egg retrieval.  I'm nervous and excited all at once....while I've done my research I'm still not s sure what to expect.  Of course Chris will be there and my sister from New Hampshire has offered to come down.  I'll be out of commission for a day or two so it's a big help.  Weirdly, I'm not as worried about the pain or discomfort, but more of the outcome.  Not every follicle will contain an egg and not all retrieved eggs are capable of being fertilized.  My main worry is not having enough because we can't afford to do this again....and my body is slowly having a nervous breakdown.

I was recently browsing the internet and came across someone else's blog about their struggles with infertility and thought I'd share bits and pieces.  It's a letter someone else has written to their friends and family.  It about sums it up for me.

Dear Family and Friends, 

I want to share my feelings about infertility with you, because I want you to understand my struggle. I know that understanding infertility is difficult; there are times when it seems even I don't understand. This struggle has provoked intense and unfamiliar feelings in me and I fear that my reactions to these feelings might be misunderstood. I hope my ability to cope and your ability to understand will improve as I share my feelings with you. I want you to understand. 

You may describe me this way: obsessed, moody, helpless, depressed, envious, too serious, obnoxious, aggressive, antagonistic, and cynical. These aren't very admirable traits; no wonder your understanding of my infertility is difficult. I prefer to describe me this way: confused, rushed and impatient, afraid, isolated and alone, guilty and ashamed, angry, sad and hopeless, and unsettled. 

My infertility makes me feel confused. I always assumed I was fertile. I've spent years avoiding pregnancy and now it seems ironic that I can't conceive. I was hoping this was going to be a brief difficulty with a simple solution such as poor timing.

My infertility makes me feel rushed and impatient. I learned of my infertility only after I'd been trying to become pregnant for some time. My life-plan suddenly is behind schedule. I waited to become a parent and now I must wait again. I wait for medical appointments, wait for tests, wait for treatments, wait for other treatments, wait for my period not to come, and wait for pregnancy. At best, I have only twelve opportunities each year. How old will I be when I finish having my family? 

My infertility makes me feel afraid. Infertility is full of unknowns, and I'm frightened because I need some definite answers. How long will this last? What if I'm never a parent? What humiliation must I endure? What pain must I suffer? Why do drugs I take to help me, make me feel worse? Why can't my body do the things that my mind wants it to do? Why do I hurt so much? I'm afraid of my feelings, afraid of my undependable body and afraid of my future.

My infertility makes me feel isolated and alone. Reminders of babies are everywhere. I must be the only one enduring this invisible curse. I stay away from others, because everything makes me hurt. No one knows how horrible my pain is. Even though I'm usually a clear thinker, I find myself being lured by superstitions and promises. I think I'm losing perspective. I feel so alone and I wonder if I'll survive this.

My infertility makes me feel guilty and ashamed. Frequently I forget that infertility is a medical problem and should be treated as one. Often others forget this too.  Infertility destroys my self esteem and I feel like a failure. Why am I being punished? What did I do to deserve this? Am I not worthy of a baby?  Is this the end of my family lineage? Will my family be ashamed of me? It is easy to lose self-confidence and to feel ashamed. 

My infertility makes me feel angry. Everything makes me angry, and I know much of my anger is misdirected. I'm angry at my body because it has betrayed me even though I've always taken care of it. I'm angry at my partner because we can't seem to feel the same about infertility at the same time. I want and need an advocate to help me.  I'm angry at my medical caregivers, because it seems that they control my future. They humiliate me, inflict pain on me, pry into my privacy, patronize me, and sometimes forget who I am. How can I impress on them how important parenting is to me? I'm angry at my expenses; infertility treatment is extremely expensive. My financial resources may determine my family size. My insurance company isn't cooperative, and I must make so many sacrifices to pay the medical bills. I can't miss any more work, or I'll lose my job.   Although I may joke about infertility to help myself cope, it doesn't seem as funny when others joke about it. Please don't tease me with remarks like, "You don't seem to know how to do it." Don't trivialize my struggle by saying, "I'd be glad to give you one of my kids."It's no comfort to hear empty reassurances like, "You'll be a parent by this time next year." Don't minimize my feelings with, "You shouldn't be so unhappy." For now, don't push me into uncomfortable situations like baby showers or family reunions. I already feel sad and guilty; please don't also make me feel guilty for disappointing you. Finally, I'm angry at everyone else. Everyone has opinions about my inability to become a parent. Everyone has easy solutions. Everyone seems to know too little and say too much.

I feel hopeless; infertility robs me of my energy. I've never cried so much nor so easily. I'm sad that my infertility places my marriage under so much strain. I'm sad that my infertility requires me to be so self-centered. I'm sad that I've ignored many friendships because this struggle hurts so much and demands so much energy. Friends with children prefer the company of other families with children. I'm surrounded by babies, pregnant women, playgrounds, baby showers, birth stories, kids' movies, birthday parties and much more. I feel so sad and hopeless. My infertility makes me feel unsettled. My life is on hold. Making decisions about my immediate and my long-term future seems impossible.The more I struggle with my infertility, the less control I have. This struggle has no timetable; the treatments have no guarantees.  It feels unsettling to have no clear, easy answers or guarantees. 

Eventually I will be beyond the struggle of infertility. I know my infertility will never completely go away because it will change my life. I won't be able to return to the person I was before infertility, but I also will no longer be controlled by this struggle. I will leave the struggle behind me, and from that I will have improved my skills for empathy, patience, resilience, forgiveness, decision-making and self-assessment. I feel grateful that you are trying to ease my journey through this infertility struggle by giving me your understanding.

Day 4

Today is day 4 of injections. I'm still on 300 units of Gonal F and 10 of LDHCG, prenatal vitamins and aspirin.  I'm getting used to the injections and "just do it" because I know this is what I have to do to have a baby.  Some people just have sex...I have to poke myself with hormone filled needles, have surgery and be poked and prodded by strangers.  Any woman who has gotten pregnant the "normal" way has no idea how hard this is, has no right to judge and has no right to give me advice.  Words can't describe what this feels like, physically and emotionally.  

Being afraid of needles, pain and blood I had no idea I'd be strong enough to be able to give myself injections.  I am proud of myself. It just goes to show that if you want anything bad enough, you'll do  ANYTHING to get it.  


 I had my first appointment post-injections this morning.  Luckily all my appointments so far have been before work, allowing me not to miss.  This has been a stress in the past and I've been lucky enough to avoid it.  My check up went well.  I didn't receive a call from the office which is a good thing as my bloodwork must have come back with good hormone levels.  My ultrasound already showed about 10 follicles forming (5 on each ovary)....after only 3 days on medicine.  10 is a good number but I am hoping for more...alot more.  Each follicle has the potential to hold an egg inside. I think I read that only 80% of follicles actually contain an egg and not all are mature or good quality....so while 10 seems like a good number, it's making me nervous.  If this fails we can doubtfully do this again.  I've been doing pretty good up until lately.  I'm starting to have some anxiety....not about the surgery for egg retrieval.... but about my eggs. Will I have enough?, will all become fertilized?, will the fertilized eggs grow (not all do)?, will I have enough to be frozen in case this first attempt fails?  These are all thoughts I recently have.  Luckily retrieval is only a few days away so I don't have long to think about it...but it seems like a lifetime.  

Ever wonder what over $5,000 of medication looks like?  It's hard to believe that most of this stuff will be going into my body in less than two weeks.  Chris and I saved and paid for IVF with alot of hard work and patience.  While I don't want to advertise the exact amount we paid, it was in excess of over $10,000....not exactly extra pocket money for our tax bracket.  We were luckier then most when it comes to the medication.  Unlike most people, I had some insurance coverage which covered all but about 1,500 in copays.  The remainder was donated by a non for profit organization called BabyQuest.  It also sounds like they may be able to help us with our medication copay which would really help.  While this journey is extremely taxing emotionally and physically, it is also quite expensive so any amount helps.  If we are blessed with children we do not want to start off on the wrong foot if possible.  We would like to be responsible and not deplete our entire savings.   When you want something SO incredibly bad, that's a hard choice.  A few months back I entered a contest to have assistance with the financial aspect of IVF.  We were upfront and honest about our struggles and finances.  While we make a good living, it's still expensive.  We knew if we were patient enough we'd be able to come up with the money eventually, however we've already waited over 30 months.  They helped us achieve our goal quicker.  When dealing with something so emotional, time is not friendly and has a way of wearing on you.  I am forever grateful for this gift and hope to someday be able to repay them in some way.  Sadly, there are many people who are probably much worse off than Chris and I.  Sometimes it seems that only the wealthy can have babies with IVF.  I encourage anyone in our situation to take a chance and reach out to organizations such as BabyQuest because you just never know.  There are good people out there who are willing to help and you may be the lucky one.  

Yesterday was my first official day of injectable medications.  I had my initial ultrasound and bloodwork and everything looks fantastic.  Last night I started two injections daily:  one of a medication called Gonal F and another called LDHCG(low dose HCG).  I've been getting pretty good at giving myself injections, although I still don't like it. Monday I go for another checkup and blood work and will possibly start a third injectable.  I'm also taking my prenatal vitamins, a round of azrithromycin, and have a baby aspirin daily as part of my protocol.  Currently the medication I'm on now is a FSH or follicle stimulating hormone that helps the ovaries to produce more eggs...hopefully LOTS of them so they can later be harvested.  THe LDHCG helps to prevent OHSS (ovarian hyperstimulation syndrome).

Here's some things I learned about IVF medications.  THEY'RE EXPENSIVE!!!  I recommend that anyone without insurance coverage call around and check with pharmacies what their "cash price" is.  Just like with anything, you shop around.  I've found that the pharmacies that only deal with infertility medications really were my cheapest route versus a bigger pharmacy such as CVS or Walmart.  I've also learned that there are many different drugs to choose from.  For example Gonal F, Follistim and Bravelle.  Essentially these drugs do the same job but may vary in cost by hundreds of dollars.  I've also learned about a place to receive medication from the UK at quite a bit of a discount (www.ivfmeds.com).  

So far I'm holding up great.  I have some pretty supportive friends who've helped me along the way and  act as my cheeleaders.  My attitude and frame of mind has been positive and I'm doing my best to eat healthy and exercise.  In a little over a week I anticipate having surgery for egg retrieval.  In the mean time I'm just taking things a day at a time.  

TESTS TESTS AND MORE TESTS

What's in store for me today....?  I have a few hours of time to pass waiting to have my second hysteroscopy.  I've been up half the night either anticipating it or having nightmares about it.   I can't wait until it's all over (I also can't wait to eat since I'm not allow to until afterwards).  14 months ago, we met with our reproductive endocrinologist for the first time.  It's hard to imagine it's been that long when some things seem just like yesterday.  One of my initial diagnostic tests was a hysteroscopy.  Most people probably have never heard of this procedure and the majority of women will luckily never have it performed.  I went into the test a bit blind, not something I usually do.  I tend to do more research.  However, for whatever reason I didn't this time.  I was told the procedure was "routine" and basically not a big deal (maybe it's routine for a surgical team, but not the average Joe).  I remember being told that I could take some Advil prior to the procedure to cut back on any pain I may experience.  I'm not sure why but pain never crossed my mind....I was so wrapped up in finding a diagnosis.  Once I arrived at the surgical center things were put into more perspective.  I remember signing a consent form that discussed all these horrible side effects, etc... I started to become a bit more anxious when I saw people walking around in surgical scrubs and even more when I was asked to change into a gown and hat.  I was wheeled into the OR room and nearly had a panic attack.  I've been in the OR before but was usually drugged up on some kind of anesthetic so I don't remember much.  Being awake the images of these "things" and "tools" really flooded my mind.  I was horrified because I saw so many weird gadgets and I didn't know WHAT they were used for.  Sometimes the unknown is worse because your imagination goes wild.  I felt like I'd just been wheeled into a medieval torture room or was in the movie Hostel.  

I was not given any pain medication, anesthesia, or sedation.  I was wide awake the entire time, literally strapped to a table with 2 legs straps on each leg and and abdominal strap or two (I can't remember)...all I can remember is that I couldn't move.  The nurses and doctors were buzzing around and I remember being scared and confused about what was happening.  They gave me very general instructions of what was going on, however I was writhing in so much pain that I could't hear or process a damn thing.  I remember that a male nurse had to physically hold me down.  Even though I was only in there about 10 to 15 minutes, it seemed like an eternity.  I don't get it....why do they give anesthesia for a colonoscopy and an endoscopy and every other kind of -scopy but not this?  I was outraged I wasn't even given the option....had I known it was that horrid I would have signed up despite all the consequences of anesthesia.  I later (a bit too late ) found out I could have had anesthesia but they discourage it due to side effects of anesthesia, you need someone to drive you home, the procedure is usually brief, and it doesn't always hurt some women.  Absolutely absurd for the ones it does....since then I have read it's more painful than natural childbirth.  The good news is that if I ever do get pregnant, I can tell you I CANNOT handle that and want as many drugs as possible.  I've had a few wrist surgeries in the past and even had surgery for appendicitis but this pain was dull in comparison.

I'm sure the above pictures give you an idea of what I'm talking about. WHO would want that inside of them....awake?  It friggin hurts!!  It's bad enough being invaded with internal ultrasounds, uterine biopsies, and exams but this doesn't come close.  Anyways, my point is this:  do your research and find out what you are in for and what your options are.  I wish I had.  Unfortunately since it's been so long since my last hysteroscope, I have the pleasure of doing it all over again today.  All I can say is thank god for drugs and I hope they work well. 

Things aren't always what they seem.

I learned that lesson in life...many times over.  Whether it's a job interview, a date, or having a baby, most people have an idea in their head of how things will pan out.  I never envisioned that we'd have trouble having a baby.... but here we are, 29 months later.  The ideas in my head of how this would happen were totally different and much more traditional.  Never did I imagine I'd need a team of people to get me pregnant.  The thought of hormones, doctor's offices and "test tubes"(really it's a petri dish), never crossed my mind when it came to conception.  It just goes to show that you can plan anything as much as you want, but ultimately whatever happens will happen.  I believe that's what has taken me so long to finally take the plunge and commit to the IVF process.  No matter what I do or how great my team of doctor's are, no one is truly in the driver's seat.  It's pretty scary knowing that something you want SO badly, you have little to no control over.  It's pretty damn hard to throw expectations out the window but I'm trying so badly.  The worst consequence in all this isn't the thousands and thousands of dollars I shelled out, the painful procedures or sleepless nights....it's throwing out my expectation that this will work.  While we have a good chance, it's still no guarantee and all the effort could be for nothing.  

Just to re-cap where we've come from:  
    - 29 months of "trying"
    - 1 failed clomid cycle
    -2 failed IUIs (with clomid)
    - 1 failed IUI (with injectable medication)
Clearly we are no longer rookies in this journey. Thursday I finally decided to make the call to the doctor's office.  We've taken a hiatus from baby planning for alot of different reasons.  Mainly financial since it's so damn expensive.   My original plan was to do IVF in October but we didn't have the money.  Then it was November but I didn't want to be faced with potential disappointment over the holidays.  Then it was January, but we STILL didn't have enough money and I started a new job.  Then it was March and come hell or high water, I was going to make it happen.  I knew from our IVF consult this past summer that they wanted a month notice in order to have enough time to acquire all the medications. What I DIDN'T realize is that since we waited so long we need to be re-tested before we can start IVF in March....that means we start NOW.  Believe it or not our last rounds of tests were in 2011!  I wasn't expecting that.  I was asked to come in the very next day for updated testing and have the rest of February to finish it up.  We need updated blood values for hormones and communicable diseases, updated ultrasounds, updated semen analysis and the dreaded updated hysteroscope....the VERY test that made me almost give this all up because it was so horrible.  I have a repeat test soon and the anxiety over it as already started since I know what to expect and it's not pretty.  I've been pretty calm about this whole situation the past few months since I've been a bit removed from it, but the MINUTE I walked into the doctor's office, all those negative emotions came flying back with vengeance and seem to be here to stay.  I didn't miss them.  The other downfall is the stress it's already starting to place on our relationship.  I will be the first to admit this is not an easy journey to deal with as a couple.  Even though we are diagnosed with male factor infertility, I'm still the one who must endure all the tests, procedures and medications.  Words can't describe how frustrating that is and how alone I feel in this process.  

I was also given my medication list.  I knew I'd be on alot of hormones....but didn't realize how many until they were written in front of me.  I feel like an old person, taking so many drugs and all.  All together it's 9 different medications...most hormones and many are injectables.  As we all know, I don't do needles but apparently I'll have a cocktail of 4 or so different types of needles.  And my husband gets.....nothing.  As it turns out BabyQuest (the organization that was going to help with with medications) may come through afterall.  I am forever thankful because it's alot of money.  To pay for IVF, yesterday I wrote out a check that was more money than our house downpayment and I nearly had a coronary.....and that's only for the IVF, not medication.  It took me over a year to save just for this one chance.  I called a few different pharmacies and the cost will be in the thousands for one round of IVF.  Upwards of over $6,000.  I have some insurance coverage but definitely not that much.  Whatever I can't acquire via BabyQuest or my insurance I will have to somehow come up with before March 1st (our official start date).  Yesterday I had to start birth control pills.  Weird.  For those that don't know what the IVF process entails, it's so they can have complete control of your cycle and when you start IVF.  It took me awhile to process this because after-all we are trying to have a baby...not prevent one!