I now understand why Sea Turtles move so s.l.o.w.

Growing 2+ dozen eggs is not an easy task and every movement is awkward and intense. Your insides were not meant to grow in large batches and your body makes sure to let you know this.  It also takes so much energy out of you, which you would not expect.  But walking 2 blocks will leave you tired, out of breath and just wanting to lay flat on the ground!

I had my first u/s appointment of this cycle yesterday and clocking more miles on the car than I was expecting to do.  I thought having a clinic 30 miles from the house was far, but driving 300 miles (one way) for a simple 15-20 mins appointment is far!  Thank goodness we at least have one decent car that doesn’t inhale gas like air!

The most important advice I can give anyone going into an IVF is not to expect anything and don’t try to plan – things are always changing!  My original plans were to stay with a friend in Vegas for 3-4 nights, because I was expecting I would need at least 2 more u/s monitoring appointments.  Then I was going to drive home and pick up a friend to and head back to Vegas for my ER.  Well that plan when to the wind after my u/s appointment yesterday morning, instead of staying out there I ended up doing a 600+ mile turn-around trip because I responded more quickly to the stims than I have with any of my previous cycles.  Nothing like spending over 10 hours in the car by yourself especially when sitting becomes the most torturous position possible.  My ovaries wanted room and did not want be squished from hours and hours and hours of sitting.  It was the most uncomfortable trip I have ever taken– but I have to say I didn’t get lost so that has to say something for Jim's navigation's skills ;)  

My appointment was at 12:15 and I made great timing and got into Vegas around 1145, thankfully they were on schedule (last time had to wait over an hour) and they got me in within minutes after arriving.   I had to have a quick physical before the u/s and as soon as he attempted to palpate my stomach I winched in pain.  Since with all my previous injections cycles (15 total) I have always had to stim for 10-11 days I figured the pain, bloat and uncomfortableness I was feeling was because I was much more aware of what was going on – I mean nothing could really be going on after only 7 days of stims.  I chalked it up to a women feeling her 4^th kid start moving months before feeling her 1^st kid, cause she was more aware of the whole thing.  Well I guess I couldnt have been more wrong.

To get a look at the follicles they basically use a dildo with a camera in it, wrapped in a condom, smeared with very cold lubricant, and they push quite hard against the cervix.  When your already in pain, this doesn’t make it any better.  And as soon as the dildo-wand hit my ovaries, both Dr. Sher and I gasped.  I had a reason for all this bloat and pain.  The was nothing but large black balls on the screen (each back ball being a follicle).   I have 25, yes 25 follicles growing.  They are all of great size and I am pretty much ready to go, estrogen levels were no too high and there should be no risk of OHSS so everything is looking fantastic thus far. Right ovary has (2)-18mm, (3)-16mm, (1)-15mm, (3)-10mm & (1)-9mm.  Left ovary has (1)-17mm, (4)-16mm, (2)-15mm, (3)-14mm, (1)-13mm, (3)-10mm & (1)-9mm.  With that being said it does not mean that each follicle will yield a mature egg, typically follicles over 15mm will have a mature egg but it all really depends on ones body and the timing of the HCG shot.  Follicles grow (with stims) at the rate of about 2mm/day, but considering how fast I have stimmed my growth rate may be a little faster than that.  I was instructed to sim for one more day, thus last night being the last night of my stim meds, and I will be triggering tonight.  

 The ‘trigger’ shot is probably the most critical in regards to timing of your IVF cycle and your doctor needs to know precisely when to give.  It requires a high level of experience and a great deal of finesse on their end.  The hCG injection induces the final steps of maturation of your eggs and if given too early, or too late, can lead to IVF failure and having the injection a day early or a day late can make all the difference in a successful cycle.  So having the up-most trust in your RE and trust his judgement really does mean everything!

The time of day/night that you are instructed to give yourself the injection is also extremely important, and you have to make sure you trigger exactly on time – not 5 mins early, or 10 mins late, because the trigger it very specific and based off the time your ER will occur.  Typically the hCG injection is given 36-38 hours before your surgery.  If you do it earlier than instructed you could risk your body ovulating on its own and the doctor missing the window to aspirate the eggs, but doing it to late you risk the eggs not realizing from the wall of the follicles.

My egg retrieval will be on Thursday, June 20th - not sure the time just yet, still waiting on that phone call (which should come today).  

Phase 2: Ovarian Stimulation. Gonal F has started

Remember when I posted the phases of an IVF … well today started Phase 2 ‘Ovarian Stimulation’.  This phase is one of the important ones, well they are all in their own way, but this phase is when the FSH (follicle stimulating hormone) injections are started.  Depending on ones protocol this can mean 2 to 5 injections a day for 7-12 days.  Thankfully I am on a protocol that will only require 3 shots a day, no complaints on my end considering in the past, I have been on protocols that required 5-6 injections a day. 

There are a few different FSH medications that can be used, but the one I will be taking is Gonal F, and this is what will stimulate my ovaries to begin producing multiple follicles.  The dosage of FSH is very complex, your body needs just enough to produce a sufficient number of follicles, if the dosage is too low you will end up with a poor response but too much and you could get OHSS (ovarian hyper-stimulationsyndrome) which can be life-threating.  In order for the doctor to keep a close eye on my progress blood work and u/s's are done every few days during the early part of treatment, then will go to every other day and towards the end of treatment will be done daily.  The blood work will be to check my E2 levels so he can watch to see how the levels are rising, making sure they don’t rise too quickly or get too high and the u/s examinations, are to measure the size of the follicles making sure they are growing close together in size, see how many are growing and just to make sure all is going as hoped.  When there are 2+ follicles measuring 18mm they will clear me for retrieval … but we will get to that in a a few more days.

 

I am so excited to start meds, mostly because it’s a guaranteed end to these god-awful headaches.  Im hoping by tomorrow night they will have found their way to another poor soul.  Its only been 4 hours since adding the hormone into my system and I am already getting some relief.  YAY!  Gonal F doesn’t have any side effects, or at least none that I experience, other than obvious – extreme bloating.  Your body is naturally suppose to ovulate 1, sometimes 2 eggs per cycle, but the purpose of the Gonal is to turn you into a sea turtle so you can lay as many eggs as possible, without getting OHSS.  So imagine the feeling of each of your ovaries growing to the size of the ball that drops in Time Square on New Years Eve.  After about 5 days on these meds you definitely notice that something is going on in those ovaries, you begin getting twinges, discomfort and bloating.  By day 8 you are more in touch with your ovaries that you ever thought possible, and you could swear that if they didn't retrieve your eggs soon your insides were going to pop like an overblown balloon.  Good luck trying to run, shoot walking fast takes effort.  I now can understand how those ladies with large Ta-Tas feel when they run, except I can’t hold my ovaries to keep them from bouncing.  And any form of intense activity will be discouraged by your doc especially anything involving twisting or turning because your insides become so enlarged that intense exercise could cause ovarian torsion and be very dangerous to the ovaries.  

Oh and then the pee cramping.  Yes that is a true thing.  You want to drink water to help starve off OHSS, and in doing so, well ... that bladder fills up fast because it doesn’t have much room since your ovaries are now the size of the NYE Ball.  When you finally get the chance to shuffle-run to the bathroom to relieve yourself, your abdomen area cramps up so bad that at times it will take your breath away, the cramping is caused as your bladder shrinks down to a normal size and your inners begin to repositioning themselves. 

So yeah, really no really 'side effect' from the Gonal F, at least none that they note on the side of the box.

So here we go – let’s get these follicles growing!!