Trigger shot at 8 pm this evening, and we have to be at the clinic at 6 am Sunday for egg retrieval at 8 am.
Yeah, we’re working on figuring out the logistics of that.
Trigger shot at 8 pm this evening, and we have to be at the clinic at 6 am Sunday for egg retrieval at 8 am.
Yeah, we’re working on figuring out the logistics of that.
Shrike will definitely be triggering this evening, for egg retrieval on Sunday.
I went with her to the appointment this morning, but didn’t actually remember to ask about the exact number of follicles seen, or how many were at “trigger size” (17mm or larger), and since I was there in person, we didn’t get the printout that Shrike’s been bringing home to me, with all that information.
I will try to remember to ask when the nurse calls later on to confirm that we are triggering (but we already know that we are). Then (if I understand correctly) an OR scheduler will call to let us know exactly when she gets the shot tonight, and what time to be there on Sunday.
I did ask for the lastest appointment possible, and they did seem sympathetic to the fact that Shrike won’t be home until after midnight Saturday and we have an hour-and-a-half drive. I refrained from mentioning the part about dropping Peeper off before we head down.
Speaking of, she was not too keen on being woke up at 9ish, after having gone to bed (who’s fault was that?!) at 2ish, and she was definitely ready for goody when we got there, and as soon as we got home, she had some more and went right to sleep (still asleep, an hour and a half later, shhhh!) but she seemed to do well staying with Shrike’s parents for about four and a half hours this morning.
Her mom mentioned that she seemed “a little off” but not unhappy.
Of course, we’ve noticed that the past few days, as well. I think she’s fighting some sort of cold or allergies or something. She had a bit of a snotty nose a few days ago, and still has a bit of a cough, especially at night. That’s better since we started running the humidifier, but there’s definitely something going on in her little respiratory system.
She’s seemed to be doing more nursing and cuddling the past few days, too.
I don’t know much is not feeling 100% or how much is about Shrike being gone so much (up and out of the house in the mornings, then home for maybe an hour before heading off to work).
Tomorrow, Shrike does have to work, but she’ll be home all morning, so hopefully that will help.
And now, maybe I’ll go lay down with Peeper and try to sneak in a bit of a nap myself.
That should make the phone ring.
I’ll post more details about Sunday as soon we have them!
Shrike just called with her daily ultrasound report (and seventy-five-minute-warning to get in the kitchen and rattle them pots and pans for lunch – or in this case, rattle them Gladware leftovers bowls) and there are now twenty-six measurable follicles, three of which are a “trigger size” already.
So, the plan is that I will go with her to the appointment tomorrow (mostly just because I want to) and she’ll trigger tomorrow evening for retrieval on Sunday, and then embryo transfer next Wednesday.
(Just like I’ve been saying for the past three days.)
I think the only shot she’ll get at her appointment tomorrow morning is the Ganirelix (which keeps her from ovulating before retrieval) and it goes in the thigh, just like the trigger shot, so I believe they’ll have her do it herself for practice since, depending on the exact (and it does have to be exact) time, she’ll probably end up having to give herself the trigger shot at work.
I believe they’ll call us tomorrow afternoon with the exact instructions for when to do that and when to show up on Sunday.
Of course, they have to do the retrieval a> when her eggs are at their optimum readiness and 2> when their operating room is available, but within those parameters, we’re going to ask for the latest appointment available, since Shrike will be working until midnight Saturday and we have an hour-and-a-half drive.
Of course, there’s also the added issue of getting Peeper up super-early and dropping her off at Shrike’s parents, but it doesn’t seem that we ought to be asking for any special treatment because “wah wah wah, we already have a baby” – given that that’s a complication that any of their patients would be thrilled to have!
(Of course, I’m sure that plenty of patients are there for siblings, just like us, but still. It seems, I don’t know, ungrateful?)
Any-who – Depending on what time the retrieval is scheduled, Peeper and I might drive down so I can give her the shot (which would require a much-earlier-than-we’d-like appointment Sunday) or I might be able to do it when she gets home (which would require a much-later-than-likely retrieval) so it’s probably going to end up that she’s doing it herself.
Which is no big deal, but she does need to practice tomorrow, because no matter how many times someone else has injected you, and how much you know that you don’t even feel the needle, it’s still pretty hard to do it to yourself that first time.
So, that’s where things stand at the moment, and we’ll have more specific details tomorrow.
Now that I look at her actual ultrasound report in print, it seems there are actually twenty-seven follicles, and she tells me that they told her she’s “an egg factory.”
Now, let’s just hope that she’s still doing a good job of quality control!
‘Tis the season for discovering hidden eggs, I suppose, and it seems that Shrike’s sonographer hit the – ahem – motherlode this morning.
On both Friday and yesterday, there were five measurable follicles on (in?) her left ovary, but suddenly, today there are ten!
They’re still seeing fourteen (not counting the cyst) on the right, bringing us to a total of twenty-four.
They told her that “everything looks great!” and we’re still likely to be triggering on Friday for a Sunday retrieval.
Shrike went down to the fertility clinic this morning for her first ultrasound since beginning the ovarian stimulation medications.
The report is that “everything looks good,” they’re still seeing nineteen measurable follicles (Yay! For what it’s worth, when we made Peeper, on stim day 4, she’d dropped from 41 to 31 follicles.) and it looks like our most likely scenario is to trigger Friday for retrieval on Sunday and transfer next Wednesday.
Of course, that’s based on the average of what most patients are doing, so it probably just means that she’s not stimming spectacularly fast or slow at this point, so there’s no indication yet that her timing will be any different.
They said that “We’ll know more tomorrow,” but we already knew that we’ll know more each day and can start maybe narrowing down the possible schedule more and more as we go along.
Our plan was for Shrike to do all these monitoring appointment on her own, but I’m starting to feel a little left out of the process, so we’re going to see if her parents are available to watch Peeper on Thursday or Friday so I can go with her.
More news as we have it.
We woke up bright and early this morning, dropped Peeper off with Shrike’s parents, doubled back to the house for Shrike’s “be sure to bring this with you to every appointment” folder and headed down to the fertility clinic to get Shrike started on her IVF medications!
We were only about 20 minutes late which, they will soon learn, is great for us. Then we were there for way too long.
Shrike is starting the cycle with 18 follicles, which they keep telling is is “a lot!” and “great!” but it’s less than half of what she had the cycle that we made Peeper (41).
(In case you’re wondering, yes, I am quite sure that I will be comparing this to our Peeper cycle every step of the way.)
Anyway, so she has 18 follicles, plus a cyst leftover from where she ovulated last cycle. Which is fine, but it’s over the 11 mm limit that requires them to check her blood work before allowing her to start the meds.
They could tell from the ultrasound that it was actually a cyst, and not an antral follicle, so it wasn’t producing estrogen, so wouldn’t throw off the blood work, but they had to officially see it first.
So, we went out for lunch, then came back and watched Real Housewives of Orange County on the tv in the waiting room (Wow. That was an hour of my life that I will never get back.) and then finally got to have the shots and hear all the instructions.
The nurse gave her the shot that was either the study med or a placebo, and I gave her the one that’s either Follistim or a placebo, so that I could practice using the Follistim pen that I’ll be using tomorrow and Monday (the two days that she doesn’t have appointments).
Then, while we waited to make sure she didn’t have any sort of adverse reaction from either injection, we scheduled the rest of her appointments (11 am everyday except tomorrow and Monday, until she’s ready to trigger) and went over all the rest of the protocol.
The girls that we talked to today (AA and MG) said that they’ve had a couple of women ready to trigger by day 7 and one actually triggered on day 6, and the longest they’ve seen is day 14. That’s a bit more of a spread than TN described, but everybody has said that the average has been about 8 days. She said that by Tuesday’s ultrasound, we should be able to start narrowing down when to expect that.
At any rate, it should all be happening within the next couple of weeks!
Then, I dropped Shrike at work (No, we didn’t leave her car there, because we didn’t expect to be that late. So, Peeper and I have to go pick her up at 11 pm. Yippee.) and, after getting stuck in traffic for a while, I picked Peeper up and brought her home for a nice long nap (since she’d not had one yet).
We both got up around 7 pm and she’s still kind of cranky-pants.
Some “hilarious!” (her words) YouTube videos seem to be helping with that.
Shrike has an appointment at the fertility clinic on Friday morning to start the IVF cycle!
That morning, she’ll have several blood tests, an ultrasound to look at her follicles, checks of height/weight/vitals/whatever, and will get two shots.
It’s a double-blind study, so no one (except some patient-assigning computer somewhere) will know if she’s in the experimental group (getting a long-acting follicle stimulating hormone, which is one shot that’s good for seven days) or the control group (getting the usual seven days of daily recombinant FSH shots).
So, the two shots she gets on Friday will either be the study medication and the first of seven placebos, or a placebo and the first of seven rec-FSH shots.
(Regardless, she is going to be getting seven days worth of ovarian stimulation, either all at once or one day at a time.)
On Saturday, she gets to stay home, and I’ll give her a shot of recFSH or placebo.
Sunday, she goes in for bloodwork only, and gets another recFSH/placebo. I think that on the appointment days, she’ll get her shots while she’s there.
Monday is another stay-home day, and I give her another shot.
Tuesday she goes for blood and ultrasound and gets the same shot, plus an additional medication (Ganirelix).
And so on, through stim day 7 (next Thursday).
Starting on stim day 8, she’ll continue to go in for monitoring, and will get Follistim and Ganirelix shots until she’s ready to trigger, with a shot of Ovidrel (HCG) to make the eggs mature.
They’ll have her do that when the largest follicles reach a certain size. (When we were making Peeper, they had us trigger when 3 – 4 follicles were 18 mm. I don’t know if it’s the same this time or not.)
When I talked to TN (study coordinator) this afternoon, she said that most patients have been triggering right around stim day 8. One was actually day 7 and the latest was, I believe, day 12.
Thirty-six hours after the trigger shot will be egg retrieval. As with Peeper, for that she’ll be under IV sedation, and they’ll go in vaginally with a needle, and then “off road” into the pelvic cavity where, watching with ultrasound, they’ll poke the needle into the follicles and aspirate all the fluid and, hopefully, an egg from each one.
When we did this before, it only took maybe thirty minutes (although they’d estimated fifteen, so I was freaking out!) from the time I kissed her goodbye and they wheeled her into the room, until I was allowed to see her again. By the time someone came out to get me, they’d already counted the eggs and were able to tell us how many we had.
While we’re driving home, they’ll thaw out Popeye’s boys, pick out the best-looking swimmers and inject one directly into each egg. (Intracytoplasmic sperm injection – ICSI)
The study protocol does not allow for preimplantation genetic diagnosis (yeah, we’re a little nervous about that) and requires that everyone do a three-day transfer, so the next two days we’ll get phone calls telling us how many eggs successfully fertilized and how the embryos are looking and then on the third day, we’ll go back for the embryo transfer. (With Peeper, we did PGD and a 5-day transfer.)
The study protocol also requires that exactly two embryos be transferred (assuming there are two healthly-looking ones), which is the same thing we did with Peeper.
The rest of that day and the following day, Shrike will need to be on what I guess is technically “modified bedrest.” With Peeper, my rules were that I was supposed to be lying or sitting around, with my feet up. I was allowed to hang out on the couch watching TV and using my laptop (with it on my thighs, not my tummy, since it’s hot-hot-hot!) and could get up to get food (and take it back to the couch to eat) and go to the bathroom.
That was pretty easy (although I did spend a lot of time on the phone and sending / receiving emails, making arrangements to – I swear – meet Hilary Clinton the next day) but this time around, we’re a little worried about how Peeper’s going to handle Shrike not being able to get up and play with her.
We’ll definitely warn her about it and I’m thinking that maybe she and I will leave for a while (hopefully it will be on a day when something’s going on with MOMS Club).
Today, it occurred to me that maybe we could rent some movies to all watch together, while snuggling on the couch.
I’m thinking Wizard of Oz (since she’s rather obsessed now, but hasn’t actually seen the whole thing) and possibly Jungle Book (since she loves the “Bare Necessities” clip that Shrike found on YouTube). We also have Finding Nemo, which she’s seen a couple of times when she was sick, and something else that Shrike bought lately, but I’ve forgotten what it was.
As rare as it is for us to even open the entertainment center, let alone actually watch something on the real TV, that ought to keep her distracted for a while.
Shrike can go back to work the following day, and then we wait.
She’ll have an official pregnancy test on day 18 post egg retrieval, but I’m sure I’ll have her peeing on sticks well before that. With Peeper, we had a very faint positive at 11 dper, a positive digital the next day and a positive blood test the following day.
If we get her knocked up, the study includes ultrasounds at 7 or 8 weeks and 12 weeks, but the doctor will want more than that, hopefully starting at 6 weeks.
So, by my calculations, it looks like the most likely scenario is that we’ll be doing retrieval and transfer sometime during the week before Easter, will have an idea of the results via peesticks by the first week of May and will have an official answer by the following week.
So, here we go!
I just got an email from the IVF study people and we are in!
Just got this email from MG, one of our contact people at the fertility clinic.
Hi Whozat –
All of Shrike’s lab results from yesterday were well within the normal limits, both clinically and for the study. To give you some meaning to them, I’ll let you know what we are looking for with the study.
Estradiol – should be low, around 60 is fine. Her Estradiol is not really something that would screen her out, but we would’ve wanted to repeat it if it had been over 100 or so, that would’ve indicated that she was further along in her cycle than D2, 3 or 4.
FSH – for the study must be under 15.
LH – for the study must be under 12.
TSH – for the study has to be within normal range for our lab, which is 0.4 to 4.00
Progesterone – like the Estradiol is not really something that would screen her out, but we check it to make sure its within normal limits for early in her cycle, we like it to be less than 1.00 on D2,3 or 4
Prolactin – has to be within the normal range for our lab which is 1.9 to 25.0
You can see that all of Shrike’s results fall well within the normal ranges for the Study and for FertilityClinic
When she comes in next time to start her IVF she does NOT need to worry about the number of follicles, the screening ultrasound is the one that could have screened her out of the study, NOT the next one.
The only thing to look out for at her next ultrasound would be if she had a cyst or follicle that was 11mm or greater. If this happens we would just have to wait for her blood work to come back (that same day) to get the OK to start her meds or not. (We look at the Estradiol to make sure that the cyst isn’t producing Estrogen). It isn’t something that would put her out of the study, but it could delay starting the meds for IVF by a few hours, a day or a month depending on what the cyst is doing. But really you guys don’t have to worry too much about this situation b/c Shrike did NOT have any follicles over 11mm at her ultrasound yesterday and typically that means we won’t see anything that large the next month.
You guys can relax for now! you will hear from us in about 10 days with the results from the rest of the labs.
Let me know if you have any questions in the mean time.
That’s the short answer of how things went this morning with Shrike’s prescreening, which is a huge relief.
Of course, the long answer is more complicated. Of course.
The first big “whew!” is that we found out that, since we signed our consents on Monday and held our spot, they have closed the study and are not taking anyone else, so if we’d not gone when we did, we wouldn’t have made it in!
When we got there, Shrike gave them a bunch of pee and blood, and got weighed and measured, and then had the “physical exam” which consisted of a doctor listening to her heart and breathing and then quite perfunctorally poking around downstairs, which I can’t imagine could have told him any more than we were about to find out with the ultrasound, but whatever.
Then he left and a sonographer came in to do that. She was much friendlier.
I said something about “We’ll feel a lot better after we see the follicle count,” and she asked “Why are you worried about the follicles. Oh, you mean you’re worried there will be too many?”
What?! We didn’t know there could be too many!
Turns out that while, generally, more follicles is better, there is an upper limit for the study, because everyone gets the same dosage of the ovarian stimulation medications, and they don’t want to risk hyperstimulation.
She wasn’t exactly sure what the cut-off point was, but she was looking at Shrike’s right ovary and counting “One, two. . . ten, eleven, damn . . . ” and then said that it looked like thirteen.
When she went to the other side, she said she’d have to call that thirteen, too, “And we’ll talk to AA and see what she can do.”
“Is that too many?!” I asked, and she just said, “We’ll have to talk to AA.”
Then, as she was measuring, she said, “Wait, I just measured that as if it was the left, and, wait, I think I might have looked at the same one twice.”
She looked around a bit and YES! – She had counted the right ovary twice, “So, if you have less on the left, you might be okay.”
Then, over to the left side, where we found FIVE.
For a total of eighteen.
Now, between the two of us, we’ve done this antral follicle count thing quite a few times, and the two sides were 6/9, 4/6, 3/3, 5/6, 14/10 (all me), and 18/13 (Shrike) – This was the biggest left/right discrepancy we’ve ever seen.
Oh, and when we talked to MG (who, along with AA, works with TN, the study coordinator), she said that the maximum allowed for the study is twenty.
So, huuuuuge whew on that one, too!
It occurred to me later that I guess that, even if everything else looked good on today’s labs (won’t know for a while) that if we go in next cycle and she has more than twenty follicles, we could get bumped at that point, and I’ve sent and email to confirm that, but I can’t imagine that it wouldn’t be the case. So, there’s that to worry about.
When we were talking with MG, I also asked her if it would really take a week to ten days to get all the labwork back, or wouldn’t they have some of it sooner than that. She said that most of the hormone levels would come back today, and she could email me when they got that.
Well, I was expecting to hear something like “Looked at Shrike’s hormones and everything looks okay so far,” but instead, she emailed me all the actual numbers, with no interpretation.
So, again, I turned to Dr. Google, and according to FertilityPlus.org, everything does appear to be within the normal range, except for LH, which was just the teeniest smidge elevated (normal is less than 7, hers is 8.14).
Her FSH is smack in the middle of the “good” range, (It was “a bit elevated” in May, and I think it’s lower now.) and Estradiol is toward the higher end of the normal range. (Lower values are better for stimulation, and “abnormally high” values indicate diminished ovarian reserve.)
Of course, the specific ranges vary from lab to lab, so that’s all sort of conjecture, too.
For those of you who’ve been down this road and are familiar with these things, here are the actual numbers:
I emailed them back and said that I understand if they aren’t allowed to really interpret the numbers, but asked if those numbers seem to be within the parameters of the study.
In the meantime, is there a reproductive endocrinologist in the house?
So, now we wait to get a call “within the next 7 – 10 business days regarding inclusion in the study.”
And then, if that goes well, we’ll still have to sweat her follicle count at the beginning of the next cycle.
So, to summarize, the correct mojo request is: Good numbers on today’s labs, and 16 – 20 antral follicles four weeks from now.
And how am I doing? While talking to MG, we were talking about how stressed out I am about it all, and I said, “Well, I feel like I can’t do anything except worry,” and she said, “Well, you’re doing a really good job of that!”