Friday, September 30, 2011

My first frozen embryo transfer

I was astonished by how quickly I recovered from my gallbladder surgery. Within a couple of days it was as though it had never happened. My fertility specialist was happy for me to proceed in my next cycle with a frozen embryo transfer.

Given that my cycle is reasonably reliable, the specialist is happy for me to do a natural cycle. I'm stoked that I don't need to take any drugs at all for the first half of my cycle, I just let my body do what it does naturally.

Once my period started I let my fertility specialist know. It is then a case of monitoring. I need to go for regular blood tests to check my hormone levels are where they should be and need to have a couple of ultrasounds in my specialist's office to confirm my uterus lining is appropriately thick. It was doing these scans that I discovered I was ovulating on the left side, the side that lost the fallopian tube as a result of the ectopic pregnancy in February. I'm kind of pleased about that. Although it is possible for the right fallopian tube to pick up the egg from the left ovary (that is freaky right, but those fallopian tubes are apparently limber little suckers with fingers on the end and can just sweep over to the other side of the uterus to pick up the egg!), I figure it isn't all that likely, so feel extremely justified in my decision to proceed with IVF treatment.

Once we know I'm about to ovulate, we have to make the decision about how many embryos to thaw - 1 or 2. The specialist is all about 1 healthy baby is the ideal outcome, and therefore a singleton pregnancy is the best chance of achieving a healthy baby. However, I'm thinking, I've just put 1 embryo back in and nothing happened, and I've already had one miscarriage, perhaps if I put 2 back in, I'll actually get the 1 we all want.

Matt and I decide we will thaw our best embryo and our worst embryo to put 2 back in. We also decide that if one succumbs during the thaw, that we won't thaw another, we will just put the 1 back in. It is pretty exciting at this point, every day I get to speak to a scientist in the lab and hear how my embryos are progressing. Both are developing well, however 1 is a little slower than it should be.

Come transfer day I go to work as usual, and then a half hour before I'm due at the hospital I log off and let my team know I'll be on mobile for the rest of the afternoon. It is a beautiful mid August Brisbane day. It is ekka time and the days are stunning, clear blue skies and warm. I walk up to the hospital in Spring Hill, stopping in at my specialist's office to drop off some paperwork.

Matt is meeting me there, but I have time to get changed into my gorgeous hospital gown before he had arrived. When Matt arrives he quickly slips on his hospital attire over his clothes and before you know it we are being lead into the theatre. Thankfully there is only my specialist and nurse in the theatre so I can assume the transfer position without too much embarrassment. Matt is in the husband chair holding my hand.

The scientist comes in and tells us that both embryos have progressed to morula stage. They are 5 days old and ideally should be blastocysts by now. My specialist tells me not to be too concerned and the scientists assures us they were both still developing well and could literally be blastocysts in a matter of hours.

A quick turkey baster job medical style and 2 tiny embryos are inside trying to make themselves comfortable. I have hold the transfer position for another few embarrassing minutes while the lab quickly check the turkey baster under a microscope to ensure the embryos actually did make it out. Given the all clear I'm off the table and covered up in moments.

My doctor walks us out and wishes us all the best. He lets me know I can do a blood test in 12 days to confirm if I am pregnant.

I slip back into my normal clothes and then sit for the compulsory half hour rest period in the recovery lounge sucking down ginger ale - that I kindly share with Matt  :)

Again the wait begins.

Wednesday, September 28, 2011

Full IVF cycle part 4 - waiting

Two weeks doesn't seem like that long to wait, until you have a lot invested.

As it turned out, I could handle one week with ease. I didn't even really think much about whether or not I could be pregnant. But as soon as I hit 8 days of waiting I started to seriously wonder. It doesn't help that there are early pregnancy that state they can pick up pregnancy hormones from as early as 7-10 days after conception. IVF means you know exactly when your egg was fertilised, so 8 days seems like a good time to start home pregnancy testing.

First home pregnancy test - negative.

At about this time I also had my first cut loose day from my pre-pregnancy weight loss diet. We had a friend that was celebrating their 40th birthday and there were many delicious treats to be had. Later that night I had weird pain in my chest. I was trying to get to sleep and this ache was throbbing away. I didn't want to take any pain killers, just in case I was pregnant. I checked out the time, thinking if I needed to go hospital I would need to know how long the pain lasted. Next thing I wake up in the morning pain free and I didn't really think much about the episode.

Queensland Fertility Group must know that about about a week after transfer all their patients start going a bit crazy, so they schedule a call to see how patients are going. When the nurse rang she asked about the ovarian hyper-stimulation symptoms I'd experienced. I mentioned the chest pain, which the nurse puts down to possibly having fluid in my lungs as a result of the hyper-stimulation.

I make it through the second week wait, with only taking three home pregnancy tests - all negative. I convinced myself that I would prefer to have an idea of the outcome of the blood test so that my hopes aren't too high.

When I head in for my blood test, I'm confident that I'm not pregnant. I'm told it should only take an hour for the result to be through to my specialist. I wait an hour and a half and ring to find out the result - they aren't there. I'm told there has been a problem in the lab and to ring back in an hour. An hour later I sneak off from my desk and ring again - still a hold up in the lab. My anxiety is rising - I tell myself, you are not pregnant, why is this stressing you out. As instructed I ring back in another hour and still there is a hold up in lab. When they ask me to ring back in hour I say no - I can't - I've rung three times and have meetings and work to do.

I ring the Queensland Fertility Group (QFG) head office to find out what the hold up is - they have no idea. I fire off a nasty email to QFG about the general lack of service, given that I just shelled out $7,000 and am emotionally invested up to the eyeballs.

Hours later when I have time I ring my specialist's office again - finally the result are in - I'm not pregnant. They tell me I should have a chat with my specialist in the coming days to discuss what I want to do next.

The next day, which happens to be a Saturday, my specialist calls me. He is so nice. I don't know how he does it. He seems so genuinely sorry it hasn't worked out and also apologises for the stuffing around the day before. He reminds me it didn't all go bad and that I'm in the enviable position of having 10 high quality frozen embryos. We discuss when I might want to try again. He tells me there is no physical reason I shouldn't try again in my next cycle, depending on how I am coping emotionally. He refers me to his website patient login area to read the information on the different approaches to frozen embryo transfers and asks me to call him on his after hours number the next night.

Matt and I discuss what we want to do and decide we are prepared to go again straight away. The next night I have dinner just before I'm supposed to call the specialist and as soon as I put down my cutlery I start to get the chest pain like I had experienced a week earlier. I ring my specialist to let him know we are keen to go again and ask him about the chest pain given that it started through the IVF cycle. He tells me it sounds like my gallbladder and that I should get it checked out before we proceed.

Once I hang up the phone the pain becomes even more intense. It feels like my chest is going to crack open. After about 20 minutes of me writhing around the house and crying, Matt decides it is time to take me the hospital. Just as we pull into emergency the pain ceases. I feel completely drained and am broken out in sweat. We decide I should go in anyway.

Presenting to emergency at 8am on a Sunday night is not ideal - unless one is actually dying. It is busy. We aren't urgent now the pain has ceased it looks like I shouldn't even be there. We wait. Nearly four hours later a doctor can see me. She gets me on the bed and feels around my abdomen. We discuss all the IVF dates the type of pain and other symptoms like sweating and nausea. She orders blood tests and xrays and asks me to head back out into the waiting area. An hour later I'm called back in and am seen quickly by the head doctor and sent off with a diagnosis of reflux and with instructions to take some mylanta next time I experience the pain.

Turns out I wouldn't have to wait long to experience the pain again. The following week our entire team was going away for a two day conference at Caloundra. As soon as I finished lunch on day 1 I felt the beginning of the symptoms with which I was now becoming familiar. I didn't have any mylanta on me, so I asked one of my colleagues to drive me to a chemist. By the time we got to the chemist I was in the full swing of the pain. My chest felt like it was going to split in half and while I felt like a could vomit I knew I wouldn't. The double strength mylanta does nothing. We go over to the doctor's surgery that is in the centre, they say we should go to the hospital. My colleague gets some quick instructions and a map and we are on our way.

In the car the pain eases and then increases again. I ring Matt to tell him it is happening again. It seems worse than ever. When we get to the hospital I'm a mess of sweat, but my pain has eased a little. The triage nurse asks me to rate my pain, I only grade it a 6. She takes some quick vitals. All of a sudden the pain is getting more intense. I bump up my pain number to 8 and a half. By now I'm groaning and I can't stand or sit still. I can't get comfortable. I hold my chest and rock. The triage nurse brings me some tablets and tells me to calm down - I think that is because of the groaning. My poor work colleague is back on the phone to my husband and filling in the admission forms, digging in my purse for my medicare cards.

Soon enough I'm the emergency ward and being asked to drink a 'pink lady' - a disgusting, thick pink drink. The nurse is sure I have reflux - I'm thinking you've got to be kidding this cannot be reflux.

I'm in a bed, the needles are going in, blood going out, and at last the good drugs are being administered. It took two IV shots of something to finally bring the pain down to the point that I could start talking normally. A doctor comes to see me and ask lots of questions about the pain - in particular is it squeezing type pain. I'm not sure. It is really hard to describe my own pain. The doctor sends me for an ultrasound of my abdomen. The sonographer tells me my gallbladder has stones, but so do a huge percentage of the population, and that it looks fine to her.

Back in the ward the doctor comes to see me again, he seems to think it is reflux, and then he is away again. My pain is now completely gone and I'm told I will be discharged soon. Matt is on his way up to Caloundra, he was planning to either pick me up, or stay at the hotel I was supposed to be in for work if I had to stay longer in hospital.

Just as Matt gets there the doctor comes over and tells me he thinks it is my gallbladder and that he wants me to make an appointment with my GP to referred to a surgeon. I'm discharged with my letter to my GP and prescription for a hard core pain killers. The emergency doctor advises me to take the pain killers with me always and if I really want to prevent further episodes to cut fats from diet.

It turns out that heightened oestrogen levels created through the IVF cycle, plus my weight loss, conspired to cause my gallbladder malfunction. My surgeon tells me gallbladders often play up during pregnancy and given that is what I'm trying to achieve that I should just get it out as quickly as possible, so we can get on with the IVF.

Once the problem is diagnosed it didn't take long to get it tended to. Instead of doing my second round of IVF, within a couple of weeks I was scheduled for surgery, my second laparoscopy for 2011.

On 19 July I said farewell to my gallbladder and within a couple of weeks I was talking to my fertility specialist to discuss when I could do my first frozen embryo transfer.

Tuesday, September 27, 2011

Full IVF cycle part 3 - the big days

Given that I have an laparoscopic surgery in February, that involved actual incisions in my body, the idea of being knocked out while the doctor needles me a number of times to suck out my eggs seems pretty low key.

I roll in to the day theatres an hour or so before I'm due to have the egg pick up procedure. I'm given my hospital gown, slippers, hair net and undies and a plastic bag to put my normal clothes in. I get into the hospital gear and am lead into a communal lounge room, all the while carrying around my personal possessions in my plastic bag.

The anesthetist leads me to a pre op consult room and proceeds to scare the bejesus out of me about all the things that can go wrong under general and then asks me to sign a disclaimer that states I've been advised of the dangers. My fertility specialist then comes in and asks if I've got any questions. He has the complete opposite effect to the scary anesthetist. I feel calmed and excited at the same time.

I walk myself, towing my plastic bag of personal possessions, into the theatre. My personal possessions are put on a trolley in the corner and I jump up on the bed.

While I've been preparing for my procedure, Matt has been preparing his own contribution. After much consideration, he had decided he would be able to provide his specimen at the hospital, meaning it would be done close to the exact time required. When I was lead off to get changed Matt was walking down a hallway with a brown bag of hospital porn dvds and a sterile jar.

As I'm getting comfortable on the theatre bed the room is filling up. There must be 6 or so people in there, the only 2 I know are my fertility specialist and the scary anesthetist. A scientist introduces themselves and advises they have Matt's specimen and that it was excellent. She tells me in the labs Matt has been declared 'stud of the day'. I laugh and say Matt is going to love that. My doctor is laughing too. Scary anesthetist hasn't cracked a smile. My fertility specialist says I shouldn't tell him as it will go straight to his head.

Next thing the anesthetist is saying 'a little sting' and I'm off to sleep.

I wake up in the recovery ward with my plastic bag of possessions on the bed beside me. After a half hour I'm up and racing, well as racing as one can be when they have ovaries the size of oranges. I change back into my own clothes and head to the communal recovery lounge. Matt arrives pretty soon after. We learn the procedure has picked up 14 eggs and Matt learns he was 'stud of the day'.

We head home just a couple of hours after we arrive. I'm a bit steady, having many of the hyperstimulation symptoms, but I'm operational.

The next day our fertility specialist rings to tell us that of our 14 eggs an incredible 11 have fertilised and that embryo transfer will go ahead as planned the following day.

On the day of the embryo transfer the embryo lab call me and say I have 11 embryos, all either grade 3 or 4 (on a 5 point scale with 5 being the highest). Some of 4 cells, some are only 2 cells. Basically, this is awesome. I have a lot of really good quality embryos to choose from. I let them know to pick the best looking one to be transferred back in.

Throughout the IVF process you are reminded about natural attrition. My specialist has advised me that every step usually only 50 - 70% progress. Therefore, of 14 eggs, I'd hoped at least 10 would fertilise. I hoped we would have 6 viable embryos at the end of the full cycle. To have 11 embryos, and of such high quality, was exceptional.

Matt and I head back into the hospital where we both suit up into the medical gear. For the transfers the husbands/partners are invited to come into the theatre. We head in together and I jump back up on the bed. Matt takes a seat in the well placed husband's chair so he can hold my hand but not see the medical component.

Transfers are basically painless although they are a little embarrassing. No anesthetic is required and it is all over in a matter of minutes however, one does have to bare all. Modesty is not a helpful quality when it comes to embryo transfers.

Afterwards we get changed and rest for about a half an hour in the recovery lounge. The first half hour of two weeks of waiting before we will know if the physical and emotional roller coaster of the injecting, tablets, pessaries, bloating, nausea, scary anesthetists, blood tests, prodding and scanning delivers the result we are hoping for.