Tag Archive 'doctors'

May 16 2011

IVF Part Six: Transfer and the Two Week Wait

Published by under Infertility,IVF,The Man

The first part of getting ready for transfer is to start progesterone in oil injections the day after retrieval is done. These are the injections that everyone who is going through IVF tends to fear. If you search them on the internet, you will find horror story upon horror story of painful shots that leave welts and terrible soreness. When you consider the fact that you have to do these shots for TEN WEEKS if you get pregnant, no wonder people look on them with dread. I wanted to minimize my suffering as much as possible, so I combed the internet for tips.

First of all, I had one of my nurses draw a circle in the target area where the shot has to be administered. On the night we did the first injection, we prepared the syringe and then recapped it and wrapped it in a hot washcloth to warm the oil. I also put a hot washcloth on the injection site to warm my muscles. The Man iced down the injection site slightly just before giving me the shot. He put the needle in quickly, slowly injected the contents, and then pulled the needle out slowly. Afterwards, I massaged the injection site and walked around for awhile to work the muscle and help disperse the oil. The next day I had very slight soreness at the injection site, but no lumps or welts. The only discomfort I experienced during the injection was the initial small poke and then a slight stinging as the oil was slowly injected.

The major problem with the progesterone in oil injection is that it is, in fact, oil. It doesn’t disperse quickly like the other injections you have to have, which are thin liquid like water. If you don’t work at helping it disperse through the muscle, it WILL just sit there and form an uncomfortable lump. Warming the oil thins it slightly as well, making this dispersal easier. I don’t doubt that some people will have discomfort no matter what – everyone responds to things differently – but make it as easy on yourself as you can.

My transfer took place three days after my retrieval, which is pretty standard. The doctors retrieved eight eggs, seven of which were mature, and five of which successfully fertilized into viable embryos. Of those five, two were transferred and three were put into cryogenic storage.

At 7:30 AM on the day of transfer (May 19, 2011), I started drinking my water and took two 5 mg Valium. We reported to the doctor’s office at 8:00 AM for an 8:30 procedure time. Just like for retrieval, I had to put on a gown and footies and go into the prep/recovery room. Kris came in and asked if I was feeling “loopy” from the Valium. I told her no, because I felt normal. So, she had me take the other two 5 mg Valiums that I brought along. We had to do some paperwork, signing a basic consent and then another consent saying that Dr. Singh was going to transfer two embryos and freeze three. Then he handed us a picture of the two embryos that were going to get transferred. That was pretty surreal: looking at two little globs of cells that might one day be our children.

After a little while, I was walked back to the procedure room. The Man came along with me and sat in a chair next to my bed the whole time, which was nice. There was a little hitch with the ultrasound machine, which didn’t want to cooperate, but after a hard reboot, it got into the game.  The procedure itself was like having an IUI or a PAP smear. There wasn’t any pain, and there was just a little wait after the catheter was in while they retrieved the embryos. Once the embryos were transferred, there was another little wait while they verified that they hadn’t gotten stuck in the catheter and had actually transferred. Then they wheeled me into recovery, where I got to lay with my head slanted down for about 45 minutes.

After the 45 minutes had passed, I was allowed to go to the bathroom, get dressed, and leave. I was on bed rest for the rest of the day. Once we got back to the hotel, the Valium finally kicked in and I slept for several hours. Once I woke up, I quickly reached the conclusion that bed rest is pretty boring. I could get up to go to the bathroom, but otherwise I was stuck in the bed, watching TV, working online, or reading books. Not really a problem if I’m at home with all my recorded shows, movies, and library, but in a hotel? Ugh.

The next day I was able to get up and move around some, although I was still supposed to be “taking it easy”. It was a big relief to sit in a chair and be able to stretch my legs for a bit when I wanted. I didn’t really have any symptoms or pain, aside from a couple episodes of mild menstrual-like cramps. I figured that was from the procedure the day before. Mostly, I spent the day instructing myself to settle in for “the long wait”. My pregnancy test was scheduled for May 31.

For the first week of the wait, I experienced intermittent cramping nearly every day. These were just like strong (for me) menstrual cramps. Of course, this really freaked me out until I looked online and discovered that this is actually a very common symptom, and as long as it’s not accompanied by spotting is really nothing to worry about. The nurses had told me that the difference between me being miserable and me feeling OK during this time period was to keep drinking protein shakes and a lot of water. I had really slacked on this for a couple of days, which might have contributed to the cramping.

Is there any way that anyone has found to make this wait pass with a minimum of anxiety? I alternated between my pessimistic thoughts that the procedure hadn’t worked, to feeling guilty for not having enough faith in God to lead me to the proper outcome (whatever that might be), to trying to force myself into a positive mindset by making baby items. I read and re-read WSU’s success rate report (78% for fresh transfers for women under 35) and tried to tell myself that we had done everything we could to ensure success.

One other thing we did during this time was refine our progesterone in oil injection procedure. We bought a heating pad, which really made a huge difference. I would heat the injection site for about 10 minutes beforehand. The filled syringe would also be heating under the pad next to me at the same time. After injection, I heated the site again for 10 more minutes. This really helped reduce the soreness and bruising.

I would have to say that for me, the biggest problem with the “two week wait” is that we went from a lot of activity down to almost none. During the stimulation/retrieval/transfer part of things, you’re doing quite a lot. I had doctor’s appointments every day where I got an ultrasound and blood work. I got a call every day telling me if my meds were going to be adjusted. Every night, I had to inject myself multiple times and sometimes take a pill on top of that. But once transfer is complete, you’re shoved right onto bed rest and then you’re left with only one lonely injection to administer every night. During the busy time, there was a definite feeling of energy, accomplishment, and purpose: “OK! Things are getting done! I am doing things to help this situation progress!” There were also daily updates reassuring me that everything was going well, that things were going just as planned. During the wait period, there is none of that. There is really nothing you can do to help things along, and there is no reassurance that things are going the way that they should. You have absolutely no indication as to whether or not all of that work paid off until two weeks after retrieval, when you take your blood pregnancy test.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

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May 15 2011

IVF Part Five: Retrieval

Published by under Infertility,IVF,The Man

The day after I took my HCG (or “trigger” shot) I had to go in for blood work. The lab work form that I got said I was in for a “Pregnancy Test – HCG”, so I guess that HCG makes you appear pregnant when properly administered. I was then told that I had to be back in at 6:30 the next morning to get ready for my retrieval at 7:30 AM. I could eat or drink nothing from midnight on.

So, bright and early at 6:30 AM, The Man and I presented ourselves at the office. Only, the office was locked. So, we stood in the hall for about five minutes until Kris came out of another door and said, “Hello, my dears! I’m going to take you in the back way!” This door led right into the prep/recovery room. I was taken into a locker room and told to get totally undressed, put my clothes in a locker, and then put on a hospital gown and footies. I did that, and went back into prep/recovery, where I was laid down on a bed while The Man sat in a chair next to me. Kris took my vitals and then went over a bunch of consent forms with me. Then, The Man and I just sat around and chatted until the nurse anesthesiologist got there.

The nurse anesthesiologist (I don’t remember her name) came in to ask if I had any medical conditions or allergies that I knew of, and to explain that I would be sedated (but not under full anesthesia, so I wouldn’t have to be intubated.) After that, Dr. Singh and Dr. Bannerjee (his Fellow, a GYN in training to be a RE – WSU is a teaching institution, obviously) poked their heads in to ask how I was feeling and let me know they were going to go change and start to get ready. After that, Kris came and tried to put my IV in, and she tried to put it in the crook of my elbow, where blood is drawn from. I’ve never had an IV before, so I was expecting a little extra pain, but this was like…um OW, OW, OW. She asked how it felt and I said, “Well, it kind of feels like someone is pinching me very hard right there, and not letting go”. Apparently, this is not how it is supposed to feel, because Kris called in the nurse anesthesiologist who said, “Oh yeah, that’s not in right”. She pulled it out and put the IV in my hand, which was a lot better. The initial pinch was a little worse than blood draw, but after that, there was no real pain.

Kris had to go prep another girl who was also in for retrieval, so another nurse took me to the bathroom and told me to empty my bladder. After I did that, I got to go say good-bye to The Man, and get walked into the procedure room. I’ve never had any kind of “surgery” before, so this was a new experience for me, and I really didn’t enjoy it, just because I’ve never felt more like a lab specimen. Kris, Dr. Singh, and Dr. Bannerjee were in the room, along with the nurse anesthesiologist. Some other guy came in just to verify that I was wearing the right name bracelet.

I got laid down on the bed. My arms were placed out to the sides, kind of like I was being crucified. Kris started putting monitors on me. Dr. Singh and Dr. Bannerjee positioned my legs in some low stirrups and then sort of wrapped them in towels (I THINK…I was flat on my back at this point, staring up into one of those big round surgical lights). Kris put an oxygen tube on me, and the nurse anesthesiologist said “I’m going to give you something to make you feel sleepy.” This went into my IV. I remember looking up at the light and thinking “Wow, that light is getting fuzzy”. And that was it. That was the last thing I remember until they were wheeling me into recovery and someone was asking me “How do you feel?” I think I told her I felt “OK”. They had apparently been talking to me before that, but I don’t remember.

They brought The Man in, and I managed to open my eyes for him. I felt kind of groggy, like I just woke up from a deep sleep, but I didn’t feel nauseous or sick. Dr. Singh came by to tell us that they had retrieved eight oocytes, which is what they expected, based on the number of follicles they had seen during all of my ultrasounds. I think I asked if that “was good”, but I didn’t get an answer.

I laid around, waking up, and talking to The Man for awhile. The other nurse – I believe her name was Laura – came in to take my vitals and ask how I was feeling. I told her I had some mild cramping, nothing terrible. She asked me where I fell on a pain scale of 1 – 10 , and I told her about a 2 or 3. Then she asked me if I remembered how many oocytes I was told they retrieved, and I said eight. She said, “OK, good. That’s one of the ways we judge how well you’re coming out of anesthesia.”

A little while later, she gave me a graham cracker and a cup of apple juice. A little while after that, I got more apple juice and two Tylenol. Then Laura took me to go to the bathroom, telling me that I had to empty my bladder before she could take my IV out. So, I did that, she took out my IV, I got dressed (The Man went and got the car while I was getting dressed), and Laura put me in a wheelchair and wheeled me out to the car. It was around 9:30 AM when we left the doctor’s office. I had stayed in recovery for about an hour. The procedure took about 30 minutes, from what I was told, and we were about an hour signing paperwork and prepping for the procedure.

The Man and I drove back to the hotel and I managed to stay awake for maybe an hour before going back to bed for a nap. My alarm went off at 12:00 PM because I had to take my doxycycline and my methyprednosolone. I woke up still feeling tired, but not too bad. My cramping was still mild. They had told me that if I wanted to feel OK instead of terrible, I needed to keep drinking a lot of fluids and drinking my protein shakes.

All I had to do now was to wait for the call to tell me how many of my eggs were successfully fertilized. They told me before the procedure that they always expect that around 70% of the eggs retrieved would be suitable for fertilization, but not every one would be successfully fertilized.

(My retrieval took place on May 16, 2011)

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

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May 05 2011

IVF Part Four: Stimulation

Published by under Infertility,IVF,The Man

Stimulation is the phase of IVF where you are ramping up for your oocyte retrieval. It’s where you use some of those drugs you’ve been accumulating to kick your ovaries into overdrive (but not TOO far into overdrive) so that you’ll hopefully have a bountiful harvest on the day you go in for retrieval.

Day one of stimulation for me was jam packed with excitement. For one thing, I had to have an ultrasound and bloodwork done in the morning. And my RE’s office is oh…two hours away. And I had to be there between 7:15 AM and 8:15 AM. That means The Man and I got up at 5 AM and hit the road at 5:30, all so we could spend 30 minutes in my doctor’s office and turn around and drive back home. When we got home, my last shipment of drugs (which contained all the ones I needed that very day) was waiting for me on the porch, so that was a big relief…until I opened it up and was confronted with needles that were about three times the size I was expecting. Most of the drugs for stimulation are taken subcutaneously (meaning under the skin, meaning little needles). What I had were big honkin’ needles for drugs that had to be delivered intramuscularly (which I would need later, but not now). When Kris called to tell me that the results of that morning’s tests indicated that I was good to go and could start my stims that night, I asked her about the needles, and she said yes, those were the wrong ones, but I could go to any pharmacy and get the right ones.

Let me tell you, that turned out not to be the case. First of all, we went to Walgreen’s, simply because it was handy. When I told them what I wanted, the pharmacy tech collared the pharmacist and like…at least one other person, and they went on a manhunt (or needle hunt) for about ten minutes. And THEN they came back with six syringes and were like “This is all we’ve got, and we have nothing in the other size you also need”. They advised us to try Wright and Filippus, which is a medical supply store. So, we drove across town to this medical supply store, only to be told that they are the kind of medical supply store that deals in braces and CPAP machines, not syringes. I was starting to get desperate, because it was 3 PM and it’s not like I had an unlimited amount of time to dork around looking for syringes. The nice people at Wright and Filippus advised us to try Healthway Pharmacy, a little compounding pharmacy that was located on one of those side streets that no one hardly drives down because it is all medical specialists. We got to Healthway and when the woman at the counter asked what she could do for me, I blurted out “I have injectable drugs that I’m supposed to be taking tonight, but my mail order pharmacy totally sent the wrong size needles and we have been looking EVERYWHERE for the right ones. Do you have syringes here?” And she said “Oh man, that is terrible! We DO have syringes. What do you need?” And ten minutes and nine dollars later, I had new syringes.

So, for the first five days of stimulation, I was taking 150 units of Menopur and 150 units of Follistim. The Follistim came with a pen that allowed me to insert the cartridge and then use a dial on the unit to select how large of a dosage I had to take. The Menopur was a little more complicated, since I needed to mix a sterile liquid with two different vials of powder, mix it all up, and then put an injection needle on the syringe. I don’t want to get into too much detail because I don’t want this to be a “how to mix your meds” post. If you don’t know how to mix your meds, CALL YOUR DOCTOR. Mine gave me step by step instructions from the drug company telling me precisely what I had to do to prep. It really helped that The Man was with me, reading out the instructions so all I had to do was get the drugs ready, and not switch back and forth between doing something and reading the instructions. He also handed me the things that I needed, like ice and alcohol swabs.

The last part of taking the drugs is obviously doing the injection, and of course this is the part that worried me the most. I, like most people, am not fond of needles, even tiny ones. However, the worst part of the whole thing was just psyching myself up to actually do it. Once I just took the plunge, so to speak, there was absolutely no pain. I didn’t even feel anything. I did use a little ice beforehand, and that may have helped.

On the sixth day, my Follistim dose was upped to 225, and I got to add a new injection to the mix: Ganirelix. This one, I was told, had to be taken at precisely the same time every day. Therefore, I now had two alarms set. There was one to tell me to do my Follistim and Menopur, and to take my prenatal vitamin, and another one to tell me when to do my Ganirelix. We also moved down to the hotel on day six, since this was when the doctors appointments went to every other day. It was either get a hotel or get up at 4:30 AM and drive for two hours every other day (and eventually it would be every day). With gas prices around $4.10/gallon, this was not a tough decision.

The other part of stimulation is the doctor’s appointments. They started me out slowly. I had to go in on day one of stimulation, and not again until day four. Then I had to come back on day six. Then, on day eight. After that, it was every single day until retrieval. The appointment consisted of a transvaginal ultrasound and a blood draw. They wanted to make sure that my ovaries were being stimulated enough, but not TOO much, and that my hormones were staying within acceptable levels. (On day six, I was told that my left ovary “had kicked in”. I guess it was a slow starter.) These appointments all take place between 7:15 and 8:15 AM, hence the second reason we moved into a hotel two blocks from the doctor.

On day 7 I started noticing…not cramping exactly, but more of an uncomfortable feeling in my abdomen. By day 9, this was more pronounced and also constant. One of the nurses told me to start drinking more fluids (anything non-caffeinated) and two or three protein shakes per day. She told me this would not only help with discomfort but also help to stave off ovarian hyperstimulation. I like chocolate quite a bit, so I chose Boost High Protein Shakes in the chocolate flavor (15 g of protein each). They were relatively tasty and it was good to know exactly how much protein I was taking in without having to check serving sizes and labels of all of the regular food I was eating.

One part of stimulation that was rather nerve-wracking was that, as I started getting to the end of my stimulation period, my drugs of course started running out. My doctors ordered for me the minimum amount of drugs that they believed I would need, to help prevent us from spending money on unnecessary drugs. However, since my dosages were increased on two of the drugs I used (Follistim and Menopur) partway through stimulation, I didn’t have enough drugs to make it to the end. But whenever I called Kris to find out if I should order additional drugs, she told me no, she would give me enough to get me through to the end. She did not want me to spend more money on drugs. This was, of course, HIGHLY appreciated by both me and The Man. I’m not sure if this is normal behavior by IVF clinics, but what I read on the internet leads me to believe that it is. There are several anecdotes online detailing free “tide over” drugs being given out by clinics and doctors.

I was initially told that stimulation would last for anywhere from 10-12 days. On day 10, my daily ultrasound was conducted by Dr. Singh, who wanted to see personally how I was progressing. That afternoon, I got a call that I was to take my HCG or “trigger” shot that night at 7:30. This marked the end of my stimulation – the HCG shot is meant to force the oocytes into their final maturation. Retrieval takes place 36 hours after the trigger shot is administered.

I was nervous about the HCG shot for two reasons: it is an intramuscular shot, so it is given with a much larger needle, and also The Man was going to give me this shot because the location for the shot is in the “upper buttock”. The ultrasound nurse, Michele, drew us a bulls eye so The Man wouldn’t have to guess where the shot went. I laid down on the bed in our hotel room, he numbed the area a bit with some ice, and then I felt a tiny poke…that was it. I really had no idea that it was over until I asked him.

The next morning, we went in for another ultrasound and more bloodwork, and we got our “final instructions”, which meant we were ready to go for retrieval.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

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Feb 25 2011

IVF Part One: Making the decision

Published by under Infertility,IVF,The Fam

For us, the road to IVF was probably longer than most people’s, and that was completely our doing. It took us a long time to get through all of the diagnostic things and other treatments that couples try before they come down to deciding on IVF.

Our infertility journey started on November 1, 2007. That was the day we first met with our first “infertility” doctor. This doctor I have referred to in other entries as “Dr. F”. He was a member of the same physician’s group where my normal gynecologist practiced. He took us through a lot of the earlier testing: The Man’s sperm analysis, my blood work, and an HSG. Everything came back normal. After the initial rounds of testing, he recommended that I go on Clomid and we start doing intra-ueterine insemination (IUI), which would boost our chances of pregnancy. I think we ended up doing six rounds of Clomid and six IUIs before we called it quits on that treatment. All of that testing/treatment had taken about a year, and we’d had no results. We waited for a few months before going to another office visit with Dr. F, and at that time he basically told us that his belief was that I had endometriosis and that I needed a laparaoscopy.  Since we had pretty terrible insurance, that meant we’d be paying the cost of the procedure out of pocket, an expense of about $10,000. I was skeptical that I had endometriosis, because I had exhibited absolutely no symptoms. He also told us that if we were going to do IVF, that a laparoscopy wouldn’t be necessary, because IVF would bypass the problems caused by endometriosis. We decided after that appointment to stop seeing Dr. F, because he didn’t want to do anymore testing, and he also didn’t do IVF. It’s worth noting that his bedside manner was also deplorable and he never made us feel comfortable or like he was in control of the treatment. It was discouraging, because we didn’t know what we were supposed to do next. A comprehensive plan was never outlined, and we never felt like we knew where we stood.

After a few more months, my friend Julio recommended I go see her doctor, so I did. This doctor, Dr. S, worked in the same group as Dr. F. She was nice, but basically all she did was get me an ultrasound to check for Polycystic Ovarian Syndrome (PCOS), and when that was negative, she said the same thing as Dr. F: we can do a laparoscopy if you want, but I would recommend IVF because that will get you a baby.

It was at that point that we contacted Wayne State University Physician Group, who set us up for an appointment with Dr. Singh, a reproductive endocrinologist. This was in February 2011, which meant we had drawn our treatment out for over three years. I don’t think that, looking back, I would have necessarily moved any faster. I knew that since all of the tests we’d had done indicated no problem on either of our ends (our official diagnosis is Infertility of Unknown Origin), we would either just get pregnant out of the blue, or wind up needing IVF. I think I needed to take everything slow to get my brain to process the fact that I would eventually be undergoing IVF, which is by no means a simple process. Also, both of us were young enough that we could afford to take our time. In November 2007, when we began treatment, I was 29 and The Man was 32. If we had been closer to our mid-30s, we would have felt more urgency to move the process along.

We began the testing and assessments associated with starting IVF in February 2011. By the end of that month, if we had wanted to, we were ready to proceed. However, our finances required us to delay beginning for at least a month. It was nice to have a month of breathing time to process what we’d been through and what was coming next.

The IVF Series

Part One: Making the decision

Part Two: Flurry of tests and consents

Part Three: Drugs and money

Part Four: Stimulation

Part Five: Retrieval

Part Six: Transfer and waiting

Part Seven: Pregnancy Testing

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Aug 08 2008

Another reason I hate medicine.

Published by under Infertility

Here’s a tip for all you people who are going through infertility treatments:

If you’re on a drug that you need to take on specific days every month, but only if you’re once again not pregnant, don’t let your doctor’s office tell you that you can just call in and get your prescription re-upped if it turns out you need to.  Because you will need to call on the day that they are closed, and you can’t get a hold of anyone, and then you won’t have your drugs for the next month, so you are going to miss a month of treatment.  Just get the damn prescription at your monthly treatment.

In the meantime, I am going to try and look at this in a positive light: We will have an extra two hundred and some-odd dollars this month.

As an amusing side note: when I used my “tag suggester” plugin for this post, it thought that I should tag with “Viagra, erectile dysfunction, malaria, acupuncture”.  I’m glad I don’t depend on WordPress to treat my infertility.

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