HCG # 5

919

Pretty good one day jump for me and making me feel a bit more confident again.

Ultrasound is scheduled for Monday at 9:00.

Keep the baby dust heading my way!

HCG # 4

My HCG today was 666. It keeps going up but sure is being slow about it. I have read that most people double their HCG in 48 hours but some take 72. It seems I am more of a 3 day doubler. They want to check yet another level tomorrow and do an ultrasound on Monday. Hopefully those will go ok and tomorrow's HCG is above 800! The ultrasound hopefully shows a gestational sac in the uterus and a yolk sac (Sounds like a chicken!). It would be too early to hear a heartbeat or anything like that.

So think extra thoughts for me this weekend and send me lots of baby dust!

Dan Update

Dan's big news is next Tuesday (September 2nd) he will be defending his thesis. This is one of the major milestones for his PhD. Hopefully it goes really well for him!

He has a meeting with his new Urologist today, just a quick meeting to make him aware of Dan's case since Dr. Lewis has moved just in case anything happens in the future.

He has been riding motocross every other weekend since he got his bike, and below are a couple pictures he wanted to show. The first is him jumping, the second is him after 30min of racing around in the dirt. The dirt is even on his teeth! I thought it was gross, but he was strangely proud of it :)

HCG # 3

My level today is 408. So little walker or texas ranger is slowly but surely getting stronger. Getting yet another level on Wednesday and as long as the number keeps going up they plan on doing an ultrasound in 2 weeks. Its funny I find these past few days more nerve racking then the initial blood test. I am glad I am pregnant but since the only other time I was pregnant I miscarried I think I still find it hard to believe.

HCG # 2

The HCG today is 194 and progesterone is 228.48. They said that sometimes when the progesterone levels are so high that we don't see a doubling of the hcg level in 2 days. The good news its the level is higher and a good number for day 11. Its most likely 1 baby, not sure if it was walker or texas ranger who held on :)

Repeating the labs again on Monday, so lets hope it keeps going up!

On the OHSS front, I am still super swollen. I have gained like 6 pounds of fluid in 4 days and I am tight as a drum. I feel like I have jumped from not being pregnant at all to like 4-5 months pregnant in 1 week.

edit - Doctor's office called back. I am decreasing the Progesterone from 200mg three times a day to 100mg twice a day.

It's Offical

My HCG level on 9 days post 5 day transfer is....drumroll....118 Yea! That's a great day 9 level

My progesterone was a whopping 265, that tells us why my abdomen is so swollen. Its normally 25-50 at this time. For now I will continue the progresterone 2 tabs three times daily, but depending on the progesterone level on Friday it may be cut back or stopped all together.

So I am repeating the levels on Friday. We expect the hcg level to double in two days, so hopefully Friday's is around 235

Ovarian Hyperstimulation Syndrome

So apparently all this swelling is not normal. I got diagnosed today with moderate Ovarian Hyperstimulation Syndrome. This is a potential complication of doing fertility treatment, and occurs in approximately 1% of patients! (I am so special). Basically my symptoms are: Abdominal bloating and bloating all the way up to my lungs, increased abdominal girth (39inches!!), Mild Shortness of Breath, and some fatigue. It hurts to lie flat so I am actually sleeping with 2 pillows under my head and 1 under my knees. Yesterday when I was taking a shower I had to stop and sit in the shower because I thought I would pass out from the humidity in there, so figured it was time to let my clinic know how I was feeling.

The plan is daily weights, abdominal girths and hydration. I need to drink plenty of Gatorade to keep my hydration up. Basically fluid is leaking from my ovaries and the follicles into my abdominal cavity and as long as my ovaries keep producing progesterone they will keep secreting this fluid. Now the silver lining here is that the clinic says I am probably pregnant, as if I wasn't my symptoms would have gone away after 3-4 days post egg transfer (I am 8 days post transfer). However since your ovaries keep producing progesterone the entire first trimester this is something I will be dealing with for weeks and could get worse. In extreme situations you get so dehydrated that your kidneys stop working right and you need IV Fluids or even an abdominal tap (long needle into your belly to suck out fluids as if I was a liver patient with ascites or something.)

So that's the excitement here, I am clinging to that silver lining so I am not going through all this for nothing!

EDIT:
You see a 2nd line right? Faint but being only 8 days post transfer....

Waiting

So not much to report, after 4 weeks of busy excitement, shots, ultrasounds, bloodwork, etc now there is nothing to do! Since the egg transfer on Monday my main goal was just to feel somewhat normal again. I was so bloated and swollen from about Monday-Wednesday from my large ovaries & fluid that for Monday and Tuesday especially it was actually painful to breathe or move around. I felt full from my throat to my pelvis like everything was just swollen. I kept making up diseases that I am sure I had like toxic mega colon and other fun stuff. But now I am feeling more normal, I dont feel like running any time soon but I can bend over and touch my toes again!

Ok, enough complaining. In one more week I will do the blood test that hopefully shows defiantly one way or the other if the IVF worked. I am hoping for an HCG level around 100, anything above that would be super, below that would be a bit worrisome. No matter the level they will repeat it probably 2-4 days later to see the trend (hopefully rising). I dont "feel pregnant" but no one should at this point.

Not much else to report, its going to be a long 7 days.

Frosties

The laboratory report this morning was that only one blastocyst was frozen. The three remaining embryos were cultured overnight but upon further inspection two candidates for freezing were abnormal blastocysts with inner cell masses that were “not good”. They were not frozen. Not the best news in the world but its ok. Should this current cycle not work we can try with the 1 frosty next cycle.

Not much else going on, been resting alot and watching Olympics non-stop (How about that swimming relay and men's gymnastics!). The 2 blastocysts are supposed to break out of their shell somewhere between day 7-10 and implant. So until then I guess they are just floating around in there :) Hopefully they start digging in tomorrow and get ready for a long 9 month ride.

Embryo Transfer

Ok, I am all back from my whirlwind morning. I had acupuncture at 10, embryo transfer at 11 and then another acupuncture session at 12. I am feeling good and hopeful. The transfer itself was really simple, took perhaps 2minutes. Basically they did an external ultrasound just to check how my uterus was laying (they wanted it basically in a straight line so its easier to get the catheter in). They then went over the embryo report. We had 3 grade 1 blastocysts, 1 grade 1 early blast, and 1 grade 1 morula. The remaining ones were still slow to grow and not good candidates for freezing. They double checked that I want to transfer 2 and that I wanted to freeze the other 3. Tomorrow they will be freezing the 3 that I didn't use giving us a good option for our next attempt. After we told them we want 2 placed back, it was "load and go" time. They loaded the 2 best ones (pictured below) into a catheter and inserted it into my uterus. They were watching the catheter progress on the ultrasound until it was near the back of the uterus. They then injected the embryos out and you could see two little flashes of light on the screen. They then double checked the catheter to make sure that both were inserted and I was done.


My temporary name for these 2 guys are: Walker (Left) and Texas Ranger (Right)

Fertilization Report # 3

OK, more good news, the 9 little guys are chugging along.

We currently have: 4 - 8 cell, 1 - 7 cell, 1 - 6 cell, 2 - 5 cell, 1 - 4 cell.

The lead embryos have no fragmentation and the cells look even, making them class 1. The lead embryos are also beginning to show signs of compaction which is the next stage of development. While the slower growing ones will most likely not be the ones we transfer on Monday they will be good candidates for freezing as long as they keep growing. And then we can use the frozen embryos in another try later on.

Blast Development

2pn stage (1 cell with 2 pronuclei)

Cleavage stage (2 to 10 cells)

Compaction

Morula

Cavitation

Early Blastocyst

Full Blast

Hatching blast

Hatched blast

The plan is now set. Tonight I do another HCG shot (but only 0.5cc instead of 1cc). This is a booster shot. It will promote secretion of progesterone by my ovaries which aids in implantation.

Monday I have acupuncture set for 10am. Then the IVF Clinic at 11am for an 11:15 transfer. I should be home by noon. And then at 2pm I have another acupuncture session.

Then I wait 11 days until they can do the pregnancy test and see if it all worked.

Fertilization Report # 2

I just received the update from our embryologist.

"There are 6 4-cell embryos, 1 3cell and 2 2cell embryos. All embryos are Grade 1 except for a couple at grade 2. Saturday AM a day 3 report will be given to Dr. Burwinkel and I will confirm tomorrow AM by phone if a Saturday or Monday transfer will be done. I am guessing at this time that it will be Monday but I will call as soon as I know."

Embryos are graded on a scale of 1-5 with 1 being the best.

I am very excited that all 9 embryos are dividing and growing!! If we do go on Saturday, it would be around 9:30am.

EDIT -- HAPPY BIRTHDAY MOM!! I hope your having a wonderful birthday, if you tune into NBC tonight you can watch some Olympic fireworks in your honor

Fertilization Report # 1

Out of the 18 eggs retrieved yesterday 12 were mature and injected with sperm.

Out of 12, 9 fertilized and will be growing and dividing over the next couple days. (75% fertilization rate which is just below the average of 80%)

Tomorrow I will get an updated report about the number of embryos and how they are growing in order to determine if the transfer will be on Saturday or Monday.

I am super excited to have 9 embryos to work with, hopefully those nine will all have a great day growing.

Feeling Fine

Just a quick note - I am feeling fine. Mild cramping but not bad at all. I did sleep until 2pm when we got home but that was Tylenol #3 assisted sleep. I am very excited that they got 18 eggs and that Dr. Groll thinks we can maybe do the 5 day transfer. Thursday and Friday (and maybe Saturday) I will get a report telling me how many were mature and how many fertilized.

Dan is taking good care of me and you can see his detailed review of the morning below.

My mantra for the next few days is "Divide and Conquer", which is what I hope all my little embryos are doing.

Egg Retrieval Day!

Ali and I went to the fertility doctor this morning for the egg retrieval. We left at 0610, and arrived at the doctor's office at 0629. We met a couple nurses, a very nice anesthesiologist, and Rex, the embryologist. Each was very patient and answered all of our questions. Rex said that they don't normally take pictures of the embryos as that prolongs the length of time outside of the incubator. However we will get a picture of the final 2 they select to put in on the day of transfer. They took Ali away at about 0700, right on schedule, and I had enough time to watch about three sets of highlights on ESPN before Dr. Groll came and got me.

Dr. Groll reported that the procedure went very well and Ali was doing fine. He also said they are going to try for a five day egg growth/replacement cycle, as those embryos that remain strong for long enough to meet the five days outside of the womb tend to have a higher rate of pregnancies. However, he said if some proportion (not sure of the number) of the embryos did not appear strong enough to make that time window, that he would then opt for a three day replacement as there is clinical evidence that shortening the outside-the-uterus-incubation cycle yields a higher probability of successful pregnancies in these cases.

When I went to see Ali, she was understandably doped-up and tired. I forgot to bring a camera, so I had to edit this picture of what Ali's transformation looked like:


We spent about 20 minutes allowing Ali to recover, during which time she dined on a bountiful harvest of a half-can of Sierra Mist and four (4!) crackers. Next time I fuel up, I expect to see a noticable improvement in fuel economy due to Ali being 18 eggs lighter on the way home.

At roughly 1100 this morning Rex will clear away the excess cellular tissues and other organic materials from the eggs and assess their overall qualities. From approximately 1300 to 1400 he will inject each egg with a sperm according to the previously documented ICSI process. They will email Ali tomorrow morning with the results of everything that has transpired from the time she left the office through tomorrow morning's embryo inspection. She will continue to receive updates and instructions for medications and schedule on a daily basis.

She is still sleeping now, after a taxing early morning. She starts a new and exciting medicinal program this evening, which along with her new iPhone, I am sure you will all hear/read about shortly.

Preparation for Egg Retrieval

First off I would like to say my butt still hurts from that shot yesterday. I e-mailed my IVF Nurse to make sure this is ok and she said it could hurt for 24 hours...walking up stairs is just killer I feel like I have a gun shot wound to my butt or something.

Since I dont know how I will be feeling tomorrow I thought I would post a little bit of information about the Egg Retrieval (ER) and Intracytoplasmic Sperm Injection (ICSI) which will be taking place tomorrow at 7am.

Egg Retrieval

Egg retrieval is a minor surgical procedure that is performed under deep sedation by an anesthesia provider. A vaginal ultrasound probe along with a thin aspiration needle is placed into the vagina and under ultrasound guidance the needle is inserted through the back wall of the vagina into the ovary. The doctor then punctures each follicle with the needle tip and aspirates the fluid from the follicles. The fluid is collected into sterile test tubes that are passed along to the laboratory where the contents are screened for an egg. The egg retrieval should last about 20-30 minutes. Not all follicles will have an egg and not all eggs will be mature, but hopefully we will have somewhere around 12-15 mature eggs to work with.

Intracytoplasmic Sperm Injection (ICSI)

Because we are working with a limited supply of sperm that Dan banked prior to starting chemo we are using ICSI. This procedure takes a single sperm and injects it into an egg. Dan's sperm are currently frozen still but will be thawed first thing in the morning. They should survive well from the process but since we are using ICSI they will just select the best ones they can find.

I found this cool video on youtube to show you how its done under the microscope.

Final Ultrasound/Bloodwork

Fast Facts:
Lining: 12mm
Right (4) in mm: 12,16,17,18
Left (13) in mm: 11,13,13,13,14,15,15,16,17,18,18,18,19
E2 Level: 1918


So right now we have 5 mature follicles(>18mm) and several more that should become mature by Wednesday morning. My doctor is very happy with my group of follicles and thinks we should have lots of ones for fertilizing.

I will be doing my trigger shot tonight at 7 pm. This injection is of a medication called HCG, which causes the eggs to complete the maturation process. This is taken only once in the cycle and is a shot deep into your muscle. Release of the eggs should occur about 36 hours after the shot. Since I will still be at work at 7pm one of my coworkers will be giving me this shot.

Egg retrieval is scheduled for 7 am on August 6th.

edit - That shot is THICK! I am still feeling it in my butt 3 hours later.

Latest Ultrasound & Bloodwork

Fast Facts:
Lining:12mm
Right Ovary (4) in mm: 11, 13, 15, 15
Left Ovary (10) in mm: 11,11,12,12,13,14,15,16,17,17
E2 Level: 849

My right ovary is so lame.

They have pushed my egg retrieval day one day to maximize the number of mature eggs and to get my E2 level higher. I have modified my calender to show the new dates of things. The goal is to have as many 18mm and larger follicles on egg retrieval day so that they are mature eggs. So if they all grow another 8mm they would be like 19-25mm on egg retrieval day. If they went with retrieval on Tuesday as planned there would probably be 3-5 non-mature eggs which have no chance to fertilize so its worth waiting an extra day.

It will be interesting to see how my ovaries feel after 4 more days of growth because they are already pretty weird feeling. They don't hurt but my lower back feels full.

Next ultrasound and bloodwork is Monday - so as always I will post once I get the lab call in the afternoon.

Welcome Jason and welcome home Dad

My cousin Jason had his 2nd child a couple days ago, Jason Robert - 9lbs 4oz. Just wanted to share a nice photo of Jason, and his son Jason! Congrats to Jason & Amber, and big sister Grace on the arrival of baby Jason.

Also my dad recently got home from a trip to Israel. Both my parents went to Europe for 2 weeks on vacation but then my dad went to Israel with a group of fellow Baha'i. I just love making photo slideshows so I offered to make one of his trip, check it out if you like. You can view it below or view at youtube for better quality - Select "view in higher quality" directly below the video on the rightside.