Embryo transfer and freezing

Embryo transfer was set for Friday morning. My acupuncturist recommended at least 1 treatment that day so I ended up taking the whole day off work. I know from IUIs and the mock transfer that I can have pretty bad cramping after intrauterine procedures, and would end up being at work for just over 4 hours (over lunch so even less work time) so it just made sense to take the day off so I could relax at home.

My husband also took the day off so we put on our matching-ish Game of Thrones t-shirts to go for the embryo transfer. I had to drink 2-3 cups of water 1 hour prior to transfer, and I actually measured it out to make sure I had enough, but not too much so I wouldn’t have to pee too badly.

Once we got to the clinic it was back into the nightgown, shoe covers and hair cap for me, and the shoe covers, gown, hair cap and mask for my husband. The transfer was performed in the same room (and even same position on the table) as the retrieval. No meds for the transfer. The embryologist came in first to talk to us about the embryo. We had one day excellent looking 5 day blastocyst that was already hatching to transfer. The embryologist said that four of our blasts looked great and would be frozen that day. The other two needed another day of growing before they could be ready for freezing. The embryologist was sure at least one would be ready to freeze but she wasn’t sure about the second one.

The RE came in once the nurses and embryologist had everything ready. One nurse worked the abdominal ultrasound to visualize my uterus while the embryo was placed and the other nurse assisted the RE. The RE inserted a speculum and then cleaned my cervix to make sure no bacteria were transferred into my uterus. Then he treaded in the catheter and once it was in position the embryologist brought in the embryo. We could sort of see it get placed in my uterus. The embryologist checked that the embryo had been transferred before the RE removed the speculum.

We got a picture of the embryo and a picture of my uterus with the air bubbles around the embryo visible, which is pretty freaking cool.

The day after the embryo transfer we got the call from the lab that both embryos were ready to freeze which means that we have 6 embryos in the freezer, and that all 7 of our embryos made it!

Egg Retrieval

My egg retrieval was scheduled for 9am on the Sunday of the Victoria Day long weekend. I needed to arrive at the clinic at 8am to be prepped for the procedure. I also had a list of things I needed to do at home prior to coming to the clinic, including both my husband and I having showers that morning, no food or drink after midnight, wearing socks, tying my hair back, bringing a pad and a few other things.

When I woke up Sunday morning I was starving and thirsty and really nervous. I still felt crampy like I had the night before so I was a little less worried about ovulating before the retrieval. My husband and I prepped at home as instructed by the clinic, including wearing our matching Star Wars t-shirts. We took a picture together to put in an IVF scrapbook before heading to the clinic.

At the clinic I changed into a very cute squirrel nightgown, surgical booties and hair cap, took a sedative and had an IV started. I was given an antibiotic with the IV to help with infection. My husband had to wear shoe covers, a gown, hair cap and face mask. Before going into the procedure room we were told that it was common for each follicle not to have an egg, and for not all the eggs to be mature. My husband provided his semen sample before the egg retrieval.

For the egg retrieval I was set up on a table similar to what is used for giving birth. I was started on oxygen and my blood pressure and heart rate were monitored regularly. My husband was able to sit by my head during the procedure. There was 1 nurse monitoring me, 1 helping the RE, the RE, and a lab technician in the room. I was given a pain killer and something else during the procedure so I don’t remember anything after the RE started placing the speculum and cleaning my vagina/cervix.

To retrieve the eggs they use a vaginal ultrasound and a big needle to suction out the fluid from the follicles. My husband could watch on the ultrasound screen and see the follicle disappear. I asked him to take a video but he didn’t, so I just got pictures of my ovaries with all the follicles there. The whole procedure took less than 10 minutes and the lab tech confirmed that there was an egg in each follicle before we went back to recover.

I had some cramping and a little bit of bleeding after the procedure. I was starving so as soon as we left we went to McDonald’s. My husband would only let me have fries, but they were so delicious. I spent the rest of the day relaxing on the couch and watching tv.

And so it begins . . .

After 4 appointments in 2 days we are finally ready to start IVF with my next cycle. We had to meet with a counsellor to talk about IVF and infertility and our communication and coping with having infertility, failed IUIs, and how we will work through the IVF cycle. That was followed by an hour long introductory video to IVF. The video was pretty much useless and I could have done a better job on it. I can’t decide which part of the video annoyed me more – the fact that the narrator kept mis-pronouncing progesterone, the fact that they were trying to be all dramatic with cryopreservation and just showed them taking the lid off a liquid nitrogen tank, or the fact that they made the vagina look super weird in their cartoons. They also used scare tactics to dissuade you from transferring 2 embryos without providing any statistics to show if these increased risks were actually statistically significant. The only thing I did learn was that pre-implantation genetic screening is offered at our clinic, but only for couple with multiple miscarriages, multiple failed implantations, or known carriers of genetic diseases.  On the second day of appointments we met with one of the doctors to sign the consent forms, which involved such fun discussions as what should be done with the embryos if either one of us (or both) die, or if we divorce. I had a mock transfer done, which was pretty similar to an IUI, although I had a lot of cramping and nausea in the afternoon after that. Finally, we met with a nurse to get my IVF protocol and do the injection training. I think my husband was kind of overwhelmed by having to measure the medications, mix medications, and the whole injection process, but it was all very similar to injecting mice so it was no big deal to me.

There was a little bit of panic about if I’d actually be able to start with my next cycle because they want me to come in on CD2 for a blood pregnancy test, but I’ll likely be out of town for work on that cycle day so they are letting me do a home pregnancy test and call in with the results.

IVF Cycle Plan

CD1 – call to report CD1

CD2 – take a home pregnancy test and call with results. Wait for call from nurses about when to start birth control pills.

Take birth control until May 5 then have a withdrawal bleed.

CD1 withdrawal bleed – call to report and schedule monitoring

CD3 – Ultrasound and blood work. If everything looks good will start stimulation drugs (225IU Gonal-F, 75IU Luveris)

8-13 days of stims with monitoring ultrasounds and bloodwork every few days

As follies get close to being ready, start taking Cetrotide to prevent ovulation.

HCG trigger shot 36 hours before egg retrieval

Egg retrieval predicted for the week of May 21 (Happy Birthday to me :S). Eggs fertilized using ICIS

Transfer on day 3-5 depending on how embryos are growing. Start progesterone suppositories after egg retrieval. I will push for 400mg prometrium like I took during my IUI cycles because I know that that amount should stop the bleeding.

Pregnancy test 13-15 days after transfer. They don’t recommend testing before the blood test but I think I will test that morning so I can be prepared when they call with the results.

Test Results

We had our $50, 5 minute phone consult on Friday and it was not good :(

The semen analysis results indicated that the male factor infertility is worse now. The test didn’t look at morphology, which was our only male issue on the last semen analysis from a year ago. This tested looked at count, motility and ability of the sperm to swim around to find an egg. While motility was still great, there was a dramatic drop in count. This means that there are not enough sperm getting to the fallopian tubes to try to fertilize an egg, so there is pretty much no chance of natural pregnancy occurring and that IVF + ICSI will be our only option for pregnancy. This result was a bit confusing for us because count was great on the last semen analysis and for all 3 IUIs we did last year. It could just be a fluke result, or something could be going on that has impacted the sperm production. We could do a repeat semen analysis or other testing to try to figure out what’s going on, but this could just add more time and cost more money and not change our treatment plan or success rates, so we are going ahead with the plan to freeze a semen sample and do IVF + ICSI.

My test results were a little confusing. Everything came back in the normal range, but my AMH, which is a measure of ovarian reserve and potential response to the fertility drugs came back on the low side of normal. The RE mentioned that my AMH is closer to what he would expect for a woman that is 38 not one that is 30, which could mean nothing or could mean I am at risk for having diminished ovarian reserve. I didn’t ask for my FSH so I don’t know if it’s on the high side of normal, which would be another indicator of low ovarian reserve, and have not had an antral follicle count down, which is why we don’t know if my lower AMH means anything. Nevertheless, it’s not great because it means that I’m less likely to get a lot of eggs produced. The RE said that a normal response to the fertility drugs would be 5-14 eggs retrieved, but that they would expect me to be on the lower side so maybe 5-8 or 10 eggs, and that I would likely need to take higher doses of the drugs to get these eggs. The fewer eggs, the fewer embryos. In a “typical” IVF cycle it is expected that ¾ of the eggs will fertilize and about 1/3 of those will make it to 3-5 days and be suitable for transfer. Now, ICSI should ensure that all eggs are fertilized, but if we get 5 eggs we are likely looking at 1-2 embryos produced.

This low anticipated result now changes our plan. Ideally, we want to have 3 children, but really more than 1 would be great. When we were expecting a 10-15 egg result we should be able to get 3-4 embryos from 1 retrieval cycle, so unless the first 2-3 didn’t take then we wouldn’t need to do another retrieval cycle. Now that we are looking at 1-2 embryos that changes things, especially based on the AMH and semen analysis results. Now the plan is to “bank” at least 4 embryos so we should hopefully have enough healthy embryos to have 2 kids. We talked a little about doing this because then my eggs would be 30/31 instead of 33+ if I got pregnant from the first round and had to do another retrieval later. Now, we are concerned that my ovarian reserve is dropping or the amount of healthy sperm is dropping so we went to get a bunch of embryos now in case something happens and we don’t have that option in the future.

Testing Completed

We have now completed all of our repeat testing for the new RE. My husband’s testing was pretty straightforward. He was able to get an appointment to do the swim-up semen analysis a week after our appointment, and then he did his blood work right after. Since I have to wait for specific cycle days it took a little longer. Since I was right around ovulation when we had our appointment with the RE I did my 7 days post ovulation test and STI/immunity panel first. I was supposed to go in CD20-22, so 6-8 days post ovulation. Of course, that just happened to fall completely on a long weekend. I thought it would be fine because there is a lab my by house that I could go to that was supposed to be open. Turns out the RE needs to update their information because that lab is not even open on weekends. I also had an optometrist appointment on the Saturday morning so I needed to wait until almost noon before I could go to the lab. I had my husband franctically calling all the labs on the list from the RE with weekend hours to find one that would be open past noon that day. Luckily, there was one that was open. The only one that was open past noon. That clinic was also supposed to be opened Sunday morning but not holiday Monday, but I didn’t want to risk it so I headed straight to the lab after my optometrist appointment. I did not want to have to wait another full cycle to be able to get my progesterone tested.

I hate parking lots and just parking my car in general, and the parking lot at this lab was so narrow and tight, so that sucked. The lab was at a walk-in clinic and it was packed with people. There were 10 people ahead of me at the lab and one older man said he had been waiting for over an hour at that point. In addition, doctors from the clinic were sending people with “urgent” labs that got to jump the line. I really wanted to spend the Saturday of my long weekend hanging around a walk-in clinic. Luckily, a few people ahead of me had disappeared so I got in after about 45 minutes. The lab tech confirmed what cycle day I was on and said I really got screwed with this testing.

My second set of testing was a huge hormone panel done on CD2-4. Of course, this cycle I had a hard time determining when the new cycle started because my bleeding had picked up making it hard to distinguish what was my normal luteal phase bleeding and what was actually menses, so I had to rely on my temps and secondary signs like cramps and my luteal symptoms going away. Luckily, this fell on a Thursday-Saturday so first thing Friday morning I went to the lab by my house. Of course, since nothing can be easy, I wasn’t sure if it was open because I couldn’t find consistent lab hours online. Seriously, it ranged from not open on Fridays, to open at 7:45, 8, 9, 10, so I decided I’d go at 8:30 and if it wasn’t open I’d go to the same one from the weekend. Turns out it opened at 8 so I could have gone earlier and not been late for work, but it wasn’t too bad. There were 8 people ahead of me but I got in in about 30 minutes. I had so much blood taken. The good thing was that AMH was free here (it would have cost $150 in our old province).

Now it’s just waiting. I called the RE and if I want an in-person appointment to get all the results and next steps then we have to wait until May 2. That really upset me so I asked about a phone consult because it’s really just is everything okay for IVF? And do we need ICSI or not? And was able to get a phone consult for March 17 . . . but, we have to pay $50 for this. I’m so over waiting, so I took the phone consult.