Less than 24 hours to make a big decision

Today's retrieval was not what I expected. Admittedly, my first ER wasn't exactly textbook, having been converted at the eleventh hour from IUI to IVF because of the number of follicles that had developed (11 on OI meds). This time, monitoring had revealed 18 measurable follies on CD10. I, of course, was not informed of this until this morning, at the hospital, minutes before the ER when the nurse reviewed my chart with me. My E2 was 3970, also on CD10. Anything over 4000 is considered high risk for OHSS (ovarian hyperstimulation syndrome), but since I'm 41 and E2 was a hair below 4000, they really weren't overly concerned.

Until they started retrieving eggs. Lots of eggs.

Now, I was preparing myself for a relatively high number. But because of my age, I was ready to make do with maybe 15 or so (even when "making do," I aim high). I was excited to hear that the last u/s had counted 18 measurable follicles. Eighteen is my lucky number. The nurse specifically told me that not every follicle would necessarily contain an egg, so my actual retrieval count might be a little lower than the 18 counted on Tuesday. Ok, I thought, we're back to my original hopeful expectation of around 15.

Nothing new in the procedure room- beeping monitors, super-high stirrups, masked faces popping into my line of sight asking if I'm OK. Speculum goes in just as I drift off to sleep. The next thing I know, I'm back in the waiting and recovery area. The pain is worse than the first time, but I was told to expect that. After all, there were a lot more follicles to handle this time. Friendly nurse helps manage my pain then tells me that the preliminary count (they were still counting when she had to finish the early paperwork) showed that 27 eggs had been retrieved. No wonder I was hurting!* TWENTY-SEVEN! not bad for an old hag.

It gets better.

After managing the pain, the nurse comes back to me with a final egg count. She had to repeat it a few times because I couldn't believe what she was telling me.

I
feel
I
must
drag
this
out
for
dramatic
effect...



40

Yes, you read it right. FORTY eggs retrieved today. Un-freakin-believable. Which brings us to the second criteria for anticipating the probability of OHSS- high egg count. My E2 was borderline worrisome, but my egg count is off the charts. The RE working today said that she's leaning toward freezing all the fertilized eggs because transferring them now would involve a high risk of OHSS. She confessed that OHSS doesn't affect pregnancy, and that freezing the embryos might damage some that would otherwise have been viable. She doesn't think taking a month or two to de-bloat and get my body back to normal would hurt my chances of becoming pregnant, but she also said that OHSS could be managed if it came to that. I have to decide by 11 am tomorrow whether to freeze all or proceed toward a 3DT. A doctor will call me tomorrow with the fertilization report and another opinion on the matter, but ultimately it's my decision. If I develop any symptoms of OHSS between now and tomorrow, or between now and Sunday (planned ET day), then the decision will be easy- freeze them until my body is ready again. But OHSS may not develop until several days after ET, when HCG levels start to rise with pregnancy.

I should have studied OHSS more, but I thought it was something only younger IVF patients had to worry about. I understand that severe OHSS is hell. I don't want to go through hell. But I so desperately want to be pregnant and I don't want to risk any of those hard-won eggs unnecessarily. MAYBE I won't develop OHSS. If I do, MAYBE it'll be a very slight case.

This is a lot to consider, in a very short time. And the pain meds (which I do need this time) are not helping.

*I will admit, because I'm no martyr and I want to present this realistically, I was in a LOT of pain- nine out of ten on the scale. I cried when I woke up because of the deep, intense ache in my left side. I was tensed and afraid to relax because it might hurt even more. The nurse added more pain meds to my IV, and it slipped to a 7 in a few minutes. A pain pill, with some apple juice and crackers (I was also terribly thirsty, and pretty hungry from the "no food/beverage after midnight" directive) dropped it down to 2 after about 15 minutes. By the time I'd eaten some graham crackers and downed another cup of juice, the pain was gone. This time, I filled the prescription for pain meds. Last time, all I needed was a heating pad.

11 on CD11

Retrieval today went without a hitch and 11 eggs are now exposed to sperm. Tomorrow afternoon, they'll let us know how many fertilized. On Sunday, they'll tell us what time we should report for Monday's transfer.

C is incredibly optimistic this cycle, repeatedly saying, "Everything is moving along like clockwork," and things like that. I am optimistic, too. But I have to bite my tongue every time he quips something like that. My instinct is to tell him that everything was like clockwork for each of our failed IUI cycles, too. I have no more and no less hope for this cycle than any other. Except maybe the first one, when I thought our only hurdle was getting our hands on some sperm. I thought sperm was our magic bullet. I think C believes IVF is.

Anyhow, things look good so far. Eleven eggs on a converted OI/IUI cycle is more than I hoped for. The embryologist said the norm is about 70% fertilization, but he's seen everything from 0 to 100. I'm just hoping that we have something to transfer. A couple to freeze would be gravy. But for the moment, my focus on on the transfer.

Recovery-wise, I feel pretty good. A bit sluggish bloated and crampy, but otherwise normal.

Oh, and the hcg shot? Well, I am incredibly grateful that my husband has a sister-in-law who happens to be a nurse and who didn't mind me showing up in her kitchen at 1:15 am.