eeny, meeny, miney, moe, plus one for good measure

ET today. Dr. Aggressive was on , so I did not have to justify our decision to any of the nay-sayers. This was the first time in my IF life that a male doc was involved, which was a little strange- especially since I'd never seen the guy before and had only spoken to him the one time, Friday, to discuss the fertilization report. Add to that the male who assisted (led me into the OR, arranged me in the stirrups, and slathered u/s gel on my lower ab), and it was almost awkward. But, as I'm sure everyone living the IF life knows, modesty has pretty much disappeared, so I got over it almost as soon as I realized these were the first two men to "know" me in an IF way.

Here's the real news of the day- we transferred FIVE embryos. At first, the quantity had me a bit alarmed. I was afraid it meant they were all crappy and had little to no chance of implanting, so they were just throwing the maximum in there to see what would happen. Not so. We had two 8-cell grade 1 (aka PERFECT) embryos, one 7-cell grade 1, one 8-cell grade 2, and a 4-cell grade 2 to round out the full house. Even to our untrained eyes, C and I thought today's embies looked better than the three we transferred in April. The rest of the 15 that fertilized apparently did not fare well, but I don't know the details. I believe there's nothing to freeze.

The transfer itself was nothing spectacular, aside from the fact that this time I got to watch the u/s monitor while the embies were released. Mr. Nurse pointed on the screen to where I should focus my attention while Dr. Aggressive manned the u/s doohickey, pressing it almost painfully into my abdomen while a resident did the actual transfer. She was great- I'd met her in April, when she was observing procedures. I swear she didn't open the speculum as wide as the transferring doc did last time, and I didn't feel a thing when she fed the catheter through, so it would have been painless if not for Dr. A and the u/s.

I asked about OHSS- specifically, how much is "a lot" (i.e. "drink a lot") and of that amount, how much should be Gatorade-type beverages. Dr. A pressed on my bloated belly and said I have nothing to worry about because I'm soft and squishy around the middle and I haven't gained any weight since the retrieval. But he said I should continue to drink 2-liters or so daily (his definition of "a lot") just to stay hydrated, and at this point none of it needs to contain electrolytes. I'm not sure I buy his "don't worry" diagnosis, since OHSS often doesn't flare up until HCG levels rise with pregnancy. I'll keep weighing myself daily and paying attention to how much goes in and how much goes out. I'll be vigilant, but I won't worry.

I have enough to worry about... FIVE embryos and the TWW.

Just what I was aiming for

I just got the call with the fertilization report and another doctor's recommendation on how to proceed. Of the 40 eggs retrieved, 24 were mature. The number might have been higher if they'd anticipated that many eggs, but the 18 that were measured on CD10 were ready to go so that's why we triggered when we did. I'm extremely happy with 24. That's more than quadruple last time (11 retrieved, 5 mature), and more than I'd even hoped for.

Of the 24 mature eggs, 15 fertilized normally. That's 62.5%, which I guess is fairly normal since last time 60% (3 out of 5) fertilized and the RE was happy with the fertilization rate in IVF#1. So, I got the 15 mature, fertilized eggs that I was dreaming of. Hurray!

After the numbers, we discused the big issue- 3DT or freeze all. First, anyone with a reasonable response to IVF meds experiences some degree of OHSS. In fact, OHSS is the goal of all those shots; CONTROLLED overstimulation. Second, the doc I spoke with today says he's never seen a severe case of OHSS in a patient over 40 in all of his 15 years working with IVF (I forgot to ask how many 40+ patients had produced 40 eggs). He's confident that I will experience mild to moderate OHSS, but our chance of success is much higher with a fresh cycle. Given my age, he wants to be aggressive. I do to. I want more than anything for this to work. You all know how that feels. And if I decided to freeze all those embies and none of them ever became our children, I would second-guess and regret my decision until the end of time. We're giving it all we've got. If I end up uncomfortable and hospitalized, I'll know I did everything I could. We've been sacrificing for our children for years now. Why stop now?

I know I may regret this decision. Two REs and three nurses all advised against proceeding with a 3DT. It might have been different if yesterday's RE had been working today. Ultimately, I'm glad Dr. Aggressive called. I'm not holding anything back. I'm more than a little scared, but so hopeful that this will work. Fingers and toes crossed, here we go.

Uncertainty

I'm more bloated than yesterday, but I lost three pounds and I feel a bit better. There's still a lot of cramping, but I plan to medicate with a heating pad and lots of rest rather than narcotics. Again, I'm no martyr- if this gets truly painful, I won't hesitate to reach for the Tylenol-3. I want a clear head. I have a big decision to make, and less than 5 hours in which to make it.

Today is a holiday, so the RE's office is only open for monitoring. I may call and ask if they can do anything that would give me more information to base my decision on. But then I remember what yesterday's RE said about OHSS symptoms not flaring up until days after ET. I went to bed last night convinced that freezing them all is the right thing to do. But now, I'm feeling better and I'm not so sure.

I need to know, if they freeze all the fertilized eggs (assuming some fertilize- I know that's not a certainty either), how do they decide which ones to thaw for FET? Can they thaw them all and see how they grow and then freeze any viable ones we don't use? Or, can a poor little embie be frozen only once in its tiny life? Why is it better to freeze them right after fertilization instead of growing them for 5-6 days, as is generally done in a fresh ET that results in extra viable embies? Should I get my E2 measured today, and would that number help cement my decision one way or another?

That's it- I'm calling the RE. The worst they can do is tell me they can't do anything that will make the decision any easier.

Fert report expected by 11 am today, at which time some decision has to be made. If we decide to continue toward a 3DT, we can still change our minds.

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.