Schedule of Events!

We had our Plan of Care appointment yesterday.  This is where we got our entire “schedule of events” and instructions on medications.  It was a long appointment, but we got all of our questions answered and are very excited about the whole process!

To start, the “mock transfer” that they did turned out great.  Due to the healthy condition of my ovaries, I am going to be on the lowest dose of medications available, which means less money and less side effects (hopefully).  K’s “swimmers” were perfect - as usual - so they don’t anticipate any problems with fertilization. 

There were many consent forms to read and sign.  Do we agree to do IVF?  Do we understand it isn’t a guarantee?  I agree to use Lupron (more on that in a bit), even though the FDA hasn’t approved it for fertility.  What do we want to do with K’s back-up sample in the case of his death?  What do we want to do with the frozen Embryo’s in the case of my death?  His death?  Both our deaths?   Do we give them permission to do ICSI (manually inserting sperm into the egg) if the eggs don’t fertilize on their own?  There is a lot to consider and a lot of legal junk.  We took all that paperwork home to discuss and sign. 

Here’s a list of the medications I/we will be on:

Birth Control Pills (BCP’s):  These are to help control my cycle and to let my ovaries rest.

Lupron:  This inhibits the release of certain hormones by the pituitary gland, which may interfere with development of healthy, mature eggs.  It is actually only approved by the FDA for use in endometriosis (scars & cysts in the uterus & cervix), but it is the most commonly used medication for IVF cycles.  Lupron causes a false menopause, but the purpose of using it is so my doctor has total and complete control over my cycle.  She explained to us that my 'normal' cycle as we know it no longer exsits.  This is extremely important.

Bravelle & Menopur: both are a follicle stimulating hormone s(FSH) used to stimulate my ovaries to mature a bunch of follicles (pre-eggs). 

Progesterone: This is to keep the lining of my uterus nice and thick so the embryo’s have a soft spot to nuzzle into. 

Metformin: a common diabetic medication, but for me, it will help decrease the chance of miscarriage and gestational diabetes.

HCG: human chorionic gonadotropin.  Say that 3 times fast!  This is known as the “trigger shot”.  This shot will tell my ovaries to release all the mature follicles.

Pre-Natal Vitamins: this is pretty self-explanatory

Baby Aspirin: this is to keep any clots from forming

Doxycyline: Anti-biotic to keep everything nice & healthy around simple procedures

Medrol: Steroid to take after the retrieval since it is a fairly invasive procedure

Then we got our color-coded calendar for the next 6 weeks.  From now until 10/10, I just do my BCP’s and pre-natal vitamins. 

~On 10/11, we got to a shot class, medications in tow.  This will be to confirm that we know just the right amount of Lupron to use and how to administer it.  This is also the final day to pay.  We both start an antibiotic this day as well, and I start on baby aspirin, too.  I will still be on my BCP’s.  The pre-natal, BCP, antibiotic, baby aspirin, Lupron cycle continues for one week. 

~10/18 is the last day I take my BCP’s and 10/20 is the last day for our antibiotics.  I still continue on the Lupron, pre-natal and aspirin. 

~On 10/25, we go in for a baseline ultrasound to see how my ovaries are resting, how my uterine lining is doing and to do another shot class for the FSH shots, which start this day.  I also get a blood test this day to check my hormone levels.  I continue the Lupron shots, FSH shots x 2, pre-natal and aspirin through 10/29.  This is also the last day I am able to exercise and K’s last chance to get lucky for a bit. 

~10/30 leads to yet another blood-draw. 

~11/1 is when the fun truly begins.  I am still on all 3 injectible medications.  Now I go in for daily ultrasounds to see how large the follicles are and how thick my lining is.  Each day after this is touch & go depending on the results.  If they aren’t quite mature, I continue my shots and go in the next morning for another ultrasound. 

Right now, based on my ovaries’ previous response to medications, it is estimated that my trigger shot (HCG) will be done on 11/3.  It is very interesting how this part of the process works.  The trigger shot tells your ovaries to release all mature follicles (called eggs once they are released into the fallopian tubes).  In a normal person, your body naturally does this and you release 1 mature follicle.  After all my drugs, we are hoping to get 18-25 follicles.  Exactly 36 hours after the trigger shot, I will go in for the egg retrieval.   So, I will probably be told to do my trigger shot anywhere from 7:00pm to 1:00am on 11/3 so that the retrieval can be done during normal business hours on 11/5. 

K takes one antibiotic the day prior to the retrieval, so that his fresh sample is healthy.  I will re-start an antibiotic and also start a steroid for the day of the retrieval.  This is because the egg retrieval is done with a needle that goes through the vaginal wall, directly into the fallopian tubes, where all the little eggs are floating around, just waiting to be snatched up.  Since the retrieval requires me to be in a twilight sleep, K will take me there, give his fresh sample while I am in the procedure, and then we’ll have a day of relaxation at home. 

And then we wait.  During this time, each healthy egg will be put in its own little dish (used to be test-tubes).  Then,  50,000 to 100,00 sperm will be put in EACH dish, and the fun begins again.  Friendly people in white lab coats will watch each egg to see if they fertilize and divide cells.  They will watch the eggs for 3 days.  After 3 days, if we have lots of healthy, mature, divided eggs, they will be considered viable embryo’s.  If we have some ‘average’ to ‘good’ embryo’s, they will be transferred on Day 3 to try and grow inside the uterus.  If we have a lot of ‘excellent’ embryo’s, they will wait until day 5 to let them get big & strong before they transfer. 

The estimated transfer date (ET) is currently 11/8 to 11/10.  They will take the embryo’s (1 to 3 max) and place them in my uterus.  Immediately after this, I will rest for 30 minutes in their office, completely laying down.  This is when the acupuncturist will come in and do another treatment.  Studies show that acupuncture done the day of the ET can increase success rates by 20%-50% and decrease miscarriages by 20%.  Plus, it is just so relaxing! 

The next two days are required “Couch Princess” days.  I get to lay around, eat lots of high-fat dairy foods (Ice Cream!!) and be waiting on hand and foot!  I think I’ll be bored pretty quickly, but K will be taking time off to keep me company, and we’ll probably rent every movie at Redbox!

8-10 days later, they will do a blood test for baseline results.  I won’t hear the results of this test, because there won’t be anything to compare them to.  Then, 8-10 days after that, we’ll do another test to see if it worked! 

I know that was a lot of information for us to process, so I’m sure all of my family and friends out there reading this have probably given up by now!  I will be updating you all each step of the way, but that was your crash-course into IVF (at least our IVF). 

I bought the medications today, and they will be delivered tomorrow to K’s bank.  I don’t think he will be quite prepared for the huge, refrigerated box of liquids, powders, creams, pills and syringes!  Thankfully, it wasn’t as much money as we were anticipating for medications, so that is a big bonus!

I go to the acupuncturist, Scott, tonight for my first consult and treatment.  I am very excited about this visit, as he has great reviews from friends, and is highly recommended by Dr. Slater.  Just talking to him on the phone to schedule my appointment made me feel less stressed!  So, I’ll update this about that visit tomorrow!