Friday 8 November 2013

Measure Twice, Cut Once: IVF DIY

After we bought our house, our addiction to HGTV was replaced by our infatuation with the DIY network. Our favourite guilty pleasure was (and still is) Renovation Realities. This low budget production simply films amateur homeowners as they tackle various home improvement projects. Although a few are successful, most have disasterous results, and it is often a cautionary tale of what not to do. After describing their plans, the participants reveal their budget and estimated time for completion. Husband and I always burst out laughing as almost everyone grossly underestimates the costs and time frame. After multiple projects, we've learned to always double the projected length of time and to overestimate the budget as unexpected costs are inevitable.

So far, our first IVF cycle is following the suit of many of our DIY projects. (Yes, I'm still in the process of painting our kitchen cabinets and should have some updated photos soon) If I were to offer any advice to anyone embarking on this process, it would be to really clear your schedule, and to have extra meds on hand. While it's not desirable to have unused meds, it can cost less in the end than having to arrange for overnight shipping, and is much less stressful. I cannot emphasise the much less stressful aspect enough.

I was quite frustrated at the start of my stimming cycle, when I felt that I wasn't receiving a clear picture of my monitoring schedule. Now I understand how truly day to day this process is. My RE originally projected that I would stim for 9 days and retrieve on SD11. I knew this would be tentative and I would have to be flexible. The original retrieval date was on a Wednesday, so I arranged to have the day off. Husband was scheduled to leave on Friday afternoon to officiate at a hockey tournament in Southern California, but we thought it was unlikely to conflict.

After my visit on SD7 noted 10 follicles and high estrogen levels, my RE noted there would be a slight possibility of triggering on SD9 (Monday) and that a retrieval on Thursday or Friday was more probable. (On the off chance I were to trigger on Monday, I had to order Lupron from a supplier in Southern California, who could deliver in time, but at twice the cost as Freedom Fertility) I figured it would be Thursday, as that was the most inconvenient day for both Husband and me. He was umpiring a highly competitive hockey match (which was televised on ESPN11) and I was scheduled to teach a contraceptive methods class in the South Bay. I made arrangements to have someone else cover for me in the event it would be egg hunting day.

My estradiol level reached 1162 by Monday and I picked up one more follicle on each ovary to bring my total to twelve. "Don't focus on the number of follicles," my RE warned "it only matters how many are mature." Yeah...yeah... I acknowledged to myself. I was budgeting for fewer mature follicles, but whoo-hoo! I was up to a dozen! He was now projecting the ER to be on Friday or Saturday. This was good news as I could fulfill my teaching assignment, but it would mean Husband would have to delay leaving for Santa Barbara. He knew the collegiate umpire coordinator was scrambling to fill as spot for a Friday night game, so he volunteered to do that game, which indebted him to the coordinator. I was so proud of his resourcefulness.

I had to request to take Friday off and I needed to move my patients to Wednesday. I updated my colleague on my status. "Are you getting excited?" she asked. No, I thought to myself. I'm terrified that this is going to be a huge waste of time and resources. Instead, I just nodded quietly. "Just let us know if you need us to see any of your patients" she offered, a gesture I truly appreciated. Two days later, I was back in the stirrups. I was counting the follicles as he was measuring, but I wasn't paying too much attention to their size. There were now 4 or 5 on my right and I think I was up to 9 on the left. Could it be that I have 14 follicles?

It was Wednesday and my Estradiol level was now 1503. My RE thought the follicles might need a little more time to mature and was now projecting triggering on Thursday or Friday for a retrieval over the weekend -Saturday or possibly Sunday. Oh, was this cycle ever going to end? This now meant Husband wouldn't be able to attend the tournament at all. We had been walking ourselves through multiple contingency scenarios based on when the retrieval would be. "So, we'll need to see you back here tomorrow" he instructed "Same time?" I had been arriving at the office as soon as they open to have my blood drawn at 8:30 and then was returning at noon for my scans. It meant a lot of driving, but allowed me to discretely leave the office and most importantly, I didn't have to reschedule any patients, although I was late a few days due to 'traffic'. "Um, I can't come in for my blood work tomorrow morning" I explained that I had a two hour drive for my class. "Do you absolutely need the estradiol level?" I asked while knowing the answer; if he didn't have it, there would be a reason why he'd want it. "We're this close to the end, Jane..." he said in a tone that was reminding me of my priorities.

He left the room and Misery looked over toward me and asked the question that I was thinking. "Do you have good veins and can you draw your own blood?" Yes and yes, I replied. She gave me some supplies and I would have Husband run the vials down to the office. I must admit I was a bit nervous as I can't remember the last time I performed a venipuncture. At least better to do it on myself than someone else. I drew my own blood. That bears repeating. This time with the F-word. I fucking drew my own blood! I started dancing around the house proclaiming, "I am awesome!"

Oddly, that would be the high point of my day. Although my class went well and it's a good thing I didn't crash during the long drive, especially as I was on the phone with Freedom Fertility Pharmacy to secure another overnight order for my antagonist. That's the other unexpected aspect of living day to day in your stimulation cycle. Special shout out to Jen S of Overworked Ovaries who delivered her leftover Ganerelix at the last minute for me. Infertiles truly come through for each other!

I noticed that he didn't count all the follicles this time, just the larger ones, but I wasn't keeping a tally for myself. The decision to trigger was led by my estradiol level, which had plateaued at 1500. "So, I think we'll get 6-8 mature oocytes" he projected. There it was. The let down I been anticipating. The slap in the face from reality that I needed when I was getting excited about the number of follicles. It didn't seem like it would be enough to adjust for the male factor issues to produce a workable yield. All my decisions about PGD and single embryo transfers seemed moot.

"You seem subdued today" he commented and asked me three or four times if I had any questions. I was struggling to keep my composure. I had many questions, but none in particular came to mind at that moment. I figured we'd have our answers in the next few days after the retrieval and fertilization was complete. I'm sure there were other questions I didn't ask as I wasn't ready to hear the answers. I did have one question: can I swim the day after my retrieval? "Well, it's a vaginal procedure, so I'd advise against it..." he replied probably acknowledging to himself that I wouldn't comply.

Misery actually put her arm around me and gave my shoulder a little rub as she reviewed my ER instructions. It was a comforting gesture; one I really needed at that point, although it did give me pause to wonder if she thinks we're fucked. I went to watch Husband's hockey game and sat far away from the crowd. Tears were streaming down my face. Now I understood the blame Husband had assigned to himself. I was the one letting us down. My ovaries were supposed to come through for us! Double the length of time and overestimate the cost... I felt it was time to acknowledge that we may need to do more than one IVF cycle. Nothing like feeling defeated before the game even starts.


  1. First off, you kick ass. Drawing your own blood!? That takes your awesomeness to a new level. Second, I am so sorry about the disappointment. This is all so stressful and there is so much involved in an IVF cycle. It's such a let down when things don't go as planned (which is typically the case). Sending you so many thoughts that all goes well with ER and you are happily surprised by the number of mature eggs!!!

  2. Wow, you drew your own blood? I am really very impressed!!

    Also, while I agree with you that in some situations it is good to prepare yourself for alternate outcomes in case your plan doesn't work out, you really never know which IVF cycle is going to result in a baby. I had 12 mature eggs retrieved on my first IVF, and did not get a BFP. On IVF #2, I had 29 eggs retrieved which also resulted in a BFN. I'm sure we both know people who had 1/3 of the eggs I had, and got pregnant with twins.

    I guess what I'm trying to say is, no matter the treatment, it's always a gamble. Sometimes we end up on the happy side of probability, and (more often than not it seems) we end up on the negative side. I'll be hoping for a positive outcome for you!

  3. I am so beyond impressed about you drawing your own blood! None of us can boast about giving ourselves injections after that :) You = badass.

    I'm really sorry that you got disappointing news about the mature egg estimate. I can only imagine how draining and stressful this whole cycle has been for you. I'm still hopeful that you will have success with this first round of IVF. Thinking of you!

  4. Don't get too down on yourself!! 6-8 eggs is great!! Especially if they are all mature and are good quality! I will be praying and thinking of you! XOXO

  5. Don't give up hope. First off, remember that this is your first IVF cycle. I tried to think of my cycle as a diagnostic cycle because you (and your RE) simply have no idea how your body is going to handle the drugs. Secondly, my RE retrieved 11 eggs, only 6 were mature. Only 3 fertilized, one is in me and one is frozen. Small numbers of mature eggs CAN be okay. Stay positive as you never know how this cycle will turn out.

  6. Don't forget that it was just an estimate that he gave you, not an exact. And I agree with the others, you are truly a badass rockstar! Going through the IVF process is so hard. You just never know exactly the dates for everything so it is a scheduling nightmare. We also want the BEST possible outcome, and it can't be guaranteed. Not to mention the raging hormones. I'm impressed by Misery coming through for you. She really must have had a change of heart. I am hopeful for you Jane. Don't give up. As you said, the game hasn't started yet.

  7. I think you're jumping the gun on assuming that you're letting anyone down (which of course wouldn't be the case no matter what happens). My doctor has always been conservative on her estimates of how many mature eggs we'd get. Last time they said "hoping for 5!" and all 7 ended up mature. I'm still holding out hope for double digits for you...the trigger shot can do amazing things!

    1. Replying to myself to add that, fuck yeah for self blood draw! That earns you a special star on the infertile walk of fame. I could never do that. In a million years. Ever.

  8. Yeah the nature of IVF cycles: highly unpredictable. One thing I have learned is to take it day by day. I am liking your number of follicles and am hoping for a nice number when you retrieve. And yeah, that was amazing that you drew your own blood!

  9. Infertility is what happens when we've made other plans. Kudos for sticking out all the ups and downs. Try not to get too down on the RE's estimates of what he'll retrieve. It's possible there could be more mature eggs at retrieval time....happens all the time. Don't let all the numbers rule your life.

    If there's one thing I've learned it's that women with only 2 eggs harvested can get pregnant and women with 20 eggs may not. I know how nice it is to have that safety net for "more tries" mentally, but It's NOT predictive of the outcome. Stay hopeful! :)

  10. I think very much like you. So I really do understand. I already have the next year planned out....assuming this cycle is another fail and we don't even transfer until next week.
    I will encourage you, as other ladies above, that QUALITY is really what wins the IVF battle. I had 30 eggs collected and yet here we are on the last batch of FET. I know it's hard to not focus on the numbers because it's finally something quantitative to hold on to. But try to just really only need one great embryo/blast.
    Kudos for the self blood draw. I'm already dreading Tuesday because I'll then be self injecting PIO. I stick patients with needles all day...but I was hoping to avoid it personally.
    Wishing you good luck (no matter how down and out you might feel about the numbers)!!!