Tuesday, March 25, 2014

Trigger Shot and Egg Retrieval

I had my trigger shots of Ovidrel and Lupron on Friday at 10:30 PM, and unlike in my first egg freezing cycle (see previous post), everything went fine. I did notice that the area around the Lupron injection started to get red and itchy over about an inch-wide area, but this was not a particularly big deal. If I were to do another egg freezing cycle, I would definitely ask for the Ovidrel again because it was much easier than the HCG.

I dragged around all day on Saturday, my ovaries felt pretty heavy and I didn’t feel much like doing anything. I was ready to get the eggs out!

On Sunday, my mom drove me to the clinic for an 8:30 arrival time. I was feeling pretty hungry and thirsty, having not had anything to eat or drink since I went to bed around 10:30 PM the night before (you are not allowed anything, even water, after midnight). During my first egg freezing cycle, I had been so nervous that I actually started getting faint during the pre-op consultation (see previous post). This time I made it through the entire consultation just fine, and the nurse asked me a bunch of questions that I didn’t remember from the first time, like if I was having any joint pain. I’m guessing those questions got cut short the first time when I started feeling faint. The nurse clarified for me that although a third-year fellow would be seeing me before the procedure and would be in the room during the procedure, Dr. Westphal would actually be doing the procedure. I appreciated the clarification because last time I found it quite strange that I never saw Dr. Westphal and only saw the fellow--it made me wonder if the fellow was actually doing the procedure.

I changed into a gown and went to the pre-op area. There was already someone there, with a curtain drawn around her bed. I learned a few minutes later when she started to wake up that she had finished her procedure already. The nurse put in an IV which hurt quite a bit, and she gave me a hot pack to help with the discomfort. Then the anaesthesiologist came in. I was a little surprised when she said, “Hi, I’m your anaesthesia doctor,” because she looked about 18 years old and was not wearing any kind of white coat or other “doctor” type clothes. I was comforted that she said she had read over the notes from my previous procedure, because everything went fine with the anaesthesia that time and I figured if she just did the same thing again, it would be fine.

Soon it was time for me to move into the procedure room. The medical assistant told me to lie at the very edge of the table so that it almost felt like I was falling off, and strapped my thighs into some large stirrups. She secured my arms with pieces of cloth while the anaesthesiologist attached a blood pressure cuff, heart rate monitor, and electrodes to monitor my vital signs. The medical assistant covered me with a warm cloth, I heard the beeping from the heart rate monitor and that’s the last thing I remember until I was back in the recovery room after the procedure.

I woke up back in the pre-op area feeling fine. The nurse asked if I was feeling any nausea from the anaesthesia, andI was not. She offered me juice which I immediately downed, and she got me a second cup of juice after remarking that I must have been really thirsty. I asked for crackers, which I knew they had from last time, as I was also quite hungry.

The nurse called the lab to check on the number of eggs retrieved, and when she told me, I couldn’t believe it: they had retrieved 32 eggs! I asked how that was possible, as there had only been 18 follicles at my last ultrasound (and the doctor had thought only 13 or 14 of them would be big enough to contain mature eggs). The nurse explained that sometimes a follicle can have more than one egg in it and that I must have had lots of follicles with more than one egg. I would find out the next day how many of the eggs had been mature. Obviously I was really happy with the result, but I still had some worries in the back of my mind: what if most of the eggs were immature? What if they had mixed up my eggs with someone else’s? It seemed so improbable that there could be so many eggs coming out of 18 follicles.

I was able to get up and leave pretty soon after I woke up, and my mom drove me home. I was still somewhat in a state of shock over the number of eggs that had been retrieved. I had some food, including a whey protein shake as suggested by the clinic to help prevent OHSS, and went to take a nap.

I woke up to use the bathroom a few hours later, and quickly ran into trouble. I made it to the bathroom just fine, but while I was in there, I started feeling dizzy and faint. I was very unsteady and crashed into the wall, overturning a mug full of tweezers, nail files, and other similar utensils on the way. I made it back to bed but was rather shaken. Why was I feeling dizzy all of a sudden? I had felt fine just after the procedure, had been walking around and had no trouble fixing myself food. I felt fine once I was lying down again, but was was afraid the dizziness would return if I got up.

A while later, I called my mom and asked her to come help me because of my dizziness. I felt fine as she walked me from my bed to the dining area and sat me down there while she fixed me a high-protein snack (I was supposed to be following a high-protein diet to help prevent OHSS). While I was sitting at the table waiting for the food, I started to feel dizzy again, and also to feel really hot and sweaty. I put my head down at first, but I continued to feel bad so I asked my mom to walk me to the living room so I could lie down on the couch. I collapsed into the couch and soon began to feel better. It seemed that I was fine as long as I was lying down. I ate my snack lying on the couch and eventually my mom helped me walk back to bed.

Thankfully, I didn’t have any more occurrences of feeling dizzy though I continued to have my mom help me for the rest of the day as a precaution.

The next morning, I got a call from the clinic with the “cryo report”: they were able to freeze 26 eggs. The lady on the phone spoke of being able to freeze “26 out of 30” which was strange because the previous day they had told me there had been 32. I regret not asking her about the discrepancy. But anyway, apparently 2 of the eggs were immature, 1 was over-developed, and one was “empty.” I don’t know what happened to the other 2 eggs. But I couldn’t believe it, 26 frozen eggs! That was really great news. My goal had been to have a total of 25-30 frozen eggs, and now I had more than that: the 26 from this cycle plus the 11 from the previous cycle, for a total of 37.

Before the retrieval, I had thought it was very likely that I would need to do a third egg freezing cycle to get to my goal number. And now all of a sudden I was there! It was a weird feeling, maybe I could now be done with egg freezing! I think that with 37 eggs, I have a really good chance of having a baby. Of course there is no guarantee about the quality of the eggs, but I have to think that with that number, the chances are good.

Thursday, March 20, 2014

Day 7 Ultrasound

I had another ultrasound yesterday, and things are looking a little better--this time the doctor said she thinks there are 13 or 14 follicles that are big enough. So that is an improvement over the last ultrasound, even though it’s not quite the number I was hoping for.

The egg retrieval is coming up on Sunday. Tonight is my last night of stimulation injections, tomorrow morning is my last Ganirelix, and tomorrow night I do the trigger shot at exactly 10:30 PM. That means that in all, I will have done 8 days of stimulation injections, which feels much shorter than the 11 days I did last time. I am on double the dose of medication this time so I guess it makes sense that it would take less time in total. But I can't believe that this egg freezing cycle is almost done!

I also learned that in addition to the Ovidrel trigger shot, I will also be doing a shot of Lupron at the same time. I am not sure why this is necessary but I will do as the doctor says! I have to pick up the Lupron shot from Walgreens Specialty Pharmacy tomorrow. They mix it up specially and it has a limited shelf life.

In other news, I am definitely feeling my ovaries! Last cycle I thought I felt some heaviness, but I wasn’t entirely sure that it wasn’t my imagination. This time I am positive--I especially feel the one on the left, it is sort of an achy feeling that I especially notice when I am lying down. I hope this means there are a lot of good eggs in there!

Tuesday, March 18, 2014

Day 5 Ultrasound

I went for my Day 5 Ultrasound yesterday--the first ultrasound since starting the injections. The doctor probed around my ovaries and read off the sizes of follicles that she saw. She saw 5 10s (I am not sure of the units) on the right side, and 5 larger ones, 12s and 13s, on the left. So a total of 10. Plus two smaller ones, a six and an eight. I am disappointed with the number of course--I was really hoping to get 15 eggs on this cycle and it looks like the number will be more like 10.

The increased dose of meds (compared with my first cycle) is definitely making the follicles grow faster. Unfortunately it doesn’t seem to be making the follicles more numerous. I may trigger as soon as Friday which would be after only 8 days of stimulation (last cycle, I had 11 days of stimulation). I have another ultrasound tomorrow. Crossing my fingers that somehow more follicles will have appeared by then!

Friday, March 14, 2014

Injections Day 2

I started feeling unusually bloated after dinner. Could this be due to my growing ovaries already? It seems too soon to be feeling the effects of the stimulation drugs already but I didn’t eat a particularly big dinner or anything. Not sure what’s going on.

I did my second day of injections. This time a spot of blood appeared when I pulled out the Gonal-F needle. I didn’t have gauze handy so I dabbed at it with an alcohol swab. The Menopur stung again going in, but was otherwise uneventful.

I am speeding up with the injections--last night it took me almost 30 minutes, tonight less than 15.

Blood Test Results

The results of my blood tests are in. Although as it turns out, there is no result for AMH and instead there is a result for TSH (Thyroid Stimulating Hormone). I think this is a mistake because the doctor definitely mentioned testing AMH, which is a measure of ovarian reserve.

  • FSH: 6.4 mIU/mL
  • Estradiol (E2): 26 pg/mL
  • Prolactin: 12.1
  • TSH: 1.47 uIU/mL

I got a note from the doctor that all the results are normal. I sent her a note inquiring about the missing AMH test; will have to wait and see about that.

Since the tests were normal, I guess they do not explain why there are so many days between my periods. So that is still a bit of a mystery. I’m just hoping that my long cycles aren’t related to perimenopause--I have read that long cycles can be an indication of perimenopause and since I’m hoping to be fertile for a good long time, that would be very bad news.

Thursday, March 13, 2014

Starting the Stimulation

My period came yesterday, so that means that I started my stimulation injections tonight. This time there were 33 days between periods, which is kind of a long time, but better than last time when there were 39 days between periods!

I went in for some blood tests today for various hormones, including some that need to be tested on day 2 or day 3 of the period. I got tested for FSH, estradiol, AMH, and prolactin. The hope is that these tests will give some insight into why I have such a long time between periods. I did not actually have these tests because of the current egg freezing cycle though I have learned from reading other egg freezing blogs and sites that most clinics test for estradiol (and maybe other hormones too) at the beginning of each cycle; however Stanford does not routinely do that. In this case I was having the tests to try to find out why my menstrual cycle is so long. But I am kind of glad I got these tests done at the beginning of the cycle anyway, even though Stanford doesn’t use them.

My injections went well tonight. I was doing Gonal-F for the first time(since I used Follistim during the previous egg freezing cycle) and I am happy to report that the Gonal-F did not hurt going in. I even had a pretty easy time with the Menopur injection, my old nemesis from the first egg freezing cycle--though that one did hurt going in.

Now I will have to wait and see if there are different side effects compared with last time.  I am on double the dose of medication, 150 IU Gonal-F + 150 IU Menopur compared with 75 IU Follistim + 75 IU Menopur last cycle. Therefore I am a bit concerned that I may experience more side effects.

Wednesday, March 5, 2014

Baseline Ultrasound

I went in for my baseline ultrasound today. Ideally my period would have already started, but it has not; as long it comes in the next five days, then things will be ok. Today a resident was with Dr. Westphal, and the resident manned the ultrasound probe. This was very uncomfortable. The ultrasounds, which involve having a probe inserted into the vagina, had never bothered me before but this one was different. The resident obviously had not yet developed good technique, so I was in some pain throughout the ultrasound. She counted 6 antral follicles on the left and 7 on the right, for a total of 13. Definitely not the number of antral follicles I was hoping for--I would have ideally liked to have 10 on each side. I’m hoping that she did a bad job counting and that there are actually some more follicles hiding back there. So overall it was not a great appointment, what with the resident poking around painfully and with the relatively low antral follicle count. At least there are no cysts on the ovaries, so we will be able to proceed with the cycle.

The next step is for me to wait until my period comes and then call the clinic.