Dec. 28, 2009: Getting Started
The medications started today - 10mg of Lupron per day, shot into my belly. The shots are surprisingly easy to do - the needles are teeny tiny little insulin syringes with 1/2” tips. I didn’t even feel when I put it in, though it itched a little as the medicine went in.
Jan. 3, 2010: The denial begins
... and I don’t just mean a river in Egypt! Today I cut out all those things I’m not allowed to have during the IVF cycle/pregnancy. That means no more:
- caffeine
- aspirin
- NSAIDs
- alcohol
- antihistamines
Add to that the tetracycline I stopped taking a month ago and, as my doctor pointed out to Joe when we went over the list - I should be a joy to live with! Oh, and I don’t think I’m supposed to dye my hair either, so I’ll be an achy, stuffed up, acne-ridden, grey-haired lady...but if it works, it’ll all be worth it And because of the timing, at least I can claim it’s just another set of New Year’s Resolutions!
January 6, 2010: Baseline Ultrasound
Today was the day for the “baseline ultrasound”, where they take a look at the ovaries and follicles and see what they look like BEFORE all the gonadatropins start pumping up the eggs. It also gives them a chance to make sure the Lupron is working - suppressing my body’s desire to have one follicle take the lead while the rest of them just chill (and thus making only one egg). Luckily, I could do this one in the afternoon, so I was able to rush out of school and make it for the 3:45 appointment time. The rest of the “monitoring” appointments have to be in the morning, so we’ll see how that goes.
Since UCSF is a “teaching hospital”, there’s almost always two people in lab coats in the exam room. I don’t know what the hierarchical positions are called, but I’ll call them teacher and student. For the most part, the student does the physical exam, while the teacher oversees, takes down the info for the chart, and takes over if there’s a problem. Today the student was a middling aged Indian woman who was pretty clumsy with the ultrasound. This is probably the fourth or fifth time I’ve had this done (once by Dr. Huang at Kaiser when we got started with the process, once again by Dr. Rosen and his student when we first came to UCSF, another time by Dr. Huang when I had a saline sonagram done), but this time it was pretty uncomfortable - pinching as she switched from one ovary to the other. Afterwards she did an abdominal exam, noted the puncture marks and asked me what type of medicine I was injecting. The teacher pointed out I was taking Lupron, and that it was in the chart. I’m not sorry this woman won’t be with me through the whole process.
Today they also did a “test transfer” where they check out which kind of catheter they will need when the day for the actual embryo transfer comes. That means they have to thread a catheter in through the cervix and into the uterus, so it’s a little uncomfortable. But the doctor (the Teacher) was able to do it relatively painlessly, and I was on my way!
January 8, 2010: More Medicine
Tonight, I started taking all the additional medications - Menopur and Follistim. These are the gonadotropins that will encourage all the follicles to produce eggs and grow them nice and large.
The Menopur comes in a little sort of tablet that has to be dissolved in a sodium solution, mixed around, and then injected. This involves using a syringe with a “mixing” cap to draw up the solution and inject it into the bottle with the tablet, then switching to a little .5” needle to draw it all back into the syringe and inject it.
The Follistim comes in fancy little cartridges and has its own “pen” device that you use to set the amount of medication and inject it. So - 150 mg of Follistim via the pen, 1 vial of Menopur via the syringe, and now down to 5mg of Lupron via the little insulin needle...three shots a day! They all go in the belly and are relatively painless, but it is a challenge to rotate around the belly so as not to over-aggravate any specific area.
January 11, 2010: More Monitoring
Today’s appointment is just for a blood draw, at 7:45 am. But since it’s a collaboration day at school, I’ve taken a 1/2 day - I couldn’t be sure I’d only miss 1st period, and even so I’d be charge for a full sub if I used anything from that 30 minutes to a full three hours, so I went for the full three hours.
After my quick stick blood draw, I drove to Redwood City and realized I could use the extra time to hit the DMV and get my car registration worked out. Got to school at exactly 11:00! PERFECT TIMING!
The nurses called that afternoon, giving me my estrogen level and telling me to stay on the same dose of all three medicines.
January 13: The next Ultrasound
This week the “Teacher” is Dr. Fujimoto, a smiling gentleman with salt & pepper hair, and his “Student” is Dr. Tran, whose lab coat boasts that he is both an MD and a PhD. Whatever his training, he is quite skilled at performing the ultrasound, which is almost entirely painless. He identifies 14 follicles and says it looks like I’ve got 13 eggs developing at this point.
Because it’s a Wednesday, I didn’t need a sub, and the lovely Martha was available to get my fourth period started if I was a tad late, which (luckily) I wasn’t.
After the exam, I was met by a pretty young Asian doctor who wanted to talk to me about an FSH study I’d been recommended for by Dr. Rosen. UCSF is a research facility as well, so a lot of the releases and things we signed had questions about allowing discarded tissue samples, unused embryos, etc. to be used for research. This study aims to replicate not just the main hormone surge that happens at ovulation (which is mimicked with the hCg “trigger” shot), but also a smaller FSH peak that happens in natural cycles. So, this means that when I have my trigger shot I will also take an additional shot, which might be the fsh or it might be a saline solution if I’m part of the base group.
The doctor was very gracious, thanking me over and over for participating. I figure if people didn’t volunteer for these sorts of things along the way, I wouldn’t be at the point I’m at, so I’m willing to do my part...as long as it doesn’t jeopardize my chances. They assured me it doesn’t.
In the afternoon I got the call with my estrogen level and am told to keep going with the same medications and doses and to come back on Friday.
January 15, 2010: More monitoring
Today’s ultrasound went well again. As Dr. Tran looks at the U/S, he calls out numbers, which Dr. Fujimoto notes on the computer. These are the measurements of the eggs that are developing. Today it sounded like they’d counted 10 (there were a few quick “5” counts, which I took to mean those ones hadn’t grown). Dr. Tran said it looks like we’re developing well and it’s getting close, but that we’ll know for sure when the estrogen results come back.
They gave me the FSH study syringe this morning, and it had to be refrigerated, so I had to rush back to the house and drop it off with Joe before heading down to school - luckily he could meet me at the curb so I wouldn’t be late.
I made another apopintment for Saturday morning. When the call came, it was to stay on the same medication and come back Saturday.
January 16, 2010: Still waiting
Again, the ultrasound went well, again it looks like we’re “close”, but they won’t know until the blood test results come back. The “trigger” shot will either be tonight or tomorrow. If it’s tonight, then the embryo retrieval will be on Monday, which would be great because it’s Martin Luther King, Jr.’s birthday and I wouldn’t miss school. But, since we don’t know for sure, I made sure to leave lesson plans for Tuesday just in case the trigger shot gets delayed until Sunday.
The call came in the afternoon to just continue with the regular medication, so the trigger shot must be tomorrow...good thing I made those lesson plans!
January 17, 2010: Triggering
The ultrasound this morning was pretty positive - it sounded like there were eight or so “good” numbers when the eggs were measured.
Afterwards, I returned to the waiting room until the IVF cycle nurse could call me back to go through the next phase of my “calendar” with me. They’ll call tonight with the time of my “trigger” shot. This time has to be exact because the trigger happens 36 hours before retrieval, so they have to figure out what time my retrieval appointment will be and then count back. Tonight between 6 and 7 I take my last Lupron shot - no more Menopur or Follistim. Then it’s the big hCg shot and the FSH study shot.
On Monday I’ll have to come in for a quick blood draw for the FSH study (a sort of before and after thing). Then on Tuesday I come in for the actual procedure. Two days later, I start taking the progesterone shots to support the uterine lining and an immunosuppressant pill to help keep the womb from rejecting the embryo. Good news? Three whole days with no shots!
Near four-thirty (when the phones at UCSF revert to “please call during business hours” hell), I realized that I’d forgotten to give them the home number, and the cell phone doesn’t work here! I called in and was lucky enough to get in touch with the nurse, who told me my trigger shot was set for 12:30am and that I should then be at the facility at noon on Tuesday to check in and get ready for the retrieval.
Staying up until 12:30 was a chore! Joe marked the time by making obscure references to a “secret mission” on Twitter, which I found totally hilarious. When the time came, it was actually kind of anti-climactic - just two more shots, just like I’ve been doing for three weeks...even though psychologically this one MEANS so much more...
January 19, 2010: Egg Retrieval
The upside of doing this on Tuesday? I get to sleep in!
Joe was a little nervous about his portion of today’s proceedings, so he took care of it at home and we raced over to the clinic to get it dropped off and comfy in the incubator. We’re doing ICSI, in which each egg they retrieve will be individually pierced with a needle and injected with a sperm, so he only needed to deliver as many healthy sperm as the number of eggs I’ve grown. I’m pretty sure he’s far surpassed that number.
We had a little issue at the desk when we got there - Joe dropped me off before he went to park, so we could get the goods into the office as quickly as possible, and the lady at the desk said she couldn’t take them without Joe’s PHOTO ID...as if the fact that they would be injected into MY EGGS wouldn’t give me an incentive to make sure they were the right ones...so weird. Finally, after three or four minutes, they decided I could go upstairs and drop them off in the incubator, and then Joe could show his ID when he got there. Whew! Joe came a few minutes after I’d gotten back down to the seventh floor. I explained the issue and he tried to show his ID at the desk and the same woman who’d made the stink told him to “just go upstairs”. I have discovered there are a few gaps in the customer service aspect of this clinic...this was one of them.
As we headed up in the elevator to the eighth floor where the procedure is done, the very friendly receptionist I’d dealt with all week came scurrying over to apologize for the other woman’s reaction and to wish us good luck. That was nice.
We got upstairs and called back into the procedure area. Joe did his paperwork while I started getting dressed in my little gown, booties, and hat. You walk out and sit in a chair with a reclining back and pop out footrest - nice - and they put a nice warm sheet over your lap to make up for the flimsiness of the gown.
Then it was time for the IV - first they pulled some blood out for the FSH study and then they pumped me full of antibiotics (Joe took a single Cipro pill last night to kill off any ickies he might be contributing). Next the anesthesiologist came by to check in with me. She was a little concerned about my acid reflux and warned me that if I had any problems with breathing during the procedure they might have to put a tube down my throat.
Next they rolled me into a little procedure room and Joe went out into the hall to wait. They brought more heated blankets to prop up under my chest which felt truly wonderful. I felt a little burning when the anesthesia started flowing into the IVF (it’s a mix of propophol and something else...I only remember the propophol part because Michael Jackson made it famous) and the next thing I knew I was waking up in the little beds of the recovery area.
I heard the nurses talk to the women on either side of me, telling them they could take 1-2 advil for the pain - but I’d been told NSAIDs were a no-no, so that confused me. These women also responded that their pain level was in the 6-7 range. So, either something else was going on with them or I have a greater threshold for pain, because I really didn’t feel anything beyond a slight post-anesthesia nausea.
Dr. Fujimoto stopped by to let me know they’d retrieved 9 eggs (a whole baseball team, as my dad pointed out). The nurse gave me some saltines, graham crackers, and cranberry juice mixed with ginger ale. And then I got dressed and Joe walked me back to Kaiser where the car was parked and we headed home. I slept on the couch the rest of the day and got up just to have a little dinner and then go back to bed.
January 20, 2010: No shots!
Tonight was book club, and it was also my last day of no shots to take. Serendipity!
January 21, 2010: Pain in the butt
The progesterone shots started today. Nathanael came over at precisely 9:00pm to administer the shot. He was able to stab me in the “upper outer quadrant” in a way that I felt absolutely nothing until the very end of him depressing the plunger to get all the medicine into the muscle. Let’s hope it’s not beginner’s luck!
We’re not sure about our transfer date yet. Tomorrow morning, they’ll take the embryos out and examine them. If they meet the criteria (at least five embryos which have progressed to six or more cells each), then they’ll continue to grow them to “advanced blastocyst” stage and the transfer will be on Sunday. If not, then they’ll ready the best looking embryos and the transfer will be tomorrow. The trick is, we won’t know until 9:00-9:30 tomorrow morning, so I have to take the whole day off regardless. And if it’s Sunday, then Joe will have to take that day off work too.
January 22, 2010: Transfer delayed
This morning there was no call from UCSF, so I broke down and called them. It seems that our eggs meet the criteria for “advanced blastocyst”, so we are waiting until Sunday for the transfer.
So today we took advantage of the time off work to visit Joe’s mom for her birthday (which is tomorrow). She is very excited about the process and is planning to name any of the embryos that end up being frozen (cryo-preserved).
January 24, 2010: Transfer Time!
The embryo transfer was set for 12:30, which meant my process started an hour earlier, at home. My task - take two valliums (10mg total) and make sure Joe got me to the clinic on time. Mission accomplished!
Once we got to the clinic, we each changed into our sterile outfits, all the way down to the booties. Then they checked my blood pressure and pulse and we waited for Dr. Cedars to call us back into the procedure room.
Once we got there, Dr. Cedars walked us through our embryo report. Of the seven eggs that successfully fertilized, two had stopped growing entirely around day three and were discarded. One more had stopped between day three and today and was going to be discarded. This left us with four viable embryos. Two of them were stellar candidates, and the other two were on the “wait and watch” list. So, the two top of the classers were identified as the candidates for transfer:
The procedure was quick - feet up in the stirrups, speculum in (she had to switch types at one point, but it wasn’t too bad), then a catheter was threaded into the opening in my cervix and Embryos A and B were fed through and into the uterus! And that’s it - now it’s just two more weeks until we can take the initial pregnancy test and see if it worked!
January 24, 2010: Real pain in the butt!
The progesterone shots have been pretty awful. The shots themselves don’t hurt at all, but I am VERY sore at the injection sites - if I bump my hip/butt on anything, like a car door or a chair back, I yelp in pain, and it hurts even when there’s no pressure. Joe’s been especially worried and today I looked at it in the mirror after a shower and noticed some pretty ugly red patches around three of the injection sites.
Worried it could be an infection, I took my temperature and - lo and behold - 100.5 degrees. I called UCSF, and since it’s Sunday their service had Dr. Tran call me back. He took a moment to convert the temperature into Celsius and then suggested I come into Urgent Care at the hospital. Since there’s no way I could afford that, I called Nathanael and we packed me into the Smart Car and down to the Kaiser ER.
While we were in the waiting room (after triage but before being treated), they called for an Edith, and I got up - but it turned out they were calling for the older woman in the wheelchair sitting next to me. I think it may be the first time I’ve ever been in the presence of another Edith in a waiting room!
I was taken back to the “isolation room” and a doctor came in, looked at the spots on my back, poked at them to make me scream, and decided it was cellulitis. Also, because there were multiple spots, they suggested it was probably that I am one of a small minority of people who is especially susceptible to these infections, rather than anything to do with the injection methods. I was given IV antibiotics and fluids and a prescription for 10 days worth of antibiotics.
Joe came to the hospital after work and relieved Nathanael of his duties. By the time we got home it was well past dinner time and neither of us was hungry so it was a pretty low key evening at home.
February 3, 2010: Options
After the ER incident, the friendly folks at UCSF decided they wanted to see these problem spots for themselves. I had a 3:15 appointment (for which I arrived at about 3:30). After about 45 minutes I was moved into an exam room, where I nodded off for the next 30 minutes until Dr. Kashyap and Dr. Tran came in.
Dr. Kashyap looked at the problem areas and said it all looked normal, but that the areas were warm to the touch, which was not normal. So, I’m to stay on the antibiotics and I was switched over to a 3-a-day progesterone suppository instead of the shots. That’s right - after tonight - NO MORE SHOTS!
I picked up a week’s worth of the suppositories at the Kaiser pharmacy and since the prescription was written by a non-Kaiser doctor, it’s not covered. $84 for one week! And this is medication I have to take for nine more weeks if I’m successfully pregnant! Yikes!
February 5, 2010: No more pain in the butt
I don’t need to share any of the specifics of the suppositories, but let me suffice it to say that compared to the pain of the injections, it’s like I’ve died and gone to heaven.
February 7, 2010: Super Sunday
Super Bowl Sunday was our official 2-week mark from the embryo transfer. And what does that mean? Time for a pregnancy test!
I got up early and headed down to the Kaiser lab. I got there at 7:45 and was the only person in the room. I was in and out and home before Joe even left for work!
Now it’s all about the waiting - results will come tomorrow.
February 9, 2010: POSITIVE!
I woke up at 3:15 this morning wanting to run and check the computer to see if there’d been any results and had to talk myself down - there won’t be results this early, go back to sleep. But it was useless, I tossed and turned until the alarm went off.
Then, normal routine in the morning (stopping at 7-11 to pick up some birthday peanut butter cups for a friend) and settling in at school. At 8:20 I had a meeting with the principal that lasted until about 9. When I headed back to the room, Martha needed to use the computer for a bit, so I sat in a desk and graded papers. At about 9:20, I logged back into the computer, having successfully distracted myself with work.
And there it was. A notification from the Kaiser website that I had a message waiting from my doctor. I almost shook as I logged in, and then there it was: “Pregnancy Test Positive”. YAY!
I have to go back tomorrow and have another test, to make sure the levels are rising appropriately, and then an ultrasound two weeks after that. But the first step is positive and we are on our way!
This shows Baby A on the left side of my uterus, with babies B and C in their shared placenta on the right (the ultrasound images are reversed).
And Baby B, who was a little squirrelly through the whole procedure, making it harder to get a good set of pictures (or measurements):
Baby C seemed to just eat up the camera, though:
