Embryo transfer

Two days ago (day after my OPU), I received a call from my Embryologist. He said that out of 4 eggs collected, 2 are matured. Fortunately, those two are successfully fertilized.

As usual, we arrived early at the clinic for my embryo transfer procedure. I went to the blood extraction room first to give my blood sample. Then I was admitted and prepared for the procedure. I changed into the hospital gown. This procedure will require a full bladder because they will be using an abdominal ultrasound to guide the catheter in the proper place when they perform the embryo transfer. I arrived at the clinic with an almost full bladder but the nurse told me to pass urine first because I might be waiting for another hour.

Thirty minutes before my scheduled procedure, I started to drink water. At 10am, my bladder is totally full. However, the nurse said that no one in the operating room called yet. So my schedule is delayed. I thought that it would be delayed only for a couple of minutes. But 5 minutes, 10 minutes, 20 minutes came.. still no call! I feel like my bladder is about to burst! I told the nurse that I cannot hold on to it any longer. She advised that I pass urine but only a little. She said to suppress it after 3 seconds. I took her advice but was in agony after! Yes, I was quite relieved when I excreted some liquid but I didn’t know that it was so hard to limit it and then suppress it.

When I stepped out of the wash room, she told me that they are now ready for me in the operating room. The procedure was done by Dr. G. Unlike the same procedure in my previous IVF, I felt more uncomfortable this time. But Dr. G is more warm and friendly. The discomfort is just because of the suppression of my urine earlier. The embryologist met me and told me that I’ve got two perfectly beautiful embryos. I was so delighted to hear it!

The assistant placed the ultrasound device in my belly and started to press and search for my uterus (which caused more discomfort!) Dr. G started by cleaning the area around my cervix. There is no anesthesia used in this procedure. So you can actually feel what they are doing down there. A transfer catheter was then inserted inside the cervix towards the optimal place in my uterus (this is where the ultrasound is needed). And then two embryos were transferred to my uterus. They gave me an ultrasound copy of my twins.. although you could only see a tiny bright spot where my babies are smiling. J

After the procedure, Dr. G told me to stay for a while in the operating room. She chatted with me about my previous IVF and my ectopic pregnancies. She said that I have to hold on.. God is just testing me. She said that God is good and that hopefully this time, I will have a successful pregnancy. I was teary-eyed when she said those words. I was really moved and thanked her for the kind words.

After a few minutes, the nurses helped me to a wheelchair and I was transferred to the recovery area. I immediately went to the wash room to relieve my bladder. It feels so good after! Although, it was actually difficult to pass urine at first.. maybe because of the procedure or perhaps the prolonged suppression of my urine. When I came back to bed, the Indian assistant came and helped me lie down. Then she placed a pillow under my butt. She told me to stay for about 45 minutes. I was actually happy that they let me stay this time. I remember in my previous IVF that they only let me stay for about 20mins!

I got a call in the evening about my hormone levels. They told me to increase the frequency of my medicines (Progyluton and Cyclogest) to 4 times daily.

Ooctyte Pick Up (OPU) or Egg Collection

Just like my previous IVF cycle, I didn’t sleep well the night before the OPU. I feel so hot even when the air conditioning is on. But maybe I’m also a bit anxious about the procedure. Anyway, I still feel the tightness of my abdomen due to the unusual size of my ovary (the doctor said that it is about the size of an orange fruit).. but it is more tolerable compared to the previous cycle.

We arrived at the clinic before 8.30am. I settled the remaining payment for the IVF package first at the cashier. Then I was admitted and prepared for the procedure. I changed into the hospital gown (took off everything). Since this is my fourth time to be admitted, I am feeling more comfortable and less nervous of the procedure. The nurses are also more familiar especially the Indian nurse who often gives my IV. She gave me paracetamol, antibiotic and the usual dextrose. There are less patients that day so the environment is more relaxed.

I was then transferred to the operating room. Dr. S took charge of the procedure. There were also a few people in the room that assisted in the procedure. They are all very warm and chatted with me to take off my nervousness. At around 9.45am, I was given the sedative and immediately I passed out. When I woke up, I was already in the observation area outside the operating room. I’m still a bit groggy then, but I remember asking one assistant how many eggs they have collected. She told me that they collected 4. I actually expected that they would collect more so I was a bit worried. In my IVF #1, they have collected 8. Anyway, I hope that all are in good quality and will turn out to be good embryos.

I was then transferred to the recovery area near the nurse’s station. I continued lying down till my dextrose was all absorbed. I felt slight cramping in my right side and at the bottom around my anus. Afterwards, I changed back to my clothes and was discharged. The nurse gave me my presciptions: Progyluton to be taken 3x daily (after breakfast and lunch to be dissolved below the tongue and after dinner to be inserted in the vagina) and Cyclogest 400mg suppository 3x daily (to be inserted in the vagina).

My husband said that he also gave his semen sample while waiting for me.

When we arrived home, we ate our lunch first (I was starving!).  Then I slept. There is still pain in the right and bottom part of my abdomen. It is also quite hard to pass urine. I also observed some blood on the tissue after I peed.. but I read in the internet that it is quite normal so I’m not too alarmed.

Fifth appointment for my IVF #2

We have spotted an additional follicle! I have now 5 so far with sizes 12-21mm. Since the biggest one is more than 18, my doctor is thinking that I may be scheduled for the final trigger shot this evening. She told me that they will call me this evening as soon as my blood test result is out. They wanted to confirm my Estradiol level. Although my nurse who gives me the injections told us that it is very likely that they will ask me to take the final trigger shot because my previous Estradiol level from my last appointment is a bit more than 1000. She said that they are usually looking for >1000 level. She told me that my lining is a bit thin though. It measures 9.4mm now. She said that the ideal thickness should be 10-12mm. Although based on my internet research, it says that more than 8mm is good enough. Besides, after my OPU, I would be taking medicines which will make my lining thicker. Therefore, I’m not so worried.

Just before 9.30pm, I received a call from the clinic instructing me to take the trigger shots at exactly 9.30pm today. It’s good that the nurse gave us the medicine so we didn’t need to rush back to the clinic. The medicine is the same as what I took in my IVF #1. It is called Ovitrelle 0.5ml. This injection is used for the final maturation stage of the follicles. I took 2 injections – left and right tummy. Timing is very important when taking this medicine. The OPU (Ooctyte Pick Up) or Egg collection should be done 34-36hours after the trigger shot. Mine is scheduled on Thu 9.30am. I was advised to come to the clinic an hour earlier for the preparations before the procedure. Some precautions were also advised such as: no perfume, lotion, nail polish and feminine wash before the procedure and fasting after 12am.

Compared to my previous IVF, I didn’t feel too much discomfort during the course of my stimulation this time. Probably because my ovary is still inflated from my previous cycle. The reduced number of injection also made it feel lighter. Though I still experience mood swings, sudden twinges in my abdomen, a bit tightness in my belly, frequent urination, mild headaches, and the feeling of being thirsty all the time.

We are also more optimistic for this cycle compared to the previous one. I remember having a dream of just giving birth to twins. We are in the hospital room and I am breast-feeding them. My husband also had a dream of us having twins. We are really excited for our-soon-to-be God’s Bundles of Joy. We are really claiming that this time is God’s time for us to have our family complete! I can’t wait to see a BFP (Big Fat Positive) on my first post hormone blood test!

I like ANC’s final word tonight that is posted in Facebook. It goes: "Nothing is impossible. The word itself says: I'm possible." Good vibes!

Fourth appointment for my IVF #2

My follies are growing fast! We have seen 4 of them with sizes 9-14mm. I am still on the same medication, which is actually a relief because in my IVF #1 I think by this stage I have around 2 or 3 injections per day.

Third appointment for my IVF #2

I’ve got 3 visible follicles seen in my ultrasound which ranges from 8-10mm. I hope that in the next few days they would continue to grow more and that more follicles will be spotted. My doctor recommended the same medication (Pergoveris 300 IU) for 3 days. I also did my blood work after.

Second appointment for my IVF #2

Days before this appointment, I observed that my period became heavier (it started to be so light). But on the day of my second appointment (D6 of my period), it was reduced to almost spotting. After my TransV, my doctor said that I can start my ovarian stimulation. She prescribed Pergoveris 300 IU for 3 days. Pergoveris injections contain the two active ingredients, follitropin alfa and lutropin alfa. Lutropin alfa is a synthetic version of a natural pituitary hormone called luteinising hormone (LH). Follitropin alfa is a synthetic version of a natural sex hormone called follicle stimulating hormone (FSH). In the ovaries in women, FSH and LH increase the number of growing follicles and stimulate their development.

After taking my routine blood test for my baseline hormone levels, I went to the basement floor to take my injection. The Filipina nurse was not there. Instead, there was the Indian nurse that I’ve previously met during one of my operations. She insisted on giving the shot because she wanted to show me how to prepare the injection. One box of Pergoveris contains two vials— powder and solvent solution for injection. The powder vial contains 150 IU (equivalent to 11 micrograms) of follitropin alfa and 75 IU (equivalent to 3 micrograms) of lutropin alfa). Since my prescription is 300 IU of follitropin alfa, I need to take 2 boxes of Pergoveris in one shot. The nurse inserted the syringe (with big needle) into the solvent vial and took out the liquid. Then she injected the solvent into the vial of powder. After the powder is dissolved, the solution is taken back into the syringe. She then injected the solution into the second vial of powder (second box of Pergoveris), which completes the 300 IU of follitropin alfa. As soon as the powder is dissolved, the solution is taken back into the syringe. The big needle is then replaced with a finer one and then injected in my tummy below the belly button. I’m glad that the other solvent was spared because it would mean more liquid injected! The drug was a bit painful but it doesn’t linger.

First appointment for my IVF #2

The problem with my breakthrough bleeding (see previous post: Summary of IVF#1) is that I had difficulty in assessing the start of my period. After having a failed IVF cycle (IVF#1) followed by a hysteroscopy, my doctor prescribed birth control pills before I could start IVF#2. I read that menstruation period usually comes 3-5 days after the last pill. Since I was constantly having spotting, I found it challenging to determine if it is the start of my genuine period or just the usual spotting (a side effect of taking the pill). Three days after my last pill, I got bright red spotting that is more than usual (but not yet enough for me to wear a pad). The next day was more blood but still very light. After reading some posts in the internet, I decided that this should be it! I called the IVF clinic and asked for an appointment for that day since it is D2 of my period. Fortunately, they squeezed me in Dr. M’s busy schedule.

After my TransV ultrasound, my doctor said that I am ready to start my treatment. She changed my medications though. She prescribed two days of Gonapeptyl 0.1 mg injection which is for hypophysary inhibition or blocking of pituitary gland in order to prevent premature ovulation during ovarian stimulation. Just like in IVF#1, I took a shot of Ceftriaxone 1g antibiotic injection. I was also advised to take the same set of drugs as my previous IVF cycle: Vibramycin 100mg (taken twice daily) and Folic acid 5mg (taken once daily).

 

We took home the Gonapeptyl injections. This injection is the easiest one to administer because it is ready to use.. no need to mix, measure, or transfer to the syringe. The needle is also small and thin. As usual, my home nurse (my husband) gave me my shot. Perhaps it’s because I am now used to injections that I’ve become more prick-tolerant.. or maybe my nurse has become a pro in giving the shots!