Its Time… IVF is Here

This whole time, Robbie and I were secretive about our IVF timeline was so that we would have the flexibility and no external pressures of asking “how is IVF” or “are you pregnant yet?” So to bypass those unavoidable questions, we just simply didn’t tell the whole timeline. But that February day I got the call that our name came up on the list, I was told, expect IVF come this April or May.

We were over the moon. By April or May, we could be pregnant. We’ll me, not Robbie, of course. ONLY TWO OR THREE MORE MONTHS.

As March rolled around, I got the call that our IVF cycle would be postponed to May. Under any normal circumstance, I would have been upset by this all. But in May I had a baby shower I was planning, my cousin bridal shower to attend, and her wedding 7 hours away at the beginning of May. I kept going over the rough timeline they had given me and the dates wouldn’t have worked out.

I would have had to possibly drive to Ottawa the mornings of the showers (also not possible since the one shower was 5.5 hours away) and the embryo transfer would have lined up imperfectly with my cousins wedding. I started to have dreams where I missed everything and was so disorganized. I even had a dream I showed up to my cousins wedding wearing a hospital gown because I had come down right after my egg retrieval to her wedding.

So needless to say, getting the call to postpone one extra month was quite the relief for me.

At the point when we got the call in February that we would be doing IVF come this spring, we already knew that Robbie would be out of province and I would be riding solo for this.

It didn’t bother me at all. I’ve done the drives to Ottawa, I’ve done the needles all myself.

I can do this.

I started my estrogen patches on April 29th (100 units, alternating butt cheeks every other day) and was to continue that protocol until I got my next period to start cycle day 1. Thankfully I had an acupuncture appointment a few days later. That was greatly appreciated as my estrogen related headaches were in full swing, a constant throbbing that had been persistent for days since I started the patch. The acupuncture helped greatly and I felt amazing after my appointment. The only bit of a hormonal swing came the night of May 1, when I cried to Robbie over the phone that all I wanted was a veggie garden.

Not essentially something I would cry about on the average day.

I was starting to feel so mentally prepared for IVF. I had this in the bag. I’ve been eating clean, reduced toxin exposure drastically in my life, put in the time at acupuncture to get my body flowing properly, and mentally, it just felt right. I’m not superstitious, but I am a little-stitious. At this point, I just had my bad luck of three (my cat almost dying, my car almost dying, my oven died). All my bad luck was out of the way.

The day of my cousins wedding, we sat through a beautiful religious ceremony (well the whole wedding itself was gorgeous, including the stunning off the shoulder gown my cousin worn – uh so heavenly) that talked about marriage, the bond between husband and wife, and procreation – becoming and welcoming the roles of parenthood.

We sat there, Robbie squeezing my hand through the speeches like that, as if it was gentle reminder that our time will come too.

Also, Robbie had left at the beginning of March for work but flew down for 2.5 days for the wedding, hence why he’s suddenly here but won’t be for the rest of this IVF journey.

Later that evening, I got my period. The moment I was waiting for. I ran out of the washroom, and bee lined it straight to Robbie to tell him excitedly that IVF IS HERE. I slipped outside to phone the clinic, knowing all too well that no one would answer but this way, they would receive my message first and call me back earlier in the morning come Sunday.

Everything was coming together. I believe in the circle of life and at that wedding, I had my ah-ha moment. My cousin, who had coincidentally caught my bouquet at my wedding, was the first person to get married next that attended my wedding. Now here at her wedding, listening to the ceremony about procreation, it somehow seemed fitting in my eyes that I would now be able to go on wards to the next step. That probably doesn’t make any sense to you but in my mind, it does.

And for the first time in years, I had my first menstrual cycle without cramps. Thanks to acupuncture, of course. The holy grail of the natural healing world. It just seemed fitting that after all this time, I would be going in on a clean bill of health. Everything just seemed to align so perfectly.

The clinic called Sunday morning and I got my IVF medicinal protocol. I would switch my patch this morning (May 5th) and take it off the morning of the 7th. On the evening of May 8th I would start my gonal-f* injection of 300 units (225 units more than I was used to for our IUIs) and Luveris* injections (150 units) every evening until the following Monday evening (May 13th). Starting that Monday, I would take my first cetrotide injection in the morning (to stop me from ovulating) and my first ultrasound and blood work would be Tuesday morning.

*Gonal-f: a follicle stimulating hormone – aka the hormone that makes you grow lots of follicles (each follicle typically contains one egg and when large enough – 15 mm or larger, its ready and mature enough to ovulate)

*Luveris: a luteinizing hormone – a hormone that is used in conjunction with gonal-f to stimulate a follicle (egg) to develop and mature

The complete set up and supplies needed for when I take my gonal-f and luveris injections. Alcohol swabs, medications, mixing needle, needle disposal bin.

This all was so exciting. Except I realized that by the time my ultrasound came on Tuesday, I was probably already going to have ovulated so that wouldn’t work. I usually ovulate way earlier than anticipated. I called the clinic back stating that my concern was I will already have ovulated by then. They decided to get me in two days earlier on the Sunday for my first ultrasound. Just in case.

On May 8th, I started my injections. At this point I was getting over a chest infection/ cold so I was feeling exhausted but I accredit it mostly to the sickness, not the hormones. Otherwise I kept up with my injections, ate healthy, drank lots of freshly squeezed orange juice to boost the immune, and I felt fine. Until May 11th when I started to have minor lower abdomen bloat and tenderness on my stomach from being the injection site. In fact, I started to just feel bloated and muggy all over.

Top Photo: Left Ovary
Middle: my empty uterus
Bottom Photo: Right Ovary

May 12th came and I woke up at 5 am for my ultrasound and blood work in Ottawa. My endometrim lining (uterine lining) was good at 8mm (above 8 mm is where you want it) and my anterior wall of my uterus is meeting the posterior wall (which is the three lined, squash like shape in the middle ultrasound picture), which according to my ultrasound technician and the Reproductive Endocrinologist (RE) on call, is excellent and just what you want to see.

The large black holes in the top and bottom photos are my follicles. This photo is also now proudly hung on my refrigerator door, for absolutely no apparent reason other than the fact that maybe, one of those black craters would be my future children.

Throughout this infertility process, the one thing I have learned is to be your own advocate. Thank goodness I learned that because this ultrasound revealed that I had one follicle at 24 mm that would have ovulated. Had I not made the call the schedule an earlier ultrasound, I would have ovulated and this IVF cycle and all the money spent on medications would have been for nothing.

They may know more about reproductive technologies and how the logistics of the body work, but I know my body.

Had I not arranged this ultrasound, essentially I would have been out hundreds of dollars on the medications I have used up to this point but still would have had another opportunity to pursue the funded OHIP IVF. With the funded version, you have two attempts up until the egg retrieval (as long as you don’t complete the retrieval) so I still would have had one more chance. It would have just been wasted time and money at this point.

My follicle count for my ultrasound was good and we felt very confident with the results. With the larger doses of gonal-f I had 13 follicles on the right ovary (the measurable ones measuring at 24, 13.2, 10.5, 10, and 9 mm) and 9 on the left (the measurable ones at 14.5, 13.3, 10.5, 10 mm). A grand total of 22 follicles, which for the naturally fertile people my age is around par with the follicles count. They just wouldn’t have that many that are measurable. They upped my dose of gonal-f from 300 units to 400 units (which is the max dosage you can receive at my clinic) in hopes to stimulate a bunch of follicles that were smaller and weren’t quite showing signs of growing.

After my ultrasound, I was immediately sent up to the pharmacy to pick up a cetrotide* injection to stop my body from ovulating that one follicle at 24 mm, as my blood work was also showing that my body was starting to ovulate as well.

*Cetrotide – an injection that blocks the gonadotropin-releasing hormone that causes eggs to be released from the ovary, and is used to prevent premature ovulation during controlled ovarian stimulation (aka IVF)

Essentially that one 24 mm follicle will just die off, so that the smaller ones will continue to grow. Remember with IVF, you want more follicles, typically within a similar range so they can all mature together. So its better to lose one follicle, to gain many more.

The following morning, I woke up and took my cetrotide injection and it stung a little more than usual. My poor stomach was feeling tender from all the injections and feeling like a little human pin cushion. I had slight cramping on the right side and began to get worried that maybe it was ovulation cramping and my cetrotide from the day before hadn’t stopped my body from ovulating that one follicle. I was worried but until I had my ultrasound the following day, there was nothing I could do about it.

I kept telling myself, worst comes to worst, we stop and attempt this all over again next month. It’s just money lost, it could be worse.

On Tuesday (the following day) I went for my second ultrasound and the technician was so very quite. I had had her before and every time we were so chatty and today she was, until the ultrasound started. The RE on the floor came in and was oddly quiet as well and I knew something wasn’t right. I was worried that I had ovulated, so I asked.

The RE promptly said “no, you didn’t ovulate” and that was all that was said.

After the ultrasound, I got dressed and I heard the ultrasound tech say “well that didn’t look good.” I sat in the waiting room for 15 minutes, anxiously waiting for the nurse to call my name to go back and go over my ultrasound results.

In short, the increase in my gonal-f was to stimulate the smaller, non-measurable follicles to grow. Instead, the increase grew my follicles that were already measurable and made them mature. I now had 16 follicles on the right ovary ( but only 6 were measurable at 20, 17.5, 14.5, 14, 12, 9.5mm) and I had dropped to 8 total on the left ovary (4 measurable at 18.7, 17.2, 15, and 12.7 mm).

The bolded numbers are my 5 follicles that I had that are considered mature.

Since the measurable follicles had grown so much in two days since my Sunday ultrasound and the non-measurable follicles didn’t grow at all, the concern was that if I didn’t trigger ovulation, I would risk losing all of those mature follicles as they would “over ripe.” Once they get to large, they just die off. Since my smaller follicles (non-measurable follicles aka the bunch that were under 9 mm) didn’t grow at all, there was no hope that I would be able to stimulate them to grow any larger. I was already on the maximum dose of gonal-f and they hadn’t budged.

At this point, my only option was to trigger and have my egg retrieval on Friday. Which meant I only had 5 mature eggs going into my retrieval. to give you some context into the IVF world since the average person might not know much about this particular topic, the few people I had known at this point to do IVF had over 25 mature follicles. Same with the many youtubers I had watched. All usually had over 20 at least. And some ended up with just one embryo.

I had 5.

Now I know with my diagnosis of Low Ovarian Reserve that I was to be expecting much less in terms of mature follicles going into the retrieval, but mentally I was preparing for 12-15. 10 at worst.

Not 5 measly, pathetic follicles.

I sat with Jackie (one of my two IVF team nurses – who are both simply wonderful) as she explained my schedule for the next few days up until the egg retrieval. I hardly spoke, afraid that if I did my emotions would get the best of me and I would just end up crying right there.

I was to take my cetrotide injection this morning (and one the following morning), and that tonight would be my last night of 400 of gonal-f and 150 of luveris injections. This last dose and hopefully the next few days until Friday morning, we were anticipating that maybe a few more of the follicles might reach the 15 mm mark and be ready to use.

I got into my car and cried. The whole two hour drive home I cursed my stupid body, for never doing what it should. For betraying me again and again and again. For sabotaging my chances of ever being a Mom. I screamed into the nothingness “I’m so damn tired of working this hard for something that should be so easy.” It was disheartening for my body to not do what I so desperately wanted it to.

I got home and felt so unsettled about my results so I called Jackie back and asked about possibly postponing this cycle and trying again next month. Hopefully with better results.

Approximately an hour later, my RE called me and explained all the options. She said “with your diagnosis and that we already have you maxed out on gonal-f, sadly, this is a very good result for you and very on par with where we expected your mature follicle count to be.” She went on to clarify that if we chose to go forward with a new cycle, that we would probably have the same result, if not less.

We had choices but we didn’t. I didn’t know if I could go forward again and have possibly less mature eggs going into this. After talking to Robbie, it just wasn’t something we could risk.

I just kept thinking “the numbers are against us, this isn’t going to work.” Because the numbers are against us. And I really didn’t think this would work.

Wednesday May 15, I had to drive to Ottawa just to get literally one teeny tiny vile of blood drawn to get my progesterone levels tested. With the OHIP funding, its billed directly under your fertility clinic so all blood work/ appointments have to be done there. So I drove 3 hours to Ottawa (thanks to rush hour traffic) to drive almost 2 hours back just for blood work. A complete waste of my day and I had to work an evening shift that night.

Not to mention the fact that I was just tired and mentally exhausted.

Just “shooting up” in a parking lot. Gotta do what you gotta do.

I had to take my last cetrotide injection in a Chapters parking lot after storing my injection in a lunchbox with a ice pack to keep it cold. Infertility treatments make you take injections in weird spots because they are so regulated by a timed schedule, you bring them everywhere with you and take them wherever you are at the time.

That night at 9:30 precisely (since it takes 36 hours to ovulate after trigger and my retrieval was scheduled for 9:30 am on Friday), I took my last IVF injections. A double trigger shot. 10,000 iu of hCG* and 0.6 ml of lupron* to trigger my body to ovulate. My RE prefers to use a double trigger shot as the clinic has had more success with successful ovulation. In addition, it is also used to help the eggs detach from the follicle wall so that its suspended in fluid and is able to be retracted more easily on egg retrieval day. I’ll go into more detail about this in my egg retrieval blog.

*hCG Trigger Shot: triggers the eggs to go through a final growth spurt and ovulate (be released from the follicles) within 36 hours.

*Lupron: also used to help stimulate ovulation.

I went to bed, took a milk of magnesia laxative (also another fun part of the IVF protocol). If your bowels are full, it can create more difficulty when attempting to remove the eggs on egg retrieval day. That’s your not-so-fun-fact of the day.

I wrote in my jounal that night. Send all the good vibes universe. I need it. Baby Melanson is being made this weekend and I pray that this embryo is strong willed and healthy. That it grows up knowing how hard we wanted it, how hard we fought for it. How when I felt like giving up, I couldn’t because I needed you little one. We love you so much already.

At this point, all that needed to be done was done. There was nothing else I could do now. My 5 follicles disappointed me, but I tried to remain hopeful at this point. The next day, I went into work and took 2 weeks medical leave. I was under strict orders for 2 weeks that I could work as long as I obeyed 2 conditions.

  1. No heavy lifting.
  2. I’m not on my feet all day.

And if you know a day in the life of a PSW, especially on a dementia unit, that is virtually impossible. At this point, Robbie and I have poured so much time, money, and emotions into this, it wasn’t worth risking it all.

And so it began, the virtual waiting and most anticipation I have ever experienced. What a surreal feeling, to feel like you are so close to being a parent, if all goes well.

Nothing great ever comes without struggle.


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