IVF: The Retrieval

Please note that I am not a medical professional. Everything I write is based on my own experience, the experience of friends I’ve spoken with, and research I’ve done.

Hey, hey! I’m back with an update! Last we talked, I was gearing up to get started on the retrieval part of the IVF process. We are officially through that part and have just begun the next phase – the transfer. Today however, we’ll focus on the retrieval. It’s quite a process and really the most involved. Not to mention that it was one of the scariest and biggest unknown parts for me when deciding whether or not to go through with all of this. So let’s chat about it.

First came the birth control. It seems counter intuitive to take birth control when you’re trying to get pregnant, but there seems to be some belief that it can help your body respond better to the medications. Plus, the doctors can then control the timing of when things get started and appointments and such.

In April we officially got started. Birth control ended and the first thing was the baseline appointment. They do blood work to monitor your hormone levels and such and do an ultrasound. During the ultrasound, they count out the number of antral follicles they see. Antral follicles are basically the number of itty bitty little eggs in each ovary that could develop that month. It’s a “predictor”, if you will. However, it seems that often that number is on the lower end of how many there actually are, since they can’t always see them all. My endometrioma cyst was still hanging out in my right ovary, so there were only 7 counted on that side. The other side showed 18, for a total antral follicle count of 25.

I’m not going to lie, I left that appointment in a few tears. The side with 18 sounded great, but the side with the cyst was the one that I’d been made to believe would be most likely to underperform. Having only 7 there to start with seemed discouraging. There was a bit of fear creeping in (even though looking back it seems silly – those were still great numbers). But I pulled it together and just got more serious about staying healthy and doing what I could to give my body it’s best chance.

On the note of being healthy, I’ll mention that I didn’t have any caffeine during the retrieval process and for about 2-3 weeks prior. I still haven’t gone back to drinking it and don’t mind it at all. The first week was brutal – I felt so tired and had headaches. But now I really don’t even need it. I think I feel better without it. It’s great.

I also had no carbs like bread, pasta, rice, etc. I allowed healthy carbs like fruit and oatmeal, but otherwise cut them out completely. I drank green smoothies and was otherwise disgustingly healthy. 🙂

IVF retrieval medications

The day after the baseline appointment, we started shots. For those curious, the full cost of our retrieval meds was roughly $3,500. Insurance covered the alcohol swabs but that was basically it. Our primary medications we had were Menopur, Gonal-F (vial, not pen), and Cetrotide. Then of course the trigger medications – Pregnyl and Lupron.

The first couple of days of shots were stressful. Mixing those suckers is intimidating. Each dose is literally hundreds of dollars of medicine and the thought of doing it wrong is not only an expensive thought, but more importantly can mess up the medication you receive. The second night we thought we’d done something wrong because after mixing things, there was less medication left in the syringe than there was supposed to be. We called the emergency nurse who said it was ok, but again I won’t lie to you – I was a bit of a mess for a solid hour as I worried a bit over the fear of this not going well.

IVF retrieval shot mixingIVF medications day 1

After the scare, the hubs – being the wonderful man he is – pulled out some used vials and needles and practiced several times that night so that we’d have it totally together for the next night. It was the best thing we could’ve done. I felt so much more confident with every shot after that. I love him and his calmness.

We continued shots and then on day 6, we had our first check up to see how things were going. Again, it’s blood work and an ultrasound. During the ultrasound, the doctor was calling out numbers to the nurse. I was doing my best to keep track of each one. The total number of numbers he called out would be the total number of follicles that were progressing enough so far. The actual number he called out was it’s size. They need to get to around 15-20 mm in size to be considered mature enough for retrieval.

Since we still had a few more days to go, they weren’t full mature yet, but the ones that were progressing well ranged in size from around 8-11mm. At this point, there were 15 follicles that were doing well. There are usually others in there too, but they weren’t measuring big enough to count yet. I can’t remember the exact breakdown between the ovaries, but to my surprise the more mature ones were on my right side – the one with the cyst and fewer antral follicles at the first appointment. In the end, that ovary ended up producing fewer eggs, but they were the more mature ones.

After that appointment, the tears were of relief and happiness. Having 15 so far was a great number and I was so encouraged.

So at this point, I felt pretty good. The bloating wasn’t bad, the shots had been pretty decent and I was feeling good. The shots really didn’t give me bruises and only left a tiny little mark where the needle went in. However, within about a day of that monitoring appointment, the bloating got real. I mean for reals. And then the shots started getting more uncomfortable. Not horrible or anything, but I think there’d just been so many shots in the same general area that there wasn’t anywhere new to go and they started to hurt. Plus, we added in a third shot everyday and that one would give me a slightly itchy little rash for an hour or so around the injection site.

IVF retrieval shot marks
NOTE: A shot of my belly isn’t the most beautiful thing ever, but I’m sharing it for those who might go through this at some point. This part was what I was most afraid of and I wanted to show it because it turned out much less awful than I feared. There are many parts of this process that are hard, and the shots can be too, but they were ok. Not fun. Not something I’d want to have to do. But not a reason to not do this whole process.

When we’d picked up our medications, I’d been annoyed to see these Synera patches included. They were $40 and it seemed an unnecessary expense. Well, once the injections started hurting I changed my tune! Love those things! They took the pain away, which was wonderful.

We went back for more monitoring on day 8. There were 31 follicles measuring at this point, with about half of them in the larger mature size range. I was extremely bloated and uncomfortable at this point. Standing up, sitting down, walking – all of it was uncomfortable. I felt like a stuffed chicken. The doctor wanted me to do one more day of shots to see if we could get a few more to mature, but that depended on how the blood work came back.

When I got the call that afternoon, they said to take my trigger shot (to trigger ovulation) that night. No more medications. That was a Friday night and the retrieval was scheduled for Sunday.

I was a little disappointed to hear we wouldn’t have one more day of shots for things to mature, but you can’t risk your body ovulating on it’s own. There are several different ways of doing the trigger shots, but mine was a series of three shots. A shot of Pregnyl first. Then one hour later, a shot of Lupron. The third shot was 12 hours later – more Lupron.

IVF retrieval medications complete

On the day of retrieval, I was ready. I felt like a full term pregnant person the way I was so full and waddling around so slowly. I was afraid I might burst if you poked me too hard.

When we got to the doctor’s office, we got prepped, they hooked me up to an IV and shortly after that, took me to the procedure room. As soon as they gave me the anesthesia, I was out.

Prepped for IVF retrieval

The next thing I remember is slowly waking up to hearing the hubs and nurse talking. Then I got some really delicious juice. I think it was mango. 🙂 The juice was SO good! Ha!

Then the news – they’d retrieved 21 mature eggs that would be fertilized! For those who aren’t familiar with all of this, that’s an excellent number.

For us, they’d recommended using ICSI, a process where they inject a sperm directly into the egg, rather than letting it happen on it’s own. I firmly believe this was the right call.

The afternoon after the retrieval, we just relaxed. We weren’t sure what to expect, as I’ve had friends who didn’t feel all that great afterwards. That particular day, I actually felt fine.

We got a call the next day that 13 eggs had been fertilized successfully! Again, a great number! Next came the long wait to see how many continued to grow and make it to day 5 or 6.

Over that next week, there were two things. One was that I was relatively calm in the waiting period. I definitely wanted to know the final number, but I felt good. I’d done my part, the doctors and nurses had done theirs and the rest was in God’s hands. He was with us through this entire process and I felt at peace that the answer that came with the next phone call would be ok – whatever it was.

Because there’s usually around a 50% rate of decline with each step and we’d had about that when going from eggs to fertilized eggs, I was hoping we’d have around the same percent with this next step. So I was hoping that 6 or 7 fertilized eggs at the most would to make it to blastocyst stage/embryos, but fully knowing it could be fewer. And might even be likely to be fewer. Who knew?

The other thing was that the bloating didn’t go away immediately. I was still very uncomfortable and (sorry for the TMI) SO constipated. I hadn’t really been warned about the constipation and I won’t go into detail, but I’ve never experienced that before and it was an issue for a couple of weeks. That honestly may have been the worst part. Fortunately, my body has recovered now.

So about a week after retrieval we got the call. We had 8 embryos make it. EIGHT! To say we were thrilled is an understatement. It was the best news.

IVF retrieval results

So next (because there’s always another step in this process), was sending off the biopsies of the embryos for PGS testing to see if they were all chromosomally normal. That waiting period was about 2 weeks.

During that time I did my best to get my body back to feeling good. The retrieval process is kind of brutal on the body. Between the bloating and constipation, it didn’t feel like my own body for a bit. When I finally got my period (which BTW was maybe the worst period ever – SO crampy!), things eased up. When doing the PGS testing, it means you’ll do a frozen transfer, instead of fresh (which would have meant transferring an embryo into my uterus right away basically). I’m really thankful we decided to do the frozen transfer after the PGS testing was done. That month gave my body a chance to recover and I think it’s the best thing. I felt like me again and was ready to start the next phase.

When we got the call about the genetic testing, I had been hoping that maybe 4 or 5 embryos would come back normal. I was shocked to hear that 7 of the 8 were normal and completely healthy. I couldn’t believe it!

So we officially have 7 healthy embryos frozen and waiting.

We met with our doctor to discuss the results and the embryo grading. Basically the grades come like this – a number, then two letters. The number refers to the amount of fluid in the embryo indicating development, the first letter is for the mass of cells on the inside of the embryo that would become the baby, and the last letter is the outer cells that would become the placenta. A higher number is better, and an “A” is better than a “B”. Is a higher number or high letter more important? That seems to be debatable, but here were the grades we were given.

4AA
4AA
4BA
6BA
6BB
6BB
6BB

We know that 2 of those are girls and 5 are boys. And we know which are which, but we aren’t saying anything more than that. We have some family and friends that know all that information and we’ve decided to keep our decision about moving forward a secret for now. Revealing anything more would reveal our decision – to you and to them – and we aren’t ready yet. All the embryos are healthy and ready for transfer. Which one will be transferred will be revealed after the fact. It won’t be a surprise for us, but we want it to be a surprise for everyone else. 🙂

I will say that finding out the gender of the embryos was an incredibly emotional thing. Neither of us expected it, but it just made everything so much more real. The embryos aren’t just embryos, they’re our boys and girls. It’s hard to even believe sometimes. We love them so much already.

………

About a week ago, I began the medications for the transfer round. I won’t go into detail about it all – I’ll save that for another post. But so far, so good. The transfer is set for June 16, assuming all goes according to plan. By June 26, we’d know whether or not I’m pregnant. I won’t promise to reveal the answer right away. Regardless of the answer, we’ll need time to decide things. But I’m hopeful and would love any prayers you continue to send our way.

As I’ve said before, I remain grateful that this whole process has been an option for us. And I can’t even begin to express how thankful I am that it’s gone as well as it has so far. I have friends who have much a much tougher road. I know how fortunate we are. I still don’t know how it will all turn out, but I’m thankful to the Lord for seeing us through it all. There have been moments of fear and doubt, but there have been many more moments of faith, trust and grace. For that I’m so grateful.

“He gives strength to the weary and increases the power of the weak. Even youths grow tired and weary, and young men stumble and fall; but those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.”

Isaiah 40:29-31

“The LORD is my strength and my shield; my heart trusts in him, and he helps me. My heart leaps for joy, and with my song I praise him.”

Psalm 28:7