The Process (written 30th January 2015)

After a few random questions on what we’re going through this cycle I’ve decided to write a post on the different stages we’ve completed and what is yet to come. Assuming we’ve contacted the clinic, chosen our donor, passed all pre-work (which we have) this is what is happening from start to finish of our cycle. Here goes.

  • Suppressing my cycle. Just after the period I have following my evaluation cycle, I start on birth control pills (seems totally contrary to what we’re trying to achieve right?!?). Just over a month later, on the 5th of January, I inject myself with Lucrin (known as Lupron in other parts of the world), another drug designed to suppress my cycle. I’ve previously nicknamed this drug “Lucky Dip Lucrin” as when taking the daily injections in my 2nd IVF cycle it was a lucky dip as to what side effects I’d have each day. Luckily this is the monthly dose, which I don’t seem to have as much of a problem with.
  • Supplements: I begin (or in some cases continue) a range of supplements, which assist my body get into the best shape possible for our cycle. These include a pre-natal multivitamin (exceedingly hard to find in New Zealand so I have to opt for a ‘pregnancy & breast-feeding’ one, and boy do I feel like a fraud taking that!), folic acid, iodine, and a low-dose aspirin.
  • Blood test and ultrasound #1: This is a baseline scan that essentially checks the starting point for our cycle. They measure the thickness of my uterine lining and make sure my ovaries have been suppressed by the last few weeks of drugs so that they aren’t producing any egg-containing follicles. For us this occurs on January 12th.
  • Estrogen substitutes: I start taking Progynova (estradiol valerate) on the 13th of January and will continue taking this (hopefully) until my 12th week of pregnancy. Beginning with a low dose (one pill in the evening) I slowly build up my dosage until I am taking five tablets a day. This drug helps to grow my uterine lining to a decent thickness (anything greater than 8mm) so that it is ready to receive our embryos when we get to that point.
  • Donor scan and meds: Our donor has her own baseline scan and blood-work done in San Diego on the 15th of January and is all set to start her medication on Saturday January 17th. We’re not informed of what drugs she’ll be taking but assume that it will be similar to the ones I’ve taken in previous cycles – some kind of follicle stimulation drug (Gonal-F or Follistim for example) to encourage her ovaries to produce a multitude of egg-bearing follicles; and not long after, a lutenizing hormone antagonist (e.g. Cetrotide) to stop her body from ovulating before we need it to.
  • Blood test and ultrasound #2: Another blood test and internal ultrasound to make sure my uterine lining is developing and that everything is on track for our cycle. Both bloods/ultrasound #1 and #2 occur at our clinic in New Zealand. #2 occurs for us on the 20th of January.
  • 23rd of January: We head to The States! I inject Clexane, an anticoagulant, three hours before we fly, to help prevent blood clotting issues such as deep vein thrombosis. Not only does flying increase the risk of such problems but the estrogen substitute I’ve been taking also adds to the chance of such issues arising.
  • Final blood test and ultrasound: A final set of bloods are done and yet another date with ‘dildocam’, this time at the clinic in San Diego ensure that my lining has reached an acceptable thickness (it needs to be 8mm and mine is 7.6mm, but not to worry, they round it up to 8mm, phew!). 27th of January and we’re good to go! Our donor also has an ultrasound today and from this the clinic determine the dates for egg retrieval and embryo transfer. At the point in time of this ultrasound our donor is showing between 35 and 40 follicles, which will hopefully result in anywhere between 24 and 32 eggs (they expect to retrieve eggs from 70-80% of follicles).
  • Donor trigger: Once the clinic has assessed our donors scan results they decide that egg retrieval will occur on Thursday 29th In order for this to happen our donor needs to ‘trigger’. This mean she injects herself with a human chorionic gonadotropin (hCG) product (e.g. Ovidrel) to instruct her body to put the finishing touches to the maturation of the eggs, and to begin the process of ovulation. Our donor won’t actually ovulate normally as the clinic will extract the eggs before this can occur. However, by setting ovulation in motion, it becomes easier for the clinic to retrieve our donor’s eggs and allows for their final maturation process.
  • Egg retrieval: Just what it says. Our donor heads into the clinic and the docs there remove all the lovely eggs she’s been growing for us. As mentioned above, this happens for us on the 29th of January.
  • Sperm collection: At the same time our donor is having her eggs collected, my husband drops his sperm sample at the clinic so that it can be ‘washed’ and ready for the fertilisation process.
  • The first set of numbers: Later on the day of egg retrieval the clinic contacts us to let us know the number of eggs collected during the morning procedure. This is our first anxious wait, hoping for the best result possible. It’s good, we have 27 eggs collected and of those 26 are mature (able to be fertilised) with the final one having the potential to mature in the couple of hours before insemination.
  • Insemination: Once both the eggs and sperm have been washed (cleared of any excess debris not actually related to the sperm or egg). The lab fertilise our donor’s eggs with the sperm my hubby has provided. There are different ways to do this. The simplest and possibly most common way is to introduce multiple sperm into the petri dish the egg is contained in and let them fight it out, much as they would if the embryo was conceived ‘normally’. For our cycle we’re doing things a bit differently and are using a process called intra-cytoplasmic sperm injection or ICSI. In this process a single sperm is selected and manually inserted into the egg. This of course has its pros and cons. It makes the fertilisation rate much higher but it also increases the risk of the embryo or child having something wrong with it as it’s not necessarily the strongest sperm making it to the egg. The increase is very small though, so in the interests of getting the best possible result overall we’ve agreed to go with this option. The day of egg retrieval/insemination is known as ‘Day 0’.
  • Fertilisation report: The day after egg retrieval/insemination (January 30th for us) we receive a fertilisation report from the lab to let us know how many of our eggs have fertilised into embryos. For me this was one of the most harrowing times of the process so far, I think perhaps because this is where everything has gone wrong in our other cycles. The news this time is good and 24 out of the 27 (yes our last little egg that was lagging behind in maturity caught up) have fertilised. At this stage, day 1, the embryos are only a single cell. Tomorrow they will start to divide and we will begin to see differences in their development and quality.
  • The daily updates (this is currently the stage we are up to as I write this): From now until transfer day we will receive daily updates as to how our embryos are doing. On day 2, the second day after egg retrieval/insemination the embryologists begin grading our wee embryos. They look at the number of cells each embryo has, the quality of the embryo (poor, fair, or good – a call dependant on various factors such as the graininess/transparency of the embryo, the symmetry etc.), and finally the amount of fragmentation the embryo has (this is the amount of excess waste generated by the dividing embryo. A heavily fragmented embryo, much like our embie in our first IVF cycle, will have a lot of this waste trapped within the embryo itself rather than excreted and expelled).
  • Pre-implantation genetic screening (PGS): Most normal IVF couples would proceed with the daily updates until it was decided the embryo/s were ready for transfer. Again, we’re doing things slightly differently and have elected to pay extra to get pre-implantation genetic screening, or PGS, done on our embryos. This is more insurance for us, having travelled so far, that the embryos we implant are chromosomally correct. This will hopefully reduce the chance of miscarriage further down the track should we be lucky enough to fall pregnant. The testing, which for us will occur on day 5 (the 3rd of February), involves taking a few cells from each of the embryos chosen for assessment. These cells are then examined under a microscope to determine whether they have the correct number and arrangement of chromosomes, and any abnormal embryos are discounted. Abnormal embryos might result in a pregnancy (although pregnancy is less likely) but are far more prone to miscarry before full term. The standard number of embryos tested is 8 but, due to the number of embryos we currently have at day 2 we’ve decided to pay to get a further 4 examined. We’re not going to get this chance again and figure it will give us peace of mind that any embryos we’re able to freeze for future use will be chromosomally normal.  It’s also at this stage that you can find out the sex of your embryos and can choose whether you want girls/boys/one-of-each transferred into you.  We’re opting to go for the two best-looking/highest quality embryos and leave they sex of them to chance, we want that to be a surprise further down the track.
  • Egg transfer: This is it, day 6 (4th February). Decisions are made on the best quality embryos and we head into the clinic for egg transfer. Finally I get to play my part in this process. Because we’ve selected the success guarantee program (essentially, “we guarantee you a baby or your money back”) I am to have two embryos transferred into me.   Basically I rock on up to the clinic, pop my legs in the stirrups and have two little embryos inserted into my uterus via a catheter. Having been at this stage twice before (with less than ideal embryos) I have some idea what to expect. Every clinic is different though so there may be some slight disparities in what I expect and what will actually occur. I know of one already. Back home in New Zealand, our clinic performs this transfer with a full bladder. I consume 750ml-1 litre of water an hour before transfer so that by the time I get in there I’m desperate for a pee. It’s horrendous for the patient but helps the doctor with both ultrasound visibility and with the uterus’ position. Thankfully our San Diego clinic is able to perform the egg transfer without the exceptionally uncomfortable full bladder, so I am one happy camper!
  • Home time: A couple of days of relaxation then it’s time to head home. On the 6th of February we’ll drive back to LA and hop on a plane bound for New Zealand, hopefully with two very precious cargo still on board. Another shot of Clexane 3 hours before the flight and away we go!
  • Test time: The nerve-wracking two-week-wait (2ww) and pregnancy test. A couple of weeks after we arrive home I’ll have a blood test to determine whether all this has worked or not. It’s an excruciating wait, not helped by the fact that our test day will be delayed due to the San Diego/New Zealand time difference, and clinic hours. I hope the wait will be worth it. Wish us luck!

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