Wednesday, 4 December 2013

Retrieval day!

FYI - I started writing this post the night before retrieval. Then I was interrupted and didn't finish. Tried again after retrieval, but again didn't finish. Take-home message: retrieval is a busy time.

Yesterday morning was my egg retrieval and they found an extra one! So 13 retrieved total. I only expect 10 mature though, and I'll get the fertilization report and transfer time tomorrow (2 days after retrieval). Retrieval was not fun, but it's over, and after the pain meds wore off (and they gave me a lot  - their words), I was feeling pretty good, and the meds they sent me home with don't make me woozy, which I like. So now I "take it easy" - not bed rest, I need to get up and walk around for 5 minutes every hour. I need to stay well hydrated, and I need to thus pee a lot.

There was a lot I didn't know about IVF injections before I started, and now I feel like a pro. Everyone's protocol is different, but there are some consistent similarities. So I wanted to share what I learned.

Down regulation - I was on birth control pills for 20 days. This started on day 3 of the previous cycle, and then on the 18th day of taking the pills I was scanned to make sure my ovaries were "quiet" and lining thin. The purpose of down regulation is to get your hormones, ovaries, and lining to a good starting point before stimulation. Think lining up at the starting gate. When the scan looked good, I got my instructions when to stop and wait for the next cycle to begin. There are different down regulation protocols, and some women are put on what's called a short protocol, in which there is no down regulation. As much as we all want to get the show on the road, the short protocol is usually used with older women and women expected to be poor responders.

Follicle Stimulating Hormone (FSH) injections - it's just as it sounds. Naturally, your body would produce a surge of this at the beginning of each cycle. In IVF, you start around day 3 taking high doses. I was on two injections daily for 10 days: 225 units of Puregon (cut to a half dose on the last day) and 75 units Menopur. There are numerous brands of FSH, and dose will be determined by a number of factors, but this is a critical part of the protocol. These are also the most expensive of the drugs, easily accounting for 75% of my drug expenses in this cycle. So the older you are (or the older your ovaries think you are, regardless of what it says on your driver's licence), the more you will pay in drugs because this is where most of the variation in protocols occurs too. The higher your day 3 FSH level (naturally), and lower your antral follicle count, the more of these drugs you'll need to produce a decent number of follicles for retrieval. 

GnRH antagonists / agonists - there are several brands of these, and they don't all work in the same way, but they all have the same effect: to prevent you from ovulating before retrieval and let the non-dominant follicles catch up. Ordinarily, about a week into a cycle, one or two follicles would become dominant, and the smaller ones would shrivel up and die. These dominant follicles start producing more and more estrogen, which would eventually reach a critical level that says "we're ready" and initiate the LH surge to kick off ovulation. In IVF, you don't want that to happen, so on the 5th day of FSH injections, I began a 3rd: Orgalutran. It comes in pre-filled single-use syringes so I didn't pay much attention to the dose. I took that with the FSH for the next 6 days. Meanwhile, my follicles kept growing, my estradiol kept rising, but my LH stayed nice and low.

hCG Trigger shot - On the final day of injections (all 3 injections were taken at the usual time this day), and exactly 36 hours before my scheduled retrieval, I took a single shot of Ovidrel. This is a synthetic form of hCG (it's the CG, as 'h' stands for human) that is a stand in for the LH surge. It also came in a pre-filled single-use injection pen. This injection gives the follicles a final maturation push, as well as start to loosen up the follicles for retrieval. Timing of this injection is very precise. This is also the chemical that pregnancy tests react to, so as long as it's still in your urine, you will get positive pregnancy tests. Some women with pee-on-a-stick obsessions test out the trigger - take a test each day and watch for it to become negative or at least fade substantially, then if it starts to get dark again you know that is your pregnancy taking hold, not the trigger shot. I have every intention of doing this, simply because I have a big box of test strips ordered from before my diagnosis, and what else am I going to do with them? I don't see much point in starting this before transfer day but I might.

What the heck, I'll go do it now, I need to see what a positive test strip looks like!

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