Embryo Transfer

So in a last minute call from my clinic, the embryologist decided that he DID want to transfer the embryos today instead of Wednesday. We made the two-hour drive in about an hour and a half (we would have loved a police escort) but we arrived safely.

The procedure was done adjacent to the cryogenics lab. We even got to peek inside. It's so amazing; the floors around the cryo-tanks peel (even concrete) because it's so cold! The doctor doing the transfer told the embryologist to prepare the embryos and then the embryologist just popped out of the cryo lab and handed them to him. The transfer took just seconds and we were able to see the two "embryos," well actually just the tiny bubble they were riding on, as they entered my uterus through the tubing. Truly incredible. I can't say enough about how insane it was to watch. After that the embryologist checked the catheter to make sure that the embryos weren't still in it and that was it! Other than the ridiculously full bladder I had (necessary for the procedure) it was an enjoyable day at the clinic.

OH! And I actually have a picture of the two embryos that were transferred today. I'm hoping to be able to say to my kid(s) one day, "hey, this is you three days after conception when you were only eight cells big." Who gets to have a picture of their eight-celled children?? I do! I do! I'll have to make Jonathan scan it so that everyone can see our amazing little Strunk babies.

Embryos are graded like students: A=excellent, B=good, C=not so good (but passing), D=boo for you. So out of our ten embryos, we have three grade A (two of which were transferred today), two grade B, and five grade C.

The two B's and one A left over will be frozen today for potential use if this cycle fails of if we want more kids. The other five will be given a couple more days to grow to see if they would be strong enough to make it through a thaw. If there are any of those five strong enough after two more days, they will be frozen along with the three from today. It gets confusing even to me so if you're lost you aren't alone.

So far so good.....

Hi everyone! It's Melissa again. Thanks so much to Jamie for keeping everyone in the loop while I was out of town all weekend. And thank you for the prayers. They're working and God is working miracles at a laboratory in Atlanta!

The IVF nurse called me this morning and said they're 90% sure that the embryo transfer will be on Wednesday but we'll know more tomorrow morning. This is great news. The longer the embryos have to grow, the better the embryologist can "weed out" the weaker of the bunch. Of course I'm hoping they'll all be strong and fabulous and they'll have trouble picking out which two are the best for transfer because all 10 are so great.

More updates tomorrow....

Egg Update

Melissa just texted me and reported that of the 24 eggs retrieved, 20 were mature and 10 of those fertilized. Now we just pray that they keep growing. They're on their way!!

All for now!

JCD

Egg Retrieval Update - She's awake!

Hi Again! (It's me, Jamie)

Jonathan just text messaged me and said that Melissa is awake and doing well.
The doctor told her (and I'm quoting Jonathan here) that "she was an egg machine" and that they counted 24 eggs - two years worth!

On Saturday, they will know how many mature eggs were retrieved and how many fertilized.

All for now!

JCD

Say a little prayer!

Good morning!
My name is Jamie Dickson, Melissa's best friend. As you all know, she will be having the egg retrieval procedure at 8:30 this morning, so I am reminding you to please pray for her and Jonathan as they take another step towards parenthood.
I'll be posting updates today and tomorrow, so stay tuned. =)

And, on behalf of the Strunks, thanks for your prayers.

Jamie C. Dickson

Egg retrieval: Friday 8:30am - Prayers Please!

Ok, so this should be a short post because I've got to take Cleveland to the vet in a few minutes.

I just got a call from our IVF nurse and the Pregnyl (trigger shot to "trigger" ovulation) is to be administered tonight at 8:30pm. That puts egg retrieval at precisely 8:30am Friday. We'll be at the clinic from 7am that morning, but if everyone could please put a note on your fridge, bathroom mirror, blackberry, iphone, WHATEVER to pray for us and our doctors at 8:30am Friday, we would appreciate it very much. I don't care if you're Budhist, Jewish, Hindu, Christian, or atheist; just pray. I promise we will appreciate it all the same as I am extremely nervous, not necessarily about the procedure but the quality of my eggs and their successful fertilization.

We won't know until Saturday how many mature eggs were retrieved and how many fertilized but I will update as soon as I know.

Thanks everyone! By the way, this is the prayer I have been repeating to myself for comfort over the past few days:

"May today there be peace within.

May you trust God that you are exactly where you are meant to be.

May you not forget the infinite possibilities that are born of faith.

May you use those gifts that you have received, and pass on the love that has been given to you.

May you be content knowing you are a child of God.

Let this presence settle into your bones, and allow your soul the freedom to sing, dance, praise and love. It is there for each and every one of you."

One more day of FSH

Nancy, our IVF nurse, was VERY pleased with the progress my ovaries are making. She and our reproductive endocrinologist ordered one more night and one more morning of FSH. This means that tomorrow night Jonathan will give me the trigger shot.

The trigger shot is hCG (that's right, the pregnancy hormone) called Pregnyl and will cause my body to ovulate. After five straight days of forcing hormones to STOP by body from ovulating, the Pregnyl is administered to convince it that yes, it IS time to ovulate and that it needs to be on time. And it must ovulate precisely when egg retrieval is being performed in order to capture the most number of mature eggs possible. My clinic will let me know tomorrow what time to give myself the Pregnyl and exactly 36 hours later I will be under the knife....er.... needle that is.

I've been freaking myself out all afternoon googling images of egg retrieval. These are not graphic, thank goodness but they are still unsettling when I think about all that is at stake. http://www.avapeter.com/p/en/483-1.gif

I will be under "twilight" anesthesia for Friday's egg retrieval. It is similar to the anesthesia used for dental work and colonoscopies; I will be semi-awake and able to respond to commands but will I won't remember a thing. Which is great, because I'm pretty sure that stuff could haunt your nightmares.

While I am under, Jonathan will be providing a... sample.... to fertilize the eggs. Each of my eggs will be fertilized by a procedure called ICSI, or intracytoplasmic sperm injection. It sounds complicated and I'm sure it's not easy but it's simple enough to break down; ICSI is basically just injecting one single sperm into one single egg with a microscopic glass needle. Technology is amazing, isn't it?

Jonathan and I will get a call sometime Saturday to let us know how many eggs were retrieved and how many were mature enough for the embryologist to fertilize with ICSI. Then we wait for more news as the microscopic embyros grow. After three to five days of growing, we will hopefully have at least two embryos to transfer back to my uterus. The rest will be frozen for later. We're desperately hoping that "later" means when the kid conceived this month is ready for a sibling and not "later" this year because this IVF wasn't successful.

It is really hard to believe that we're getting ready for egg retrieval. This has been months, even years in the works. We actually have a 50% or greater chance of becoming pregnant next week. Incredible!

Overdue update

Let me first apologize for the delay in updating the blog. We were in Atlanta all weekend going to IVF appointments AND having a little bit of much-needed fun with the family.

My medication dosage was increased on Thursday afternoon and I've been trucking along on the new dosage since then. My estrogen levels have been right on track; this is great news because serum estrogen levels are one indicator of how many follicles I've got and how ready they are for retrieval. For every mature follicle, there should be approximately 200-250 units of estrogen. As of today, my level was at 702. There were 20 (!!!) measurable follicles on ultrasound today. My doctor seems certain that at least 14 to 15 of them will make it to maturity by Friday, my (tentatively) scheduled day for egg retrieval.

On Saturday, my doctor added Ganirelix, another injectible medication, to my daily regimen of drugs. Ganirelix stops the LH (luteinizing hormone) surge that causes ovulation. By giving myself the Ganirelix injeciton every morning, I am forcing my body to wait for ovulation until it is time. It burns and itches more than the Follistim injections but that's just because of the slighly larger needle.

For the next couple of days, I'll continue to give myself the Follistim twice daily and Ganirelix in the mornings. I go in for more labwork and another ultrasound tomorrow morning and should know by tomorrow afternoon if my egg retrieval will be set in stone for Friday. I'm really hoping that it will be because that will give more follicles a chance to get mature enough and potentially get to the 20+ egg retrieval goal my doctor had set for me.

We have definitely felt everyone's prayers and well wishes pulling us through this past week. So far, it has been less stressful than all of last year's treatments. I am not sure if that is because we finally feel like we have the opportunity to pursue a treatment that we feel will be successful for us or if it's the fact that we've shared our struggle with everyone and so they have been able to pray for us. Perhaps it is a combination of both. Either way, we are SO GRATEFUL to everyone and everything you are all doing for us, from my mom buying low sodium beans because she knows that I'm supposed to be eating very little salt to prevent OHSS and replacing her flourescent light bulbs with incandescent so that I won't get a migraine to Jake and Jamie always offering to feed our dogs if we get home late from appointments. Thank you so much. Please continue to keep us on your prayer list.

AFC = 30!

We had a wonderful day yesterday at the clinic. We found out that my antral follicle count (AFC) was 30! The AFC I had done in June was 20, which is still a great number, but 30 is fan-friggin-tastic!

Because each fluid-filled follicle should contain an egg, an AFC test gives the doctors an idea of how well you could respond to the medication and is the potential number of eggs that could make it to maturity by egg retrieval time. However, sometimes there are more eggs retrieved and sometimes there are less but it's a good starting point to help understand what our chances are. Here is a great link that shows how promising this cycle looks for us: http://www.advancedfertility.com/antralfollicles.htm (see charts)

Since my doctor would like to retrieve between 20 and 30 mature eggs from me, we are right on track.

I could hardly believe it when after counting 13 follicles on my right ovary, the ultrasound technician just kept on counting with my left ovary until she got to 17! While an AFC of 30 does put me at a slightly higher risk for ovarian hyperstimulation syndrome, or OHSS, it is one of the reasons we have to travel to Atlanta every day for the next week and a half. Our doctor and nurses will be monitoring me very closely through ultrasounds and bloodwork to try and make this process as safe as possible while still successful.

Last night I began the FSH injections. FSH is follicle stimulating hormone. Our bodies (male and female) produce this naturally, but the additional amounts of hormone added are meant to allow as many potential follicles to grow as possible. Right now my dosage is 150IU at 7pm and 225IU at 7am daily. After tomorrow's bloodwork results come back, a nurse will call me and let me know if I need to change my dosages. For now, we'll just wait and grow the follicles until they tell us it's time to go get those eggs!

IVF time!

Hello everyone! I am so excited to announce that it's finally time for our IVF cycle to begin! Cycle day one came early this morning after days and days of waiting. (Thirty-seven to be exact.) That means that tomorrow we'll make the first of many treks to Atlanta to visit with the doctors and nurses and hopefully get the "all clear" to begin the injections tomorrow night.

As for today, Jonathan and I are beginning the first week of our antibiotics to make sure we're both healthy enough to make it through this process. Your prayers and well wishes are appreciated.

I'll be sure to update everyone tomorrow on our protocol and let you know if we are good to go!

Medication has been ordered - major milestone

Hi again! First of all, let me say how encouraging it is to read your comments and messages about the blog. It is always scary to put yourself out there when you've kept family and friends in the dark for so long about your infertility struggle. I appreciate everyone who is following us regardless of whether or not they are posting comments/sending messages.

I called Concord, our fertility pharmacy on Thursday just to make sure they had the progesterone in oil (PIO) that was suspended in ethyl oleate (the thinner oil) that we used for our last IUI cycle. They had told me previously that all I needed to do was give them a heads up so that they could make it and have it ready when I needed it. Well, when I called them Thursday, the tech informed me that they could no longer get PIO in ethyl oleate and that I would have to use the PIO in sesame oil or peanut oil, which are much thicker than ethyl oleate. This means that instead of sticking myself with an 1 1/2 inch-long 25 gauge needle, I would have to stick myself with 1 1/2 inch-long 22 gauge needle. I know this does not sound like a big deal, but it's the difference between large, painful bruising and tiny, tender ones. Above, I posted some pictures of the difference between a 21g needle (I didn't have a 22g on hand) and a 25 g needle so that you could see what a difference this would mean for an intra-muscular injection.

Thankfully, we found a pharmacy that could get us the PIO in ethyl oleate so I won't have to worry about that anymore! All of my medications are being delivered to my job on Tuesday on dry ice. I'll have to run home and pack most of them in the fridge until it's time to use them. I think it will finally seem real when every time we open the fridge, there will be our vials of medication sitting next to the milk and eggs! All but one of the medications we have used before when doing IUI but has been awhile. Thankfully there is a refresher course online I can take if I forget anything.