IVF PROCESS

- DOWNREGULATION

Beginning July 9, 2007, I took birth control pills and then began Lupron shots and dexamethasone pills. The purpose of this down-regulation protocol was to reduce likelihood of cysts as well as ‘recruit’ follicles without initiating premature maturation.

Since I had the pesky cysts last time, the first countdown was to the suppression check on August 2, 2007 (results shown here). That morning, the Reproductive Endocrinologist (RE) did an ultrasound to measure the lining of the uterus, determine the number of resting antral follicles, and the presence/absence of any cysts. I also had some bloodwork, E2 (Estrodiol) to measure the level of Estrogen in my system. It needed to be less than 50 to proceed with the ovarian hyperstimulation.

- HYPERSTIMULATION

Ovarian hyperstimulation began Aug 4, meaning I had shots in my stomach twice per day in an effort to grow the available follicles in preparation for egg retrieval. During this process, I had regular ultrasounds and bloodwork (like every other day) to measure the progress of the follicle size and estrogen levels. Any given day’s results would determine the timing of the next appointment until the fragile balance of follicle size to estrogen levels were achieved for retrieval.

- RETRIEVAL

As adviced by my clinic, I took the day off for the egg retrieval. The procedure itself was painless and done under conscious sedation. Which gave me the opportunity to be administered my most favorite drug that I can’t ever remember past the first four seconds…and that is Midazolam, more commonly known as Versed. But darnit, those four seconds, the world is so very clear and I feel so capable! I had cramps afterwards for about an hour – think heavy period sans Aleve.

- FERTILIZATION AND TRANSFER

After the egg retrieval, the embryologist injected the viable eggs with a single sperm in an effort to achieve fertilization. This process, known as Intracytoplasmic Sperm Injection, or ICSI, is better described here. We had hoped that at least 1-2 fertilized eggs would continue multiplying cells for at least 3 days. Depending on the cellular structures, we would then transfer the 1-2 embryos back in three to five days after fertilization. I was to be on strict bedrest for 48 hours after the transfer.

ACUPUNCTURE:

Throughout the IVF cycle and for many months leading up to it, I concurrently received acupuncture treatments. I went about every 10 days. To be perfectly honest, I don’t know much about how it “works”, but I had read studies that it does. And more importantly, I BELIEVED that it would. I’m mostly Type A, and one thing I’ve learned in the process of trying to conceive is that we have to LET STUFF GO. With that, I stopped charting and reading medical journals and looking for explanations, and instead, started meditating and relaxing. But there’s a good summary here of how acupuncture can improve the outcome of Assisted Reproductive Technologies, such as IVF.

When I first started acupuncture, my cycles (Basal Body Temperatures) were all over the board. Acupuncture has helped regulate my cycles and help with my stress (that’s a needle in the top of the head, by the way; and just inside your ears). I very much looked forward to my sessions. I was very lucky to reside in the same city with a renowned fertility acupunture clinic. The founder published a book, entitled The Infertility Cure, which describes how Traditional Chinese Medicine (TCM) can be used to assist in conception. I also purchased the book and reference it often for ideas on dietary consumption. It’s amazing how these things actually help, though the only proof I have is this. There is also a survey in the book that helps you diagnose, through TCM, any fertility issues and gives dietary suggestions and pressure point illustrations for helping yourself.

One week before my Lupron shots began, I started going twice per week up and will continue that schedule up until transfer.

Conception is a Miracle.

***WARNING*** Proceed with caution. The amount of details will might compel you to make some snarky comment about the amount of details. But these details are not for you. These details for those like me who, upon embarking on the IVF train, hungered for information about how much of what you’d take when and in what form and how long it might take and what things look like. 50% of the reason I put this together was because I never could find anything that was comprehensive enough. The other 50% is because I’m a total nerd I am teaching myself HTML and was looking for a project to practice making tables in code.

CD1: 07/07/07
BCPs: CD3-CD19 (17 days)
Acupuncture: CD3, CD11, CD20, CD25, CD28, CD31, CD33, CD39, CD42, CD45
Lupron/Dexmethasone: 10IU CD17, then 5IU beginning StimDay1/CD29 thru end of stims
Stims: Begin CD29 thru a.m. CD38 (9.5 days)
Retrieval: 16 eggs retrieved, 13 mature enough/available for fertilization with ICSI; 9 fertilized – 69% fertilization rate. Clinic expects to see 50%-70% fertilization rate.
Transfer: Day 5 Transfer; 2 blastocysts 4AA and 4AB

Day of Week THU FRI SAT SUN MON TUE WED
Cycle Day (CD) 27 28 29 30 31 32 33
Stim Day N/A N/A 1 2 3 4 5
Lupron Dosage IU 10 10 5 5 5 5 5
Gonal F Dosage IU (a.m.) N/A N/A 225 225 225 225 225
Repronex Dosage IU (p.m.) N/A N/A 225 225 225 225 225
E2 Level 43 239 774
P4 Level
Follicle # > 10 mm 0 6
Size Range (of >10 mm) 0 11.1 – 11.9
Follicle # <10 mm** 9 15
Other Information(c) SC AC AC AC

Day of Week THU FRI SAT SUN MON TUE
Cycle Day (CD) 34 35 36 37 38 39
Stim Day 6 7 8 9 10
Lupron Dosage IU 5 5 5 5
Gonal F Dose IU(a.m.) 225 225 225 225 225 0
Repronex Dose IU(p.m.) 225 225 225 225 NONE
E2 Level 1632 3725 4783
P4 Level 0.39 1.35 7.08
Follicle #>10 mm 11 14
Size Range (of >10mm) 10.6-14.8(a) 15.1-21.3(b)
Follicle # <10 mm** 8 9
Other Information(c) 5000IU hCG AC; hCG 131

(a) Stim Day 7 follicles: 14.8, 14.8, 14.0, 13.9, 13.9, 13.4, 12.8, 11.8, 10.9, 10.6
(b) Stim Day 10 follicles (trigger hCG day): 21.3, 21.0, 20.4, 20.0, 19.9, 19.7, 18.7, 18.6, 18.5, 17.7, 17.5, 15.9, 15.9, 15.1
(c) “SC”=Suppression Check day; “AC”=Acupuncture

Embryo ID 1 2 3 4 5 6 7 8 9
Day 3 Cell # 8 8 7 8 6 6 6 5 2
Day 3 (8/18) Grade (d) 4c 4 4c 2 3 3 2 4 4
Day 5 (8/20) Grade (e) 4AA 4AB 4AB 2 MC MC MC MC MC
(T)rnsfr (F)reeze (D)iscard T T F ? ? D D D D

(d) Multicell embryos that recieve grade 3 or 4 often develop to the blastocyst stage, those receiving grade 1 or 2 rarely develop to the blastocyst stage.

Grade 4: even cell division, no fragmentation
Grade 3: even cell division, small fragmentation (normal)
Grade 2: uneven cell division, moderate fragmentation
Grade 1: uneven cell division, excessive fragmentation
*Sometimes the laboratory uses the reversed scale. Check with your lab.*

(e) The first letter refers to the inner cell mass (the part of the blastocyst that is going to be the baby), the second letter refers to the quality of the trophectoderm (the part of the blastocyst that is going to be the placenta). According to RE, anything above BB is very good, with 4AA being the best. The first number refers to the degree of expansion; at my clinic this is on a 4 point scale, 4 being the highest.

Other notes of interest…

  • If there is a drop in E2 after trigger, then indicates poor egg quality. That’s whey they check the day after. If it’s rising, it’s a good sign.
  • Want to see absorption of hCG of at least 75 the day after trigger.
  • Rise in P4 after trigger indicates LH surge in progress

The Betas
Beta #1 – 08/29. 9dp5dt or 14DPO: hCG =260
Beta #2 – 08/31. 16DPO: hGC=422; P4=60; E2=1332
Beta #3 – 09/04. 20DO: hCG=1742; E2=1571

I found these websites helpful in my obsessive research:
Embryo Quality Information
Day 3 vs Day 5 Transfer

MY TTC/IVF RESOURCES:

Houston IVF (IVF clinic)
Eastern Harmony (acupuncture and herbs)
Xytex Corporation (donor source)
The Board” (Northwest Cryobank chatroom)
Pregnancy Calculator (for IVF and non-IVF alike!)
Hormone Levels and Fertility Bloodwork
Betabase (good source for beta obsessing)

IVFy VISUAL AID:
IVF 101 - For The Visually Inclined