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)
16 comments
Comments feed for this article
September 1, 2007 at 11:16 am
Michell
Wow, that’s a lot of work that went into that chart. Not to mention a lot of emotional stuff into the whole picture. I am definitely sending wishes that you will be posting your BFP soon.
September 2, 2007 at 7:48 am
indigoscot
good luck! i have fx that those 2 embryos STICK! 🙂
September 4, 2007 at 11:39 am
Jody
Fxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx!!!!
September 4, 2007 at 2:36 pm
aradia
No snark from me… I’m totally impressed! You’re a supa-star!
September 4, 2007 at 5:30 pm
kittenroar5
So… um… totally delete this… but … um?
September 5, 2007 at 7:14 am
aradia
Bad kitty 😛
September 5, 2007 at 9:41 am
RaJen
VERY bad kitties. 😉
September 6, 2007 at 12:26 pm
Shawna
I love you and your IVF charts!
This chart is perfect and I was just obsessing after being on stims for 6 days and wanted to make sure I was on track!
Best wishes and sounds like things are going great! Congrats!
Shawna
January 3, 2008 at 6:54 pm
Suz
Wow, that’s impressive! The only thing I did was mark it on my calendar.
April 28, 2008 at 5:48 pm
Alicia
I have been following your blog forever now (from the NW boards) and I never realized you had your IVF journey listed over here! How amazing! You are so smart and congrats on the babies!
August 28, 2008 at 2:55 pm
twondra
I just wanted to say thanks so much for putting this together! I’ve been studying it soooo much and getting a lot of helpful information. I think I’m going to get going on the acupuncture…I’ve heard so many great things.
Anyway, I just wanted to say thanks! This page is a huge help!
March 16, 2011 at 5:43 pm
Hogy Kell Csajozni
Wazzup Fella, What you ˙have here greatly have me wicked up to the last sentence, and I must tell you I almost never read through the full length post of blogs ’cause I generally got sick and tired of the gibberish that is presented to me on a daily basis and then I just end up checking out the pictures and the headlines and so on. But your tag-line and the first few rows were great and it immediately got me hooked. Thanks for tearing me out of this boring world! Thanks, really.
January 11, 2012 at 7:54 pm
megvogel@gmail.com
Thanks for a great and informative site. I am on my 5th day of stims of my second IVF cycle. I just made a spreadsheet like yours. Need to catch up on the information I’ve missed though.
What do you think about starting acupcuncture this late in the game?
March 10, 2012 at 3:52 am
frylnrind
All trace holidays to March 8!!!
May 22, 2012 at 10:56 pm
Anonymous
Wish every only the best of luck and a BP
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Lyn
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