IVF Cycle Three - Trigger Shot

 

Last Day of shots. YAY! On day 13 of this cycle. Tonight I trigger at 10:30pm. Monday I get a break from all meds. This time I will be doing two Ovidrel shots instead of one. We are hoping by doing this more eggs will be mature. I am trying to drink as much as I can and snacking on some potato chips for salt to help prevent OHSS next few days. Not looking forward to the shots tonight as usually a few hours after trigger I get back cramping and feel sick.

ER is set for Tuesday got to be there at 8:45am with procedure at 9:30am. Getting nervous that my eggs will be better this time and more mature. Depending on the results we may hold off and do a day 6 transfer cause if we did it on day 5 which is Christmas Day just the two Dr.'s would be there and maybe better to do it when the nurse and lab tech are also there but Dr. said we will see, have to get the eggs fertilized and they need to grow in the lab first.

Cycle Comparisons for Day 13 or Trigger Day

Cycle #3 
Estradiol: 609.9
Progesterone: 2.07
Follicles:
LS: 20.36, 18.2, 17.16, 14.92, 12.52, 11.8 < 10mm 10+
RS: 21.61, 19.57, 19.43, 19.36, 18.6, 17.88, 17.34, 16.54, 16.19, 13.02 < 10mm 10+

Cycle #2
Estradiol: 1515.7
Progesterone: 1.72
Follicles:
LS: 21.45, 20.55, 20.19, 18.1, 17.3, 15.88, 15.72, 14.02, 11.9 < 10mm 10+
RS: 18.63, 18.61, 18.02, 17.05, 17.01, 15.92, 13.59, 11.26 < 10mm 8 to 9

Cycle #1
Estradiol: 703.4
Progesterone: 3.30
Follicles:
LS: 8.38, 17.8, 17.11, 16.62, 16.43, 16.38, 16.24, 15.39, 15.24, 13.2, 12.52, 11.98, 11.74, 11.74, 10.74, 10.09 < 10mm
RS: 19.69, 19.04, 18.58, 16.3, 16.2, 15.21, 15.18, 12.9, 12.6, 11.55 < 10mm

How is IVF performed - what's the process?

 

Step 1 - Preparation
Both partners go through a variety of tests. These vary from one medical center to another, but often include hormone tests for the woman, AIDS and other tests for both partners and a sperm analysis for the man.

The medical center decides on a treatment plan -- how the egg production will be stimulated in the woman and when it will begin (on what day of the woman's cycle). This is what is referred to as your IVF protocol.

Frequently Lupron (also known as decapeptyl) is used to help the doctors take full charge of your hormones. It depresses your natural hormones, making the medication the sole source of ovarian stimulation.

Egg production is stimulated using hormones (e.g. Pergonal, Repronex, Fertinex, Follistim, Gonal F, Novarel, Ovidrel, Pregnyl, Profasi, and Menogon and Puregon), with the goal being to produce a "good" number of eggs to help increase the chances of having several viable embryos. (Good is defined differently in different medical centers). When too many follicles begin to ripen simultaneously, it raises the risk for OHSS (ovarian hyperstimulation syndrome).

The stimulation of egg production takes anywhere from several days to close to two weeks. During this time the woman is monitored closely using ultrasound and blood tests. It is very common to make changes to the IVF protocol during the stimulation process.

What you feel: You may feel swollen or bloated from the multiple follicles that are growing. You may feel irritable or have other symptoms as a result of the hormone injections and you may feel anxious about the egg retrieval process and the success of your cycle. Many clinics now offer support groups for their patients.

Step 2 - Ova or Egg Aspiration / Retrieval
Once the eggs are ready, they are aspirated or retrieved using a needle that goes through the vaginal wall and into each follicle.

This procedure is generally performed using light general anesthesia. It usually takes less than an hour from the beginning of the preparation until the woman wakes up from the anesthesia.

What you feel: After the procedure, you may feel some discomfort and you may continue to feel bloated. If you feel any significant pain or change in your general feeling, it is important to report them to your doctor or medical center.

The man is asked to give a sperm sample. He may be asked to come in with it in the morning or may be ushered to a private room... (see information about giving a sperm sample)

Step 3 - Fertilization
The lab evaluates the ova and the sperm and decides how to proceed. The end result is hopefully embryos.

Depending on the local policy, you may have information about the number of embryos as early as the following morning.

If the protocol calls for ICSI - Intracytoplasmic Sperm Injection - it is perfomed at this time. ICSI is generally used in cases where the sperm quality is very poor and fertilization would not occur naturally, such as in cases of poor (or lack of) motility. An individual sperm is selected and injected into the egg.

The initial fertilization rate is not always the number of embryos that will be available for transfer. Some eggs fertilize and then do not continue to divide properly. Depending on the decisions made at your particular medical center, only embryos of a certain quality level are recommended for transfer.

Step 4 - Embryo Transfer
Once the embryos are formed and have started to grow, it's time to put them where they belong - in the uterus.

One or more embryos are transferred to the woman's uterus using a catheter. The process is similar to IUI (intra-uterine insemination) and is usually painless. You may be asked to empty your bladder before embryo transfer. You may also be offered photos of your embryos.

Step 5 - Waiting
Maybe one of the hardest parts of the whole process. The two-week wait. It might only be two weeks, but it seems like at least 2 months.

Support in the form of progesterone suppositories or injections may be given. This helps keep the progesterone levels high, to increase the chance of a pregnancy being established.