Pregnancy and OHSS

I have developed late-onset ovarian hyperstimulation syndrome (OHSS). This is a condition in which the ovaries swell because of increased HCG levels and cause the body to release fluid into the abdomen instead of flushing it out of the system properly. It can occur as a result of the trigger shot prior to egg retrieval, or in my case, because of a positive pregnancy when HCG levels are rising quickly. It varies in severity from mild to severe and can include symptoms such as bloating, cramping, decreased urine output, decreased appetite, fever, weight gain, shortness of breath, etc. There is no actual "treatment" for late-onset OHSS because it is pregnancy-related. All they can do is monitor symptoms and do maintenance therapy, such as procedures to drain some of the fluid, encourage increased intake of fluids that contain electrolytes (like Gatorade), increase protein intake, and increase salt intake.

My case was determined to be moderate. My RE says he sees this in approximately 1 out of every 100 patients and was able to confirm my fluid retention with a ultrasound that showed fluid in all four abdominal quadrants. He was sure I had at least 2 liters of fluid, but they were only able to drain 800 ml. I have experienced some relief in that my swelling is not as severe as it was and the fluid seems to move around from my belly, to my hips, to my back and sometimes seems to decrease in volume slightly (especially after eating my protein and salty foods). I have been assured that OHSS doesn't negatively impact pregnancy, may be an indication of multiples, and is actually a good sign that pregnancy is progressing appropriately.

This OHSS may last anywhere from couple of weeks to the end of my first trimester which means that it is very likely that I may look 5-8 months pregnant for at least 2 more months. None of my pants fit (except for my few pairs of stretchy pants), so I am having to take myself shopping for some maternity clothes to get me through until I can fit into my old clothes again (whenever that may be).

This makes keeping my secret pretty tricky. I had explained at work that I had surgery (I told them I was having a cyst removed when I was actually having IVF) and this is an uncommon complication. It is true...this isn't a common condition and it is related to IVF. However, I'm waiting for other people to start asking because I have literally ballooned overnight.

We told our families on Mother's Day. I'm only 4.5 weeks pregnant, but given the slight complication and the holiday, we thought we could use the extra support. Our closest friends won't be told until after our first ultrasound which has been scheduled at the end of this month (I'll be 7 weeks by then). Other friends, relatives, work people, and general acquaintances will be told after 12 weeks. Almost everyone knows how long we've been trying and how difficult this journey has been, so we want to make it as special as we can when we share our news to each group.

At this point, I hope and pray that this pregnancy goes well and that this OHSS is the only major bump in the road.

BFP

Well, transfer day arrived and we only had 2 blastocysts that made it. We had planned to transfer 2 which meant we didn't have any left to freeze. The blastocysts we had were graded BA and AA, so they looked good. I'm not sure what happened to the other 8, but that left my husband and I to feel a sense of defeat and desperation for at least one of our two little blasts to stick since we wouldn't have anything left to do a frozen cycle later if necessary.

Transfer went well and I felt nothing essentially until four days later when I woke up feeling strange. I felt bloated and fat (I don't usually feel like this, especially when I first wake up), had noticeable cramping and strange pains here and there and my appetite changed...either I wasn't hungry, or was craving foods that I don't eat very often. This went on through the next day as well, so I caved and decided to start testing early. I fully anticipated a negative test this morning when I was testing 6 days after my transfer (and three days early), but it immediately turned positive.

I am cautiously optimistic about this. I know it could be a false positive, but I plan to continue testing until my blood test in three days. In the meantime, I have an appointment to get my progesterone level checked tomorrow, so I might mention it to my RE, but this is the first time I have ever had two lines show up on a pregnancy test, so I'm enjoying the moment for now.

I've been busy!

I kept thinking that I needed to update my progress, but things have been so crazy this month, between taking time off from work and going to appointments and trying to stay on top of everything else, that I just haven't had a chance to update until now. When I left off, I was finishing my birth control and was starting Lupron injections...

Lupron is no fun! It came with headaches and made me grumpy and I was an emotional mess (don't know if that part was the Lupron, or if it was a mix of several factors). Historically when on birth control, AF tends to do stupid things like show up in bits about a week into to pills. She didn't let me down this time, either. Official day 1 was the day after my last birth control pill, but AF had been unofficially around for a couple of weeks already. In spite of this, my baseline testing was good.

Baseline results:
     Estradiol- 38.12
     LH- 3.76

I started my FSH injections shortly after and was fully expecting my emotions to be even crazier. My husband swears I wasn't "that bad," but I felt like I was. I guess I just did a REALLY good job of keeping it to myself, or at least not taking it out on him. I had a couple of anxiety/panic days, but felt pretty good until my CD7 testing. RE's nurse seemed "okay" with results, but she and RE agreed that they needed to bump me up a bit on the hormones (as expected...they always do that to me).

CD7 results:
     Estradiol- 100
     LH- 3.72
     Progesterone- 0.57
     Lining- 8
     Follicles- 7

So, after getting my blood work back, RE decided to double my dose of medication. I was okay with this, but realized I would then need more than I had stockpiled (I bought a lot of my medications ahead of time to "save" them for this cycle, so I could save some money). This sent me into a bit of a panic, which was worsened of course by the meds which prevent me from being able to logically talk myself down from a panic. However, I was sure I had worked this out and was able to relax for a couple more days.

CD10 results:
     Estradiol- 646.88
     LH- 2.66
     Progesterone- 0.43
     Lining- 13
     Follicles- 15

RE's nurse was sure that by day 10, RE would decrease my meds, but they didn't. This sent me into a panic again because my "prior arrangements" had fallen through at the last minute. Fortunately, I was able to order just enough in the nick of time, but as a result of my panic, I skipped a dose and took only a partial dose one day, thinking I would run out otherwise. Fortunately, I was mistaken and had exactly what I needed by the time my additional meds arrived the next day.

Side story...my meds arrived no thanks to the FedEx guy...have never had a problem before, but he delivered my packages (I actually had two shipments of meds I was expecting on the same day) to my neighbor's house instead of mine. My address is clearly posted on my house and my mailbox in front of my house and my neighbor's address is clearly posted on her house as well (right above where he left the packages). I was home and waiting and even saw the truck take off after he left, then noticed that my packages had been marked as "delivered," which immediately sent me racing out the door to try to track down my mail...fortunately, they were still sitting on my neighbor's porch, so I grabbed them and brought them to my house. Lessons learned from this: Don't waive the signature and FedEx doesn't have a way that you can file a complaint.

CD13 results:
     Estradiol- 1,999
     Lining- 13
     Follicles- She stopped counting at 17 and said there were several more, but she said there was no 
                     reason to keep counting at that point.

On day 13, I was informed that I was "ready." Things looked good and they didn't even run all the lab work because my ultrasound and estradiol levels were evidence enough that things were where they should be. I was told to do my HCG trigger that night at 7:30 and my egg retrieval was scheduled two days later...we had to be at the clinic by 7am.

Let me just say that I am a morning person, but to be at the clinic by 7 meant that we were up at 4:45 to take showers, get dressed and head out the door by 5:30 because it is an hour and a half drive from our house to the clinic. It was definitely a long day!

Egg retrieval wasn't like I pictured it would be. The anesthesiologist said that some people are awake through the whole procedure, just medicated enough to keep the pain away. I was really looking forward to this, but no sooner did she put the meds into my IV did I feel them hit me and the very next thing I remember is hearing them tell me they were almost done. What the heck? I missed the whole thing! I had not been adequately prepared for how I would feel after the retrieval, either. I had expected some cramping, but didn't realize that there would also be pressure/bloating/gassy feelings in my abdomen and I further didn't realize that it would make any bathroom activities very painful! I have a high pain tolerance, so it was more uncomfortable than painful, but I think having not been fully prepared for what to expect made it a little worse initially. After I discovered that my feelings were normal, I went online to see how I could help ease the symptoms a bit. For those who may need some support with this, here is what I found... drink lots of fluids (especially ones with electrolytes like Gatorade---yuck!), sleep sitting up (RE had told me this one) for a couple of days, laxatives as needed (and in my case, they were definitely needed), high protein and low sodium diet. I also had pain meds which helped quite a bit, but made me feel really strange, so I used those sparingly. Today is "the day after" and I'm feeling a lot better. All my symptoms are still there, but to a much smaller degree. Hopefully, within another day or two, I'll be feeling somewhat normal again.

Got the fertilization report from the embryologist this morning.

     Eggs retrieved- 15
     Mature eggs- 12
     Fertilized eggs- 10

So, I'm off the hook for a few days while these little guys and girls grow. The embryologist will call us on day 3 to give us an update on how they're progressing and we are planning to transfer 2 of them on day 5. We will be freezing the rest.

I am so excited about how well this cycle has gone. RE's nurse swears I have never before responded this well and she felt really good about how things were progressing. I hadn't always been as convinced, but I do believe several factors may have helped us out: 1. weight loss- I've lost 60 pounds since our last attempt 2. herbs- I have been regularly taking false unicorn root and cramp bark per the recommendation of my herbalist even though most of this cycle 3. time off- I took several days off work to "regroup" and tried to schedule as many of my appointments during those times as I could which helped lower my stress levels. I feel really good about our results now that I know we have our 10 fertilized eggs sitting in an incubator. I'm hoping they develop the way they are supposed to and that our transfer goes smoothly. Then... I am praying that  I will soon be able to announce my first pregnancy after nearly 8 years of trying!

First wave is underway

I have been on birth control pills for two weeks and last weekend, I started Lupron injections. Once AF shows, my dose will be cut in half and I will begin my stimulation medication. Thanks to Lupron, I am now dealing with daily headaches, which are rather unpleasant and I've been a bit grumpy. I sure had forgotten just how nasty these medications are!

This makes me even more thankful that I will be off work quite a bit this month. In fact, this is the only full week that I will work for the next few weeks. I have at least 2 and sometimes three days off every week until May. Depending on how things are looking for our transfer, I'll likely take a day or two off at the beginning of May, too. We shall see how things look in the next couple of weeks.

I had made the decision not to talk to people about our IVF efforts this time because I don't want anyone to bring it up. I don't want to have to give them updates, or give them bad news and if I have good news to give at the end of this, I want to be able to decide when and how I tell them. I have a feeling that my husband has mentioned it to some of his family members because it is suddenly getting brought up by them and somehow they know exactly how much it is costing us. While I did tell him he could tell some people, I really wish he wouldn't have told his family...not yet at least.

I just hope that this roller coaster of a month flies by smoothly and quickly!

Let the countdown begin!

Sort of as expected, things aren't going quite as expected. Haha...why would they at this point? I started taking Provera last week to kick-start things and was due to finish my 10 day regimen today. However, after only 7 days, the crimson tide appeared. Day 1 was officially on Monday, so I called RE's office that afternoon and was told to start birth control pills on Wednesday...today. Looks like we're about a week ahead of schedule all around, which had me panicking a bit, I'll admit. I remember in January when we thought we were going to go through with IVF then (started birth control and set our calendar appointment), that I started freaking out. This time has proven to be no different. I really didn't appreciate enough how nice it was to NOT think about this stuff for almost a whole year. Immediately, we've jumped back into it and I am getting the reminder of a lifetime about how stressful this all is.

I am a lot healthier than I was one year ago. My blood pressure is normal, my weight is significantly less (as of this posting, I've lost 60 pounds). I am exercising more...though admittedly, not much lately. The last time I had blood work done, my results were normal for everything. I know exactly what to expect with this IVF thing. I have had plenty of time to research it, have done enough IUI cycles with the same protocol to know what it will be like. I am more ready than ever. However, I am a mess! I posted a journal note in my online support group about this and I feel a little better about it, but my mind is still playing stupid games with me.

This cycle marks a very expensive, uncertain effort for us to change our lives forever by hopefully being able to start a family after nearly 8 years of just being a couple with no kids. I want a family...we want a family. BUT...I hate feeling like I have to let go of the things I've been controlling over the past year in exchange for only a possibility, not a guarantee. I may be started to get a bit obsessed with my weight loss...I still have more to lose to put me at my goal weight which is within healthy limits, but currently I'm 5 pounds away from my original pre-IVF goal weight, so I'll be satisfied to at least get to that goal. Still, I hate that I'm still shy of the final goal, but I'll get there someday. I've got other things to do first.

The truth is, my brain has already hopped onto the infertility roller coaster again. It doesn't matter whether or not I'm taking meds right now...it's the process, the anticipation, the finances...all of it that puts this ride in motion. It guarantees to be full of ups, downs, twists, and turns and in all our previous experiences, it hasn't ended well. This time, it has to work. There is still no guarantee, but we really have done EVERYTHING we could this time to improve the odds. This would be the ultimate defeat for us if it doesn't result in a healthy pregnancy and it terrifies me to be reminded that even with improved odds, there is still a chance that it won't work. I just can't accept that.

So...as hard as it is, I am going to try my best to lose more weight in the next month before we get in full gear with appointments and medication again. After that, I'm going to try harder than ever to stay relaxed and pray for a miracle and we'll see how things go.

Delays ahead

This seems to be the story of my life these days. Everything was ready to go for IVF at the first of the year. I had been informed at the end of the year that my insurance was changing which promised to include fertility benefits, so everything was set for January.

AF made an appearance and I diligently called RE's office to get the ball rolling. I started my birth control and scheduled my calendar appointment, patiently counting down the days. A few days later, RE's office called to tell me that the insurance company was telling them that I did not have coverage for fertility treatment, so they asked me to follow up to make sure. Well, this turned into a big mess which resulted in cancelling the calendar appointment, stopping my birth control and putting everything on hold while we worked on sorting things out. I cannot even begin to describe the feelings of defeat and anger and disappointment that I felt through this ordeal. It took several weeks for me to even call my insurance company to investigate because I was so upset.

When I did finally get a difinitive response from my insurance company, the news wasn't good. While I do apparently have some fertility benefits, this doesn't include IUI or IVF. Lovely...that's what I needed coverage for. Without help from my insurance, we had to save a little more money before we could get back on track with our IVF plans.

Now it is the middle of March and we have been pinching pennies to save up the rest of what we need to fund this cycle. I was able to get most of my meds (the most expensive ones) at a significant discount and they are tucked away, ready to be used when needed. I started Povera earlier this week to make sure that AF doesn't decide to play any cruel jokes on me and I'm expecting to make the call to RE's office sometime next week. I roughly reviewed my calendar and am figuring that if things go according to plan (for once), IVF should happen at the very beginning of May.

I haven't really talked about things with DH lately. I don't want him to get his hopes up or have it on his mind constantly like I do, so when the calendar appointment gets scheduled, that's when I'll tell him that we're back on track. After this whole ordeal, I really don't think that I want to tell anyone (including work) this time. I have a ton of PTO time that I have to take before May, so after my calendar appointment, I will be able to schedule time off for all of my appointments and nobody will be aware that it is for any reason other than because I have to take off anyway.

Part of me actually wants to tell people that we're doing this again, but I want this to work so badly that I feel like we should keep it a secret for once. That way if and when we get good results, we can surprise everyone when and how we choose to share our news. If we don't get good results, we can screen who we share that news with as well and we don't have to tell them until we're emotionally ready to do so.

Hopefully, I can actually update more frequently in the coming weeks since things are starting to get moving again.

What Have I Been Doing?

No worries; I'm still here. I have been working hard over the past few months. I mentioned in my last blog entry that I had been using an app to help track my food intake and exercise habits and it was really working for me. I have lost 28 pounds since I started using the app and I'm still working on it. I had hoped to be down at least 30 pounds, but I hit a bit of a plateau for a few weeks, but the numbers on the scale have recently started dropping again.

I watch my total calorie intake every day and I make room as often as I can for "treadmill time" and other exercises to help melt away the yucky fat I have carried around for the past several years. At this point, I weigh less than I did when I started dating my now husband. Most of my clothes are too big and the clothes I had "outgrown" from my days as a single woman now fit again. I am 9 pounds away from my end-of-the-year goal. I don't know if I will make it by December 31, but I hope to be as close as possible. Once I reach that point, I plan to continue my weight loss with the ultimate goal of losing enough weight to feel like I am comfortably in the "normal" BMI range.

It is now December and if you had been keeping up with my blog, you would know that this was the month we were planning to start the IVF process...as long as things went "according to plan." When does that ever happen? In November, my employer sent out notification that our insurance provider would be changing January 1st. they promised that there would be no changes in coverage, BUT...it turns out that our new insurance offers some (very little) coverage for infertility. The previous insurance did not have any coverage, so this was a positive change. I had counted also on electing the full $5K of flex spending funds, but the government slashed that in half, so a lot went into our ultimate decision to postpone IVF until January. New year, new insurance, new start. So...we wait another month, but we are both hoping that all of our efforts over the past few months will prove fruitful and that we will be pregnant in 2013.

And so, I want to wish my blog-stalkers a wonderful holiday season. We plan to celebrate this holiday as if it will be our last without children and hopefully...this will indeed be the case. Expect more frequent blog updates once we start our IVF journey early in 2013.