Wednesday, August 28, 2013

Transfer Day

Yesterday was transfer day.  Wow what a big day!  Our transfer was scheduled for 11:30, so we arrived at 11 for Jenn's bloodwork.  After that, we went into the same area where I had gotten ready for my egg retrieval.

This is where they gave me what will hopefully be our first baby pictures (click on image to see both images)!  Introducing... Embryo A and Embryo B (I know, not very creative).  The embryo on the left was a Stage 1 blastocyst when the picture was taken early that morning.  By the time it was transferred into Jenn, it was between a Stage 1 and Stage 2 blastocyst.  The embryo on the right was a morula when the picture was taken, by the time it was transferred it was a Level 1 blastocyst.

Side Note:  Embryology 101 (by Marc, edited by me)

The morula stage is usually reached by Day 3 after the embryo reaches eight cells.  This stage is significant because in order for a morula to become a blastocyst, a large number of genes must be activated and expressed for the *first time.*  Morulas and blastocysts are able to actively replicate their own DNA which causes them to grow and develop.  The difference between morulas and  blastocysts is that blastocysts are able to differentiate (this means the cells are able to form specialized proteins and cell structures that first form the placenta and the fetus, then later specialized body parts such as the heart, lungs, liver, etc.).  

There are about five stages of blastocyst development, where a large, fluid filled cavity is formed within the cell and highly specialized smaller cells and proteins are localized at certain areas throughout the cell.  The first to be developed are the placenta and the fetus. 

Both of our embryos were similar to the early blastocyst stage as seen here.  Once in Jenn's uterus, they should continue to expand until they "hatch" and implant themselves.  This should have happened later the night of transfer or the next morning (yes, it's that fast!).

Later, on the 7-8th day the embryos will "infect" (Marc's word) the uterine wall for implantation.  The embryo will secrete enzymes that will destroy capillaries in the uterus so that it can implant itself inside the uterine wall and latch on to Jenn's blood vessel(s).  The destruction of blood vessels will also promote the uterus to make new and more blood vessels for support.  (This is why they say some spotting is okay around days 7-8)

**end technical stuff here... on to fun stuff**

Here we are, waiting to go into the transfer room, with our nurse Barb and Jenn's Transfer Day gift basket

We had matching green socks for luck..

and matching green fingernails!

Here is the room where the magic happens.  Jenn is talking with the embryologist and being prepped.  This is the same room where I had my egg aspiration.  The window at the back is where they passed the test tubes containing my eggs back to the embryology department.  BTW, girls, this bed had some serious stirrups, not the kind we are used to at our OB/GYN's offices!  No way to move your legs in this one!

Our embryos were wheeled in the transfer room in an incubator.  My eyes burned from trying to hold back my tears.  I couldn't believe they were right there!

Jenn's ready to go!  Her spirits were so high and she was so excited!  Marc and I are just so happy that God chose her to be our surrogate.

This image is difficult to make out, but this is Jenn's uterus just after transfer.  They put two bubbles in the catheter which come out as small bits of light.  It's how they know the embryos are in there, as they are microscopic.  Here, the streak of light can be seen.  Our embies are in there somewhere!

Tuesday, August 27, 2013

Knocked Up!

Just a note from me, the oven, that we transferred 2 beautiful blasts today around noon :)  HIVF has changed their transfer protocols so no bed rest was mandated, altho couch-potato status was!  Marc & Carrie were kind enough to pick me up and take me home so that Michael didn't have to miss an entire day of work.  So, after transfer, we all went out for a quick lunch at Fuddrucker's before heading back home.

Right before transfer, Marc presented me with an awesome gift basket :)  I have a pic, but until I figure out what is wrong with my computer, I'll be unable to get it off of my phone :(  So, I'll just describe it:  Inside were Lucky Charms, Success rice, Dehydrated pineapple, IM-Planters peanuts (2 varieties), and lots of green shamrocks and a cute cross. And last not but not least, and probably the most important part of the entire basket, was an EPT home pregnancy test!  (they know me so well)  It was awesome and went right along with our shamrock socks and green finger nails...all pics I have, but can't post at the moment.

So, all in all, a great day with what we can only assume will be great results on 9/5 at BETA :)  Until then, I am most definitely PUPO*!!!

*pregnant until proven otherwise :)

Sunday, August 25, 2013

Our Baby's First Report Card

So we were up bright and early this morning (again) at HIVF *in case* it was determined we were going to have a three day transfer.  Thankfully, it was decided that it would be a five day transfer.  We needed to be there and ready just in case, as the clinic is only open for two hours on Sundays.

Our embryology report (aka our baby's first report card!) looks like this:

To sum up, there are still eleven embryos.  The last four with four and five cells aren't looking too hot.  I read somewhere that they have a 10-15% chance of surviving, but I don't know if that's if they were transferred today or just in general.  It looks like we have four really good ones (eight cell) and two good ones (seven cell) at this point.  I don't know what the 4 and 4- marks mean since I don't know HIVF's grading system.

After getting there and being sent home, we decided to have breakfast together!

Today is Day 3, and our embryos (ideally having eight cells) should look like this:

Saturday, August 24, 2013

The Day They Met

On Thursday, the sperm and eggs finally got to meet each other!  This was the day I had my egg retrieval, and the eggs are fertilized about four hours after the procedure.  We got there early (7:15) and the retrieval was at 8:30.  I was nervous!  I was afraid of ovulating early, though Dr. Hickman seemed pretty sure I will not ovulate until 36 hours after that trigger shot was given.  I was awake throughout, but did not feel anything.  I don't remember much of what was said, but I do remember seeing Dr. Hickman as I was rolled into the OR with a huge smile on his face. I think he enjoys aspirating eggs way too much!  I also remember sweet CJ holding my hand the entire time.  I reacted fine to the anesthesia, but was very tired and very crampy for the rest of the day.

Here I am, pre-op:

The nurse called yesterday with our fertility report. The results were: 17 eggs extracted (which is really good since I had 17 follicles), of those eggs 12 were mature, and of those 11 fertilized.  Marc and I are very happy with these results, and it is a little surreal that we have little embryos that are a combination of mine and Marc's DNA.

The day of extraction is considered Day 0, so yesterday was Day 1 and today is Day 2.  The eggs were fertilized via ICSI (intracytoplasmic sperm injection), or the injection of a single sperm into each egg.  By Day 1, fertilized oocytes (or eggs) now become embryos, and they contain two cells.  Disclaimer: These are not my embryos, I wish I had pictures this early on!  We will receive pictures of our embryos before they are transferred.

Day 0,  ICSI

Day 1: Here you can see two pronuclei (the nuclei from the egg and sperm) coming together to create a full set of chromosomes (sperm and egg cells are haploids, and each contain half of the number of chromosomes when compared to a regular cell).

As I am writing this it is Day 2, so this is what our embryos should look like now.  Wow, what a big difference!  They should hopefully have four cells at this point.  The nurse told me that on Day 2, the embryologists do not look at the embryos, they just let them incubate until Day 3, when they make the decision for a Day 3 or Day 5 transfer.  We're all betting money that, because we had 11 embryos as of yesterday, that we will have a Day 5 transfer.  We all still need to be up at the clinic bright and early tomorrow, just in case!

"Before I formed you in the womb I knew you..."  (Jeremiah 1:4)  Although this verse is being told to the Old Testament prophet Jeremiah, and refers him, why wouldn't it apply to every one of us?  God did know us before we were born, even before we were conceived.  God knew our baby (babies), and what would come to be, even before the day they were fertilized (two days ago!) and came into being.

Wednesday, August 21, 2013

Is This What a Hen Feels Like Before She Lays Eggs?

I have never been so bloated in my life. I do, in fact feel like I am about to lay eggs... which tomorrow, I will! Or at least they will be extracted and placed into test tubes.
My follicles are huge. My lining is super thick. And my estrogen is sky high. To recap:

Monitoring Appointment from last Friday:
Follicles that were measured ranged from 9.5mm to 14.6mm (that's millimeters in area, I learned)
Estrogen: 953

Monday Appointment:
Follicles ranged from 12.4-19.1mm
Lining: 14mm

Tuesday Appointment:
Follicles ranged from 13.2-23.8 mm
Lining: 18.1mm
Estrogen: (drum roll...) a whopping 4,223

The doctor said it was time to trigger (!) when she saw the 23.8mm follicle (my overachiever). They will retrieve everything they can, but she thinks eggs that are in follicles measuring more than 15mm may be the more mature ones.

I was so relieved when she told me to trigger yesterday! It meant we could see the light at the end of the tunnel, and could schedule our retrieval day for Thursday.

Here's Marc getting ready to give me a shot in my butt. This was the trigger shot that needed to be given at exactly 10pm last night, 34 1/2 hours before retrieval. It contains HcG, which will cause me to ovulate.

Here's my Sharps container, where I've been putting all my used needles. Filled up with over forty needles, I brought this with me to my blood appointment today where they measured my HcG levels, so that they can dispose of it.

Monday, August 19, 2013

Pre-trigger Scans & Labs

Its Jenn:

Just a quick post from me to update on my stats at the moment.  Lining was 12.9 and my estradiol (estrogen) level was 751!  My uterus is ready for its new tiny inhabitants whenever they are ready for their new short-term home :)  We are inching closer & closer....and I'm really excited!

I'll let Carrie update for her side of this equation :)

Saturday, August 17, 2013

Follicle Check

To start off, for those who may be reading who are not in the world of IVF: a little Biology 101 about how follicles work: your ovaries have a certain number of follicles which remains the same throughout your life. In my case, I have twelve. This means that during every cycle, before ovulation, twelve eggs come up to bat and compete to be *the* winning egg who gets to make the trip down one of the fallopian tubes. The body then chooses the dominant egg of the twelve, the "winner," and it is released. The other eleven eggs are so devastated by this that they commit suicide (a term called apoptosis). Thank goodness the human body is able to choose one egg per cycle, or else we'd have litters like dogs and cats.

During my follicle check yesterday, the doctor did an ultrasound and counted *sixteen* follicles. That means the stimulation meds I have been on for almost a week have allowed me to grow four more follicles than usual. This is a very good number, as it means they could get sixteen eggs when they retrieve. He then measured the follicles. Measurements ranged from 9.5mm to 14.6mm. They want all of my follicles to hit 18-20mm for egg retrieval, since the bigger the follicle is, the more likely they will be able to retrieve an egg. My follicles are growing at a rate of about two millimeters a day! So, I will continue as I have been over the weekend and go in on Monday morning for another scan. My nurse has predicted my trigger shot will be done Monday night (more on that later), which means egg retrieval would be Wednesday morning!

Here is a picture of my left ovary with four follicles showing:

Here is a picture of Marc giving blood! Eight vials! For surrogacy, the FDA requires lots and lots of blood to make sure no one is carrying any diseases (I had mine done a couple of weeks ago, as did Jenn and Michael):

(he seems entirely too happy about this, if you ask me!)

Wednesday, August 14, 2013

This morning I cried, because there were no forks...

just spoons. How am I supposed to eat my breakfast without a fork? Why do we run out of forks so quickly?

So I've been a little more emotional lately. Today I am really feeling the crampiness in my abdomen and bloatedness. I took Tylenol, as it is the only drug I am allowed to take while I am in cycle. Other drugs (such as Advil) use the same receptors that the fertility drugs need to work.

Good news is, my estrogen is looking good. Since the ovaries are primarily responsible for producing estrogen, my estrogen number indicates how they are responding to the FSH (Follicle Stimulating Hormone) I have been injecting every day. I had labwork done yesterday, and my estrogen went from a 42 from last Wednesday at the suppression check, to a 227. Our nurse practitioner, Barb, said this means the medicines are working and I am heading in the right direction. When I go back on Friday for more bloodwork and a scan, we will know much more about when I will be ready for the egg retrieval. Jenn, on the other hand, is the overachiever. Her lining is at 11 mm (minimum needed is 8 mm) and her estrogen is a whopping 498 (they like for it to be over 300). So right now, she is all ready and in a holding pattern until our embryos are ready!

Look who I ran in to at the clinic! Early morning (7:30) appt.s at HIVF are our lives now.

Monday, August 12, 2013

Long Overdue

This is Jenn:

And here I am!  I live!!!  Barely, but I live :)

I've been extremely neglectful of posting, but I have allot on my plate at the moment, so sitting here at the computer hasn't happened much.

So, here's my update in a nutshell:  I started meds just a few weeks ago, and all has been good so far.  No Lupron headaches, no mood-swings, and no other side effects that I know of.  I did have a weird achy-leg thing happen (felt like the flu but I felt totally normal), but that passed with a few doses of Ibuprofen (which I had permission to take from my NC).  Thankfully, its been smooth sailing so far....maybe its just that I knew what to anticipate this time around, so that's helped?  Who knows....

Anyway, after a week on Lupron, I went in for my lining check and labs...a week too soon.  My NC (nurse coordinator) gave me the wrong date :-/  So, rather than waste the trip (of 65 miles), we went ahead and did my FDA labs and a pelvic swab (TMI?) to rule-out all of the communicable diseases that we had already ruled out with the CDC labs!  Go figure...the government (FDA) is repeating labs that we just ran less than 2 weeks ago....just in case they missed something the 1st time around?!?

So, this past Friday was my REAL lining check and first labs.  Lining measured a beautiful 11.3 :)  So, my body is responding just as it should, so far!  I haven't heard back on my estradiol (estrogen) level, so I'm just assuming no news is good news for the time being.  Before the lining check I had a bit of spotting for a few days, so I was worried that maybe my measurement might not be what it should, but the doc and NC said the spotting was likely caused by hormone flux and nothing more.

And on a personal level, last week was just flat-out rough.  Michael had an out-of-town training class in ATX last week, so he left on Monday.  On Tuesday (8/6) I started a new job - not quite full time since I'm off on Monday, but that will likely change by January.  All 3 of my kiddos got sick - started with the youngest who came home from church camp on the prior Saturday sick with a cold, then spread to my daughter Morgann, then my oldest, Alex, a few days later.  By Thursday, Morgann's asthma had kicked into high-gear and she had to call me home around lunch for help.  I did a breathing treatment with her and her wheezing subsided enough for me to return to work.  But, by the time I returned home Thursday night, she was in bad shape, so I called the pediatrician who sent us to the ER.  Lucky for us, we got to spend 6 hours there!  By the time we made it home Friday morning, it was a little after 3, and I was back up at 8:30 getting ready to leave for work.  Don't know exactly how I managed, but I did, and we all spent a good weekend resting and recovering.

On the horizon is another lining scan and estradiol check tomorrow morning, and I am prayerfully hopeful that all will still look good!  I will do my best to update again when I have those results :)

For now, I'm off to bed....G'night!

The Most Complicated Drug

So here is the picture of Menopur. To start off, I am supposed to be taking three vials of powdered "stuff." Marc says it's lyophilized compound of (this is from the product information in the box), get this, "the urine of postmenopausal women, which has undergone additional steps for purification." I would hope so. Anyway, the three vials each need to be reconstituted with 1 ml of saline solution, one at a time, in the big syringe. Hallelujah this is not the needle that's being stuck in me. The needle being used is the smaller one, still wrapped. So it's the same size as the subcutaneous Gonal-F and Lupron needles. That was great news to me, as I had a small panic attack looking at the size of that needle!

Saturday, August 10, 2013

Yay! I conquered a new device

Well, this little pen sure is nifty. This morning was my first time injecting Gonal-F, and it comes in this pre-measured pen. Each pen has two doses. Thank goodness for the pharmacy videos online, I only watched this one four times starting and stopping. I just wanted to make sure I was doing this right! Though I am injecting a lot of drugs right now (this morning was 225 iu- the max), it is to kick start my hormones and get things rolling, so I can hopefully go down later in the week and closer to the actual egg retrieval. All I know is that I'll have ovaries the size of grapefruits by the end of the week (jk)! I've gotten used to the pricks of Lupron every night and the dexamethasone (which I learned is to suppress the cortisol excreted by the adrenal glands). So far so good... will post again about all the chemistry that will go on tonight- this next drug (Menopur) needs to be mixed beforehand.

Saturday, August 3, 2013

Our Calendars

Here are our calendars I have taped to my bathroom mirror. Though I am thrilled every time I get to mark out a day with my sharpie(!), I am scared about getting closer to that last week when the stimulation meds begin and the "big gun" needles are brought out. These are some hard core drugs people! BTW, as you can see, compared to Jenn's calendar (hers is on the right), what I have to take is *nothing*!! I just want the next couple of weeks to be over with!

Would You Trust This Man?

Lupron injections started last Monday. I think Marc enjoys poking me with a needle. Feeling fine five days in... but would you trust this man?