Post Egg Retrieval: Quality and Number of Eggs Frozen

On day 5 (Tuesday), I received news from the office that only four out of the eight embryos made it to freeze. I felt the blood drain from my face when she told me the news. My thoughts raced back to the day of the retrieval when 14 eggs were retrieved. On Sunday, I was told that 11 had matured, but only 8 were fertilized. I'm still confused why it matters how many I know matured, if they never become fertilized? Is it supposed to make the smaller number that were fertilized sound better? From Sunday, to Tuesday, four out of the eight eggs became blastocysts, and were subsequently able to be frozen. The nurse told me though that the other four were so close to being fertilized that the embryologist would watch them ("babysit") them for a day or two longer to see if they developed into blastocysts. Remember, blastocysts have a stronger chance of implanting because it is a superior, healthy embryo. Impantation is the process of the human blastocyst attachment  to the uterus within six to eight days after fertilization.

I got another call on Wednesday from the clinic telling me two more had developed into blastocysts. Even though we had less than half of what we started with, I was grateful that we had two more embryos to potentially work with. Originally, I had 3 excellent eggs, 4 good eggs, and 1 fair egg. On day 5, the embryologist gives them a letter grade. The letter grades are a way of describing the potential an embryo has to implant. Their letter grades are as follows:
4BA, 4BB, 4BC, 4CB, 3AB, 3BB.

Grading System:
The number explains the degree of embryo expansion of the blastocyst cavity and its progress in hatching out of the zona pellucida on a scale from 1-6. As the embryo expands, the degree of expansion increases.

The first letter indicates  on a scale from A to C  (A being the highest) the quality of the inner cell mass, which potentially becomes the cells that form the body of the embryo after implantation.

The second letter, also from A to C  (A being the highest), indicates the quality of the Trophectoderm. The Trophectoderm are the cells that give rise to the placenta and extra-embryonic tissues after implantation

Thank goodness for my undergraduate bachelor's degree in biology. At least these cellular terms are at least familiar to me.

An update on my pain from egg retrieval on Thursday (one week ago). I woke up this morning FINALLY feeling a little better. I was in so much pain before to the point I could not get out of bed. I didn't request pain medications after my retrieval, and the doctor didn't offer them either. Out of the four donations I did prior, I received pain medications after the retrieval two or three of the four times. I guess it's the doctor's preference, but I know if a man had to go through everything the woman had to with the injections, bloating, and pain after retrieval, they would be thrown pain medications for their endeavors with IVF.

The clinic anticipates the FET (frozen embryo transfer) sometime in early April and I will update more then.

Day Four Post FIFTH Egg Retrieval (first timer IVF and 4 time egg donor)

It's been four days since my egg retrieval and I am still having discomfort in my lower abdomen. If my bladder is even somewhat full, it's like I can feel my ovaries crying from pain. During my long twelve hour shift, where I am constantly on my feet running to each patient's room, my ovaries have their special way of punishing me. This morning, I woke up feeling a lot better. But, exerting myself with little to no rest, is definitely causing me pain. I came home after my 12 hour shift, walked passed my husband's open arms, and headed straight for the medicine cabinet to grab a 1000mg of Acetaminophen, since the doctor said no ibuprofen. Acetaminophen helped more than it usually did today, than the other days. I also took my last dose of Doxycycline today (prophylactic antibiotic). 

On Sunday, I was pleasantly surprised to answer the phone from my fertility clean on Sunday. Sunday marked the THIRD day of the embryologist checking in on our embryos. It was also the call that would tell us the grade of our embryos. As a refresher from the previous post: 

I'll explain why they call on days 1, 3 and 5:
Day 0: Egg Retrieval Day
Day 1: 24 hours after egg retrieval, the embryologist can determine how many matured and how many fertilized. They wait to call until day 3, because its important to limit the amount of times the embryos are taken out of the incubator to maintain a stable environment.
Day 3: On day 3, the embryo should have divided into about 6-10 cells and be symmetrical which indicates even cell division. After day 3, embryonic DNA takes over, including genetic contribution from the sperm.
Day 5: They call to tell you how many have successfully become a blastocyst. A blastocyst is a human embryo that has divided successfully and survived to at least day five. This is also the day the embryologist gives your kiddos (embryos) their first "grade". A blastocyst is graded by their degree of expansion, their inner cell mass, and the trophectoderm. The grading system rates the blastocysts from good to fair to poor. The grading system indicates its potential to implant only.

I had just finished seeing a patient when I saw my phone lighting up on my desk and noticed the caller ID was from the clinic. I dropped everything I was doing, and picked up the phone. The medical assistant sounded happy, so I prayed it was a good phone call. She stated that eight out of our eight embryos were doing well, and progressively perfectly. Our grading was as follows: 

3 embryos: EXCELLENT
4: GOOD
1: FAIR

The grading of an egg doesn't mean how smart or beautiful a child will be. It grades how well it should impact for embryo transfer onto the uterus. 

Tomorrow is DAY 5, so I should be getting. call on how our embryos are doing. I am keeping my fingers crossed that all becomes blastocysts. 

My Fifth Egg Retrieval as the IVF patient

My fifth egg retrieval was scheduled March 8th at 12:10pm. It had been three years since my last retrieval as a donor, and now I was undergoing the process as the patient.

For my first egg retrieval, I was not put under anesthesia. I was given a valium, and I remember screaming in pain the whole time, while my legs were strapped down. It was torture. They allowed my husband in the room to watch the surgery, and he felt so helpless watching the procedure. Since that time, my first question was, "Do I get anesthesia for egg retrievals?" Every time I asked, they seemed shocked. They had never heard of not being put under for an egg retrieval and always promised me I would be sedated soundly during the procedure.

For my second through fourth donation, I would tremble uncontrollably minutes before the procedure, just remembering my first time. My fifth egg retrieval was no different. I trembled and felt very scared. I kept reminding the nurse anesthetist to make sure I was "under," before starting.

Walking back to get my IV put in, one of the nurses casually told me that I was their last procedure of  the day probably because I had the most eggs of the day. This made me really happy and excited. I've never produced a lot of eggs, but I was kept as an egg donor, because of the excellent quality of my eggs.

When I woke up from the egg retrieval, which I was told lasted only 20 minutes or so, I remember feeling an 8 out of 10 pain. My pelvis felt like it had been hit by a train. The nurse taking care of me gave me 650mg Acetaminophen (Tylenol) and waited 15 minutes to see if this helped alleviate my pain. Fifteen minutes later, she returned, and I told her I still felt like that train was ramming into my pelvis. In addition to several heating pads, she administered 2mg Morphine and Zofran though IV. I've had Morphine once in my life and I didn't recall any bad reaction. Within a few minutes of morphine, my pain level reduced to about a 6 out of 10, which was tolerable. It felt like period cramps from hell, but at least it wasn't the train ramming into my soul anymore. She let me sit down a few more minutes, until I felt ready to walk out on my own. I have never been able to walk out on my own, so I took that the pain being bearable enough for me to walk out was a good sign. A few hours later, my pain started becoming more noticeable, but still tolerable.

Once I was lucid from the anesthesia, the nurse told my husband and I the information we were most curious about-- how many eggs were retrieved!? I anticipated either 12 or 14 because that is how many follicles they have been getting. We had 14 eggs retrieved!

The next morning (Friday), I felt like my lower abdomen was stiff (not distended) and very crampy. I was not nauseas, had no vomiting, and no reduced urine output (signs of OHSS).  My pain level was back at an 8 out of 10 though. I took 1gram of Tylenol in the morning, which helped take the edge off, but I couldn't walk around my house without being in significant pain. My husband was hospitalized a few years ago for a pneumothorax, and he had some expired oxycodone from that time. Since Tylenol wasn't working, I took a half tab, which barely touched the pain, This morning, I took a full tab with another gram of Tylenol, which helped bring the pain down to being tolerable. When the MA called me this afternoon, I did mention to her my pain. She said for me to wait until Monday and if I was still in pain, they would evaluate me. Why don't women get any pain medication after this? Ive read a lot of blogs about day after egg retrieval and many of them feel just like me! If you got pain medications after your egg retrieval, let me know. Is it just my doctor?

Being so focused on the pain, helped me not to focus on waiting for the call today from the clinic telling me how many of my eggs retrieved were mature and how many fertilized. The MA on the phone told me 11 of the 14 matured. She stated two were very immature, and one just fell apart. 8 out of the 11 that matured fertilized. I was a little bummed out that only 8 fertilized, because they still have to survive and divide the next few days. Statistically, we should anticipate 20% loss from those fertilized. I am hoping that all 8 survive! The fertility clinic calls on day 1, 3 and 5 to give updates on your embryos. I return to work on Sunday, which is day 3, and I can only hope that not only will my pain subside, but that my numbers don't change too much.

I'll explain why they call on days 1, 3 and 5:
Day 0: Egg Retrieval Day
Day 1: 24 hours after egg retrieval, the embryologist can determine how many matured and how many fertilized. They wait to call until day 3, because its important to limit the amount of times the embryos are taken out of the incubator to maintain a stable environment.
Day 3: On day 3, the embryo should have divided into about 6-10 cells and be symmetrical which indicates even cell division. After day 3, embryonic DNA takes over, including genetic contribution from the sperm.
Day 5: They call to tell you how many have successfully become a blastocyst. A blastocyst is a human embryo that has divided successfully and survived to at least day five. This is also the day the embryologist gives your kiddos (embryos) their first "grade". A blastocyst is graded by their degree of expansion, their inner cell mass, and the trophectoderm. The grading system rates the blastocysts from good to fair to poor. The grading system indicates its potential to implant only.

So much of the IVF process on the other side, is the waiting game. So not only am I bloated, in pain, I have to be patient. 

Former Egg Donor to IVF patient: The Other Side of Things

It has been three years since last egg donation process. After my fourth egg donation, I decided to call it quits. I hyper stimulated on my last donation, and no amount of money could tempt me to do it over again. Unless, of course, I was doing an egg retrieval for myself.

My husband and I had been trying to have a baby for two years without success. I hadn't even had a miscarriage. At my age, I would not be considered a "geriatric" patient, but let's just say in a couple of years, I would have been.

During one of my egg donations, I had seen an IVF doctor in my home state for monitoring, and he was very kind. I had worked with several in and out of state endocrinologist reproductive specialists, but they all had treated my like a number, and not a human being--except this doctor in my home state. I told myself at that time, if I ever needed IVF, I would contact him.

After two unsuccessful years, I looked him up, and made my first appointment. Looking back now, I was very fortunate because he now has a wait list for a year.

Being a four time egg donor, I have had the chance to do ALL the injection medications. My doctor chose the Gonal-F 250 units at night and Menopur 75 units in the morning. I did these medications, until the last few days, where he increased my Goal-F to 300 units two days, and 375 units on my last day. During the last five days of my stimulation medications, I started taking Centrotide/Ganirelix every morning in addition to menopur.  From what I understand, this medication helped to prevent me from ovulating until the procedure.

To give an idea of how quickly the medications act on estrogen, here are a few of my numbers that I kept record of so that you can see how quickly the medications take effect:
Feb. 27th, my first blood draw with stimulation medications: Estrogen level was 124.8pg/ml
March 1st:  Estrogen level was 303 pg/ml
March 3rd: Estrogen level was 467.6 pg/ml

On the night of my trigger shot, I was instructed to take 10,000 units of Pregnyl which contains the human chorionic gonadotropin (hcg) intramuscularly at 12:10AM on March 6th.  Once I took my trigger shot, I was instructed to no longer take any of my stimulation medications. Pregnyl is time sensitive, and it is very important to take it exactly the time your doctor tells you to.  The egg retrieval was scheduled for 12:10PM on March 8th.

I was also prescribed Doxycycline 100mg twice daily to start taking the night of my trigger injection. Doxycyline is a tetracycline based antibiotic used prophylactically prior to egg retrieval. As a medical provider myself, I like Doxycyline, It has little GI side effects, and I don't think it has a lot of resistance yet. Mankind is still abusing the z-pak (azithromycin) for their "sinus" infections or "bronchitis" that is probably a virus anyway. #AntibioticResistance But that is another story.

The cost of just my medications was $3,020 (which is actually cheaper than most that I have seen and read), which I paid for in February.

I want to mention that getting my blood drawn and ultrasounds so frequently in the mornings was really rough on me. I work 12 hour shifts (8am to 8pm), where 8am is my fertility clinic's first appointment. It was extremely hard for me to get other providers to cover for me for the first hour, and when I couldn't find coverage, embarrassingly ask my bosses if I could come in late. It may not sound like a big deal, but it was. I was so embarrassed to always ask my company to work around my medical appointments. I don't know how working women do this, unless they work from home, or they don't work at all. It's hard to imagine a woman not working in this situation though. IVF is so costly and I can't imagine that we could ever afford this if both my husband and I weren't working bringing both incomes.

While on the topic, I should also share the decisions I made before IVF, knowing that I wouldn't be able to hold down a full time job practicing medicine. I gave my 60 day resignation notice to my old job back in December for various reasons. Firstly, I knew already they wouldn't work with my schedule going in for frequent blood draws etc. I knew, being a donor, that they can schedule additional blood draws or ultrasounds last minute based on your levels, and there is no way my old job would have allowed me to miss work even with 24 hour notice. Secondly, my medical insurance was a nightmare. Because their health insurance was THAT bad, I chose to only cover myself, and purchase accidental insurance for my husband. The deductible for just ME was approximately $6,500/year. It was terrible insurance. It covered 3 IUI (intrauterine insemination), but it was a personal decision for my husband and I not to do IUI. My doctor did suggest we should try that before IVF though. My new company's insurance does not cover for infertility treatments, but the health insurance had a lower deductible of $3,000 for just myself, with an HSA. I could have chosen the $2,000 plan, but I wanted the HSA to help cover for infertility costs. Thirdly, my company wanted me only full time, and would not allow me to be part time. My new company had only a part time position open, so it worked out perfectly. I feel like I am not a mom yet, but I am already making a huge sacrifice of cutting back on my career to allow time for all of my IVF appointments, egg retrieval / egg transfer, plus recovery time, and potential complications (I've had OHSS before).

I feel like I made the right decision going to this new company. They have been understanding through this all, but I am GLAD my chaotic schedule is over (for now). I don't want to abuse their kindness any longer.  How do these mama-to-be's do it while working??