10 Days post surgery UPDATE

Just an update on how I have been feeling since the surgery and any new information I received.

I received a call one day after the surgery and was told 23 eggs were retrieved and 21 were frozen. During the 'average' egg-collecting procedure, doctors typically retrieve 10 to 12 eggs so 23 is excellent!

The surgery occured on a Friday and I felt absolutely fine going home and the next day. About Sunday evening, I started feeling nausea and a fullness feeling in my stomach that made it hard to breath. The shortness of breath was the worst I had ever experienced. I stayed in bed a lot. I was tired.

Tuesday night, I had plans (a Court case-if I did not go, my case would be dismissed)that could not be canceled. I felt particularly 'vomity' that night but after having some soup and plenty of sleep Tuesday night, I felt 100% perfect the next morning. Basically, I had about 3 days of feeling yucky, not super yucky, but yucky enough.

My guess is that I had a slight to moderate case of OHSS aka Ovarian Hyper Stimulation Syndrome. I diagnosed myself with this after doing some research. This is what I found.....

What is Ovarian Hyperstimulation Syndrome?
OHSS is a complication associated with ovulation induction. Ovulation induction is commonly performed with IVF and IUI infertility treatment procedures in order to increase your chances of conception. It uses specific types of fertility drugs (including Clomid and gonadotropins) to increase the number of follicles in your ovaries. Sometimes, however, too many follicles begin to develop in the ovaries, causing them to become swollen and enlarged. Known as OHSS, this syndrome can cause severe pain and trigger the release of fluid into the abdomen and lungs.

I am sure, based on the number of follicles produced and my estrogen level at retrieval (over 4K), I had mild to moderate OHSS.

Wiki indicates that mild symptoms of OHSS include abdominal bloating and feeling of fullness, nausea, diarrhea, and slight weight gain. Since Wiki did not mention shortness of breath, I kept searching and found this....

The symptoms of OHSS vary depending upon how severe the condition is. Symptoms typically manifest four or five days after egg collection, and are often associated with pregnancy. Possible symptoms include:

* nausea and vomiting
* diarrhea
* abdominal bloating and distension
* abdominal pain
* sudden weight gain (due to fluid accumulation in the stomach)
* the appearance of cysts on the ovaries
* difficulty breathing

Additionally, depending on the severity of your OHSS, you may experience reduced frequency in your urination as well as dark urine.

Wiki claims symptoms resolve in 1-2 weeks but I had planned a visit to NYU that Wednesday if the symptoms did not resolve. Luckily, the symptoms left as fast as they came.

Wiki indicates that treatment requires reduction in physical activity (check-I was chillin' in bed from Sunday night to Tuesday/Wednesday), closely monitoring fluid and electrolyte balance (I drank a lot of gatorade), and aspiration of accumulated fluid (ascites) from the abdominal/pleural cavity may be necessary, as well as opioids for the pain (luckily I did not need either an aspiration or any type of pain meds). Over time, if carefully monitored, the condition will naturally reverse to normal - so treatment is typically supportive, although patient (moi) may need to be treated or hospitalized for pain, paracentesis, and/or intravenous hydration (again, luckily this was not needed).


Now, I am just waiting for my doctor's assistant to contact me back to have my follow-up visit. I have some questions that hopefully she can answer. I will update once again after this visit.

OD15 - The Party's Over.

So, the Retrieval Day was today. I will start from CD 12 which was Tuesday. That day I took Antagon in the AM and 150 of Gonal F in the PM. Dutifully taken, no problems.

When I went in on Wednesday, CD 13, I was told later that day when the nurse called, my HCG trigger would be that night at 10:30 PM. No more Anatgon. No more Gonal F.

At about 9:30, I started getting ready. I took frozen veggies on a bag and prepared my medications and needles and alcohol swipes. I tried to see if the veggies would be cold enough to freeze my butt area. By 10 PM, the veggies were not doing the trick. I got out a frozen pot pie. That worked better. Better surface area. Since I was at my parents for Thanksgiving, my brother was luckily around. Since he worked in a vet's office, I got super lucky. He was able to give intramuscular shots to any thing and anyone. He agreed to shoot me up.

I mixed the drugs starting 10:15 PM....it took 15 minutes to do it because i was super careful. I went line by line of the instructions that I found on a website that I mentioned in a previous entry. I then prepared a heating pad on my bed and my brother and I went back and forth as to where the right outter quadrent of my ass was. It was hysterical.

With my pants partly down (no whoha showing), my brother and I watched the clock on the computer. At exactly 10:30, he started counting "1, 2...." and then he said he was done.....I was like "HUH". He said he shot it in my ass at the count of 1. I didn't even feel it. It's good I don't have a size 2 ass.

The rest of the night was 100% uneventful. I rubbed the area a bit because I didn't want lumps. The rest of the night....No swelling, no pain, no nothing.

I was a bit scared to be honest and so was my brother. he thought he screwed up. I thought he screwed up. My parents even thought he might have. I would go in the next day to NYU to know whether it was screwed night. Nervous, I went to bed and waited.

The next morning, I went into NYU promptly at 7 AM and only had to do blood tests. I was back in Brooklyn. What a relief not to be done with sonograms and blood tests. At 2:45, I had not heard from NYU so I called to see if the HCG trigger worked. They said it did and advised me that they only call if it did not work. Thank goodness.

This morning, at 730, I left the house for my scheduled arrival time of 8:30. At about 9 AM, I was called in, donned a robe or 2 and got my medical history taken along with blood pressure and temperature. Everyone was super nice.

At about 915 AM, I met the anesthesiologist and he took me in to the OR. I got on the table, a warming blanket was placed on me, placed into stirrups, and given the run-down of the anesthesiology by the anesthesiologist. I met the biologist who made me sign a form and was told the drugs would work in 20 seconds. I wanted to see if I could force myself to stay up but no luck.

The weirdest thing about the surgery was I never met the doctor who performed it. Odd, right? I saw her later in the recovery room but she never spoke with me.

At about 10:15, I was awakened in the recovery room. Again, the nurses were nice, telling me to take a nap but I felt 100% fine. I thought that was very odd. I was hooked up to a blood pressure machine and IV/saline solution drip was still in me. I never took out my contacts (no one asked but I never told - though you are supposed to take them out) so I saw everything. I asked what what my egg retrieval number was and I was told that they retrieved 23. Awesome. I was very excited considering the last number I heard was 12.

At 10:30, I asked the nurse to pee because I felt some slight abdominal pressure and I assumed it was the massive amounts of saline in me. That helped some but not much. It truly was not that bad...about a 2/10 in discomfort, if that. I was given apple juice and graham crackers some time around then and at 10:45 AM, placed in a chair, sitting up. My blood pressure was taken again, I was handed a blue sheet of discharge instructions and was told around 10:50 that I could go. By 10:55 PM, I was in the car with my brother going home.

The discharge instructions listed the number of eggs retrieved was 23 and my estrogen level for yesterday, a staggering 4484. I can only assume that is HSS aka hyper-stimulation syndrome. The nurse did say she was surprised I did so well considering the estrogen levels and my egg count. I was told that tomorrow, I would be called with the number of eggs that were frozen ( and sadly the number of eggs that passed on or didn't make the cut).

I must say, surprisingly, I feel perfectly fine. I took the doxycycline and some gatorade (recommended by one of the nurses) and have napped a bit but otherwise, I am hungry and feel like nothing happened. A let down almost.

I will also add that I took my unopened Gonal F (3 boxes) and unopened Antagon (4 boxes) to the Center. They give them to needy cancer patients. I felt good about that. Otherwise, it would have been well over $3K wasted.

More tomorrow with the exciting freeze results!

Trigger Time!

I was called at 3 PM today and told today is the trigger day....finally. My estrogen hit 3287. My trigger time is promptly at 10:30 PM. I only have a 5 minute window to inject (although the doctor who performed today's sonogram claims it is more like 15 minutes but I will be injecting at exactly 10:30 PM no matter what). I certainly do not want a $9,000 mistake.

Based on my trigger time, my surgery should be scheduled (according to my calculations) for Friday at 9:30 AM. I believe I need to be at NYU one hour before the scheduled surgery time. Luckily, Friday will be a easy day to get into Manhattan since it is the day after Thanksgiving.

I found some websites to show me how to prepare the trigger shot of HCG and also how to inject the HCG. The sites are here (respectively):

http://www.ivf1.com/hcg-trigger/

and

http://www.ivf1.com/intramuscular-injections/

Still growing...

The future kiddies are still growing. Yesterday, I dropped down to 150 IU of Gonal F. Monday night, I took 225 IU. I continue every morning with the Antagon before I leave to go to NYU. The sonograms and the blood work is daily now. It will continue until I go in for retrieval.

My estrogen for yesterday was 2760. It should go up very little in the next couple of days.

The doctor who performed the sonogram today told me that there might be a retrieval on Friday. I went over the HCG shot with her today to make sure I knew how to do it.

The sonogram picture, if I am reading it right, shows a future kid to be almost 22 1/2 mm and another one is almost 20 mm!

CD11 - Getting Bigger!

Here are the future kiddies. I read a blog about a woman who underwent IVF. Post implantation, she called her future child (which she does not even post if all went well as her due date was 10/22/08) Poppy because he/she was the size of a poppy seed when she received confirmation that she was officially pregnant. I have to think of a name for these guys/ girls. I sure hope all of them make it out and get to successfully hibernate.

CD11 - Dropping down to 225 IU

I continue taking the early morning Antagon shot and I left for NYU by 630 AM. I was NYU nice and early this morning and had a sonogram and bloodtest. It was uneventful other than the doctor who did my sonogram today mentioned that my retrieval day might be Thursday or Friday. My personal doctor (who did my sonogram on Saturday) said most likely retrieval day will be Thursday (which is what I am hoping for). I did get sonogram pictures from the visit today which I will post in the morning.

The nurse called as usual in the early after noon advising me of the next days schedule. My estrogen now measures 1645 so it is increasing nicely. Because of this, my Gonal F was decreased from 300 IU to 225 IU for tonight. I will continue to take the Antagon tomorrow morning. I have to head back to NYU in the morning to have yet another blood test and sonogram. Tomorrow muight or might not be my trigger day.

The only thing that I have noticed is the 'bloaty' feeling has gone down (maybe I am used to it). I am exhausted all the time. I take tons of long naps. I also get a bit sick / 'vomity' mid-afternoon since about 2 days ago. The doctor I had the sonogram with today said it is because of all the hormones. I don't get that reasoning because aren't my hormones decreasing now? I have a feeling it has something to do with the Antagon.

Today was a bit different. I actually had my songram done by my doctor. She told me I didn't have 6 eggs but that I had 6 in each ovary approximately. Better news. She said things were going along just as she hoped. She confirmed that my retrieval most likely would be Thusrday. I thought that as extremely ironic. Thanksgiving = future childre. That is a lot to be thankful for!

I also received my estrogen levels and instructions:
My estrogen level this morning was 1366 which is good according to the nurse.
Saturday night I am to take 300 IU of Gonal F. On Sunday evening, I am to take one shot of Antagon. On Sunday evening, I am to again take 300 IU of Gonal F. On Monday, I am to wake up, take Antagon and then go in for a sonogram, and blood test.

Here are the future kiddies!

Not much to report yet.....

Yesterday morning, which was CD 8 (one week since my period started), I took my first shot of Antagon. Antagon suppresses your body from ovulating. It basically keeps the eggs cooking. Last night at about 10 PM, I took 375 IU of Gonal F. The Anatgon is easy to take. It is in a pre-filled (glass) syringe so I don't have to measure anything. The only thing I was told to do by the nurse is pull the plunger back a bit to break the seal. I shot up just as I did with the Gonal F. Both are subcutaneous.

Not much to report other than I still feel bloaty. I certainly am not eating as much as normal. I feel full all the time and once I start eating, I feel even more full and bloaty.

I am heading to bed as I am out of the house by 630 AM so I can be at NYU tomorrow at 7 when they open. I want to go in and get out quick. I have a sonogram and blood test scheduled. Hopefully, my follicles have grown. Maybe I even have some new ones growing.

The sample 'No Lupron EF Cycle' calendar Jennifer from NYU gave me shows that I might have my retrieval Thursday. Thursday is Thanksgiving. Happy Tday to me.

CD 7 Sonogram Pictures

If anyone knows how to read these, let me know.

Some good articles...

In my research, I came across some pretty good articles that I will list occasionally.

Basic article with scientific information about FSH, LH levels.
http://www.gfmer.ch/Books/Reproductive_health/Monitoring_IVF.html

A one hour radio show about egg freezing and the recent advancements.
http://www.blogtalkradio.com/creatingafamily/2008/04/30/Human-Egg-Freezing-

Here is an article (which I consider quite negative) that examines some of the considerations that should be made before proceeding with egg freezing.
http://100infertilityquestions.blogspot.com/2008/01/egg-freezing.html

Excellent information about recent breakthrough; Egg Selection and freezing process combined increase success rates.
http://findarticles.com/p/articles/mi_m4PRN/is_2008_Oct_24/ai_n30934531

Article about the Hope Registry. The Registry is enrolling women of reproductive age over a three year period. These women will have their oocytes frozen, thawed and the resulting fertilized embryos transferred. My doctor mentioned this to me as a way to defer the costs of egg freezing. However, my purpose in doing the freeze was to have the eggs for later use.
http://www.bio-medicine.org/biology-technology-1/EMD-Serono-Launches-Landmark-Patient-Registry-for-Egg-Freezing-9001-3/

Keep cooking....

Thursday was a huge day. I got to NYU at 7 AM. I was taken in for my blood test within minutes and then had my sonogram.

This time, the sonogram felt very uncomfortable. It was like I had a full bladder, which I didn't, and there was enormous pressure from the sonogram 'thingie' when the doctor was searching for the follicles. The doctor took, what seemed like forever, to search around for the follicles. She then told me that she found some follicles. I believe she said she found about 6 or 7 follicles (how could they not know the exact amount)? I asked how large they were and she said they were all around 9 mm. I could be wrong about that though. I was just happy they found something and the stimming was working. I asked if it was normal to only find 6 or 7 at this point and she said it was average. I thought the number was low and the doctors probably say 'average' not to upset you.

The doctor did say that I could make more eggs if I stimmed more (which she said I probably would do another round or two of Gonal F at 450 IU). She also added that I could also do another stim and retrieval process. That made me feel uneasy because it was tough for me to borrow the fee for this process as it was. I certainly could not do another. Literally, all my eggs were riding on this one procedure. If I even got a couple of eggs from this process, I would feel more
comfortable then never having done it.

I did ask for sonogram pictures of the follicles before the doctor even started looking. Yes, she did look at me a bit funny. I asked if anyone else ever ask for pictures and she said, yes, 'a few'. I have this nagging feeling I might be the only one though the way she said it.

The doctor mentioned that since they had not hit the optimum size, I would need to stim a bit more as well as start Antagon in a day or two to ensure I do not ovulate. I was done by about 7:20.

I headed out to Metro Drugs downtown and picked up my refills on Gonal F. At about 2, I got a call from the nurse at NYU informing me of the results of my blood test from the morning and instructions for the next several days. I asked the nurse if she felt 6 or 7 follicles were about average and she indicated that my chart showed 9 follicles. I think I wasn't listening carefully to the doctor. I would love to know what was really found. I guess I have to wait until Saturday.

The sonogram picture is interesting. I definitely see what appears to be 6 follicles on 3 pictures. I cannot tell if it is 6 in total for one ovary or 6 in one ovary and some more in another. When I figure out how to post pictures here, maybe someone can help me read it. I will ask for help reading a sonogram on Saturday as well. best to be an informed patient!

My results and instructions were as follows:

E2 / Estrogen is now 541! Yeah me!!
LH is 1.4. The nurse said that was good. I have to look that up myself and see how 'good' it really is.

On Thursday night (tonight), I am to take 375 IU of Gonal F. I just did that so I am all set for tonight.
On Friday morning, I am to start the Antagon. It is a pre-filled syringe so all I have to do is open it and shoot up. The nurse did mention there is some air in the needle and explained how to get that out.
On Friday evening, I am to shoot up 375 IU of Gonal F.
On Saturday morning, I am supposed to shoot up a vile of Antagon and go into to NYU for more blood work and a new sonogram.

I am all set now to research the LH level and estrogen level and then head to bed. I still feel very bloated and I assume I am going to feel more 'bloaty' as I stim more. I am also not that hungry because I feel stuffed all the time. Today, I only had an egg on a roll right after the NYU visit and I just had a bowl of cereal. That's it. It was more than enough. I am also going to start drinking a lot more water. Maybe that will help with the bloaty feeling. It could also make it worse but whatever (as I always say).

Another 450 IU of Gonal F.

I took another shot of 450 IU of Gonal F Wednesday night. I have finally decided that the bloaty/ full feeling cannot be the burrito, knish with kraut, cream soda that I ate yesterday since I still feel bloaty 24 hours after eating all that crap. It HAS to be be because of the medication. I feel bloaty and some abdominal pressure. Almost like a full bladder but not like I have to use the bathroom. I almost want to say that it feels like I would be about 3 moths pregnant but since I have never been pregnant, I don't know what that feels like.

Anyway, other than the bloaty feel, I fell fine. No headaches. No cravings. I think the knish, burrito, kraut and cream soda was part of where I was at a certain time and not being able to not eat them because I was there....if that makes sense. I was right in front of Katz's so I couldn't not have a knish with kraut. What goes with with Katz's food? Dr. Brown's Diet Cream! I couldn't not have that leftover burrito from the night before otherwise I would have to toss it. No reason to waste food. Now, I feel like having a cream soda. OK, maybe I cravings.

Tomorrow is a HUGE day. It is the first day I get sonogram results after the start of stimming. This is HUGE! I will find out if the meds are working. I will find out if the follicles are growing. I will know if I can keep going forward. I feel very positive and hope that I get some good news tomorrow. Considering my E2 levels Tuesday were 185, I hope those numbers double or triple by tomorrow.

What's also quite odd is that I feel very, very protective of my tummy area. I am very, very careful doing things. I don't want anything to go wrong and I don't want to 'hurt' my growing eggs. I cannot fathom that that will happen but I am just being super careful.

It's also odd to know that half of your future children are growing in you and you haven't even met the possible dad/ husband yet. I really am amazed by that. Some guy better thank me one day. If he is really a lazy guy, he literally doesn't even have to have sex with me to have a kid with me. OK, that is way TMI but whatever.

Eeesh.....

I just read my post from last night about putting my eggs to sleep. I meant that they should be put in a bed and go get some rest. The other meaning would be gruesome and defeat the purpose of all this work I am doing.

I am going to shoot up tonight a bit earlier than usual as I want to get into NYU at 7. Since I will be coming from Brooklyn again, I have to leave and drive in by 615 AM :( I will need my sleep.

Antagon.

I have to rewrite since the original never posted. The joys of blogging. I called to confirm that I will need to bring my Antagon in to the center tomorrow. I don't know why they want me to but I will. I also have to refill my Gonal F prescription. I had the scrip transferred to the downtown Metro Drugs so I won't have to go all the way uptown again. Metro Drugs is awesome in that they have everything you need and do not have to order it. The pharmacist in the uptown location was super nice as well.

I wonder how people without insurance pay for all these drugs. The Gonal 5 450 IU is $950 a box. My insurance co-pay for 5 boxes of Gonal F 450 IU is $25. Instead of paying $950 x 10, I will be paying $50. Amazing. I have such a love/hate relationship with my insurance carrier. Usually, I want to strangle every person who works at Oxford. Today, I could kiss them all (maybe not on the lips, well, maybe if there is a cute guy that is cute).

Another 450...

....one to go. Nothing much to say. I shot up at about 11 and tried to sleep but couldn't. Kind of anxious but feel fine. No headaches like I had the first time I shot up 450. I should probably put the eggs to sleep.

Maybe this will help me feel better...

...I found this and someone on Craigs List also sent this to me.....


Estradiol (E2) Day 3 25-75 pg/ml Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve.

Estradiol (E2) Day 4-5 of meds 100+ pg/ml or 2x Day 3 There are no charts showing E2 levels during stimulation since there is a wide variation depending on how many follicles are being produced and their size. Most doctors will consider any increase in E2 a positive sign, but others use a formula of either 100 pg/ml after 4 days of stims, or a doubling in E2 from the level taken on cycle day 3.

My Day 2/3 Estradiol Level with no meds was 41 in June. My 'number' this morning, if it is estradiol, was 185 and it is on meds. Therefore, that would be good.

What I learned today: 1) I will have to ask much more questions of the nurse next time. 2) I will always carry a pen and paper and my questions with me at all times when I am expecting the nurse to call.

185?

I was at the Center at 715 AM and had only a blood test. What a let down! I was hoping to see the beginnings of my future clan! I was out of there in 15 minutes feeling kind of empty.

At 2 PM, I received a call from the nurse with my instructions for the next 2 days. Tuesday PM, take 450 IU of Gonal F. Wednesday PM, take 450 IU of the Gonal F. On Thursday morning, I am to report back to the Center for a blood test and sonogram. I also was told to take medication with me to the Center. I think she said to take the Gonadatropin. But, now I realize the Gonadatropin (I call it Gonal F) will be all gone by that morning. Why am I taking it with me anyway? I have to call tomorrow to confirm what I am doing. I was online at Katz's Deli when the nurse called and was all a flutter in knishes, fries, corned beef, kraut, cream soda and hot dogs. No, it wasn't all for me and yes, I do have heartburn now.

I did ask one question that was sort of silly...I asked if my numbers in the morning blood test were good. OK, maybe it isn't a silly question but WTF do I know what is good or not? What numbers was I talking about? The nurse said, yes, they were good. 185. 185? What's that? I said, oh, ok. I will see you Thursday and hung up. WTF?

OK, so I get home and try and google 185, fertility, gonal f, etc. I don't find a thing. I am guessing it has something to do with estradiol but I am not sure. I went on craigs list and posted a question in trying to conceive. no response back yet. I am rechecking there constantly. I wish someone would answer.

OK, time to shoot up.

Waiting...

....not much to report. I was at the Center at 715AM and only needed a blood test. My FSH levels from my test Saturday (day 2) were 10.8. I have never had a FSH level reading that high. Each of my tests from the last year have gone up. One year ago, they were at 6.5 I think. Then they hit8 or 9. I am gald I am doing this egg freezing if the levels are rising so rapidly.

The nurse calls later to let me know what my AM and PM doses of Gonal F are. I will post again then.

CD 5 Let's hope for several 3mms!

Today is a huge day. I will find out if anything is growing.

Last night, I took my PM dose of 225 IU of Gonal F. No problemo. No headaches. I am awake though at 150 AM when I need to be up at 6 and out the door at 630! No too smart.

The Center said I should be growing follicles at a rate of 1mm a day so since I started on Saturday, I am hoping to hear that some follicles are at 3mm.

I will find out soon! I am also asking for my blood test results and photos of the sonogram to post (not sure if they will give me the info but i don't see why not).

UGH...My Head is Killin' Me!

I just took my 225 IU Gonal F shot tonight and I cannot bear to post much. My head is killing me. I got a little headache reprieve towards the late late afternoon but after just taking my PM shop, it started up. I also feel a tad vomity but that could be the small amount of ice cream I just ate. I am going to bed.