IVF, In Vitro Fertilization, is a very complex process. Every doctor and every clinic do things just a little bit differently. The process my clinic uses is starting your cycle on birth control pills. One option is to add a medication call Lupron, which is a suppressor, to the time you are on the pills. Once you stop the birth control pills you continue the lupron and start an FSH hormone. The objective of the FSH medication is to stimulate the ovaries and allow multiple follicles to emerge. During this time you are monitored through blood work and ultrasound every couple of days. Sometimes another medication, LH is added to the mix. LH is lutenizing hormone that helps improve the quality of the eggs that are being produced. At some point the lupron is stopped and when bloodwork and ultrasound confirm it, it's time to ovulate and have the eggs retrieved for fertilization. About 48 hours prior to egg retrieval you discontinue all medications and at 36 hours prior give yourself a trigger shot (usually a medication called Ovidrel). This medication causes ovulation so that egg retrieval can be done. Egg retrieval is the process of being sedated and the doctor, using ultrasound guidance, aspirates each of the mature follicles. From there the eggs are fertilized, either naturally or with a procedure called ICSI (this is the process of injecting each egg with an individual sperm). The eggs are then checked for fertilization and then for embryo development. Clinics generally do an embryo transfer at either 3 days or 5 days post fertilization. The theory on a 3 days transfer (at least at my clinic) is if the embryos do not appear to be developing well, that they are better off inside the body than out. A 5 day transfer is preferred because it provides the best of the best embryos and often gives the embryos an opportunity to show survival of the fittest. Finally, a blood test, or beta, is given anywhere from 13 to 16 days after egg retrieval. (This is of course by no means a scientific or complete explanation of the IVF process, it is just the best explanation that I can provide based on the information and experience I have had with the IVF process).
So, we decided to do our egg retrieval the week of July 24th. Because of a world wide shortage of lupron, my RE decided that instead of doing the lupron, we would instead use Ganirelix. The difference between these two drugs is the timing of when you start taking the shots. Instead of taking the Ganirelix prior to starting the FSH drugs, we would start the Ganirelix a few days after starting the FSH, which we used Follistim. Eventually the doctor also added Luveris, an LH med, to improve the quality of my eggs. Everything went well with our medication and follicle development and on Tuesday July 26 we had our egg retrieval. Steve was out of town for work, so luckily we had a frozen sample in storage that we were able to use because he couldn't provide a fresh sample. We had 10 eggs retrieved and 7 of those fertilized. The doctors decided to do a 5 day transfer on Sunday July 31st. Of the 7 embryos, we had 1 that was at a blastocyst stage, 2 that had degenerated, and 4 that were still in morula stage. Because we had one really good embryo, we only implanted that one. We were told that we would receive a call the next day letting us know if any of the remaining 4 embryos were able to freeze. We were hoping to have frozen embryos as a back up plan in case the IVF didn't work or to have for a second child in the future if it did work. But alas, none of our embryos made it to freezing so all of our hopes and dreams were pinned on the one embryo we put back. Our first beta was scheduled for Monday August 8th.
Sunday August 7th I took a home pregnancy test and got what appeared to be a very faint positive. The test was an EPT and after getting several opinions I decided I needed to take another test to be sure. I had several pregnancy tests in my bathroom drawer left from previous purchases of ovulation predictor kits (it's cute that they give you a free pregnancy test with the purchase of the OPK's, it makes me think that even the company is rooting for your success). Luckily, the tests I had in the drawer were digital tests. I was thrilled because this would give me a definite answer, the result would literally say "pregnant" or "not pregnant". I took the test and the result was "pregnant"!!! I was thrilled and immediately started spreading the news to our friends and family. I knew there was no way around sharing because everyone knew we were doing the IVF and would be anxious to hear the results. The next morning I went for blood work and the pregnancy was confirmed. My beta was a 40. This number is a little low, but I was only 8 days post a 5 day transfer and at this point, anything over a 5 is considered pregnant. A repeat beta was scheduled for Weds Aug 10. The reason they check your levels again so soon is because your HCG levels should at least double every 48 to 72 hours. The second beta came back at 60. This was definitely concerning because the numbers hadn't doubled, but they had risen, so there was hope. The doctor decided that we needed to wait 6 days before repeating the blood test again. After researching, I found that the most likely reason for this was if we had a chemical pregnancy, the numbers would be back to less than 5 by then end of the 6 days. But when I went back for the blood work on Tuesday August 16, my beta was 985. The nurse and doctor were thrilled and they scheduled our first ultrasound from Monday August 22.
At this point I was having some pregnancy symptoms. I was queasy a lot, pretty much all day and was mostly eating bland, soft foods - yogurt, bananas, mashed potatoes. I was also finding myself craving chicken. I am normally a person who eats chicken and red meat pretty evenly. But for some reason, all I wanted to eat was chicken. I could eat it for breakfast, lunch and/or dinner. It sort of shocked me that I could have cravings so early. I was also really nervous about the queasiness. I figured if I was already experiencing it, the chances were pretty good that I would experience some pretty heavy morning sickness as the pregnancy progressed. I was also pretty nervous about the pregnancy itself. I felt like I would feel better once we saw a heartbeat and was anxiously counting the days to that particular goal.
Friday August 19th, at 5 weeks and 3 days, I was at work and felt this weird gush sensation. I sat down, put my hand between my legs on the outside of my pants and had blood on my fingers. I ran to the bathroom and had a lot of blood in the toilet. I immediately went home, calling my husband on the way to let him know what was going on. I figured that we would be going to the ER because I was having a miscarriage. I also called the RE's office to see what they thought I should do. While I was waiting for them to call me back, I arrived home and noticed that the bleeding had significantly slowed down. I was still having bleeding and some clotting and mild cramping, but no more gushing. The RE's office said it sounded like a subchorionic hemorrhage, a complication that is common in early pregnancy and is caused by implantation. Basically what happens is that there is a hematoma that develops in the uterus, but outside of the gestational sac. The nurse told me that as long as I wasn't having severe pain or filling a pad in an hours time, that I should be ok. But if it was worse or I felt that there was something wrong, I could call them or go immediately to the ER. Because the bleeding slowed down every hour as did the cramping, we decided that things must be ok. By morning the bleeding had completely stopped.
Monday August 22nd we went to our ultrasound appointment as scheduled. The tech gave us a due date of April 17th and said we should be 5 weeks and 6 days along. She told me that usually they cannot see a baby until at least 6 week, but since we were so close we might see the baby. However, she said we were looking for a gestational sac and yolk sac. She asked us to give her a few minutes to look around and then she would show us what she saw. After several minutes she turned the screen towards us and showed us where the cervix was and where the top of the uterus was and explained that there was nothing there. She said that we most likely lost the baby during the bleeding that happened on Friday. She said she needed to check my tubes to make sure there wasn't an ectopic pregnancy and that after that we would see the doctor.
After blood work and a meeting with the doctor, we had to wait an hour for the results of the blood work. They were again checking my hcg and the results of that would determine our options. Luckily, my beta was 221 which made the doctor feel pretty confident we had had a natural miscarriage and would not need to have a d&c or take medication to eliminate an ectopic pregnancy. I had to go back to the clinic the following week to have my blood taken again, beta was 8.5, so had to go back again the following Monday. Finally on Labor Day, Monday September 5, my beta was less than 2.5 so they determined that the miscarriage was complete and I was cleared from having to have any additional follow up care. And sadly, our very much wanted pregnancy was completely over.
It only seems fitting that the next post will be titled "Miscarriage sucks". So stay tuned.
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