Below is my personal experience with an IVF cycle. Before proceeding, I want to note three things: (1) Every individual is different. While this was the protocol that my clinic used and my body’s response to it, it does not mean that because your protocol is different that you should be alarmed or that one is better than another. (2) Find a reputable clinic with whom you are comfortable and whose clinical staff you trust implicitly. I would always choose clinical expertise over warm and fuzzy bedside manner. However, we were fortunate enough to have both. There is enough stress as it is, so find your clinic and then do everything you can to LET GO. Second guessing your reproductive team is not an experience you want to have. (3) Your body will not respond the same every time, in the same way that every cycle is not the same. IVF is as much art as it is science and with a lot of faith and luck mixed in. We were actually supposed to have done IVF in May but I had cysts that prevented me from moving past the downregulation stage. We had to start over. Lesson learned: Be patient.
In all, the process took 54 days from beginning to Beginning.
DOWNREGULATION
The day you start your period is CD 1. For me, this was July 7, 2007. Beginning July 9, 2007 I took birth control pills (CD3-CD19, so, 17 days) and then began Lupron shots and dexamethasone pills (10IU beginning CD17, then 5IU beginning Stim Day 1, which was also CD29). The purpose of this down-regulation protocol was to reduce likelihood of cysts as well as 'recruit' follicles without initiating premature maturation.
Since I had the pesky cysts last time, the first countdown was to the suppression check on August 2, 2007 (results shown here). That morning, the Reproductive Endocrinologist (RE) did an ultrasound to measure the lining of the uterus, determine the number of resting antral follicles, and the presence/absence of any cysts. I also had some bloodwork, E2 (Estrodiol) to measure the level of Estrogen in my system. It needed to be less than 50 to proceed with the ovarian hyperstimulation.
| Day of Week | SUN | MON | TUE | WED | THU | FRI | SAT |
| Date | 7.29 | 7.30 | 7.31 | 8.01 | 8.02 | 8.03 | 8.04 |
| Cycle Day (CD) | 23 | 24 | 25 | 26 | 27 | 28 | 29 |
| Lupron Dosage IU | 10 | 10 | 10 | 10 | 10 | 10 | 5 |
| Stim Day | -- | -- | -- | -- | -- | -- | 1 |
| Gonal F Dose IU (a.m.) | -- | -- | -- | -- | -- | -- | 225 |
| Repronex Dose IU (p.m.) | -- | -- | -- | -- | -- | -- | 225 |
| E2 Level | -- | -- | -- | -- | 43 | -- | -- |
| Follicle # > 10 mm | -- | -- | -- | -- | 0 | -- | -- |
| Size Range (of >10 mm) | -- | -- | -- | -- | 0 | -- | -- |
| Follicle # <10 mm** | -- | -- | -- | -- | 9 | -- | -- |
| Other Information(c) | -- | -- | -- | -- | SC | AC | -- |
HYPERSTIMULATION
Once my ovaries were “quiet”, ovarian hyperstimulation began Aug 4 (CD29), meaning I had shots in my stomach twice per day in an effort to grow the available follicles in preparation for egg retrieval. During this process, I had regular vaginal ultrasounds and bloodwork to measure the progress of the follicle size and estrogen levels. Any given day's results would determine the timing of the next appointment until the fragile balance of follicle size to estrogen levels were achieved for retrieval.
| Day of Week | SUN | MON | TUE | WED | THU | FRI | SAT |
| Date | 8.05 | 8.06 | 8.07 | 8.08 | 8.09 | 8.10 | 8.11 |
| Cycle Day (CD) | 30 | 31 | 32 | 33 | 34 | 35 | 36 |
| Lupron Dosage IU | 5 | 5 | 5 | 5 | 5 | 5 | 5 |
| Stim Day | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Gonal F Dose IU (a.m.) | 225 | 225 | 225 | 225 | 225 | 225 | 225 |
| Repronex Dose IU (p.m.) | 225 | 225 | 225 | 225 | 225 | 225 | 225 |
| E2 Level | -- | 239 | -- | 774 | -- | 1632 | -- |
| P4 Level | -- | -- | -- | -- | -- | 0.39 | -- |
| Follicle # > 10 mm | -- | -- | -- | 6 | -- | 11 | -- |
| Size Range (of >10 mm) | -- | -- | -- | 11.1 | -- | 10.6 – | -- |
| 11.9 - | 14.8 (a) | ||||||
| Follicle # <10 mm** | -- | -- | -- | 15 | -- | 8 | -- |
| Other Information(c) | -- | -- | -- | -- | -- | -- | -- |
On Stim Day 7, I had a vaginal ultrasound to check the number and size of antral follicles. The sizes were 14.8, 14.8, 14.0, 13.9, 13.9, 13.4, 12.8, 11.8, 10.9, 10.6. And then on Stim Day 10, those antral follicles had matured to the following sizes: 21.3, 21.0, 20.4, 20.0, 19.9, 19.7, 18.7, 18.6, 18.5, 17.7, 17.5, 15.9, 15.9, 15.1. Due to the results of the E2 and ultrasound results, Stim Day 10 was also the day for Trigger hCG. In total, I took Stims for 9.5 days, from CD29 through CD38.
| Day of Week | SUN | MON | TUE | WED | THU | FRI | SAT |
| Date | 8.12 | 8.13 | 8.14 | 8.15 | 8.16 | 8.17 | 8.18 |
| Cycle Day (CD) | 37 | 38 | 39 | 40 | 41 | 42 | 43 |
| Lupron Dosage IU | 5 | -- | -- | -- | -- | -- | -- |
| Stim Day | 9 | 10 | -- | -- | -- | -- | -- |
| Gonal F Dose IU (a.m.) | 225 | 225 | -- | -- | -- | -- | -- |
| Repronex Dose IU (p.m.) | 225 | -- | -- | -- | -- | -- | -- |
| E2 Level | -- | 3725 | 4783 | -- | -- | -- | -- |
| P4 Level | -- | 1.35 | 7.08 | -- | -- | -- | -- |
| Follicle # > 10 mm | -- | 14 | -- | -- | -- | -- | -- |
| Size Range (of >10 mm) | -- | 15.1 to | -- | -- | -- | -- | -- |
| 21.3(b) | |||||||
| Follicle # <10 mm** | -- | 9 | -- | -- | -- | -- | -- |
| Other Information(c) | -- | 5000IU | AC; | RTRVL | -- | -- | -- |
| hCG | hCG 131 | -- | -- | -- |
RETRIEVAL
As advised by my clinic, I took the day off for the egg retrieval. The procedure itself was painless and done under conscious sedation with Midazolam, more commonly known as Versed. I had cramps afterwards for about an hour - think heavy period sans Aleve.
FERTILIZATION AND TRANSFER
After the egg retrieval, the embryologist injected the viable eggs with a single sperm in an effort to achieve fertilization. This process, known as Intracytoplasmic Sperm Injection, or ICSI, is better described here. We had hoped that at least 1-2 fertilized eggs would continue multiplying cells for at least 3 days. Depending on the cellular structures, we would then transfer the 1-2 embryos back in three to five days after fertilization. The results of my ovarian hyperstimulation at retrieval was as follows: 16 eggs retrieved, 13 mature enough/available for fertilization with ICSI; 9 fertilized, so a 69% fertilization rate. Most clinics expect to see, on average, a 50%-70% fertilization rate.
Each of the fertilized eggs was then monitored.
| Embryo ID | ID1 | ID2 | ID3 | ID4 | ID5 | ID6 | ID7 | ID8 | ID9 |
| Day 3 Cell # | 8 | 8 | 7 | 8 | 6 | 6 | 6 | 5 | 2 |
| Day 3 (8/18) Grade (d) | 4c | 4 | 4c | 2 | 3 | 3 | 2 | 4 | 4 |
| Day 5 (8/20) Grade (e) | 4AA | 4AB | 4AB | 2 | MC | MC | MC | MC | MC |
| (T)rnsfr (F)reeze (D)iscard | T | T | F | ? | ? | D | D | D | D |
(d) Multicell embryos that receive grade 3 or 4 often develop to the blastocyst stage, those receiving grade 1 or 2 rarely develop to the blastocyst stage.
Grade 4: even cell division, no fragmentation Grade 3: even cell division, small fragmentation (normal) Grade 2: uneven cell division, moderate fragmentation Grade 1: uneven cell division, excessive fragmentation *Sometimes the laboratory uses the reversed scale. Check with your lab.*
(e) The first letter refers to the inner cell mass (the part of the blastocyst that is going to be the baby), the second letter refers to the quality of the trophectoderm (the part of the blastocyst that is going to be the placenta). According to RE, anything above BB is very good, with 4AA being the best. The first number refers to the degree of expansion; at my clinic this was on a 4 point scale, 4 being the highest.
On Monday, August 20, 2007, we transferred two Day 5 blastocysts (4AA and 4AB). They looked like this:
I was to be on strict bedrest for 48 hours after the transfer.
ACUPUNCTURE
I was very lucky to reside in the same city with a renowned fertility acupunture clinic. The founder published a book, entitled The Infertility Cure, which describes how Traditional Chinese Medicine (TCM) can be used to assist in conception. I purchased the book and reference it often for ideas on dietary consumption. There is also a survey in the book that helps you diagnose, through TCM, any fertility issues and gives dietary suggestions and pressure point illustrations for helping yourself.
Acupuncture was part of my efforts to conceive long before we ventured down the road of IVF. When I first started acupuncture, my cycles (Basal Body Temperatures) were all over the board. Acupuncture helped regulate my cycles. During the IVF cycle, one week before my Lupron shots began, I started going to acupuncture twice per week and continued that schedule up until transfer. Specifically, I had acupuncture on the following Cycle Days during the IVF cycle: CD3, CD11, CD20, CD25, CD28, CD31, CD33, CD39, CD42, CD45.
Here's a good summary here of how acupuncture can improve the outcome of Assisted Reproductive Technologies, such as IVF. Do I know that it helped? I don’t. But I BELIEVED that it would. In the same way that I believed I would one day be blessed to be a mom. I'm mostly Type A, and one thing I've learned in the process of trying to conceive is that we have to LET STUFF GO. With that, I stopped charting and reading medical journals and looking for explanations, and instead, started meditating and relaxing. In the end, the only proof I had that maybe acupuncture worked was this.
THE TWO WEEK WAIT (TWW)
More on that here.
THE hCG BETA RESULTS
Beta #1 - 08/29. 9dp5dt or 14DPO: hCG =260
Beta #2 - 08/31. 16DPO: hGC=422; P4=60; E2=1332
Beta #3 - 09/04. 20DPO: hCG=1742; E2=1571
And then on September 12, 2007, we found out we were having twins.
The rest is history.