The End is Near!

Monday, I finished my last day of injectables.  Yay!  I was quite happy to finish my injectables as I was starting to have heaps of side effects - excessive vaginal discharge (so much that I had to wear a panty liner because I soaked through 2 pairs of scrubs!), really tender skin where it was beginning to hurt to give subq injections, bruising on my stomach after injections, extremely tender and sore breasts, constipation and an irritable mood.  At first the injectables just made me happy with no symptoms.  In the end, they were really starting to wear on me.

Monday at 2230, I took my hCG trigger shot (35 hours prior to retrieval).

Tuesday, I began my antibiotics.

Wednesday was egg retrieval day.  My sister took me to my appointment at 0830 for a retrieval by 0930.  My blood pressure was sky high for me (140/85) at admission because I was so nervous about being put under anesthesia and waking up in pain.  Luckily, I had my sister there to make me laugh and comfort me.  My anesthesiologist was phenomenal as well.  He put me at ease right away with his good nature and humor, and he really listened to me regarding my anesthesia fears.  I was under anesthesia previously for a tonsillectomy and had the worst time coming out of anesthesia - difficulty waking up and staying awake for over 24 hours.  I have the same issue when I take any prescription narcotics or other meds that say "may cause drowsiness".  In me, they ALWAYS cause drowsiness and it is typically a drowsiness I cannot easily shake.  I will often sleep for 12-18 hours straight after taking those types of medications.  So, it was wonderful to actually have him take me seriously and listen to my concerns instead of blowing me off.  He then gave me only 1/2 of the versed and fentanyl right before the procedure instead of the whole dose.

Before the procedure started, I asked my RE to look and make sure my eggs were still there prior to going under anesthesia.  I did not want to go under if I had already ovulated!  Thankfully, the IVF round was not a loss and I had not ovulated.

I was given versed in the pre-op room in order to calm my fears, and then I was given fentanyl when we were back in the procedure room.  After that, I do not remember a thing.  I was given propofol (yes, the Michael Jackson drug) and I went off to sedation land.

I woke up in my pre-op room, now a recovery room dimly lit with my RN sitting at my bedside charting my vitals.  She asked the usual questions - how did I feel?  was I in any pain?  did I feel nauseous?  I felt fine, actually.  Just a bit foggy in the brain, but otherwise, no pain and I woke directly after the procedure with no hangover.  That was the best thing!  I drank some apple juice and ate some pretzels and then they brought back in my sister.  The RN monitored my vitals for some time until all was good (BP now 114/72), gave me my post-op instructions and gave me my first progesterone injection - 0.25 ml with instructions to give myself another 0.25 ml that evening.

My RE popped in with the news that there were 7 eggs.  I was disappointed in hearing that as we had hoped that there would be at least 10-12.  It was disheartening, but I tried to think positively and hope for the best.

Going home, I was to continue with my antibiotics for 5 days and give myself 1 mL of progesterone every evening. They said they would then call me the following day with news of my eggs.

My sister then took me to Whole Foods for lunch, which was lovely.  I had a nice pretzel sandwich with field roast and a white bean and kale soup.  Yum!  It was nice to spend time with my sister and have someone with me who really cares about me with my husband being gone. She took really good care of me too!  My sister then drove me home, and I spent the rest of the day sleeping and resting - hoping that I would receive good news the following day.

Progress

Friday I had another US and more blood work (having every other day appointments now) and it looks like my follicles are maturing faster than expected.  My RE said we are on track for retrieving 8-12 eggs, but she is not sure if they will all be mature enough.  I am going to have a follow up US and blood work done on Sunday. If the follicles are plentiful and the sizes are good (indicating proper maturity), then I will have my egg retrieval on Tuesday.  My RE says it is a fine balance between retrieving prior to ovulation and ensuring maximum number of follicles possible and that the eggs are mature.

My estrogen is also doubling and increasing nicely.  So far, so good!

I've stayed at 375 IU for Gonal-F each p.m., 1 vial of Menopur each p.m., and 10 units of Lupron BID (twice daily).  Sadly, no decreases in the Gonal-F for me.  This means that I have gone through 3 pens of Gonal-F, and had no more pens after last night.  We never knew the meds would be so incredibly expensive, and when we drained our savings for our 4 rounds of IVF (2 fresh and 2 frozen with Attain), we had no money left.  When the pharmacy called and said our meds would be $3500 and that our insurance would not cover it, I almost had a heart attack.  Literally, I ended up in the ER with PVCs (pre-ventricular contractions).  We ended up having to take a personal loan to pay for our medications.  Our insurance only covered the progesterone and Lupron, so the $3500 was for the Gonal-F ($900 a pen x 3) and Menopur ($80 a vial x 10) alone.  With the RE office not ordering enough pens for me in the beginning (since they are so expensive, they are cautious not to order too many), I was in a panic when I realised I would run out of the Gonal-F on Friday with no way to buy another pen at $900 a pop.  Thankfully my doctor's office donated a pen to me.  Wow - what a blessing and such a relief!  One less thing to worry about.

On the midwifery front, I have made progress in my clincals as well.  I caught another sweet baby boy yesterday increasing my count to 12.  (This count is only my US births and does not count the babies I caught in Ghana.)  My program only requires 20(!) births, which I think is far too low to call myself experienced/ready to practise on my own, so I am setting a goal for myself of at least 60.  I would ultimately like to make it to 100 (they say you feel comfortable with births after your 100th catch), but anywhere between 60 and 100 would be sublime for me.  I also sutured my first patient yesterday with bilateral labial lacs, and a wonderful MD taught me how to tie one handed with my left hand (non-dominant hand).  Now, I can hold my instrument in my right hand and tie with my left without ever having to switch hands or put down the needle.  Woo hoo!  So exciting!

I needed a day like yesterday.  It was such a moral booster.  I made wonderful progress in both my IVF course and my studies this past week.  Excited to see what this next week brings!

Ghana bound

I have decided to do an elective in Ghana via Work the World in September when I am on my 3 week break between summer and fall terms. There I will be working in a hospital in Takoradi - a 4 hour drive west of Accra along the coast of the Gulf of Guinea. The experiences other midwives and students have had sound phenomenal. I am quite excited to go, albeit a bit nervous as I have never been to Africa and do not know what to expect of the country or the healthcare. I imagine it will be quite shocking at first and not at all what we are use to in our Western industrialised nations.

To enter Ghana I had to have a pre-travel appointment with the travel clinic and found I needed both Typhoid (only good for 5 years and my last was in 1991) and Yellow Fever, which certification of receipt is required to enter Ghana. Upon receiving the news that I was not pregnant (again) I quickly secured my vaccinations since you cannot take either whilst pregnant due to the live viruses they contain.

This now delays my next IUI since I need to wait a month before trying to conceive after taking these vaccinations. I was a bit skeptical about trying another round of IUI in May though, as both Malaria meds are pregnancy C category and if pregnant, I cannot take Doxycycline at all. I also read that mosquitos are more attracted to pregnant women (hence why many pregnant women in Ghana also have malaria), so I am a bit leery about that. I am following up with my physician to ensure it will be okay to be pregnant and go to Ghana. I definitely do not want to work so hard to get pregnant to then put my baby or myself at risk of being infected with a disease.

I have asked for a consultation with my physician, but it seems that all appointments are booked up for consults until May. That is a bit disappointing. I am hoping to get in before we do our next round as I would like to discuss our short term and long term options. Obviously I know we can do another 2 rounds of IUI, but there are further issues to contemplate. I will be gone to Ghana for 3 weeks in September, and sometime around September my husband will also be leaving on business for 4+ months. We hope to inquire about sperm freezing as well as speak about our options with IVF to include how it would work if my husband is gone, financing, risks, etc. I never thought I would consider IVF, but it looks like we are heading that way. I just do not know how it will work with me being out of country most of September and my husband leaving the same month. Possibly we have to do egg retrieval and insemination before he leaves with implantation after I return? These are the questions I would like to learn answers to.

I will be 39 this November. I feel like my time is running out. I want to be pregnant before I turn 40 as success rates after 40 drastically decrease while risks of Down's Syndrome and other age related issues increase.

Gosh. Hoping for a miracle!