The Big Day

The Big Day ~ Transfer Day

Big day indeed. My day started early and on very little sleep. We, my cousin and I, were to be at Life IVF Center by 9am for one last blood draw to check my P4 (progesterone) levels.

After my blood draw we hunted down a local bakery. It ended up being the most amazing experience! The place we stumbled upon is called 85C Bakery Cafe and it is an Asian bakery full of flavor combinations that I never would have thought up but that will be filling my dreams with delicious cravings. Two of my favorites were a savory combination called Potato Cheese, A puff pastry with potato and cheese filling, topped with cheddar and mozzarella cheese. The other was a sweet combination called Milk Pudding, A traditional Japanese style soft bread with vanilla custard inside. The savory tasted like Thanksgiving and the sweet tasted like a Hawaiian roll with vanilla custard inside, AMAZING!!! Like I said, flavors will be filling my dreams.

We had to return to the clinic by 11 am to check in for the transfer appointment. There was a minor snafu with how far my cousin would be able to accompany me but we were able to work it out and I got to have her by my side for a large amount of the time. I was called back shortly after that and was asked to change out of my shoes into some slippers before being directed to a changing room to put on a gown and a scrub hair net cap, but I was able to keep my shirt and bra on under the gown. My cousin went straight to my holding area to wait for me. We waited in a curtained-in space with an electric reclining chair with foot stool and a guest chair in a dimly lit area with spa music that sounded as though it was off in the distance. It did the trick to relax me! I nearly dozed off a few times. There were a few remaining pieces of paperwork requiring my signature and I had to confirm my identity verbally several times through out the entire process.

Finally, shortly after noon I was called out of my holding area where I had to leave my cousin. At the entrance to the transfer space I changed my shoes again into a pair of slippers with shoe covers on them and put on a face mask. I was then ushered into a large sterile room that vaguely reminded me of a delivery room with a medical exam bed in the middle of monitors and spotlights. I spelled my names out loud, confirmed date of birth, confirmed that I would be receiving one boy embryo, and confirmed my name on the large TV monitor that was displaying the contents under the microscope. On the TV monitor I then saw the tiny little blastocyst (5 day embryo) and it was so special for me to be seeing it without extreme magnification. It just amazed me in an awe inspiring way to think that something that tiny (see size reference in gallery) could grow to an infant in 9 short months. I was cleaned up and prepared to receive the embryo. One last ultrasound to check my uterus and the uterine lining was conducted before one more cleaning. Then a catheter was inserted into my uterus through the cervix and the ultrasound wand was close to follow in order to guide the placement of the catheter. They placed the embryo into my uterus and before I knew it I was sitting up. So much build up for ultimately a very quick procedure.

I was gently walked back to my little holding area with a nurse holding the back of my hips until I got in the chair and was cozied up with a down comforter to rest for about 15 minutes. After receiving my after care instructions, getting dressed, and my next two lab orders it was time to leave. What, already? Wow, that was a quick finish indeed.

The first Beta blood test will be on April 8th, 9 days post transfer. I haven’t decided yet if I will be one of the many impatient recipients of a transfer that get POAS happy with home pregnancy tests (HPT) or if I will remain patient and wait for the blood results. As of now I am hoping to hold out for blood. We’ll see how that goes.

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Travel Companion

Part of the requirements for the transfer trip is that I have a companion during my trip, not necessarily flying with me though. Just someone to ensure I am taken care of. At first this requirement was a little tricky logistically for me because the majority of people I know are parents of very young children or have jobs that require a two week notice for personal time off. After clarification that my companion can pretty much come from anywhere I thought to contact a sweet cousin of mine to check her availability and willingness to come on an all expenses paid whirlwind fast trip to Orange County, California. To my great relief she said Yes! Thankfully her job is flexible enough that she was able to request the days with such short notice. So, my darling cousin, Susanna, will be flying from Illinois to join me in southern California (hopefully, haven’t received travel plans yet) Sunday, only to turn around back home on Tuesday. I’m looking forward to a little visiting time with her but neither of us has much to go off of as to what we are to expect out of this trip. Only time will tell!

FIVE days until transfer!!!

We Have Scheduled Your Embryo Transfer

Today welcomed several wonderful emails and a phone call to confirm that an embryo transfer has been scheduled! My medications are going to kick up several notches between now and Monday (yes, THIS Monday), but thankfully none of them are injections. What a blessing!

All of my monitoring results are looking great. An optimal measurement of Endometrial Lining thickness for the implantation of a fertilized egg is greater than 7 mm and preferably greater than 8 mm. Mine is already sitting at 9.8 mm and will most likely increase further by the time transfer arrives. All of this is very encouraging indeed!

What’s next? Confirming my travel companion’s availability and travel arrangements booked for both of us by my agency. And of course, I will continue to eat healthy while taking my new regiment of medicine over the next several days.

Test Results

Below are the results from your CD13 appt:

Hormone Levels:

E2: 249

FSH: 6.8

LH: 18.7

P4: 0.5

Ultrasound Results:

Endometrial Lining: 9.8mm

Right Side Follicle: not visible

Left Side Follicle: not visible

Doctor’s recommended plan is as follows:

1) Continue Estrace 2mg, 2 tablets by mouth-twice a day daily.

2) Oral Progesterone 200mg, 1 tablet by mouth once daily at night time, starting 3/25 and continue.

3) Endometrin 100mg, 1 vaginal supp-twice a day on 3/25 then increase to 1 vaginal supp-three times a day on 3/26 and continue.

4) Please follow up on 3/28 to check your P4 level.

5) Lastly, we have scheduled your embryo transfer on 3/30 @ 11:30am. Please plan to arrive 30 mins prior to scheduled procedure time.

* Please skip the morning dosage of Endometrin on day of transfer, 3/30. Afterwards, you may continue as directed.

Find the funny in your life.

I was very tired this morning but having a little giggle before the Doctor came in helped perk me up significantly.

Time To Increase The Meds

After stalking my email through the day yesterday I received an email last night with the results from my early morning appointments. Things are looking good so far. I do have to double my Estrace dose but so far all medication is still oral. Next step will be another round of lab work and monitoring on Tuesday. Which also means another day of hitting refresh on my email every 30 seconds.

Test Results

Below are the results from your CD9 appt:

Hormone level:

E2(85)

LH(5.7)

P4 (0.3)

FSH(pending)

Ultrasound:

Endometrium lining thickness: 7.3 mm semi-laminar

Right side follicles: quiet

Left side follicles: quiet

After reviewing your results today, below is Dr. Yelian’s  recommended treatment plan:

1) Increase Estrace 2mg to 2 tablets by mouth twice a day( total 8mg per day) daily, starting CD9 (3/20) and continue

2) Follow up  on CD13 (3/24) for blood work and ultrasound

LH in Adult Females

Luteinizing hormone (LH) is a glycoprotein hormone consisting of 2 noncovalently bound subunits (alpha and beta). The alpha subunit of LH, follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), and human chorionic gonadotropin (hCG) are identical and contain 92 amino acids. The beta subunits of these hormones vary and confer the hormones’ specificity. LH has a beta subunit of 121 amino acids and is responsible for interaction with the LH receptor. This beta subunit contains the same amino acids in sequence as the beta subunit of hCG and both stimulate the same receptor, however, the hCG beta subunit contains an additional 24 amino acids, and the hormones differ in the composition of their sugar moieties. Gonadotropin-releasing hormone from the hypothalamus controls the secretion of the gonadotropins, FSH and LH, from the anterior pituitary.

In both males and females, LH is essential for reproduction. In females, the menstrual cycle is divided by a midcycle surge of both LH and FSH into a follicular phase and a luteal phase. This “LH surge” triggers ovulation thereby not only releasing the egg, but also initiating the conversion of the residual follicle into a corpus luteum that, in turn, produces progesterone to prepare the endometrium for a possible implantation. LH is necessary to maintain luteal function for the first 2 weeks. In case of pregnancy, luteal function will be further maintained by the action of hCG (a hormone very similar to LH) from the newly established pregnancy. LH supports thecal cells in the ovary that provide androgens and hormonal precursors for estradiol production. LH in males acts on testicular interstitial cells of Leydig to cause increased synthesis of testosterone.

Reference Values

> or =18 years
Premenopausal
Follicular: 2.1-10.9 IU/L
Midcycle: 20.0-100.0 IU/L
Luteal: 1.2-12.9 IU/L
Postmenopausal: 10.0-60.0 IU/L
Source: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8663

For references on what E2, P4, FSH, and Estrace are; click here to read my previous post.

Treatment Plan Through CD10

Last night I began my treatment plan! The nurse from Life IVF Center in Irvine, CA sent me a big email full of results and a plan for the the coming week.

The cliff notes version is that everything is on track and I am now taking an oral medication called Estrace (more information below). I will be taking it once daily through tomorrow then increasing to twice a day. At the end of the week I will also have additional blood work and a monitoring appointment at Texas Fertility Center. They have not given me a transfer date yet but if it is supposed to be around CD23 then it will approximately be April 3rd.

For a more in depth look at the results, medication, and type of blood tests with reference values please see the fun facts listed below.

Test Results

Below are the results from your CD2 appt:

Hormone Levels:

E2: 27

FSH: pending

P4: 0.4

Ultrasound Results:

Endometrial Lining: 4.8mm

Right Side Follicles: 6mm, 5mm and 5 of <5mm

Left Side Follicles: 9mm, 8mm and 5 of <8mm

Doctor’s recommended plan is as follows:

1) Estrace 2mg, 1 tablet by mouth once daily, starting on your CD5 (3/16) and continue for 3 days. Then increase to 1 tablet by mouth-twice a day daily, starting on your CD8 (3/19) and continue.

2) Please follow up on your CD10 (3/21) to check your E2, FSH, LH, P4 and ultrasound.

What is Estrace?

Estrace is a medicine that contains estrogen hormones.
Source: http://www.drugs.com/pro/estrace.html

E2 Reference Values in Adult Females

Females
Premenopausal: 15-350 pg/mL**
Postmenopausal: <10 pg/mL
**E2 levels vary widely through the menstrual cycle.
Source: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84230

FSH in Adult Females

Gonadotropin-releasing hormone from the hypothalamus controls the secretion of the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. The menstrual cycle is divided by a midcycle surge of both FSH and LH into a follicular phase and a luteal phase. FSH appears to control gametogenesis in both males and females.

Reference Values

> or =18 years: Premenopausal
Follicular: 3.9-8.8 IU/L
Midcycle: 4.5-22.5 IU/L
Luteal: 1.8-5.1 IU/L
Postmenopausal: 16.7-113.6 IU/L
Source: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8670

P4 (Progesterone, Serum) in Adult Females

Sources of progesterone are the adrenal glands, corpus luteum, and placenta. Useful for ascertaining whether ovulation occurred in a menstrual cycle.

Reference Values

Premenopausal
Follicular phase: 0.20-1.50 ng/mL
Ovulation phase: 0.80-3.00 ng/mL
Luteal phase: 1.70-27.00 ng/mL
Postmenopausal: <0.15-0.80 ng/mL
Source: http://www.mayomedicallaboratories.com/interpretive-guide/?alpha=P&unit_code=8141 

Tentative Transfer and PGS

After anxiously awaiting an update I received word that we are anticipating a transfer in March! The embryos are almost ready and are going through PGS.

Genesis-24, also known as Pre-Implantation Genetic Screening (PGS), is an IVF procedure designed to examine your embryos for chromosomal abnormalities. An embryo biopsy is taken either at day 3 or day 5 and Genesis-24 is used to examine all 24 chromosomes—the 22 non-sex chromosomes plus the two sex chromosomes (X & Y) in time for your embryo transfer. Chromosomal abnormalities can result in aneuploidy (embryos having the wrong number of chromosomes – i.e. extra copy of chromosome 21 also known as Downs Syndrome), translocations (chromosomes incorrectly rearranged), or other chromosome alterations that may be clinically significant. Genesis-24 aims at improving pregnancy and live birth rates by screening your embryos for chromosomal abnormalities and only implanting chromosomally normal embryos.

For more information on PGS  visit http://genesisgenetics.org/pgs/