Finding Zwee

The science behind IVF is pretty nuts. And it’s easier to understand it when you first get a friendly basic reminder of a normal cycle. So here you are:

Day 1: the body knows it’s not pregnant, and wants to set itself up to be. So it picks one egg from an ovary, and dedicates its resource to growing that one egg. It grows in a follicle: think of a water ballon (the follicle) with a grain of sand (the egg) inside. Over the course of 14 days, the follicle grows in size from microscopic to about 20mm across.

Day 14: the body releases the egg, it travels down the tubes, and splash! lands in the uterus. If it has bumped into a swimmer along the way, the egg is fertilized, and it will implant itself in the lining of the uterus.

Day 28: if not pregnant, shed the lining, and start the whole thing over.

The important part in all this is: one egg inside one follicle from one ovary, on any given cycle.

I love being able to pretend I’m a mad-scientist. Or doctor. Or chemist. The measuring, the the mixing… it’s all kind of fun.

But before coffee, it’s a bit hard to focus, and I have moments of “wait what am I doing” as I mix.

From left to right:

1. Ganirelix. This one is the easiest. No measuring, no mixing. Just push out the air and shoot.
2. Menopur. This one is tricky. Get the liquid from one vial and mix it into the powder in vial 2. Once dissolved, pulled the liquid from vial 2 and mix it into the powder in vial 3. Toss vial 4 before you accidentally do anything with it. So there are two powder doses dissolved in the liquid in vial 3. Pull the the now mixed medicine into the syringe, change the needle tip to the thinner needle (don’t inject with that giant thing!) and shoot.
3. Omnitrope. This gets mixed once, and has 3 day’s worth of doses in it. Pull out what you need, and inject. Hurry up and get the remainder back in the fridge – don’t inattentively toss it in the biohazard bucket.

All this used to be an intense, frightful few moments – “This goes here, right? Is this the right needle? How much air bubble is ok? How much liquid is ok to not capture from the vial? I injected an air bubble – oh no! am I going to die? I hit a capillary – is that ok?” All these uncertainties have lent to a bit of background nerves, but now I am in the groove and it’s just another part of my day. Now then. Where’s my coffee?

I went in for an ultrasound and labs and was met with another IVF surprise: “that’ll be $800.” I was a bit taken aback, but at this point in IVF, “another” $800 ceases to mean much. I add zeros to everything now in a way I did not just a few short months ago. My brain sputters a bit, I wish it weren’t real, and then I think “it is what it is” and we will figure it out.

I go upstairs for a mock embryo transfer. The nurse shows me the catheter they will insert today, just to make sure that on the day of real transfer,  it goes in easily, it’s the right size, and so on. The thing is like a foot long, and a quarter inch in diameter. I cringe. She doesn’t say anything about it being painful, and I wonder: Is she just waiting to tell me? Or won’t that really hurt? Because that sure looks like it’s gonna hurt.

The doctor enters, and he peels open the catheter packaging, and then (ah!) removes that foot-long casing, to reveal a slim tube. Phew.  I’m relieved.

In it goes, only he can’t see it because even though I haven’t peed in hours, it’s not a “full enough” bladder. He says it’s good enough. He seems satisfied. I should have drank more water.

Next up is the Doppler ultrasound, to assess how much blood flows to the uterus. This one required the dreaded speculum… or did it? I lose track. I’m so used to being poked and prodded I hardly notice anymore.

Anyways, the Doppler is an ultrasound on my belly, and I can see the pulsing of blood around my uterus on the screen. He says my uterus has good blood pressure. That test takes all of 4 minutes. It’s $420. I am both resistant, and deeply grateful.

Now the exciting part: the follicle count. The right ovary always seems to be easily visible, so the follicles there get counted first. I try to match his count, as he moves around, measures, looks right, fakes left, then right again. He sees 9: a great number. If half those reach maturity, that will be a solid start. If all of them reach maturity, and same for the other side, we could have a really great outcome – maybe 2 or even 3 viable embryos. But it’s too early to prognosticate. It’s one of the hardest parts of IVF: getting used to waiting, and not knowing.

He moves on to the left ovary. Today it is partly in view. About 5 follicles are visible, but the view is much hazier. He gets some measurements – enough to satisfy him but not me (find 4 more!!) – and that’s the end. Right now they are measuring between 6 and 12 mm – which is a good bit of variation. We don’t want any of them speeding too far ahead.

So tomorrow I will add in a new drug: Ganirelix – to prevent premature ovulation.

Sunday morning we will see again how they grow.

 

It’s wild to sign on for a giant medical procedure without having met your doctor face-to-face, and having not visited the facility. After being in touch for 8 weeks, today I finally get to check out their digs.

It’s every bit as spiffy as I thought it might be – it’s superficial I know, but it’s comforting nonetheless.

The nurse calls me back – first a poke for estradiol levels – which turn out to be just right at 370. Whatever that means. Then an ultrasound for follicle count and size.

The doctor sees 9 on the right, and the left is tucked away (argh!) so we will have to wait.

In the photo, you can see 3 dark circles. Each of those is a follicle. He measures across it from 2 directions to get the size. Right now they are measuring around 6mm across. There isn’t much more to know – I have a thousand questions I want answers to – but I have been here before and what I know is that is it too early to tell. So I keep my questions to myself.

That’s it – 10 minutes and I’m done.

I adore checklists, and this is one for the ages.

Gettaloda this thing! I nearly had a heart attack when I printed out the battery of tests I would need. The first two clinics I researched (and one I later used) never gave me anything like this: no wonder I felt so overwhelmed by it all.

Let me break it down for ya:

Tests to make sure everything works right, blood tests for diseases, baseline hormone levels, and other basics, similar for John, and genetic screening choices.

Now that it’s all done, I look back and go, Yeah, that all makes sense. But having all these tests out in front of you is a really intimidating process.

Most don’t hurt, but some do.

The HSG hurt like an SOB. You get filled with radioactive ink. After that test I told John I was never doing another test alone and ordered him to come with me. That was over-doing it… that was the only one that really hurt.

The SIS you get filled with saline. A bit uncomfortable, but not so bad.

The Doppler was no sweat – on the belly ultrasound.

The mock transfer was intense but not painful.

The blood draws aren’t so bad – as long as the nurse hits your vein. When she doesn’t, then it burns. That happened – twice.

In the end, I welcome it. It’s hard, but it’s all a part of the process – a process that I am choosing, a process I want to go through because I know the magic that exists on the other side. So, bring on the tests.