The Day After

The day after my ER (Thursday, 6.2.16), my pain was low/moderate, but I was not feeling 100%. One of my friends had a really hard time after her recovery (bed rest for a week), and I've read many accounts from women who suffered from OHSS, so I was pretty blessed to feel as well as I did. 

I gained 3.2 lb. within 24 hours (3.6 lb. total within 48 hours), so I called my nurse who told me that weight gain is common after ER, especially with the fluid you receive while you're under anesthesia. I also read that your follicles will fill up with fluid after the ER. The nurse recommended a high protein diet (chicken, Greek yogurt, etc.) and to continue drinking electrolyte drinks over the course of the next 2 weeks. I read on a forum that the sodium (from electrolyte drinks) encourages the cells to retain fluid instead of spilling out into the abdominal cavity. I usually prefer diet sodas, so the idea of drinking tons of sugary sweet Gatorade did not appeal to me, and though I like Smartwater, the electrolyte content is low, so I found Powerade Zero, which has 0 calories and <1 g carbs, and the Fruit Punch is pretty good.

After drinking at least 32 fl. oz. of Powerade a day, I have been steadily dropping the water weight and today (6 days after ER), I am back to my normal weight (before starting stims). I also felt well enough to go back to the gym on Sunday (4 days after ER), though I've been taking it easy on the elliptical and doing low weight/low rep weights. I did have to take Colace for a couple days to get my system back on track. :)

I know I am lucky to have had a pretty easy recovery after ER, as I know that is not always the case. Here are some of my suggestions taken from my own personal experience:

• Rest. Rest as much as you need to. I recommend staying in bed after you get home from the ER, and possibly the day after if needed.
• Drink electrolyte drinks. I started out drinking plain water, but found that drinking Powerade (or Gatorade or Propel) helped flush out my system and drop the water weight.
• Eat protein. Eat lots of protein: eggs, chicken, nuts, Greek yogurt, etc.
• Go to the bathroom. After drinking all that Gatorade, you're going to be making many trips to the bathroom, but that's ok. Your body is flushing out excess fluids. You also may feel some abdominal cramping which can worsen when you haven't had a bowel movement. After anesthesia, it can take your body awhile to become regular again. My nurse said it was ok to take something gentle like (non-stimulant) Colace (if you are having trouble in that department. 
• Trust your body. Your body will let you know what you can/can't handle. If you don't feel well, call your nurse. Keep track of your weight, body temperature, etc. so you have a reference. Take pain medication if needed, and stop when it's not needed anymore. If you are up to it, and the doctor says it's ok, start going back to the gym or walking your dog...just don't do too much too quickly.

I realized today that I am feeling pretty good; dare I say, back to normal? I'm glad I'm giving my body a chance to recover a bit before having to start more injections to prep for the FET!

Egg Retrieval

Yesterday (Tuesday), the nurse called me with my bw results: Progesterone level at 5.3 (they look for 3+); Luteinizing Hormone (LH) level at 49.2 (they look for 15+). Everything was all set to go for my egg retrieval (ER)!

The ER was scheduled for this morning at 9:45. David and I arrived at 8:15am and I was taken to the hospital area and given a gown, booties, and hair cap. I signed all my forms, discussed my discharge instructions, got changed, and then the anesthesiologist (Dr. Steve) came in with more paperwork and started my saline IV. He joked that I was a human pin cushion after seeing my arms, and despite the local lidocaine he gave me before inserting the catheter, I hated having that thing in my arm. I have probably had a handful of saline IVs (emergency room visit, wisdom teeth removal, etc.) but there's something about having that thing my arm that I can't stand. Dr. Steve was so nice, but as soon as he left, I started getting nervous and a little teary-eyed. It was so great having David there to comfort me; he showed me my favorite sloth video and I was laughing again in no time. Soon David was taken away for his sample, and I was alone in the room for a little bit.

All dressed up and no place to go. :)

Throughout the process, I could see and hear a little bit of what was going on in the next room on the other side of the curtain...this was great because I could mentally prepare myself as far as which nurse/doctor/tech I'd see next, and what the time frame was. When the woman next door was taken away to the OR, I knew I'd probably be in there in the next 30-40 minutes. David came back right before the nurse came for me to make sure I relieved my bladder before going to the OR. Then we walked David to the exit (to the waiting room), and she brought me into the OR. In the OR I saw Dr. Steve again, as well as 3 nurses. The embryologist came in to confirm my personal information, and then Dr. Steve started my anesthesia. Before I knew it, I woke up in my room with Nurse Sabrina. She asked me if I was in pain, and gave me IV pain medication when I told her I was, which helped, and then told me to go back to sleep. 

The next time I woke up, David was sitting next to my bed in the chair. The nurse returned and gave me some saltines and water, had David give me some oral Norco for the pain, and had me drink some Sprite to increase my sugar levels. She went over discharge instructions with me again, and relayed dietary instructions to David, and then told me that my doctor would come in to speak to me before we could leave. I could hear another woman that was crying from the anesthesia wearing off (it was heartbreaking!). I asked Nurse Sabrina if I had done that, and she said no, but that I was extremely funny. I asked her why, and she said I kept asking questions about how I got to my bed and who brought me there. She said she loved my voice (which was a little scratchy), that it reminded her of a character from Gravity Falls, and that I should do voiceovers. :)

My doctor came to see how I was, and told me he had retrieved 19 eggs. I was hoping to hit an even 20, but he said he was happy with anything over 15. We discussed the protocol for the next few days, and the PGS and tentative FET schedules. Then I was able to get dressed and leave. After stopping at Arby's and KFC, we got home just before noon.

Nurse Sabrina had instructed David to make sure I focus on consuming Gatorade, protein (meat, nuts, cheese), and broth, all of which David kindly got for me from the store after I woke up from a nap. I've had some spotting throughout the day, but nothing excessive. The pain is uncomfortable (similar to really bad menstrual cramps). It gets worse when the Norco wears off, but it's not unbearable. I took it easy the rest of the day, napping and resting on the couch. Tomorrow the doctor will call me to tell me how many eggs were mature and fertilized with ICSI.

David's parents are coming tomorrow for a quick visit; I'm hoping I am feeling up for the company. Unfortunately it didn't work out in their schedule for them to come a little later, and David will also be leaving after the weekend, so we are making do!

Bloating, Weight Gain, and Ultrasounds

Progression of abdominal swelling:
Left - Stims: Day 6; Center - Stims: Day 10; Right - Morning of ER

I read that ovaries are normally the size of walnuts, but with IVF can swell up to the size of plums or even small grapefruits! So prior to starting stims, I was preparing myself for the swelling and possible weight gain. (I've read varying accounts on weight gain--some women gained nothing, some gained only 5 lb., others gained closer to 15+ lb.) Today, (the morning of my ER, which I will write about in the next post), I weighed myself and I was up 1.8 lb. I will say that I had a lot less swelling than I was expecting, and my discomfort was pretty manageable (with only a few days of bad headaches at the beginning and a little bit of abdominal "heaviness" towards days 8-10 of stims). I thought I'd post a comparison of my abdomen: Day 6 vs. Day 10 vs. Day 12/ER. I actually looked and felt more bloated on some of the days in the middle of stimming compared to the morning of my ER.

Top: Uterine lining; Bottom: Follicles in my ovary

I also wanted to share some photos from my ultrasound on Day 10 (5.29.16). This entire process has been so interesting and I've learned a lot about my body and what it's capable of doing. 

I've also really surprised myself at how strong I am when I need to be. This first cycle (up to ER) was scary and difficult at times, but it was nothing I couldn't handle and make it through. I've endured endless blood draws and needle pricks, had a ton of invasive ultrasounds; I've gotten over any kind of embarrassment with doctors; I've learned to give myself subcutaneous injections! I've also spent time getting myself healthy--both mentally and physically. I'm surprised that eliminating alcohol and caffeine was as easy as it has been (though I have definitely craved a glass of Malbec here and there!). 

If you are reading this and you are interested in IVF, but are scared of the needles, doctors, and protocol involved--be brave! If I can do this, so can you. In the end, those needle pricks, blood draws, and doctors appointments will (hopefully) be totally worth it. I'm keeping my eye on the prize!

Pulling the Trigger Tonight!

Today is Memorial Day, day 11 of stims, and I went in for an early u/s and bw appointment and was told I'd be triggering this evening! Last night I decreased my Gonal-f from 125 IU to 100 IU and kept the Menopur the same; Cetrotide was the same this morning, and I will be triggering tonight with 0.8 cc of Lupron (Leuprolide Acetate).

My estrogen (estradiol) levels were 3606 (Saturday, 5/28/16); 4835 (Sunday, 5/29/16); and 5604 (today, 5/30/16). They are seeing approximately 16-18 large follicles. I'm hoping this will be 18-20 by Wednesday, which is Egg Retrieval (ER) day!

My trigger is scheduled for 9:46pm tonight, and the ER will be exactly 36 hours after this, so 9:45am on Wednesday, 6/1/16. Tomorrow night I will take 2 Azithromycin (500 mg) tablets, and then no food or water after midnight. I am excited about the upcoming ER, and not super nervous or scared yet. I'm sure it will start settling in tomorrow night!

Day 8 of Stims

Stims: Day 8 - 4th morning of Cetrotide (25 mg)
7 nights of Gonal-f (175-150 IU) & Menopur (75-150 IU)

Today is my 8th day of injections. The veins in my arms are a little bruised so blood draws are a bit harder for the phlebotomists. During the u/s, the sonographer found 10 follicles in my left ovary and 14 in my right. She said that I could expect to make appointments for every day this weekend. I keep forgetting that the fertility clinic is open 24/7, because the doctors, nurses, sonographers, etc. need to be ready at any point in time to retrieve eggs and implant embryos! Reminds me of when I worked at an emergency vet hospital all during grad. school. Memorial Day is Monday, and they don't get the day off.

I didn't get a call from my nurse this afternoon so I called the after-hours number and the nurse on-call called me back to tell me that the doctor wants me to decrease the Gonal-f dosage from 150 IU to 125 IU, and to keep the Menopur and Cetrotide doses as is. I have another appointment scheduled for tomorrow morning (Saturday).

David comes tomorrow night, so I am excited. It's been lonely and difficult not having him here, and I know he's been bored at home by himself so hopefully this will make things a little easier. David coming means that the egg retrieval is right around the corner! We don't have the date set yet, but it should be some time next week!