2017 may be but a few weeks old, but we are already breezing through our second round of IVF. I have not chronicled this round in as much detail, but for a play-by-play of an entire IVF cycle click here. The first cycle felt novel and empowering, as in: “We’re taking control of our situation and making things happen over here!” This cycle – although way less of an ordeal – has definitely lost its luster. It’s probably because it’s the middle of January and cold as hell; or maybe it’s because we have officially run out of insurance coverage and each step of this cycle is costing us a small fortune; or perhaps it’s because we only ended up with one viable embryo after our first cycle, so everything seems a bit more high-stakes this time. Whatever the case may be, I’ve kept my head down and gone through the paces of this second cycle without too much chronicling or over-analyzation. The good news? It’s almost over! Here’s the skinny on Round 2:
Round 2 Protocol:
All medications stayed the same as Round 1 meds. However, in attempt to stimulate my follicles a bit more aggressively this time, Dr. M. recommended upping our dosage of Gonal F from 150 IUs to 300 IUs and also wearing an estrogen patch for two weeks prior to starting our IVF cycle. Our second round protocol looked like this:
- 150 IUs of Menopur
- 300 IUs of Gonal F
A Note About Estrogen Patching: As it was explained to me, estrogen suppresses natural ovulation and helps to “quiet the ovaries,” which in turn, produces a better baseline in which to being ovarian-stimulation. Without suppression, your body will naturally produce a few “lead follicles” each month. Out of these, one will reach maturation first and release the egg: i.e. ovulation. However, during IVF stimulation, it is best if all the follicles grow at the same rate so that they may reach maturation – and thus be collected via egg retrieval – at the same time. Follicles and eggs have a definitive “shelf-life” of when they can be retrieved, and thus stimulating them is a delicate balance of symmetry and synchronicity.
For example, last cycle I had five very mature follicles that were ready for egg retrieval and a few smaller ones that were not. This presents a very “Sophie’s Choice” type of problem: you can stop stimulation medication and retrieve the eggs from the lead follicles, but then you forgo the smaller follicles that may have caught up in the end. Or you can decide to keep pushing stimulation medication for a few days in the hopes that the smaller follicles will catch up, but then you risk losing the lead follicles as they become “over-mature.” My doctor decided to go in for the five, as we didn’t want to risk losing the ones “in the lead” for the few stragglers left behind. Indeed, even though the doctor retrieved six eggs from that procedure, only five were truly mature, just as predicted.
With the use of estrogen patching this cycle, all follicles will begin at the same baseline and thus grow at a more even rate. On Day 8 of my natural period cycle from last month, I began monitoring for my LH surge via ovulation predictor kits (OPKs). Once LH surge was detected, I was instructed to put on my first patch eight days later. From there, I switched out patches every other day until we were ready to begin the stimulation medication.
Round 2 Side Effects:
From start to finish, we will “stim” a total of 14 days this round. Our first round of IVF we only stimmed for a total of 11 days. Despite the longer duration, the side effects were very much the same:
- increase of headaches with the rise of estrogen
- increase of fatigue and “foggy” feeling with the rise of estrogen
- increase of “heaviness” and overall bloating with the growth of follicles
- Overall, totally manageable
Round 2 Results:
When it comes to ovarian stimulation, I’m a “slow and steady” type of gal. This means that my follicles grow slowly, but progress steadily. This is fine with me, as this also means that I’m not at risk for Ovarian hyperstimulation syndrome (OHSS), which comes with a whole host of complications and side effects. What we learned from my last stimming cycle is that I don’t produce a ton of eggs; however the ones that I do produce successfully fertilize and grow into healthy blastocysts. Last time I had only 5 mature eggs retrieved, but 4 successfully fertilized and grew to blastocyst stage. Due to the high drop-off rate of this process (over 50%), Dr. M. says that 20 eggs could have yielded those same results that I got with just 5. So I’m happy with my “slow and steady” progress thus far.
This round is no different, although we are tracking slightly more eggs at this point, which is most likely on account of the increase dosage of Gonal F and the Estrogen patching pre-cycle.
Day 10 Stimulation (today):
Right Ovary: 4 follicles (maybe 5)
Left Ovary: 4 follicles (maybe 5)
Estrogen (Estradiol) Level: 1,191 pg/ml
Based on these results we are hoping to retrieve between 7 – 9 mature eggs this time. Knowing what I do now, IVF is really a quantity and quality game. Quantity: Get as many eggs as you can to ensure that there are some left over for transfer after all the hurdles they must face. Quality: Hope that some of those eggs are of sound health to make a viable pregnancy. Based on our results last time, it took 5 eggs to yield 1 perfect embryo for transfer. Here’s hoping for a few more to yield at least 2 in the end! Keeping our fingers and toes crossed.