There were arguments, frustrations and anger…Intense anxiety and raw fears…
I woke up, felt relieved, realizing that it was all just a dream. But a moment later, I sadly realized how often these fears (…) are present. But I’m not trying to fight them. What I can and should do well is to go inward and pray, which helps me stay aware of my fears without being overwhelmed.
…
No matter what happens, this journey will eventually end, and something new will start. Whether it turns out to be better or worse, it will be different. And a change is what I’m really after.
10 IVF cycles (8 egg retrievals, 2 cancelled on days 8 and 9 of stimulations). The numbers say it all… Still hopeful but hopeless at the same time.
Not related, but it’s not easy living with fear—silent but turbulent at times. Bear it, embrace it, befriend it, and pray, knowing that things shall pass.
In the worst situations, prayer, compassion, and gratitude are my navigators through struggles and miseries, without whining, “poor me!”
Two weeks before my baseline ultrasound and blood tests, I was nervous and anxious about my upcoming cycle. It was the first time I found myself emotionally and physically unavailable for the treatment, feeling negative and doubtful. I wasn’t certain if I could proceed with the treatment.
My immune system was badly affected by allergies, despite it not being an allergy month. While helping S build two flower beds in the backyard, I might have exposed to allergens or fungi when touching the old soil and decayed leaves. I ended up with constant runny nose and relentless sneezing, which forced me to take Clarins even though I didn’t want to. Additionally, I experienced swelling in one spot of my gum for unknown reasons, slow healing of a scratch on my hand caused by Sam, and sudden pain in my left knee joint. My muscles were stiff and my entire body tensed up.
S took me to a spa for a massage, which provided temporary relief. However, I still felt exhausted, and deep down, I sensed that my body wasn’t fully prepared for the treatment. I hesitated to order stimulation drugs, unsure if the baseline ultrasound and blood tests would provide the green light to proceed. It was the first time I mentally prepared myself for the possibility of failure right from the start.
The test results revealed active cysts in both ovaries and a high estradiol level of 128 pg/mL, surpassing the expected 50 pg/mL. Therefore, the doctor decided to cancel my cycle and put me on birth control pills, Norethindrone Acetate and Ethinyl Estradiol (1.5 mg). I started taking these pills on 6/26 and will discontinue them on 8/7. However, I am not fond of being on birth control pills, especially for an extended period. I had expressed my concerns regarding the risk of ovary over suppression multiple times to the doctor, and while she understood, it seemed she didn’t weigh that risk as heavily, considering the benefits it provides in preventing cysts and facilitating the clinic’s scheduling.
I felt trapped, unsure of how to strike a balance between resolving the cysts and ensuring that my ovaries respond well to the medications. Given my age and the past negative experience with prolonged use of birth control pills in the second round, I worried that I would encounter the same outcome in the future. When I asked about an alternative to birth control pills, the nurse mentioned the possibility of using long Lupron, but she added without an explanation that the doctor might not want that option for me. I was advised to talk with the doctor to understand possible solutions she could offer. This means I would have to book an appointment with her and wait for at least a month for the appointment. I hesitated to do this because though we previously discussed how to avoid the development of cysts during the stimulation phase, we have never talked about how to resolve cysts that occurred before stimulation injections. This is the first time I’m experiencing active cysts before stimulation, so I persuaded myself to try not to overthink or overanalyze the situation and to follow the professional instructions without questioning, believing that the medical team is providing the best care they can.
Fri, 5/26: I had lived in my fantasy world when my period was almost a week late. In that magical realm, all the long-standing infertility struggles we had endured were magically resolved. A miracle had occurred, washing away all the exhaustion, fear, and pressure. We were on the verge of experiencing the joy of parenthood, which would bring a sense of fulfillment to our marriage and lead me down an exciting and challenging path. The presence of our little one filled me with excitement, instilling in me the determination and motivation to overcome any obstacles that might come my way. However, this fantasy ended abruptly today with the arrival of my period. Though it was late morning, I still lay in bed, closing my eyes and holding onto the fading remnants of that illusion before it vanished completely and I had to face the harsh reality of continuing this foggy journey.
Once my dream world had been shattered, I became worried about my period. It was bleeding but not fully. It was sparse and infrequent. I had no idea what’s going on with my body. I felt lost and clueless about what steps to take next in order to make the treatment work. Every time I dwelled on this journey, a wave of darkness, heaviness and disorientation washed over me. My once unwavering determination and desire for success were wearing thin…
Sun, 5/28, I was feeling down. When I thought about my unusually light, dark brown period, I was wondering if it had actually started. I started to question about the benefits of my diligent indulgence in various supplements (Ovasitol, fish oil, NeoQ10, prenatal vitamins, True Niagen, DHEA, and Vitamin D3) for over a year, hoping for a positive change in my IVF treatment. I have restricted myself not to do this or only do that to maintain a healthy lifestyle. Yet, regardless of my efforts, the result hasn’t changed. It seems the more treatments I have, the worse the results turn out. When I was hit by my period, I gave myself a day to temporarily forget that I’m an IVF patient. I skipped taking supplements which made me relieved, and ate whatever I wanted to pamper myself.
Tue, 5/30: I was nervous before the consultation with the doctor. I wasn’t confident that the doctor would be able to provide me with a definitive answer regarding the reasons behind the continuous failures or give me an effective solution for the next cycle. There were numerous questions I wanted to ask, but at the same time, I had a feeling that the doctor’s responses might not be new to me.
Anyway, below were basically my concerns and her explanations:
1. Baseline hormones: Estrogen of the 4th cycle was 32.8 pmol/L, compared to 19 pmol/L of the first one – it changed but the difference wasn’t much as both levels remained in the low range.
2. Baseline scan of AFC: Itwas good with 24 follicles (the 4th cycle) compared to 19 (the 1st).
3. AMH: 2.3 (the 4th cycle) compared to 2.7 (the 1st measured in March, 2022). Slightly decreased but is still a good number of egg reserves.
4. Dominant follicles during stimulation: It’s not unusual as long as the blood tests show normal results. Sometimes, doctors may consider sacrificing dominant follicles and prioritize the growth of smaller ones. However, in my case, it was likely that the giant follicle sucked up most of the medication, leaving little for the smaller ones, leading to their slow growth despite the normal blood tests. The doctor advised against prolonging the stimulation phase beyond 13 days as doing so could potentially lead to poor quality eggs. I’ve experienced the issue of dominant follicles in 3 cycles and each time the cycle was either canceled or only few eggs were retrieved. It’s still unclear what she can do to prevent it for the next cycle apart from prescribing birth control pills that I have taken in each previous cycle.
5. Decreased Estrogen during stimulation: During the recent stimulation, my estrogen decreased but then bounced back up the following day. Again, there was no single clear reason for this fluctuation. It could be attributed to factors such as Letrozole or Cetrotide or age or an unknown reason. There’s only certainty is that my body has responded extremely poorly to the drugs.
5. Light menstruation: Despite having a short, brown, and extremely light period, the doctor assured that it should not be a concern. She added that a heavy menstruation is more concerning to her.
6. High FSH: A year ago, my FSH was high, 15.9. When I consulted a Vietnamese IVF doctor, he told me to wait at least 3 months before proceeding with IVF; if I insisted on immediate treatment, “you would never be successful”, he emphasized. However, my IVF doctor and the embryologist didn’t take into account this marker when I first questioned them. I brought this up again today and she reaffirmed that FSH isn’t a determining factor in the pregnancy rate. According to her, AMH is more important. At my age, when the successful pregnancy rate is significantly reduced due to the higher rates of embryo abnormalities, the more eggs I have, the better the successful rate will be.
7. Protocol for next cycle: The doctor suggested two protocols for me to consider: the Cetrotide protocol and the microdose protocol. She mentioned these would be the only ones available for me, which contradicted what she said earlier about their being no limits to how many times I wanted to try; they always had treatments as long as we could afford them. (Maybe I misunderstood?!?) Anyway, I’m not dwelling much on it. I still stick with my plan to continue the treatment in Vietnam if my attempts here fail. My next cycle was scheduled for July 8, 2023 and the protocol will be microdose using Birth Control pills, Lupron, Gonal F and Menopur.
In general, the doctor couldn’t really pinpoint the causes of the issues, why it happened that way or give me an effective solution. All she has done and is going to is trying different protocols and hoping one of them will work for me.
Worried that if there was a cyst, I would lose the chance to do the treatment. Luckily, the results turned out normal with 13 follicles on the left and 11 on the right.
Sat, 4/29 (day 1 of stim): 300 unit Gonal F (PM), 150 unit Menopur (PM), 100 mg Clomid
Sun, 4/30 (day 2 of stim): same doses, same time
Mon, 5/1 (day 3 of stim): same doses, same time
Tue, 5/2 (day 4 of stim): same doses, same time
Wed, 5/3 (day 5 of stim): Same doses, same time. Added 5 mg Letrozole (2 tablets).
– ultrasound and blood tests: one 12.5 mm on the left and one 13.3 mm on the right with many tiny follicles. It was good that there were no dominant ones.
Thur, 5/4 (day 6 of stim): Same doses, same time as on Wed, 5/3.
Fri, 5/5 (day 7 of stim): Same doses as Thur, 5/4, different time: AM: 300 unit Gonal F, 0.25 Cetrotide, and 5 mg Letrozole (2 tablets); PM: 150 unit Menopur
Ultrasound and blood tests: Not good. A dominant follicle appeared (19.7 mm on the right). The second biggest one on the left was 13.6, showing minimal growth compared to its size of 12.5 mm two days earlier. Additionally, Estrogen decreased from 331 to 281, indicating that follicles didn’t grow as expected, increasing the risk of the lack of ovulation. Was instructed to continue stimulation injections and go back to the clinic for ultrasound and blood tests the next day. If Estrogen didn’t turn around, the treatment would be canceled.
Sat, 5/6 (day 8 of stim): 300 unit Gonal F (AM), 0.25 Cetrotide (AM) and 150 unit Menopur (PM)
Ultrasound and blood tests: The dominant follicle jumped to 22.7 mm and the biggest second one was 15.7 mm. Other follicles were less than 10 mm and the scan showed they didn’t grow. However, Estrogen slightly increased to 336. Was told to continue stimulation injections and went back to the clinic for ultrasound and blood tests the next day; the possibility of cancelation was also mentioned. If I proceeded with the retrieval, the maximum number of eggs expected would be only 2.
Sun, 5/7 (day 9 of stim): 300 unit Gonal F (AM) and 0.25 Cetrotide (AM)
Ultrasound and blood tests: One 18.4 mm follicle on the left and one 25.5 mm follicle on the right.
Canceled the cycle following the doctor’s recommendation.
Going to have a consultation visit with the doctor on Tue, 5/30/2023 regarding an overview of the recent failed cycle and a protocol to be considered for the next cycle.
I still have 3 boxes of 300 unit Gonal F and 2 boxes of Cetrotide in the fridge. Need to remind myself to check the fridge’s temperature first thing in the morning to make sure it stays within the safe range. For the next cycle, I plan to buy enough medications around the ultrasound and blood test time, instead of buying all at once as my treatment can be stopped any time if the tests don’t show normal results. I actually tried this way last time because I wanted to avoid wasting medications, but ordering them was incredibly nerve-wracking. I spent hours anxiously on the phone, finally being able to talk to the pharmacy’s representative and place the order. I had been so worried that I wouldn’t have medications when I needed them. I then asked for the representative’s email in case I can’t reach anyone by phone next time. But I’m not sure if avoiding potential waste of money is worth the stress I experience. I can’t afford the risk of not having medications, especially on weekends and Monday mornings. The pharmacy doesn’t ship on Sunday but ships overnight during week days but the delivery usually arrives around 9 am the next day while I may need medications earlier in the morning – I typically take morning injections at 5 am so that S can leave for work after giving me shots.
I was utterly defeated each time our IVF failed but this time I’m not feeling as devastated. It’s probably because I still hold onto the hope and have chances to try again. And deep inside, my emotions have been crushed so profoundly that I told myself, “Enough is enough!” I can’t continue living a life feeling incomplete due to this any more. I need to live life to the fullest though it’s incomplete. Also, what truly helps me stay strong after the stressful experiences is that I no longer hate or get disappointed about myself. This is so meaningful as it allows me to enjoy life with all the blessings I have been given. In previous failures, I was struck by the double blow of the bitter disappointment from unsuccessful IVF attempts and the self-hatred.
Despite following my IVF doctor’s recommendations to take various supplements and eat antioxidant-rich foods, I still feel disappointed with how I look. When I look in the mirror, my skin looks dehydrated, my face and neck are covered in pimples, and my hair is dry and frizzy. The worst thing is that my periods have become shorter and less frequent since my second round of IVF a few months ago.
I have an upcoming appointment for an overall reproductive ultrasound and blood tests in a few weeks. I had those done a year ago and after a year, I need to repeat them. This makes me feel nervous and scared as I’m not sure how my markers will be. Women from 38-40 experience drastic changes in their reproductive systems and hormones, which make it more difficult for them to have a baby. I don’t have much hope for the IVF success this time around, and the thought of traveling to Vietnam for the treatment is both thrilling and overwhelming at the same time.
I know I shouldn’t worry so much, but it’s hard not to. I need to remind myself that nothing is more important than my IVF treatment right now and that any worries or anxieties I have aren’t worth dwelling on. It’s important to affirm this thought whenever those negative thoughts arise.
I’ve been taking allergy pills for almost a week now, and this is already the fourth time I’ve been hit with allergies since the end of February. It all started when the winter started to fade away and the spring season was arriving. There was more rain, soil was moist and sometimes wet, covered by layers of old leaves. Trees, plants, flowers were coming back to life, with more buds popping and flowers blooming. The wind started to pick up, stirring up small particles and leaves, filling the air with pollen and allergens. That was the perfect time for allergies to hit people like me who are super sensitive to them.
My March went well with a lot of activities, fun and laughs.
Car AC changed
My car’s AC hadn’t been working right. It kept blowing hot air. I had been driving with the broken AC through most of the winter but on the hot days in late Feb, I couldn’t bear the heat, even with the windows open. And doing that made my pollen allergies worse. With no more room for delay, I took my car to Pep Boys to get it checked out. After waiting for a few hrs, I got 2 quotes, ~$1300 for just the AC unit replacement and ~$1800 for a whole new package. I didn’t care to look at the quotes’ breakdowns as either one was far beyond my expectation. When I told S about it, he wanted to fix it himself so that we could save some money. But after watching an instructional video on Youtube, he quickly gave up :D. We decided to order a new A/C device on Amazon for around $200 and look for a local auto repair shop to have them change it. The shop wasn’t far from our house, just a few minutes’ drive away. I left my car there on a Thursday evening and got it back on the following Tuesday. When S told me to check if the AC was working right, I said, “It’s fine,” after feeling cold air blowing out of the vents. However, upon driving it, he said it still wasn’t working correctly, so he went back to the shop. After the second fix, it is working greatly again and now I can enjoy my time on the road. Oh, I forgot, the total cost was around $700, almost half cheaper than one of the quotes.
Happy Numberth Anniversary!
Our anniversary fell on a busy weekday, so S and I decided to reschedule our celebration to the weekend. On the day of our anniversary, S brought home Peruvian lilies, white Lilies, and red Roses. They looked fresh. S isn’t a good flower buyer. The flowers he buys are usually wilted and droopy as spending more than 3 minutes picking something out means too long for him.
S wanted to surprise me with our anniversary celebration, so he kept the plan a secret. On Saturday, I wore a knitted long classic creamy dress with cap sleeves and a high neck, and paired it with a medium-sized black belt. I also picked out a shoulder purse, earrings, and peep toe ankle strap stiletto heels with purple accents. We parked the car under a building, and I still had no idea where we were headed.
As we walked further, I saw the river and a small cruise. I was thrilled and exclaimed, “Wow!” I turned to S and thanked him. We walked around the dock, taking photos while waiting for the crew to prepare for boarding. After checking in, we were guided upstairs, where recorded music was playing, and there was a band on the corner stage ready for performance. What an amazing surprise!
The band performed various love songs, both slow and fast-paced. There was a break between the show, and during that time, we went to the front of the ship to view the river at night. There wasn’t much to see, or maybe it was just me as I’m not a person inspired by nature sightseeing. The second part of the show was interactive, where guests danced under the dance instructions. A singer also congratulated couples celebrating their anniversaries and birthdays and we were asked to dance to a celebration song. I followed S, feeling embarrassed, awkward, and extremely unnatural. I had never danced like this before. We danced and sang at home but we made ourselves look silly and made fun of each other.
The cruise lasted for about two hours, and it was so quiet that I didn’t even feel like we were moving. We were also served food and drinks. The food was disappointing. We had chicken breast, rice pilaf, zucchini, and two grilled shrimp with a roll. The chicken was soaked in salt, and the shrimp was dry. The rice and zucchini were better, but the flavors weren’t special. However, the rich chocolate dessert and drinks were delicious.
Despite the mediocre food, the live band performance was the highlight of the night for me. I felt blessed for what S had done for our fun and memorable anniversary.
Citizenship Test
Mon, 3/27 – Two days before the test
I gathered all the necessary documents and made sure they were organized and ready to go. I reviewed my notes and practiced answering civic questions. Although I felt a bit nervous about the interview, I reminded myself that I had put in the effort to prepare and had done everything I could.
Next, I picked out 2 outfits for the interview in case one didn’t work for any reason at the last minute. The first one was black on black with a sheath dress and a soft jacket. I gained weight recently according to my IVF doctor’s advice, so I wasn’t confident about my lower belly. I covered it by wearing a long laced black scarf with fringes hanging down at the front and cinched it in a big-size golden belt. The second outfit was an A-shaped black dress with yellow and green stripes at the bottom paired with a loose collarless blazer featuring a large bow on the single bottom button. I added a gold cuff necklace with a big pearl pendant so that the top looked less boring.
Wed, 3/29 – Test day
I passed! I was a little embarrassed when I was the only one with a big bag of documents while the other applicants had just a thin file. My friend had also brought very little. But I didn’t want to take any chances of missing anything, so I had everything I could possibly need. I brought all the original papers required, along with additional evidence just in case. I even memorized the dates of my moves and my vacations abroad after watching a USCIS model interview video in which the interviewer asked a guy the dates he left and returned to the US. I knew I over-prepared, but for important events, it’s better to overdo than underdo as it will save me peace of mind.
The interviewer was really nice and made me feel comfortable and relaxed. He patiently answered my questions and even reminded me to consider the amount of time it would take to get my passport while applying for a full name change at the court. I told him that I didn’t need the American passport immediately and could always use my VN passport for traveling. He replied, “You need the American passport to get back to the US.” I burst into laughter because of my inexperience. I forgot that my green card would be taken back once I got the naturalization certificate.
After the interview, I was told to come back later for the oath of allegiance ceremony. While waiting, S and I went to a nearby Vietnamese restaurant for a late lunch. I got a specialty Pho and spring rolls, and S had crushed rice with grilled pork and bubble mango smoothie, which was funny that the waiter thought it was for me. I didn’t expect Pho to be so expensive now. It was $24 for the special bowl, which would be around $30 after tip and tax. By the way, it was delicious. The Vietnamese waiter, also a student, spoke with a northern accent, similar to me, which I don’t hear often here. One surprising thing was that he lived very near my parents’ house in VN.
When we got back to the field office, we entered a ceremony room where the blinds on the glass wall were pulled up so that my friends and family could “attend” from the other side. The host officer was very nice when he told us to face the glass wall so that those accompanying us could take photos of us while we were taking an oath. I looked over a few times to see if S was there, but I didn’t see him. I later found out that he was in the car, and the car next to his had blocked his view, therefore he didn’t see people gather outside the ceremony room. But it was Ok. When I pretended that I was upset because he wasn’t there, I was just teasing him to make him feel how important he was to me.
After taking the oath, the officers took photos of us individually. I was happy to have some nice photos to share with my family and friends.
On the way home, I sent the photos to MK, and she texted all of her friends to tell them I passed the interview. And then she forwarded their texts to me. I felt really embarrassed, but I felt blessed because of her love and attention for me.
IVF Thoughts
I got a call from the IVF office telling me that my appointment with the doctor had been canceled due to her being unwell. Honestly, I was relieved to hear that as I literally didn’t want to go. Though I was the one asking for the meeting initially. I had no idea what I should ask her after reviewing my previous rounds of IVF. Also, I doubted that her responses would be different from what I’ve known already.
The field of IVF is complex, and it often seems that there is no single answer to any given question or issue. No answer can guarantee a successful outcome, and I decided not to reschedule the appointment because I didn’t see a benefit of doing that. Also, S said he might be unable to take off work to go with me while I am uncomfortable attending the consultation alone.
As the expected retrieval week draws near (May 8th), I emailed the nurse to ask her what I need to do to prepare for the next round. With my period expected soon, I am unsure of what the IVF team will have in store for me this time around. Typically, it takes two cycles to begin stimulation. In the first cycle, I would normally take birth control pills to prime my ovaries for stimulation, and in the second cycle, I would undergo a baseline and ultrasound examination. If everything appears normal, the stimulation process would begin.
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A few months back, after my third round of IVF got canceled, I decided to text a well-known IVF doctor from a Vietnamese hospital where we’ve been storing S’s specimens, and ask for an online consultation regarding our potential IVF treatment in Vietnam. It was upsetting that I didn’t receive a reply from him, but I understand that doctors there are incredibly busy, especially given the high number of IVF patients they tend to. However, his silence made me feel more unsupported and alone on this journey.
I Laughed A lot
S is so humorous. My friend, Rose sent me a photo of the letter “R” – her name’s first letter that her boyfriend lawnmowered to make it when he helped her cut grass in her yard. I showed that romantic photo to S and a few minutes later, I heard my phone beep. Checking it, I burst into laughter when I saw a photo of a note with the letter “P” – my name’s first letter he scribbled in it. Then my friend sent me another photo of her boyfriend’s shirtless fit upper body and also showed it to S. After a few minutes, my phone beeped again. S sent both my friend and me a hilarious photo of a muscular 6-pack shirtless bodybuilder but his head was replaced with S’s head. LOL!
I was more nervous and cautious during Round 3 since it was my last chance to do IVF here. Also, I was worried if I could even start Round 3 because I got an ovary cyst during the stimulation phase of Round 2. Fortunately, the baseline ultrasound and blood tests showed that I was good to go. The ultrasound technician told me that my right ovary had 12 or 14 follicles (I didn’t bother remembering the exact number or asking my nurse for the precise count). I was trying to relax this time and avoided stressing myself out with too much information. I just did what the nurse told me to do. Basically, here is how Round 3 went for me:
Sun, 01/15/23: Started BCPs – I hated BCPs. I told my RE at the post-retrieval visit of the last Round that I preferred not to be on BCPs, especially for a long time considering my age. Despite this, I still had been on BCPs for 31 days.
Wed, 02/14/23: Stopped BCPs
Fri, 02/17/23: Baseline ultrasound and blood tests: 12 or 14 follicles on the right ovary
Sat, 02/18/23: Day 1 of stims: Took 300 IUs of Gonal F, 150 IUs of Menopur and 100 mg of Clomid (PM)
Sun, 02/19/23: Day 2: Same dosages (PM)
Mon, 02/20/23: Day 3: Same dosages (PM)
Tue, 02/21/23: Day 4: Same dosages (PM)
Wed, 02/22/23: Day 5
– Ultrasound and blood tests: only 4 follicles grew, one of them was dominant (15 mm): Disappointing
– Same dosages and 0.25 Cetrotide – ovulation suppress drug (PM)
Thur, 02/23/23: Day 6: 300 Gonal F and 0.25 Cetrotide (AM) and 150 Menopur (PM)
Fri, 02/24/23: Day 7: Same dosages as Day 6
– Ultrasound and blood tests: Still only 4 follicles measurable (3 on the right ovary – 19.5, 14.3 and 12.8 mm and one on the left – 10 mm): Disappointing and considered canceling the treatment. Emailed the nurse and the financial counselor asking about the potential cancelation and whether this would be counted as Round 3 or not. If not, how much more we would have to pay to continue Round 3.
Sat, 02/25/23: Day 8: 300 Gonal F and 0.25 Cetrotide (AM)
– Ultrasound and blood tests: Again, still 4 follicles (3 on the right ovary – 21mm, 16.8, 13.2 mm and one on the left – 11.1mm). At first, the largest one was thought to be a cyst. The nurse later clarified that it was a follicle. The nurse also assured me that they could still do the retrieval with just two follicles but my RE supported my decision to cancel if that’s what I wanted.
We canceled the treatment. I was disappointed when no one from the IVF team had suggested that I should cancel when I only had 2 or 3 follicles until I asked them. If I hadn’t mentioned this to the nurse, I would have had another bad retrieval again and lost Round 3 without the chance to try a different protocol to increase the number of follicles.
Looking back, I wish I had canceled my retrieval in Round 2 as well. Doing so would’ve saved me so much emotional, physical and financial pain. My Rounds 2 and 3 were quite similar. Like Round 2, I hadn’t yet started the period when I began Round 3, and had been on BCPs for a long time. Also, I had the same number of follicles with similar sizes as in Round 2. At the time, I didn’t think of canceling the retrieval in Round 2 as I trusted my RE’s instructions completely.
Since I canceled the treatment, I have some drugs left over but I can still use them for my next cycle. My friend, D, wasn’t that lucky. Her treatment was canceled on day 5 of stims and it was her last attempt after the 2 failed cycles. She spent a lot of money on the unused meds. If she had been advised not to buy the meds for the whole cycle from the beginning, she would’ve saved a lot of money. I was grateful when she offered to give me the unused meds for free. However, I still haven’t got them yet as my car is currently broken and I’m not sure if S is willing to drive me for 2 hrs to get the drugs that we may not use since the protocol for my next cycle might be different.
Throughout my IVF journey, I haven’t got enough guidance with the team. While my nurse and RE were polite and professional, I didn’t feel much support or care from them – it’s probably how a clinic works. However, I really like the ultrasound technician. She took the time to answer my questions and explain things to me carefully. I didn’t feel rushed when talking to her and felt a human connection between us. I also like a nurse (not mine) who helped me extract leftover drug fluid, and she did it with great care. She placed a note with my name on my drug box and another note inside to let me know which syringe didn’t have enough dosage. Overall, the clinic’s atmosphere was nice and supportive, but I received all my instructions only from the nurse over the phone. I didn’t talk directly with my ER. I only met her during consultation visits before starting the treatment, and since then, everything was through my nurse. Also, my ER didn’t retrieve my eggs – a different doctor did. Once you sign a multiple cycle package, you will be immediately put into the next cycle after a failed cycle without an appointment with the RE to understand what goes wrong and what new protocol will be applied unless you ask. This has happened to me in my first 2 Rounds. In short, I didn’t feel the ER’s presence during my treatment.
But I don’t intend to switch clinics. There are only 2 in my area, and starting treatment at a new one would take months, or even over half a year. I’ll try one more time at this clinic and if it doesn’t work, I’ll continue seeking the opportunity in VN where I believe there are more resources to support me.
The appointment turned out well, much better than I thought. It was the first time I had ever felt care and attention from my RE, whom I had previously been nervous, anxious and stressed about.
I had excitedly wished to see her at first. I had hoped the visit would tell us more about what happened to our Round 1, what else we needed to do to better prepare for Round 2, and clear information on the protocol to follow for that round. However, I had lost my enthusiasm for the appointment after waiting for a month. Moreover, during that time, I had already started taking birth control pills as directed by the nurse in preparation for the stimulation phase of Round 2. (I was unsure if it was a good idea for me to take birth control pills for an extended period of time at my age.) But surprisingly, the appointment ended up going well.
This time, instead of injecting various drugs with doses adjusted as needed, I would only be using Gonal F for stimulation, Lupron for ovulation suppression and a trigger shot. The doctor would not be adjusting doses; she explained that if my body responds poorly to the drugs, increasing the amount would not be very effective.
During the appointment, the doctor seemed surprised when I mentioned that in a few days it would have been 41 days since I started taking birth control pills. Answering my concern if it was ok to take the pills for that long, she assured me that it was not a problem. I had also asked the nurse about this before and received the same assurance.
We left the clinic, feeling more positive about our next treatment.
10/20/2022:Baseline ultrasound and labs for Round 2
19 follicles (11 left, 8 right)
Lab tests showed normal results.
Stimulation Phase
Day 1 (10/20/2022): Took Lupron (40 units) at 8:30 pm.
Day 2 (10/21/2022): 225 units of Gonal F (x2) and 20 units of Lupron (x2) at 5AM and 8:30 PM.
Day 3 (10/22/2022): Same time; accidentally took extra 75 units of Gonal F. The nurse instructed to subtract that amount from the PM dose.
Day 4 (10/23/2022): Same dosages, same time
Day 5 (10/24/2022): Same dosages, same time
Day 6 (10/25/2022): Same dosages, same time
Got the first ultrasound, showing 8 follicles (6.5-9.5mm). Sad!
Day 6 (10/26/2022): Same dosages, got injections 30 mins late in the evening.
Day 7 (10/27/2022): Same dosages, same time
Day 8 (10/28/2022): Same dosages, same time
The ultrasound showed a 25.7mm cyst on the right ovary; as well as 3 follicles (15.7mm and 13.7mm on the left, and 12.7mm on the right) and 2 small follicles (8.6mm and 6.3mm). So sad!
Day 8.5 (10/29/2022): Same dosages, same time for the AM dose
The nurse called me and said my progesterone were elevated, so I would not be receiving any more stimulation injections. Instead, I was to take a trigger shot at 10:30 PM that night.
In Round 1, I had used the trigger shot Pregnyl, but this time I chose Novarel, even though it was more expensive, in the hope of getting a better result. Each box of Novarel comes with one vial of 5000 units of powder and one vial of bacteriostatic water. I bought 4 boxes, 20,000 units in total.
To ensure that we were not rushed while administering a new drug, we began preparing 45 mins before the scheduled injection time. To administer 10,000 units, I would need 2 vials of powder. S diluted one vial of powder with 1cc of water, then injected the mixture into the other vial of powder and swirled it to dissolve the medication. Next, he drew the resulting solution into a syringe and replaced the needle with a smaller one, 27Gx1/2″. The prepared syringe was then placed in the fridge until injection.
Mon, 10/31/2022: Egg Retrieval
Procedure time: 9:30 AM
We were required to be at the hospital 2 hours before the procedure for admission registration, medical history checking, and pre-surgical instructions, etc.
2 eggs were retrieved (…) – I was at a loss for words to describe my feeling.
Tue, 11/1/2022: Zero embryo. Failed.
The embryologist called me and said one of the eggs was abnormal and the other was mature but didn’t fertilize. He was unable to determine the exact cause, but suggested that the sperm’s low binding rate (30% versus the normal average of 60%) could have been a contributor.
….
I began writing this post more than 2 months ago and didn’t finish it until today. It was just too overwhelming to think about how things had happened, what would be possible paths my life would take, and what I could and should do to improve my chance of success in the next round(s). We had a follow-up appointment with the doctor on November 10, 2022 ($157) to review the result of our Round 2 and discuss a new protocol for Round 3. While we exchanged a lot of information during the visit, much of it was not particularly helpful. We still don’t know which factors mainly caused the failure, as there were so many variables at play. However we all know that there is no guarantee of success in this IVF journey, despite our best efforts.
Round 2 was truly a nightmare to me both mentally and physically. I broke out in pimples all over my face and part of my neck. More terribly, I suffered a significant change in my mood. I wasn’t myself anymore. I felt extremely low during the stimulation phase. I became tremendously vulnerable and sensitive. I got easily irritated and couldn’t let it go. I cried everyday until the retrieval day. The doctor later said these mood changes may have caused by Lupron, which lowers estrogen levels in the body, triggering menopause-like symptoms.
Though S has been with me just as he always is, IVF is still a lonely journey for me.
Emptied the dishwasher, cleaned the kitchen sink, made a pot of black tea, did two loads of laundry, and folded clothes. I had sweet potatoes for dinner to make up to offset the sugary cookies I had earlier, even though I’d already hit my daily sugar limit.
On the days when I move/drive a lot, which isn’t often since I mostly stay at home, I am just so fatigue by the time I get home. I am dead sleepy, my energy gets insanely drained and all I want to do is to take a long nap or go to bed early.
Fri, 8/12/2022
We paid $4,044.62 for the IVF drugs for Cycle 1. If my baseline ultrasound shows good results today, I will start stim injections tomorrow. I need to read the instructions as well as watch how-to videos which I should have done a long time ago. I haven’t prepared well for this journey, both emotionally and physically.
I can’t blame anyone or anything except myself for this poor preparation. But I’m changing! One thing I need to seriously work on is to learn how to cope with anxiety, stress or panic attacks, which I recognized have been getting worse. I lose patience easily, boil with passive anger, and consequently can’t think straight or express clearly. This lack of control made me so disappointed in myself.
2:28 pm: Cleaned Sam’s litter box, vacuumed, ran the dishwasher and made a pot of black tea.
4:36 pm: Paid $586.07 for blood tests for E2 (Estradiol), LH (Luteinizing Hormone) and P4 (Progesterone Assay), and an ultrasound. I have been taking birth control pills (BCP) for 21 days (started on 7/23). Was thinking to email a nurse to ask about continuing BCP, what would come next and the name of the antibiotics we would take…Got a call from K. She said my tests look great and I can start 375 IU of Gonal F tomorrow night till Tues, 8/16/22. Then get blood tests again at 7:30 am, Wed, 8/17/22.
Sat, 8/13/2022
11:20 am: Did yoga, stopped by Rouses to buy fruits and drinks, made chili and two pots of black tea, ran the dishwasher, washed the vacuum’s filter and cleaned the vacuum.
…
We decided to get injections at 8:30 pm daily as we are both relaxed and alert around this time. Since tonight was my first time getting injections, I was so nervous. At 7:30 pm, S was still busy putting the door back, so we watched the educational IVF video 15′ late. I got distracted a lot as I had to keep getting up and moving around in order to prepare for the injections. The preparation included getting the drug out of the fridge, reading the info on the drug’s box carefully, checking my notes, getting alcohol prep pads and sharps containers ready. Though it wasn’t a lot, I just felt so overwhelmed and worried that I might be forgetting something. The video also confused us at times, causing us to take longer to finish watching it.
…
Moreover, just a few minutes before thescheduled injection time, S told me that I needed to get 2 boxes of drug out of the fridge, instead of just one. Holy sh*t! That meant we would have to wait an additional half an hour because the drugs should be at room temperature for that minimum amount of time before injection. Furthermore, while inspecting the quality of the drug pen, S accidentally dropped it around 24 inches onto the floor, despite being told to handle it gently. Anyway, the delay did allow us a chance to take a short break to calm down a bit.
At 9 pm, I lay on my back nervously waiting for S to give me the first shot. I could tell S was feeling nervous too. And right at the moment I saw him stick the needle into my skin, I knew immediately it would not be fun. It wasn’t the injection, it was like a stab. After the needle was inserted, he pressed down on the dose knob so hard that I could hear a forceful flow of medicinal fluid passing through my skin. Then he pulled the needle out quickly as if he were pulling a nail with a pair of pliers. The whole process only lasted for a few seconds but the sharp pain it caused was enough to make me cry out. Thankfully, the second shot was so much better.
Sun, 8/14/2022
The injections went smoothly on Day 2, were a little uncomfortable on Day 3, good on Day 4 and perfect on Day 5. S did all the steps fluently and professionally like a nurse. He let me know when he was about to insert the needle so that I was mentally prepared. He gently and steadily pressed the dose knob to release medicinal fluid, and removed the needle in the same way. Then he placed an alcohol pad on the injection spot, gently pressing it and massaging the area for a minute to help ease discomfort.
Brief information about Gonal F:
Gonal F is an injection Pen that delivers a prescription medicine containing follicle-stimulating hormone (FSH) to help ovaries develop (mature) and release an egg and cause your ovaries to make multiple (more than 1) eggs as part of an Assisted Reproductive Technology (ART) program. Unopened Gonal F is stored either in the refrigerator (36F – 46F) until the expiration date or at room temperature between (68F – 77F) for up to 3 months or until the expiration date, whichever comes first. Leftover Gonal F is stored either in the refrigerator (36F – 46F) or at room temperature (68F – 77F) for up to 28 days.
My nurse said each 300 IU pen has about 100 –125 IUs of overfill but when S and I looked at all of the 5 used ones, we hardly saw any leftover. S was confident that had given me the correct dosage (as the pen visually showed the needed dose before injection and “0” after it was completed). Where did all the leftover medicine go? I didn’t want to take a higher dosage than prescribed and the surplus of 100 –125 IUs in each dose seemed too much if it was in my body. When I took the used pens to the doctor’s office and asked a nurse to extract the remainder, she said the leftovers sometimes were hard to see and that my ultrasound and blood test results were normal, so no need to worry that I might have taken too much.
Wed, 8/17/2022
I paid $707.61 for E2, LH, P4, US tests and the previous balance. These tests were to monitor the growth of follicles.
I knew the prepaid IVF cost doesn’t include this monitoring fee but I didn’t question what “monitoring” meant when I read the contract. I simply thought it referred to the pregnancy stage after a successful embryo transfer. My ignorance is costing me an unexpected amount of around $450 every 2 days for this monitoring.
Fri, 8/19/2022
Paid $427.72 for the monitoring fee, $600 for 2 additional Gonal F pens. Nobody told me I needed more Gonal F until I emailed a nurse to ask about it. She said I had refills at the pharmacy. I called them, which usually takes a long time for someone to answer. The representative asked if I wanted a refill of Fyremadel, which hugely confused me because I’m not taking that medication. I told her that my nurse would’ve let her know which medication and how much I needed. The representative said that the nurse had only sent refills for all 5 drugs, which would have cost me more than $4k if all were refilled. I have made an decision to order 2 pens based on my adjusted dosages and the latest drug use calendar and paid $20 of shipping cost to have them delivered on Saturday. I was vey relieved and felt so lucky to be able to get this done at 5:20 pm. If I had done it later in the day, I might not get them on Saturday, or even worse, if I hadn’t done until the next day, I would not have a dose for Monday a.m.
Sat, 8/20/2022
The nurse adjusted my dosages. I would get two subcutaneous shots of 325 IUs of Gonal F and one 250 mcg syringe of Fyremadel in a.m and one shot of 75 IUs of Menopur in p.m. It was stressful to dilute the Menopur powder because right after S added the saline to the powder, it inexplicably disappeared. We looked at the vial again and again and still had no idea why it was empty. Having no time to find out what was wrong with it, S diluted another vial, which was fortunately successful that time.
Sun, 8/21/2022
Paid $300 for a Gonal F pen.
As my drug use calendar was only updated up to Monday morning, I only ordered Gonal F enough up to that period. Then I thought I should order one more pen just in case the nurse might say I would need it for Tuesday morning after reviewing the monitoring result on Monday. If I waited until Monday, it would not arrive in time before my injection at 5 am on Tuesday. So I decided to get one more pen in order to feel secure.
My IVF friend, D wasn’t as lucky as I. She ran out of doses for Sunday evening and Monday morning, and she was unable to reach any nurses by phone or email on Saturday. She then called the pharmacy but they said they didn’t have an order for refill. Even if she had the refill, she wouldn’t be able to get them in time as the pharmacy’s shipping agent doesn’t ship on Sundays. D’s only hope was that there might be some in the doctors’ office where she would have to drive 2 hours to get there, and there was no guarantee that she would be able to meet her nurses there to ask for additional doses. I texted her, “As long as there is someone in the office; they will have to do something for you.” I couldn’t imagine if it was me in this dilemma. Thinking about it only was enough to make me frantic. However, D remained remarkably calm and even texted me on the way to the office that she wouldn’t going to stress anymore over the meds. Fortunately, she were finally given 3 leftover dosages that other patients had donated to the office.
Sun, 8/21/2022
Thinking about D’s incidence, I just felt how lucky I was to have checked the quantity of my meds early enough, instead of waiting for and depending on the nurses’ instructions. I felt grateful to go through the most crucial treatment phase in a stress-free and balanced mood. My mind had been extremely turbulent in the week before I started stim drugs; and if I hadn’t got better, I could have failed in keeping track of all information about and updates on the meds, tests and medical visits. I thought the Higher Power had seen me being stuck in the inescapable feelings of being small, powerless, distressed and unfulfilled and had helped pull me out of that rabbit hole.
Mon, 8/22/2022
Continued getting shots and monitoring tests. ($464.53)
Tues, 8/23/2022
Same as the day before. ($452.17)
I still didn’t know when I would get the trigger shot and when my retrieval day would be. Running out of a p.m. dose of Menopur for the next day, I anxiously emailed my nurse to ask if I needed extras and to make it clear to her that I would be freaked out if I was in a situation where there weren’t meds when I needed them, and that I wanted to do everything I could to make sure that wouldn’t happen to me. She replied, “No worries, I have some here in the worst case.” Though I was still worried, especially after hearing about D’s experience, I trusted the nurse and waited for her next instructions on the meds for the next day, which would depend on my blood tests and ultrasound results in the morning.
Wed, 8/24/2022
A.M: got shots of 325 IUs of Gonal F and one 250 mcg syringe of Fyremadel
P.M: got the trigger shot of 10000 IU Pregnyl. The injection time was strict, so to make sure I would get the shot exactly at 9:30 p.m as required by the nurse, we started preparation 45 mins earlier, including reading the instruction, watching the educational video, checking the med and spent the last 7 minutes to mix the med.
Fyremadel is used to prevent the premature LH surge that might cause a premature release of egg cells. (LH, Luteinizing hormone, is a chemical in your body that spurs ovulation.)
Pregnyl is human chorionic gonadotropin (HCG), a hormone that helps stimulate follicles to maturity, so that ovulation can occur.
Thu, 8/25/2022
Had the last monitoring test. ($157 for E2, Bhcg and Venipuncture)
Fri, 8/26/2022
S took me to the hospital at 6 am, 2 hrs before the retrieval. I met a lady at the front desk first to provide identification and sign some consent forms. Then, I followed a nurse into a private room where I had my vital signs checked and answered medical questions about the name of the procedure, meds I have been taking, allergies, when I last ate or drank, and any jewelry I was wearing, etc…After checking my identification wristband, she took me to a shared big room divided by curtains where my main caregiver nurse was waiting for me. I changed into a hospital gown, and put all my belongings in a plastic bag provided by the hospital. The “room” had an adjustable bed with a pillow and blankets, and a TV for entertainment while waiting for the procedure. The nurse gave me an IV bag to avoid dehydration. Then the anesthesiologist came in to ask me some questions, inform me of potential side effects and check if I was wearing removable dentures. Finally, the physician who would perform the procedure showed up and introduced himself. He was warm, friendly and caring. He showed his interest in VN and complimented Vietnamese people. He even knew there is a large Vietnamese community in AL. S stayed with me during the waiting time and kissed me through his mask before I was knocked out by anesthesia and on the way to the operating room.
S informed me that we only got only 3 eggs after I woke up…
Sat, 8/27/2022
3 eggs were mature, 2 were fertilized successfully.
Sun, 8/28/2022
One embryo stopped division, the other fair grade one was developing into 4 cells with some fragmentation.
Mon, 8/29/2022
The embryologist informed me that the cycle was ended as the only remaining embryo had stopped growing.
The moment the embryologist called each day to update on the fertilization process was absolutely nerve-wracking. No matter how hard my heart was pounding or how profusely my hands were sweating, I still had to be calm during the conversation to fully understand our embryo’s status.
I was at a loss for words to describe my feelings. My mind was empty. Our IVF had failed before I mentally and emotionally prepared for it. S joked that we were going to hold the funeral for our two embryos, bought them tiny suits, mini caskets and a bunch of magnifying glasses so that our guests could see them one last time and say goodbyes. His humor was so funny that it made me burst out laughing, despite the sad circumstance we were in.
Begin life at forty 