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 