Episode 4: ABCs of IVF (Part Two)

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Hey everyone and welcome back to Confessions of a Slow Cooker. I'm Ashlyn Blue and today is the second episode in the miniseries I call the ABCs of IVF.

Last time we went over the first cluster of steps in the IVF process, picking a clinic, scheduling a consult, and then the workup with tests on tests on tests. Say that five times. I also talked about Marcus's and my first hiccup, which resulted in a year long pause for the whole process. So that's where I'll pick up today, in February, 2023.

After months of taking meds and getting blood draws and other tests done, Marcus's urologist suggested we come to Denver for his sperm to be manually retrieved. Remember what he called it, getting his balls ice picked.

They discovered an obstruction, so that was going to be the only way to get his swimmers out. But that was the thing. Would there be any? We didn't know, and we wouldn't know until the procedure was performed. And I remember sitting in that surgical lobby, trying to be cool and calm, and inside I was a mess. Because what if they didn't find anything? It would destroy Marcus. And then what?

Thankfully, it was such a quick procedure, I didn't have too much time to go down my little rabbit hole. The urologist came out in his scrubs with his thumbs up. Got a million, he said with a huge smile. And that was that. Finally, some good news. And because we were already at the fertility clinic I would be doing all my procedures in, we were able to talk to my doctor as well before we drove home. After a year of waiting, I finally got a date for an egg retrieval. Whoa.

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Not an exact date because remember everything is based around your cycle. But at least we had a month to work toward. April.

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The egg retrieval itself only takes about a few minutes in terms of procedure, but the lead up to it, that's where all the action is. And let me stop just to say one thing. If you know you're getting an egg donor, you don't have to do this part. You can skip this entire episode. Depending on your body, you might already figured out that's the route you're taking. Alternately, I know some women who figured out that they would have to get an egg donor through the process of their own egg retrieval. Talk about a hiccup.

For the purposes of this series, I'm going to talk about the process as if you are going to be the one getting the egg retrieval. Cool?

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There are a few basic exams you have to have completed before you get the retrieval. So I got started on scheduling that as soon as I knew the April timeline. Number one is a pap smear. You need to have a normal pap smear to proceed. Number two, an annual physical exam by your primary doctor. It has to show documentation of a normal general exam, a normal pelvic exam, and a normal breast exam. And then number three is for patients 40 and older.

If you're 40 and over, you need to get a baseline mammogram, which obviously also needs to be normal. I was only 37 at this time, so I didn't have to do that.

These exams, they need to be done within 12 months of the egg retrieval. So if I had already done one or two of these and I had results, I could just get those results sent to my fertility clinic. I hadn't, so I had to get them scheduled. And the only hiccup was with my pap smear. I'll back up. As soon as I had gotten my April timeline, I decided to add in weekly acupuncture to give my body the absolute best chance at success.

My cycle had been pretty much the same every single month for years. I mean, I could look at the data on the calendar and put money on a two-day window when my period would come. So, it came as a surprise when I made my March Pap smear appointment and, I had started my period three days early. Great. They weren't sure if it was enough blood to dilute the results, so they sent it off anyway. And of course, it was too much blood.

So they couldn't test it and they had me come back in once I was back off my period. And that sounds fine and all, but if I didn't get the normal PAP results in time to start what's called the priming cycle, I would have to push everything out another month. Something I did not want to do. I had waited a really long time to get started. And if that sounds really dramatic to you, just wait till you're in the process yourself. Every hiccup equals at least one cycle to wait. And a month is a long time.

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Ultimately, my Pap smear came back normal, but we were like at the last day for the results to come in. I remember my nurse up here in the Roaring Fork Valley was on a trip with her son in like Barcelona. She texted me, coming to you from Barcelona, your normal Pap results with a little smiley face. She'd been a part of everything we'd gone through from the IYs and blood tests leading up to the IVF journey.

She sorta knew I was desperate. Angie, you're still the best.

I don't know what they do at other clinics, but mine sent me a schedule once I started my period. I was told to call the clinic on day one of my cycle and subsequently my nurse filled in the applicable dates. If you're not watching this, you won't see the actual schedule I've got up on the screen. So I'll describe it a little. By the way, I can't believe I still have this. Actually, I can. This is Ashlyn we're talking about. Okay. So on cycle day 10.

which would have been March 4th, 2023, I was to begin testing for my LH surge, AKA ovulation. And I would do this using over-the-counter ovulation kits. I was to test the same time daily in the morning. And then two days after the LH surge, I was supposed to start estrus, which is estrogen, by pill twice a day until I was told to stop. This is what they refer to as the priming cycle. It's priming my body for the next step.

which is the stim cycle, stimulation cycle. I looked this up to be a little bit more precise, and here's what it said. The prying cycle is used to calm the ovaries, suppress the natural hormones, synchronize follicle growth for better, more predictable development, especially for those with poor ovarian reserve or uneven growth, basically aiming for more mature eggs. Sometimes they put you on a birth control for a month and sometimes estrogen.

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I was prescribed the latter. And please note that every patient is different, so this might not align with your protocols. This was just what my body presented, and therefore what my doctor prescribed me.

The priming part, if I recall, was pretty low-key. You just have to remember to take your meds every day. The next part is more involved, more complex, and a bit more painful at times. Based on my schedule here, it says I was supposed to take my last dose of estrus on March 21st. So I would have been on estrogen for 18 days at that point. And then I would get an ultrasound and lab draws up in my valley locally on March 22nd. Hold, sorry, sorry, sorry. I need to pause right here, sorry.

I want to tell you about how I kept up with my medications. My planner was not going to have enough space. And anyway, I wanted to keep it separate so I didn't miss a dose. It's crucial you don't miss doses during anything, but definitely not during STEM. I Googled printable calendar and printed off one for March and one for April of 2023. And again, for those of you who are not watching this episode, I wrote down all my dosages each day and put across the box as soon as I had completed that day's dosages.

just keeping it really clear. Sorry, thank you. Back to my schedule. The next day I would start the Stem Meds, which would stimulate and encourage my eggs to grow. My personal prescription was to give myself two shots of Menipur in the morning and then give myself a shot of Gonal F, I don't even know if I'm saying any of these names right. And then I take Clomid and dexamethasone in the evening.

The shots at the beginning were administered by my husband because there was no way I was going to be able to stab myself in the belly. And I get a lot of shots. I get one in each arm every two weeks. And I have since 2012 with my allergic asthma. But giving myself a shot, nevermind three of them every single day, was not something I was prepared to do. At least not yet.

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It's crazy what you learn to do and how you just get over certain things during IVF. So at some point in this process, you actually have to go to the clinic to be monitored in person, like ultrasounds and blood work. And remember we lived in Aspen at the time, so that was three and a half hours from my clinic in Lone Tree. And I don't know if I've mentioned this, but my husband is a periodontist and we got our schedule, the one you've been looking at.

And he looked at his and then he realized he had too many patients to take off an entire week and not actually know when the date was going to be. So my wonderful, wonderful mom said she would fly out from Nashville to Keatney company. And Marcus would join me for the actual procedure. Once we figured out that date, he would just fly in and then we would drive back together. I thought perfect. She used to be a nurse. She can give me my shots. And then we looked at her schedule too.

She wouldn't get there until my second day in Denver. So, ya girl had to rip off that band-aid and learn how to do it herself.

Y'all, it was actually easier to do myself. Different kind of anticipation because you like know when the stick's gonna happen and you just pinch your belly and the fatty part and just boom, done. You can do it. If I can do it, you can do it. All right, sorry, back to my schedule. The day before I was going to drive to Denver, which would be March 28th, they had me get another ultrasound and lab draw locally.

Those results would be set to the fertility clinic and then they would call me with instructions on my next doses. So from this point forward, I was told I should sort of expect things to be more fluid. Everything would hinge on the latest ultrasound or lab draw. For instance, they knew they would have me take cetratide, again, I don't know if I'm saying that right. We'll say it's right. Cetratide. They knew they would be having me get on that.

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but they didn't know when I would start it until they saw my lining and follicles on this day or that day. And at this point, I still don't know which day will actually get my retrieval. So they suggested that I let the hotel know that I might be adding more days to my trip. It's all around your body's progress. And when you know, mine was slow. I remember after my first appointments with them, my nurse called and said, hey,

You're not going to have to come in tomorrow because there just isn't going to be enough growth between now and then. So you get a day off. Day off? Sounds great if you're working. But in IVF, getting a day off made me nervous. What if my follicles never grew enough for me to do this? What if my lighting didn't get thick enough? Do you know how expensive these medications were? Thousands of dollars. But during that time, I was told to be as chill as possible.

Not because they didn't want me to have emotion, but because my body needed to be chill so that I would have the best chance of success. During that week and a half, my mom and I went on long, leisurely walks, went to the nearest coffee shop. No caffeine allowed though, so boo. We went to Target like 10 times. It's a really big one. And the one closest to where I lived at the time was like an hour away.

we also went to the mall in Cherry Creek. I haven't been to a mall in a long time. And I bought some overalls that I thought I could maybe wear when I was pregnant. If I got pregnant. I journaled, I read, I crocheted, I watched Harry Potter. It was as good as it could have been with like a massive belly. As the week continued, my body showed more progress, thankfully, even though I was still slow. And then finally they said I was ready for what's called the trigger shot.

This shot is actually two shots and it's very, very specific in terms of when you take them. At this point, you know exactly what time your retrieval is going to be and they work backward from there. So for me, that meant I had to take my first trigger shot at 11 p.m. on April 4th and then the next one at 11 a.m. on April 5th. Of course, all that happened to be on the same day my mom was leaving and my husband was flying in for the procedure.

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I took this video in the parking lot of the pharmacy in between my airport runs. All right, I'm about to take my trigger shot.

I'm pretty good at this.

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Talk to you soon.

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My last shot to take.

and feeling good about it.

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it

Right, that looks about right.

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1058.

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getting faster. Things took so much longer when I first started.

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So all these, very pretty. My belly is huge and distended, but that is okay because it is worth it.

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Let's go in

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I think I did the middle last night. I'll do this side.

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Alright, can't see anything. One, two, three.

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All done. No more shots. Can't wait to have like my waist a little bit back.

and poochie.

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The reason I took my trigger shot in the pharmacy parking lot was that I was at a particular pharmacy that was willing to take back the unused fertility medications. I'd had to get like more of one since my body was slow and I had to take more medication than originally planned. And then I guess I ended up with some extra and they were willing to take it back. Some pharmacies do it, some don't. If you can find one that does, it could maybe save you a few hundred bucks, which that was worth it to me.

After my trigger shot, after taking back the meds, I picked up Marcus from the airport and we went to an early dinner close to our hotel. And then we had a low-key night doing very little. By this time I felt bloaty-goaty, so I didn't want to be doing much anyway. My retrieval was at 9 a.m. on April 6th, but I was told to get there at eight. I had a lab draw and they got me ready for the procedure. Kind of like other procedures if you've ever had one. You're not awake for it, but...

It's really quick, like I said earlier. I want to say mine was like 15 minutes start to finish, sorry I was told. And it didn't hurt, so that's good. usually during the same time you're getting your retrieval, your partner or whoever is donating the sperm would give his sample. The embryologists would take that sperm to fertilize the eggs that are retrieved. Remember, though, Marcus already had his retrieved two months before during his ice picking, so he didn't have to do that on that day.

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They were able to retrieve 15.15 of my eggs, which is about what they thought they would get. I know women who have retrieved a lot more and I know women who have retrieved a lot less. And you probably know this by now, but IVF is a game of numbers. And the numbers were about to get nerve wracking, not to mention the waiting. But we'll wait for the next time to talk about the post retrieval part. I have certainly overloaded you enough today, I think.

I do want to mention though that I did get a fully caffeinated latte as soon as humanly possible before we drove back to Aspen. It was glorious. If you have questions about anything I talked about today, please reach out. Whether that be via social media or YouTube or via email, there's a link in the show notes for all of that. Going through IVF, even contemplating it can be so overwhelming and you don't have to go at alone.

And if you know someone who is going through this or is contemplating it as well, and you think it may be of help, please share it. Like I said, the next episode in our series will cover the time after the egg retrieval. It's the embryologists time to shine. Until then.