Today began by checking my blogroll to catch up on what everyone had been up to the past couple days. AF just arrived for my friend Fran and she outlined what was ahead of her over these next few weeks for her IVF protocol. Fran and I will practically be cycle buddies (though she's a week or so ahead of me), which is neat. (By the way, Fran: I tried commenting to your latest post, but had no luck... the darn comment button just doesn't appear to be functioning. Anyway, just wanted to say "Hooray for starting!")
After reading her post, my progression of thoughts went like this:
Fran knows what's ahead of her, which is awesome!
I wish I knew.
... I know.
I'll see what Dr. Google has to say.
Then, with limited knowledge of what type of protocol I'll be on,
I type: "how does a typical lupron ivf cycle work?"
To which I stumble on a site and find this:
Gulp. If this DOES represent what my protocol will look like, then I'm starting even SOONER than I thought with injectables (Lupron could begin around July 2nd!!). The only thing I've been told so far about my protocol was what Dr. Ahering said in our last appointment with him back mid April. He said at first glance he imagines he'll put me on a "classic" Lupron protocol, or L3C (as it's referred to at SIRM). What you see above is considered a "classic" Lupron protocol, according to that particular clinic; I would assume my clinic's would be nearly identical.
Without confirmation from my clinic, here is what COULD lie ahead for me. These conclusions are based on the above chart/clinc info noted below and a sample calendar from another clinic. My thoughts are in blue.
- Menstruation starts. (Should be around June 16 for me.) Baseline labs such as FSH can be drawn on day 3. (Around June 18 for me?)
- Birth control pill (Begins on CD 3?) is used to suppress the pituitary and to resolve any residual ovarian cyst from previous cycles. The pill also allows flexibility in IVF scheduling. Women who start menses at different times can have their cycles synchronized by the pill in order to start IVF treatment as a group.
- Lupron, an injectable medication, is started near the end of the pill cycle to further suppress the pituitary. (This could be around July 2 for me!?) The pill is eventually discontinued while Lupron is continued into the next phase to maintain pituitary suppression. Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. (Based on this sample calendar, from yet another clinic, it sounds like I might just continue Lupron up until the time everyone else starts their stims, so July 15... I guess there's no harm in "over" suppressing my ovary, especially since I have PCOS?)
- Ovarian stimulation is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. The injectable medications used to stimulate the ovaries (Bravelle, Follistim, Gonal-f, Repronex - I believe I'll be doing Follistim or Gonal-f) are actually LH and FSH, the same hormones normally produced by the pituitary. Close monitoring of the ovaries with blood works and sonograms is essential during this period to ensure optimal egg development and avoid complications.
- Human Chorionic Gonadotropin (HCG) injection is given when the follicles reach mature sizes. HCG induces the eggs to undergo the final maturation. It also causes the eggs to be detached from the wall of the follicles to facilitate their removal.
- Egg retrieval is performed about 36 hours after the HCG injection. The procedure takes 20 minutes and is conducted under IV anesthesia. A long needle is introduced into the pelvic space through the vagina under ultrasound guidance. After their aspiration, the eggs are inseminated or injected with the sperm in the same day. (ER for my cycle will be on or around August 3.)
- Embryo culture typically takes 5 days after the day of retrieval, the same duration an embryo takes to travel from the tube into the uterus under natural condition.
- Embryo transfer usually takes place on the fifth day of culture (otherwise known as the blastocyst stage). Two best blastocysts are transferred into the uterus using a soft catheter. The procedure is similar to an IUI and requires no anesthesia. The remaining embryos, if there are any, can be frozen for future use.
- Endometrial support with progesterone and estrogen supplements is important to prepare the uterine lining for implantation. Progesterone is started on the day after the retrieval. Progesterone transforms the endometrium into a rich environment to prepare for embryo implantation. Progesterone is usually administered in oil (PIO) form by deep muscular injection into the buttocks. (Our patients use progesterone vaginally instead of by injections. Our decision to use vaginal progesterone is based on numerous scientific researches that showed the superiority of the vaginal route over the intramuscular or oral route in endometrial maturation. I think my clinic normally recommends PIO, but I'm going to ask about suppositories or Endometrin inserts instead.) (Estrogen is added back to maintain hormonal balance within the endometrium. The estrogen level usually drops after egg retrieval since many estrogen producing cells are also removed along with the eggs. Estrogen can be used as a patch or as tablets. (I don't know if my clinic gives Estrogen supplements like this.)
- Pregnancy test can be performed 12 days after embryo transfer (Not sure if this is the typical number of days my clinic likes to test on). Once the test is positive, progesterone and estrogen are continued until the 11th week. A vaginal sonogram is performed at the 7th week to confirm the pregnancy.
Also, it's time to cut out caffeine and alcohol. Not that I was ever a big consumer of either, but I ought to eliminate this just to be safe. This weekend was full of enjoying a little of both. My mom came over on Friday to visit (we had a wonderful time!) and we bought some Teavana tea - very expensive, but it was so unique it will be a nice little treat from time to time. I bring it up for those who are undergoing, or about to undergo IF treatments. Their Tarocco Ruby Orange Herbal Tea/Apple Lemon Pomegranate Rooibos Tea combo is completely caffeine-free and is absolutely AMAZING! It tastes exactly like super yummy fruit juice and is fairly thick, for an iced tea. If you're looking for something different and IF friendly, I'd highly recommend it.
All in all, it was a great weekend. Lots of time spent with family and friends, which I always love. I even got to celebrate our upcoming IVF with my husband on Saturday and then with my good friends Sunday. What more could you ask for!! Going into a new week, please pray that we get good news back about our loan situation. This is the last big nail biter in terms of something that would be able to hold us up from starting. We applied last week and should know early this week if we'll be able to get the financing we need to pay for our upcoming cycle. We've gotten ourselves excited enough already that it would definitely be tough to let go of our hope now.