Yassy's K9 Central

Yassy’s note;Natural IVF cycle and finally…

In 2012, we were still thinking about trying for another round of IVF using the frozen embryos, but we did not opt in for doing the another round of IVF right away. We did not give up on our chance, but we needed time to try for another round.

Us (me and my husband) and rest of my side of my family take turn to visit each other’s home;Japan vs USA. For the year of 2012, it was our turn but we were not sure what would be the best way to go schedule wise.

 IF we tried another round of IVF before the trip back to Japan and possibly got the good news, then, we would not be able to go see my side of family because of frequent monitoring at the clinic plus OBGYN checkups and all other necessary visits.

  If we go see them first and then try another round of IVF in the year of 2012, it is better but if we do so, possible months looked like around hot months (strong air conditioned in the building) , or colder months (chilly,windy,snowy weather).

 I did not like the idea to do the transfer during the cold month or hot months because the colder it is, the more it makes me want to go quicker for the bathroom trip and if outside is hot,many hospitals use strong air condition in the building and too cold for me to even visiting on days that I do not have to do embryo transfer.

 I was not confident that I could do the transfer without fail;coming with full bladder,holding for 15 minutes extras on the bed after the procedure under the such environment.

Therefore, we decided to take a break in 2012 for the IVF and instead, we decided to visit our family in Japan. Then, we decided to go visit hattasan soneiji temple in Japan.

Hattasan soneiji temple is located in the city called “Fukuroi city“,which is in south western part of Shizuoka prefecture.

 Part of the reasons that we decided to go there beside wishing for the good luck,getting rid of bad luck for the next round of IVF,was because I had not had a chance to dine my favorite broiled eel dish,and Shizuoka prefecture is famous for the eel. Plus, for my husband, visiting historical place was interesting to him.

Also, the temple has long stair step that is called “Shi-n-zo-u Ya-bu-ri no ka-i-dan”; “shi-n-zo-u” means “heart”,”yaburi” means “challenge” , “ka-i-dan” means “stair steps” in Japanese.

 The long stone steps are known to make visitors out of breath by the time you reach to the top.

 Once you see ahead of you and think “OK, a little bit more steps and should be on the top”, you are wrong.Still more to go..

It is very spacious temple with such unique stair steps and I thought it would also be a good exercise for us too, and the scenery was great. That was added bonus visiting the temple.

Also, the temple had the one special spot; small building across the stone bridge,which my father told us that this is the place you would wish only one thing and it is believed that “the only one wish” shall comes true.

Therefore, we have visited the special spot, and I wished for the success of IVF.

 Then, in 2013, when it was my family’s turn to visit us, my father got us amulet and other charms from the temple for the good luck for the success of IVF.

 He  came to visit us before we start another round of IVF. I have kept those charms/amulet all the time with me. Whenever we visit the clinics,I kept the the little daruma doll that is believe to bring in the good luck plus all other charms my father brought to us in my purse.

Another round of IVF; Before starting with Natural cycle with frozen embryos..

As you can guess, as you age, the lower the success rate will be for the IVF. I was approaching to big 40 in a few years,and we wanted to do the another round of IVF as quick as possible.

 Again, before we try the another round of IVF with natural cycle, we had to read,sign,and notarized the consent forms. Then, we visited the billing department to ask for the cost of natural cycle using the frozen embryos.

This time, since we had 3 frozen embryos left, we did not need to repeat the fertility drug part to stimulate the ovary to retrieve the eggs produced. Therefore, the cost of the cycle was lower but it was still the expensive price to pay for.

The natural cycle with frozen embryo IVF cycle was estimated as $4,980 and mock egg transfer procedure ($400),  pre-screening testing,medications, pregnancy testing, storage of embryos, follow-up visits with doctor was excluded.

What included were ovarian monitoring with sonograms,blood test for estradiol/progesterone, laboratory preparation of embryos for transfer, assisted hatching, ultrasound guided embryo transfer.

We also learned that if we got blessed with little one;become a pregnant, then, the clinic would want the separate cost for the pregnancy package deal,which was $550 that included a couple of times of clinic visits for monitoring the little one in the belly up until 6th week via ultrasound and blood test to keep monitoring the hormone level.

After that, checking with insurance companies for the coverage, I had to do the mock embryo transfer (had to be full bladder) along with cervical check and other blood tests including HIV/Hep B Surface Ag/Hep C ab when next cycle came because we did not do the another round of IVF within 6 months. The blood tests needed to be updated every 6 months.

Natural IVF cycle..

With the natural cycle, steps you would take is very similar to the stimulated IVF cycle but slightly different.

When your cycle started, you would call the clinic on day 1. Then, they will have you come on day 2 or day 3 for the baseline blood test along with sonogram. From there on, your ovaries will be monitored.

Since you are not giving yourself fertility drug shots, the clinic visits are much less frequent.

Next time you visit the clinic will be cycle day 7 through day 11. During the time, you will get your blood drawn to be checked for estradiol and progesterone (hormone level check) as well as sonograms to monitor your ovaries.

  Somewhere around day 10, if you did not have frozen embryos, since you would want to get the egg retrieved,and then to get it fertilized, you will get HCG shot 2 days before the egg retrieval day.

  When the eggs were fertilized, you would wait 5 days to see if the embryo could survive the 5 long day in the dish. If they did, you have the embryo to be transferred into your uterus.

When you have frozen embryos to be transferred, you would still get the HCG shots 2 days prior to the could have been the egg retrieval day without actually getting the egg retrieved.You would skip that part.

After that, you would wait 5 days, and then finally,the embryo transfer day.

 Before the transfer, the laboratory staff would pick the best embryos in the bunch and thaw them to be transferred.

Natural IVF cycle with frozen embryos..

 Just like before, we were asked how many embryos we wish to be transferred. We decided to try 2 embryos again. Our 2nd round of embryo transfer was September,2013.

2 embryos transferred in September,2013..

On the day the 2 embryos were transferred, I tried to stay laying down as much as possible with legs a little up.

 Another long 2 weeks wait til the pregnancy blood test had started.

 With our little son “Liam”, I feel one day passes by so fast now, but that 2 weeks wait was longest wait ever. The 2 long weeks wait had the anxious/nervous/exciting feeling all mixed together.

Unfortunately, those 2 embryos did not implant as we hoped they would. Another sad moment for both of us.

 By now, we have experienced embryos not making it to the 5th day, when they did, embryo did not get implanted two times… We still got one embryo left but, we were very disappointed for the result.

 After the sad news telling us that I was not a pregnant, once again, we were very sad but knowing we still got one last chance to try (We wanted to keep trying until we get blessed but financially, it is hard on us and, we were aging each year..), we decided to try to be positive and stay strong. Stress is not a good friend for this.

Natural IVF cycle; One embryo,one last chance.. and finally….

We then decided to try another round of Natural Cycle with frozen embryo. We were not sure if we could afford to try more even if we wanted to.This round was possibly the one last time. It was November,2013.

This time, after the embryo transfer procedure, even though we were told ok to resume to the ordinal routine from the next day, but since I have read that the first 5 days after the embryo transfer is the most crucial date for them to implant in other news article, I have decided to stay much more cautious this time and,I made myself laying on the bed with legs a little up as much as possible for more than a day and made myself not to move around much. Plus refrained from strenuous physical activities.

Liam as embryo… November 2013..

As you can guess, that one last standing embryo eventually became our little son “Liam”. We have received the great news that telling me that I was a pregnant finally.It was December 2013. Great Christmas gift for both of us.

 I still remember how we spent the day we received the great news.

After visiting the clinic for the pregnancy blood test, we dropped by the nearby Asian store to get Palette’s meal to stock up her freezer. Then, we decided to dine in at PF Chang’s because we do not have much chance to dine in in our area.

It was cold day and I remember it was raining. My husband then took me to the nearby store to show me things that he thought would be interesting to try.

 After coming back to the house,I was cutting down beef heart for Palette so I can portion out her meal to freeze them. It was that time the phone rang and, at first,I did not know who my husband was talking to downstairs,but he came up and told me the great,great news.

As soon as I hear the great news,my tears started coming out because I was very very happy and we both knew that the road that come to the positive result was such a long one.Not only that, we had so many emotional/physical stress and all the emotions came out.

 In the kitchen,we hugged and cried for a while.. It was that much of news that meant so much to both of us. While we were doing the natural cycle IVF for the last embryo (Liam), I found a few 4 leaves clovers in our yard. It might had nothing to do with this,but I kept the clovers in between the book I was reading. I still have one. It brings good luck,and we wanted one:-)

 One embryo, one last chance, and we got blessed with him:-)

 I do not know what to say about this. Embryo ,which is “Liam” to be, beat the odd!  Our doctor was amazed for the result knowing it was the last embryo, and it would have been our last try with IVF.

Pregnancy test and beyond..

Now we knew that I was a pregnant, next chapter of pregnancy journey has begun. In my case, I had to visit the clinic about a couple of times for the blood test and ultrasound for the doctor to monitor/assess the embryo (Liam).

I still remember the doctor showed us the image of the embryo (Liam);white dot in the sac my uterus, and said “Can you hear the baby’s heartbeat?”. He did find him/her right away and amazed how strongly growing this little one was. It was still weaker sound just enough to be able to hear if the room was complete silence but we did hear the heartbeat for the first time:) It was mid December,2013.

When we heard his very first heartbeat…

There was no arms and legs yet, but we saw the white spot in the sac that turns on and off as we hear the sound of the heart.

That little heartbeat sound was such a strong beat to my heart and it made the big impression on me.

Meanwhile,we had to find the OBGYN we wanted to go to for the rest of the pregnancy weeks after the IVF doctor release us to the regular OBGYN.

Then, one incident that got me worried if I were still fine for the pregnancy-wise; I took Palette out for the potty and the ground was slippery from the rainy weather previously and when she suddenly pulled hard, I fell on my butt.

Then, I had heavy bleeding after that. Therefore, when we went to go see the doctor, I told him about the incident and it made his face white,which made me nervous.

However, everything was good, and he saw Liam was growing at the rate he should. He reassured us for that.

After the positive pregnancy blood test,doctors are to determine if the pregnancy is in the uterus,and embryo is at the appropriate size (growing as it should), the doctor will refer you to the OBGYN in your area.

With us, on the second visit, the doctor said to us that today’s visit will be the last visit for both of us and now we will be seeing OBGYN in our local area next.

All in all, after the positive result from pregnancy test,I got to see him only twice.Then, rest of the pregnancy weeks were monitored by high risk OBGYN and regular OBGYN in our local area.

I was blessed with Liam at the end but, even if I got pregnant, at that time, I was still nervous/worried/scared of miscarriage and all other possible difficulties we may face against. Never ending worries to come…

 

Jan 08, 2015 | Comments are off | IVF

Yassy’s note: Stimulated IVF cycle journey

In the previous entry titled “Yassy’s Note:Impossible dream made possible“,I wrote that 12 years ago, I came to the states via marriage and,after spending about 2 years ourselves alone, we started thinking about starting a family. However, doctor has found the toxic fluid for babies in one of the tubes and the other tube was closed , plus I had the wall in heart shaped uterus (bicornate uterus). Therefore, both tubes had to be removed.

 Since my uterus had so little space for the babies to grow, our first doctor told us that our option for our dream of life will be achieved via surrogate program,which runs up 60,000 dollars.

 In the another previous entry titled “Yassy’s note; first step into IVF journey“,  I wrote about how our very first IVF journey has begun.

 In this entry, I would like to write about how our very first stimulated IVF journey went.

Fertility drugs, injection teaching, ovarian monitoring days..

 About 2 weeks prior to the very first stimulated IVF cycle treatment, we have scheduled the injection teaching class so we get to learn how and where and when I would or my husband would give the series of fertility shots to me. This was the day when I thought we would finally start stepping forward to our long waited dream; starting family of our own.

At the end, I have got this much of fertility drug shots…

These are from 2 round of stimulated IVF cycle,and 2 round of Natural IVF cycle.

The injection teaching, in our case, was done at the clinic and, we learned what medications we will be getting from the fertility drug pharmacy, and how much of each drugs I would be getting as well as the time of the day I give myself a shot each day.

 The clinic has told us to give myself a series of shots of ..

• Lupron ; one dose each night. It is to be given in either thigh or abdomen. However, the injection site got swollen up in my case.Therefore, I had to take different medication (Synarel) in place of lupron shots.

 The Nurse will tell you when to start the medication, and then, when your cycle has started,you are to call the clinic on day 1 so you can go to clinic on day 2 to get your blood drawn for the cycle day 3 hormone baseline test.

The clinic we went to have patients come early in the morning between 7am-9am for the blood work of all kind as well as all the monitoring work such as sonogram.

•  Follistim pen; one dose each night unless otherwise noted by physician. It is to be given in either thigh or abdomen.
• Menopur; One dose each night. It is to be given in either thigh or abdomen
• HCG; This is the drug you would get shot with 2 days before the egg retrieval day at the specific time.The nurse will schedule the egg retrieval day first and then give you the instruction as to what time exactly you should get HCG shot. This injection will be given in buttocks.
• Progesterone in sesame oil; This is the shot you will get shot with on the day of egg retrieval. This shot will be given in buttocks.

As you can see,some of the shots are given in the buttocks where you cannot give yourself the shots with, so it was my husband’s duty to do so for me. He was a little nervous about the shots but he did great job.It was not painful at all.

After the injection teaching, we have received the fertility drugs and we have called them up to tell them my cycle has begun. On the cycle day 19, which was August 2010, I have started getting lupron/Synarel along with baby aspirin for 10 days in my case until next cycle begins, each day.

  Then, when the new cycle started, on day 1, you will call your clinic to let them know that your cycle has begun. Usually, they will have you come for the baseline blood test on cycle day 3, and they will instruct you to start getting the series of the fertility drugs you have received.

 On your cycle day 3,4,6,8,10, and 11, you would visit the clinic to get your hormone level monitored via blood test and also you will be checked how your ovaries are responding to the fertility drugs via sonogram.

 Soon, giving myself the series of shot became one of my routine stuff to do each day. It was September ,2010.

 The medication dosage for the each drug would start with the same for everyone at first, but depending on the individual person, the dosage can go higher or lower based upon the blood test you do every so often at the office during the stimulated IVF cycle.

 Since there are variety of shots you would need to give yourself a shot with, the clinic has provided a chart so we can simply fill out the date and dosage to keep track with.I thought it was a good idea.

As you can see, we had to visit the clinic every so often to get my ovaries monitored closely. It was such a tiring days on the conic visit because we had to wake up really early in the morning and drive up to the clinic;90 minutes trip each way.

 By the time we back home, we were zombie and needed a short nap to function. However, every time we go see them and hear that the physician says that there are xx number of follicles are being produced on my ovaries, we got so happy knowing that my ovaries are responding to the drug well and producing the eggs that could make our dream come true.

 Egg retrieval day..

Between the cycle 11-14 days, based on the images that the physician would see, your egg retrieval day will be scheduled.

In our case, the procedure was done via IV sedation at the clinic with recovery time for 1 hour. One hour before the procedure, I was asked to take Valium (diazepam). That medicine made me feel so heavy in body and,I think it worked too good for me. The next cycle we did, I had to take only half dose I got for the first try.

It was the exciting day for both of us. I felt like it was the real start for us,one step forward toward the dream of our own.

On the day of egg retrieval, your husband will provide a sperm sample to fertilize the eggs retrieved.

The doctor has retrieved 11 eggs from me on that day, and 7 eggs out of 11 eggs were fertilized.

Now the real question/challenge for them was whether they could survive the period of 5 days growing in the dish. If the fertilized eggs did not survive the 5 days in the dish, we had no embryos to be transferred into my uterus.

Those 5 days wait was our very first anxious period of time,waiting for the good or bad news to come and see if we can move forward to the next step;embryo transfer. It is especially because you will be getting series of fertility drug shots including the new regime to get your body prepared for the embryo transfer day if things went good while waiting for the news and,that made us both more anxious.

Unfortunately, the fertilized 7 eggs did not make it to the 5th day enough for the doctor to consider it as good quality embryos. Therefore, our very first IVF cycle was stopped right there.

If the fertilized eggs made it to the 5th day, the lab technicians would have selected best looking embryos from the bunch and I would have been moving on to the embryo transfer.

 In the best scenario, if I could move on to the ultrasound guided embryo transfer,then I would have done embryo cryopreservation for some and transfer 1-2 embryos into my uterus hoping for the implantation. Then I would have wait 14 days to get tested for the hormone level via blood test to check if I were a pregnant or not.

As you can see, there are so many waiting time for specific steps/procedures, and you can imagine how disappointed we were when we heard the bad news;the embryos did not make it to the 5th day..

Both of us had strong wish to start our own family so, we have waited a bit to try again but we knew we would try again hoping for the better next time.

2nd stimulated IVF cycle..

Since me and my husband,both had strong wish to try the IVF again hoping to have our own family,we decided that we would keep trying as much possible as we could. It sure was hard financially, but our dream had more strong impression on us and we made our dream as priority.

The spring came, we have decided that we would try another round of stimulated IVF cycle. There is no guarantee that we would be able to have our dream come true with the second try,but we had to try to seek the chance.

Just like our first try with stimulated IVF cycle, we repeated the steps we have done with the first IVF cycle; series of fertility drugs,frequent clinic visits to get my blood drawn for the hormone level,plus sonogram to get my ovaries monitored closely between 7am-9am each time. Since our house was 90 minutes drive away from the clinic and traffic was horrible, every visit made us very tired. Whole IVF cycle had emotional,physical stress altogether.

Now the egg retrieval day came in April 2011. This time, doctor has retrieved 28 eggs. I do not remember how many eggs were fertilized, but at the end, we had only 5 embryos that survived 5th day in the dish.

At this point, we were not sure yet if any of the 5 embryos would come meet us, but “survived the 5th day in the dish” was good enough news for us then since previous fertilized eggs did not make it to the 5th day.

  On the embryo transfer day in the late April 2011,I was nervous and at the same time,I was excited with the hope this might work. I was nervous because I knew that I had to drink lots of water (clinic told us to start drinking  64 oz of water about 2 hours prior to the procedure. ) and had to come to the clinic with full bladder.

  We have decided to transfer 2 embryos that day. It was the fresh embryos. Here is the picture of them.

Our very first embryos to be transferred into my uterus..

  I was worried if I would not burst in the clinic during the procedure. After all, the procedure went ok although my ovaries were responding to the medicine too well and it was swollen a bit and the procedure itself was a little painful.

After the embryo was transferred, I had to rest in the room for about 15 minutes and went home. I was told bed rest for a day,and still keep taking the fertility drugs. Now the long 14 days wait begun till the pregnancy test via blood test.

During the long 14 days wait period, we had to come to the clinic on 4th and 8th day after the egg transfer to get the blood hormone checked. Based on this result,sometimes, doctor would order the adjustment for the drug dosage.

Come May 2011, I went to the clinic for the blood pregnancy test. I was nervous again, but excited to hear the news whether I was a pregnant or not.

I remember that I have received a call from the doctor telling me that my result was not good. I was not a pregnant. You can imagine how sad I was. I remember I kept question myself whether I can really become a pregnant someday, and start the family..

I was really sad to hear the news but on the flip side, we still had 3 embryos left to try. Therefore, we have decided to try again when we can afford to do so. Meanwhile, we have asked the clinic to cryopreserve our embryos for later use.

The next step we could try was via Natural cycle (no fertility drugs) with frozen embryo transfer. This is going to be a little different in the steps to follow.  I am going to explain in the next entry.

Dec 30, 2014 | Comments are off | IVF

Yassy’s note: First step into IVF journey

 

In the previous entry titled “Yassy’s Note:Impossible dream made possible“,I wrote that 12 years ago, I came to the states via marriage and,after spending about 2 years ourselves alone, we started thinking about starting a family. However, doctor has found the toxic fluid for babies in one of the tubes and the other tube was closed , plus I had the wall in heart shaped uterus (bicornate uterus). Therefore, both tubes had to be removed.

 Since my uterus had so little space for the babies to grow, our first doctor told us that our option for our dream of life will be achieved via surrogate program,which runs up 60,000 dollars.

 In this entry, I would like to write about how our very first IVF journey has begun.

Mock Egg transfer/Hsteroscopy..

 It was April 2010. This procedure is often done between day 6-11 of your cycle and,you would feel like pap smear.It is not a painful procedure although since you come with full bladder, it is a little uncomfortable during the procedure.

Often times, the clinic will ask you to call when your cycle has begun;day 1. Then, schedule your mock egg transfer/Hysteroscopy.

 The clinic would ask you to take the antibiotic on the day of mock egg transfer/Hsteroscopy day. At the clinic we went to, they also asked us to take the painkiller such as ibprofen to decrease the cramping one hour before the procedure.

 The procedure itself is done by inserting a speculum into your vagina,and then local anesthetic is injected to numb the cervix. The physician would then gently insert the hysteroscope to look inside the uterus.
 After the procedure is done, you will be asked to rest for 15 minutes in the room.

 The clinic we went to did mock egg transfer when they scheduled me for the hysteroscopy at the same time.

 The clinic we went to asked me to start drinking water 2 hours prior to the appointment and drink at least 8 cups of water. However, I had long drive to the clinic and it would have been so uncomfortable if I drank that much. Therefore, I simply drank the water just enough to have my bladder full without feeling too full.

  This mock egg transfer/Hysteroscopy procedure were not included in the IVF program,and we had to pay roughly $500 through our insurance company for them.

  When you think about trying IVF program, ask the financial staff as to what are included in the program,what are not included in the program and at the same time, ask your insurance company whether what are not included in the IVF program at your chosen clinic would be covered or not beforehand.

What the treatment agreement basically said was risk and benefit of the treatment such as the fact that the treatment is not something they can guarantee that the treatment will be effective to maintain the pregnancy or the pregnancy will result in the delivery of the healthy,living child.

 Also, it is to allow them to test us, and to remind us that the IVF treatment could result in multiple pregnancy,consequences of multiple pregnancy, Ectopic pregnancy, and could have risk of fertility drugs along with the information what would happen if the doctor thinks pregnancy should be terminated because of the medical reasons.

Another one we received was the statistic information sheet,which we had to read and sign it. Below is the copy of the success rate chart we have received. You can click the image to view the enlarged image.

In VA, law requires all the physicians who are performing IVF to submit the statistics to patients.Therefore, we had the chart given to us prior to the treatment and know that the chance of the success with IVF that are related to the age,and the cause of infertility.

Interesting thing it said was that, you can call American society for reproductive medicine  to find out the statistics of particular clinic in the states if you wish to find out about it by yourself.

If you would like to know the statistic of your particular fertility clinic’s success rate of IVF treatment, you can call at 205-933-8494 also.

The IVF clinic also submit the statistic data to CDC and  SART (Society for Assisted Reproductive Technologies). These tables are then published and available online to the public. You can click the link here, at the SART website,then, click your state to find out about the success rates at your preferred IVF clinic. Their data format is very easy to read.

How to read the IVF success rate chart..

Pregnant/Retrieval; % of patients whose eggs were retrieved and got pregnant

The national infertility association suggests that we should focus on the % of the embryo transfers that resulted in the pregnancy/live birth. The association says that this statistic tells you how many babies were born for each IVF cycle, as opposed to the numbers of babies conceived.

The clinic we went to gave us the data sheet prior to the treatment but the data we got was not that clear if you try to look for the implantation rate that resulted in the live birth but SART got that information and you can find it out very easily. 

For example, looking at the 2012 data submitted to SART via the clinic we went to, 35 years old and younger had 71 embryo transfer,then the percentage of transfer resulted in the live birth was 35.2% (using thawed own eggs). With the fresh egg from their own, 35 years old and younger had 36.4%  of success rate that resulted in live birth.

IVF types and procedure..

At the clinic we went to, they offer two types of treatment when you use your own egg and your husband’s own sperm.

 One is stimulated IVF,which basically use the drug to grew multiple eggs and hoping to have more chance to succeed. The other one was natural cycle,which no drugs are involved to grew multiple eggs and treatment will be done based upon your cycle,using your naturally produced single egg.

 Both treatment has pro and cons.

 Depending on the treatment you choose, the step is slightly different as well as medications that are given, but generally, IVF treatment with stimulated cycle would go as followings. Since we have tried stimulated IVF program as the first try, I will explain about the stimulated IVF program first in detail.

IVF Medications..

• Gonadotropins, or injectable fertility drugs; Follistim, Gonal-F, Bravelle, Menopur

These hormone drugs are to stimulate the ovary in hopes of  encouraging the growth of several eggs over the span of 8 or more days

All injectable fertility drugs have FSH ( follicle stimulating hormone) that will stimulate the growth of the ovarian follicles which contains the eggs, and some of them have LH (Luteinizing hormone) ; that will work with FSH to increase the production of estrogen and growth of the follicles.

The dosage of the drugs,timing of the drugs, timing of the egg retrieval date are unique to the individuals,and it will be determined by your physician in response to the frequent blood tests to check the hormone level as well as the images of the ovaries via ultrasound.

• Lupron; injectable medication that will prevent a premature LH surge,which could result in the release of the eggs before they are ready to be retrieved. This drugs also be used to start the growth of the follicles or initiate the final stage of egg maturation.
• HCG (Human chorionic gonadotropin) ;Profast, Novarel, Pregnyl,ovidrel

HCG is a hormone used in IVF to induce the egg to become mature and fertilizable. Physician will tell you the exact timing to receive this medication right before the egg retrieval day.

• Progesterone, estradiol; hormones normally produced by the ovary after ovulation. After the egg retrieval, since ovaries in some women will not produce the enough level of the hormones for long enough to fully support the pregnancy, physicians would prescribe these hormone.

            Also, supplemental progesterone, and some cases esradiol are given to ensure the enough hormone support of the uterine lining. Progesterone medication is often continued for some weeks after pregnancy has being confirmed.

• Oral  contraceptive pills; Birth control pills are to be taken for 2-4 weeks before gonadotropin injections are started to suppress the hormone production or to schedule a cycle (when you take birth control pills, it will regulate the cycle and it is much easier for them to give you the best timing possible for the treatment medications)
• Oral antibiotics; antibiotics are to be taken for a short time during the treatment cycle to reduce the risk of infections associated with egg retrievals, and egg transfer.
• Baby aspirin; to help keep open the blood vessels in the placenta, to  improve blood flow to the ovary, and prevent the blood clots.It would lead to better stimulation and implantation;giving us healthier eggs and embryos.

With us, our insurance company could cover the stimulated IVF program for up to maximum $10,000 in life time. Therefore, we have chosen the stimulated IVF cycle for the first try.

After all the evaluation, and physician’s consultation on our case, I was asked to start taking the prenatal vitamins besides fertility drugs they would ask me to take.

 The fertility drugs were covered by our insurance company but it was still expensive; $350. Without the insurance, it would have been much more  expensive drugs. If you were thinking of trying IVF, I would recommend to check what are covered,what are not covered by your insurance company beforehand.

And it is good to check to see if your insurance company would cover the certain amount of IVF cost. It was such a big help for us,regardless of the result at the end.

Egg Retrievals..

  After ovaries were stimulated, and produced multiple follicles, next step you would take is egg retrieval.

  Egg retrieval from the ovary is done by ultrasound probe to see the ovaries and the egg containing follicles within the ovaries.

  A long needle would be guided into each follicles and the content will be aspirated. This procedure will be done under the anesthesia. Then, aspirated eggs will be transferred into the lab where they are kept in condition that support their need and growth. Then, eggs and sperms will be placed together in specialized condition, in hopes of fertilization.

 In some case, individual sperm are injected into each egg in a technique called ICSI; Intracytoplasmic sperm injection.

Prior to this egg retrieval procedure,you will be asked to take the antibiotics to reduce the risk of infections. Also,physician may prescribe you to take diazepam to make you relax.

After the egg retrievals..

  The fertilized eggs;embryos are placed in small dishes/tube containing culture medium,which is the special fluid developed to support development of the embryos made to resemble that found in fallopian tubes or uterus. 

 Then, the dishes containing the embryo will be placed into incubators,which control the temperature and atmospheric gasses the embryos experience.

  Then, lab technicians would watch over the embryo’s growth every day. 2 days after the insemination, normal embryos would have 4 cells . Three days after, normally developed embryos would have 8 cells. 5 days after, normally developed embryos would develop into the blastocyst stage here embryos would have more than 8- cells.

 When you get eggs taken for fertilization, not all eggs would fertilized, and not all embryos would develop the same rate or develop normally. At the same time, even if the embryo could develop at the normal rate,it does not mean that the embryos are genetically normal. 

 Embryo transfer..

 After the embryos are kept in the lab being checked for the growth for a certain days (the days kept at the la can vary depending on the clinic you go to), lab technician will select the best embryo from the bunch for the transfer into your uterus.

With the clinic we went to, they kept the fertilized eggs for 5 days to grow, and selected the best one of the bunch and then transferred into my uterus. You will be asked how many embryos you would like to be transferred prior to the procedure. To help curtail the problems of multiple pregnancy, national guideline limits the number of the embryos to be transferred into your uterus depending on your age.

For example, for the 5-6 days old embryos to be transferred, women up to age 35, they recommend to 1 embryo to be transferred, and for the women between 35 to 37,they would recommend 2 embryos to be transferred.

On the day of embryo transfer, the embryo will be placed in placed in the uterus with the thin tube. The physician would use the ultrasound to guide the catheter and select the best spot for the implantation.

You will be asked to arrive with full bladder for this procedure so the uterus will be straighten up and easier for the physician to look the image and guide the catheter into the uterus for the best chance of pregnancy..

In some cases, if you had good fertilized remaining eggs that survived 5 days in the dishes/tube than you would transfer into your uterus, you can freeze the embryos for the later use. The freezing cost was $1,500 per cycle,and annual storage fee per year was $500 at the clinic we went.

Freezing can save your cost,and another fertility drugs to take to stimulate your ovaries again to retrieve the eggs in the future.

That being said, I was informed that the success rate of pregnancy using the frozen embryo is lower at the national level than with fresh embryos.

 After the embryo transfer..

After the embryo transfer, in hopes of successful implantation of the embryo to the lining of the uterus, you would be asked to take hormone medications such as estradiol, and progesterone.

Both hormone medication is given to keep the lining of the uterus thick and gooey so the embryo has more chance to implant.

With naturally conceived situation, ovaries would make adequate level of the hormone, but with IVF treatment, the level of those hormones are not at the favorable level. Therefore, often times progesterone, estradiol will be given to take for 2 to 10 weeks.

Then, you will have 2 weeks to wait till the pregnancy test (blood test), and finally, you will know if you are pregnant or not pregnant then. If you were a pregnant, your physicians will ask you to keep taking the baby aspirin,prenatal supplement and other hormone medication;progesterone and estradiol to maintain the pregnancy.

 The cost for one stimulated IVF program..

 The cost of the treatment is different depending on the clinic you will go to, and the area you are located at. Also,the costs for fertility treatments will vary widely among programs as well. 

 In average, the cost for one IVF cycle with no insurance coverage is approximately $10,000 plus the cost of medications in the Washington, D.C. area.

The clinic we went to included ovarian monitoring with sonograms, blood estrogen and progesterone measurement, egg collection,culture of eggs and embryos, ultrasound guided embryo transfer, anesthesia, supplies, cycle review,facility fees in the single stimulated IVF cycle without insurance coverage.

Medications, prescreening, cryopreservation,ICSI, assisted hatching, culture of eggs, gender selection, storage fees, complication of therapy,pregnancy testing and monitoring were not included in the program above.

What is ICSI..

(ICSI;Intracytoplasmic sperm injection ) is the method where each egg is individually injected with a single sperm using a tiny needle under microscopic guidance in hope of fertilization. The resulting embryo is then cultured similarly to an embryo produced in a non-ICSI IVF treatment.

What is assisted hatching…

 The human embryo hatches out of the eggshell (zona pellucida) at the blastocyst stage of development. Assisted hatching involves making a small hole in the shell that is surrounding the embryo prior to the embryo transfer and help the embryo emerge following its transfer into the uterus after IVF. It is believed that it increases implantation and pregnancy rates.

Just like our insurance company, some insurance companies do cover IVF program. The clinic we went to needed pre-authorization (written form) from the insurance company before starting the program.

What would happen if the IVF cycle has failed?

 The clinic we went to refunded us the fee we did not complete; fee for service. Then, if you wish to continue to try another IVF, you would schedule the appointment for the cycle review.

What would happen if you get pregnant?

 The clinic we went to did not include the office visits,sonogram,monitoring etc after the pregnancy confirmation in the IVF program package deal. The wanted the separate fee of $500.It included all the office visits,blood test,sonogram monitoring etc.. I was being monitored until I was at 6 week pregnant.

 This is how stimulated IVF program is done.

 After we have signed the all necessary paperwork,we were scheduled to visit the office to learn about how to give ourselves shots for fertility drugs, and also we were asked to go to lab to draw blood for the hormone/HIV Hep B Surface AG/Hep C ab test for me. My husband had to get his blood drawn to be tested for HIV,Hep B Surface AG/Hep C ab. These blood test will be required to do every 6 months.

 Now, We were ready to plunge into our first IVF cycle.

 It is best to schedule injection teaching, cycle review about 2 weeks before the estimated cycle day 1 because insurance company’s authorization for the fertility drugs could/would take 2 weeks.

 Unfortunately, our first try did not result in positive result, and it  took us long,long time to finally meet our little son “Liam”, but it was worth waiting for him to arrive in our arms.

 I love him.I love spending a day with our little star “Liam” and enjoy his smile each and every single day.

Dec 16, 2014 | Comments are off | IVF

Yassy’s note: One step closer to our IVF journey

In the previous entry titled “Yassy’s Note:Impossible dream made possible“,I wrote that 12 years ago, I came to the states via marriage and,after spending about 2 years ourselves alone, we started thinking about starting a family. However, doctor has found the toxic fluid for babies in one of the tubes and the other tube was closed , plus I had the wall in heart shaped uterus (bicornate uterus). Therefore, both tubes had to be removed.

 Since my uterus had so little space for the babies to grow, our first doctor told us that our option for our dream of life will be achieved via surrogate program,which runs up 60,000 dollars.

 Our journey to finally be able to hold our own child has all started from 12 years ago;the summer in the year of  2004.

 

Our little prince “Liam” 2 days old..

Our regular OBGYN at the time referred us to the reproductive Endocrinology& Infertility Gynecology specialist first. The doctor there wanted to evaluate the infertility issue for both of us,and has sent me to the test called Hysterosalpingogram a.k.a. HSG to check if the tubes are opened;this is to check if the infertility issue was one of female factors. Then,she has sent my husband for the semen analysis  to check if Infertility was make factor.

 It was clear that the issue was not male factor. Therefore, I was tested more in detail to see what was resulting to the infertility issue.

According to the doctor, the infertility evaluation process is recommended first before the treatment such as IVF if the couple has attempted to conceive more than a year without success. This evaluation is to find the possible cause of infertility.

 What kinds of tests are performed to identify the cause of infertility? Here is the list of tests done.

• Medical history of both partners
• Physical exam of female;pelvic organs (ovaries,uterus, and cervix) will be evaluated for abnormalities
• PAP smear
• Semen analysis;the lab will test for sperm function and presence of infection
• Blood test on the cycle day 3 for the hormone FSH and LH to check ovarian function, blood test for hormone imbalance etc..You will be checked for more such as TSH,PRL,ABO and Rh, Rubella, HIV,Hep B&C and RRR,
• HSG (Hysterosalpingogram) on the cycle day 7 -10 to check if fallopian tubes are opened, and to evaluate the internal architecture of uterine cavity

What is HSG?How is it performed?

HSG (Hysterosalpingogram) is the test to check fallopian tubes are opened, and to evaluate the internal architecture of uterine cavity.

The test is done in between your cycle’s day #7-10, in a radiology department at the hospital.

In the room, the contrast medium or dye is injected through your cervix and it will outline the uterine cavity and fallopian tubes so that they may be photographed on the X-ray.

You will be instructed to take an antibiotic before and after the procedure. Then, you will be instructed to take Advil or Motrin 1 hour prior to the procedure to prevent the cramping after the procedure.

• Between cycle day 13 to 16, you should be ovulating and ultrasound test will be performed to see both uterus and ovaries. This test can confirm at least one follicle containing an egg is present in the ovary and it goes away after ovulation. This test also can evaluate the thickness and pattern of endometrial lining. This ovary function,uterus lining thickness etc can effect the potential of an embryo to implant after fertilization. As for the uterus, ultrasound can check pathological abnormality on the uterus as well.
• On the cycle day 21, you will get blood test  to check the progesterone level. The progesterone level rises dramatically after an egg is released from the ovary.The progesterone prime the lining of your uterus to both becoming a pregnant and maintain the pregnancy
• Cycle day 27, endometrial biopsy to evaluate the response of the uterus lining to the progesterone if needed. I did not have to do this biopsy.

 As you can see, there are many tests before actual treatment and often times, to evaluate the female side of infertility factor, tests are done based on your cycle day,and there are so many tests to be done.

 At the time, I was working for Japanese Airline at the Airport near us,but I had to take multiple days off without advanced notice now and then because of that. At the end, I came to the conclusion that I could not do the job and do the Infertility tests or IVF at the same time,and I have ended up leaving the job.

I liked the job but it was for the good, and I have no regret for that.

  As a result of all of these tests, the doctor has found out that I have got a bicornate uterus (heart shaped uterus), ovarian cysts (which turned out to be it was simply abnormal cell,not a cancer), and one of the fallopian tubes were closed.

 She has scheduled me then to remove the cyst on the ovary and when she looked inside me to retrieve the cyst, she has found out that there was a large number of endometriosis around the ovary as well.

She could removed some of the endometriosis on me, but too many to remove all of them and she has put me on the birth control pills first to remove the rest of the endometriosis.

  Having a birth control pill was opposite idea for our ultimate goal,which was to be able to get pregnant,but she has told me that the pill will regulate the cycle,and also treat the endometriosis and I should be on it for a while until endometrosis is gone.

Therefore,I was on the birth control pill for a while to treat the endometriosis.

Looking at all the tests results, the doctor has us seated and basically told us that since I have got a bicornate uterus with wall in the center, even if I got good opened fallopian tubes, and I could conceive naturally, chances are I would more likely miscarriage.

  After all, ovaries were functioning as it supposed to,and since I had one closed fallopian tubes and I got a bicornate uterus with wall in the center, she thought I would no way that I could carry my own child via IVF successfully. Even if I could get a pregnant,she thought it would more likely end with miscarriage.

  Her suggestion was to talk to the Infertility specialist for the surrogate program after endometriosis was treated,and go from there.

  We were then referred to other Infertility clinic in our local area to talk to the option we have got to be able to have a baby.

  She also suggested to join in the support group called “Resolve“. You can find the support there as well as many IVF,surrogacy or any other family building related information.

As you can imagine, we were both shocked to find out that the only option for us to have a child was via surrogacy, and it was very hard for us to accept the fact that I was not being able to  carry a child on our own.

 Not only that, when you get pregnant, what you eat or drink and all other things in your daily life really effects unborn child and, I was worried thinking how would I know the person who would be carrying our child would be eating and drinking and spending a day as she should.

 Controlling what you would eat or drink is easy, but it would be hard to  control somebody else’s daily habit. Plus, the program itself I heard was super expensive and when you think about it, program does not guarantee the successful pregnancy of course and, the dream to be able to have a child of our own looked so far away.

  Because of the cost issue and, the fact that we were thinking that surrogacy was the only choice for us to have a children of our own, we were debating what we should do next, and we were putting off to visit the Infertility clinic  until 2008 winter.

 That is something I would regret a little because the doctor at the Infertility clinic has told us that having the wall in the uterus would not  be a big deal for us because he knew other doctor who could remove the wall in the uterus and repair the uterus so my uterus would have more chance to be able to carry our children on our own.

  You could imagine how much we got relieved and at the same time, we were so happy to find out about that. If we knew that much earlier, we could try building a family a little bit earlier then.

 The infertility clinic has sent me to the hospital to be tested for fallopian tubes and uterus abnormality via HSG again. It showed that one of the tubes was closed as our first doctor has told us and the other tube was filled with toxic fluid for the babies to grow. Therefore, both of my fallopian tubes were no good, and they had to be removed while uterus surgery.

  Of course, the uterus surgery needed some painful recovery time and we could not start the IVF treatment right away. Another time to delay the building the family. However, end result at the end, as you already know, was a good one so, I am grateful for that.

 One step closer to our dream.

 Long road to go but we were determined and faithful that we would be able to have a child of our own someday. I knew that Celine Dion has tried IVF 7 times and the last one ended up with successful outcome;twin boys.

 Therefore, I wanted to believe that we could end up with successful result like theirs at the end. We had to believe that to be strong. Infertility issue is really emotional and stressful for both. I needed something to hold on to and it was Celine’s story and it was my husband’s emotional support.

 Our real journey to be able to meet our little prince “Liam” has started in winter 2010.

 It was such an emotional roller coaster but, every time I see Liam’s face now and see his arms and legs flapping around for the excitement and smiles, it makes me smile.

 It was real hard to go through the whole IVF program especially when we were told “You are not a pregnant” over and over again, but it was worth it. One little smile from Liam is priceless and,I am glad that we could find the clinic that could make our dream come true.

Dec 08, 2014 | Comments are off | IVF

Yassy’s note; Impossible dream made possible

Family. What is “Family” to you?

To me, “Family” is the place where you find happiness,laughter and love. Also share and overcome any difficulties together. It is where I find “the rock” in my life.

12 years ago, I came to the states via marriage and,after spending about 2 years ourselves alone, we started thinking about starting a family. We both love kids and, we wanted the kids who would call us “mom” and “dad”.

Unfortunately, doctor has found the toxic fluid for babies in one of the tubes and the other tube was closed , plus I had the wall in heart shaped uterus (bicornate uterus). Therefore, both tubes had to be removed.

Since my uterus had so little space for the babies to grow, our first doctor told us that our option for our dream of life will be achieved via surrogate program,which runs up 60,000 dollars.

I had a chance to connect with one who had used surrogacy program and she told me how the expense is assigned.

According to the program she used, for the medical fee, the price can vary depending on the decision whether you will use your own egg or not. I do not know how the price would run when the egg was donors,but I was told..

This “Yassy’s note” series is where you get to read about IVF, my pregnancy, parenting,and things that I liked to use during my pregnancy time and the things that I Liked when raising our little son “Liam”.

Through this series, I wanted to share our IVF story with you so I can give others who are in the same situation to ours hope to their own dream.

Stay tuned to read more about how he came about,and more. He is the strong little guy who came to meet us against all the odds and, he gives us smile each and every day.

Nov 12, 2014 | Comments are off | IVF