On Cloud Nine...

Today is day 3 in IVF world. We were told the embryologist would call and update us on our little embryos today and I was so nervous. We have never had any embryos make it past today, with the exception of Abram, obviously, and we transferred him on day 3. So, when the phone rang my stomach did turns. You cannot imagine my surprise when the voice on the other end told me we, on day 3, still have NINE embryos!!! Seven that look fantastic and two that are on the slow end for growth but seem to still have a chance. All I could do was laugh hysterically...seriously. Then, in a complete lapse of judgement, I texted Ivy and said "Are you sitting down?" After she texted me back that she was, I delivered the news. Poor thing thought for sure I was going to tell her that we had none left to transfer and was freaking out. She was ecstatic when she got the real news and I totally deserve whatever she throws at me when it comes to beta numbers :)

With that said, the greatest amount of loss for embryos is the time between day 3 and day 5. Statistically, only 1/3 of embryos survive this time because there are some crucial things happening those days. It is amazing, that after 3 cycles, we finally made it this far. Day 5 embryos really allow the doctors to determine which are the healthy ones. I am just so thankful! So, transfer is at 10:30am on Saturday. I cannot wait to see Ivy and her Brandon and get the transfer morning report. We're all praying for two blastocysts (the medical term for 5 day embryos that look super duper good) to transfer.

Also, if you want to check out Ivy's blog, here it is...Baby Bakin Part Deux Today's post is particularly hilarious!

Numbers.

Retrieval went well yesterday. The doctor told us on Saturday to expect 7-10 eggs. Imagine my surprise when I woke up in recovery and was told 16!!! Just to recap: my first retrieval (Abram's), I had 8 eggs. 6 were mature, 4 fertilized. We transferred 2 on day 3 (got pregnant with him) and the other 2 arrested before freezing on day 5. My second retrieval (last August), I had 9 eggs retrieved and only 2 of those fertilized normally. We transferred those 2 on day 3 and that resulted in a negative. So, we were all very anxious to get the call today from the embryologist with the fertilization report. We were hoping to have at least 4, so we could do a 5 day transfer (pushing to 5 days before transfer gives the doctors a much better idea of which embryos are viable). When the phone rang, I held my breath. In August, I never expected to hear that we only had 2 embryos and did not want that feeling again. This time...we had 14 of 16 mature eggs and 9 fertilized!!! So, at 24 hours post-fertilization, 9 embryos are growing! This is great news! We will make it to day 5 for transfer for the first time ever. The next update will be on day 3, Thursday. Odds are, several will arrest before then but we're starting out much better than we ever have. This does great things for our chances of viable pregnancy. Whew.

As for me, I'm doing much better this round. The doctors decided to treat me for the complications I had last time before they occurred this time. That has made all the difference in the world. I'm still dealing with some nausea and cramping but not nearly what I experienced in August. I am just one overwhelmed and thankful girl today!

It's tiiiiiiiiiiiiiiiime!

Saturday morning's appointment revealed several follicles at the magical 19-20mm mark and several just behind. My estrogen level was at 1847, so we are good to go! I triggered last night and retrieval is scheduled for 9am.

There are so many emotions going through my head. We are super anxious to get home to our children. We miss them terribly. I am so excited to hear how many eggs we get and how that translates to embryo numbers (we'll have that information Tuesday morning). I'm also looking ahead to transfer, which will be Thursday if we have less than 4 embryos and Saturday if we have more than four (either way we are only transferring two ;). Then on to pregnancy tests and, God willing, ultrasounds. It is an incredibly exciting time and one we have been waiting for for months now. At the same time, I am terrified. My retrieval in August went very wrong and I was sick for days. I'm praying that nothing like that happens this time. That cycle also left us with lots of questions, no healthy embryos, and tons of tears and heartache. Although I know I would survive it again, I don't want to...at all. So, that's where I am tonight, roughly 13 hours before I'll arrive for my procedure...a huge bundle of nerves.

To Dallas We Go!

My first monitoring appointment at our clinic in Dallas was yesterday. We got up before the sun and headed out at 5:45am to be here for 10:15 with the intention to stay here until I retrieve. I had an estrogen check on Monday in Houston and was at 232. Yesterday, it had risen to just over 1,200. A very nice rise given the problems I had with my levels in August. Ultrasound showed 13 follicles averaging 14mm. They expect follicles to grow about 2mm a day while on stimulation meds and they trigger a patient between 18-20mm. He went ahead and doubled my lupron and added another injection to my medications to help prevent me from ovulating (I have a history of that). In August, I had a huge jump at about the same point in my cycle I am now. Dr. E. blamed it on faulty measuring between clinics (I had been seen in Houston, Las Vegas, and Dallas in less than 5 days). This time, we all thought it was best if I stayed put in Dallas with a consistent set of eyes on me. Well, sure enough, I went back this morning and in 22 hours, my follicles went from 14mm to 3 at 19-20mm and 4 more right behind in the 17-18mm range. Dr. E. was shocked. So, with that new information, the plan is to see me again tomorrow morning and assuming everything looks like it should, I will trigger tomorrow afternoon and retrieval will be 36 hours later- Monday morning. Praying, praying, praying for a much less eventful retrieval, easier recovery, and two healthy embryos to transfer 5 days later.

It's time to GO!!!

Got the call from the clinic yesterday that all was well with my ultrasound and estrogen level. The doctors decided, after reviewing everything, to have me start microdose lupron this morning and then stimulation medications on Saturday morning. I had 27 resting follicles on Tuesday. Follicles are what they use to anticipate egg development. Not every follicle will house an egg and not every egg even retrieved will fertilize, but they are a good indicator of how many eggs you can expect. With such a great number of follicles already, they think I will stimulate faster than normal for this drug protocol (I've never done this particular protocol but I've stimmed faster than normal my two previous cycles too). I will have blood drawn on Monday to again check my estrogen level (developing eggs produce estrogen). If that number is on the high end, I will have an ultrasound on Tuesday to check follicle size. When the majority of folllicles reach 18-20mm, I will take a trigger injection to tell the eggs to finish maturing and release. Retrieval is 36 hours after that trigger injection. Most women require 7-10 days of stimulation drugs to be ready. That would put us sometime between Friday, November 2, and Monday, November 5, for trigger. I expect retrieval to be Monday the 5th but you really never know with IVF. We are at the mercy of my body and its reaction. Our clinic is in Irving and although I have been able to do most of my monitoring here, as time gets closer, I will need to be there. They want me there starting Thursday the 1st and I will stay until the day after my procedure, whenever that may be.

This is, by far, the most injections I've had in a cycle. 79 total. 60 of those 79 falling in a 10 day period. Add to that that one of those is Lovenox (high estrogen levels are a risk factor for clotting and I have a history of pulmonary embolism), and I will be one walking bruise. It will all be SO worth it though!

Here's what 55 injections look like. 

One down. 78 to go. If only they all used this little needle :)

Ivy has her monitoring appointment on November 1 to make sure everything is nice and welcoming for our embryos. Then 5 days after retrieval, we will transfer the best two developing embryos to her. Ah, what a process!

Delayed

In case not everyone has figured it out, we were delayed. Two weeks ago, I went in for my baseline ultrasound before starting injections and, TMI alert, I was in the process of ovulating through the birth control pills they had me on. Not good. Our RE (Reproductive Endocrinologist) had me do a trigger injection that night to reset my ovaries. I then had blood work done last Wednesday to verify that worked. It did, so tomorrow I go in for another baseline ultrasound. If all looks well, I will start meds on Friday with a tentative retrieval November 6, 7, or 8 (the timing of these things is always a mystery). I am a nervous wreck. I just want all to go according to plan for ONCE! Because of this delay, poor Ivy has been on meds for nearly a month. She's such a trooper and has not complained at all. She's one of the good ones I tell you.

The closer we get, the more anxious I get. I know I haven't gone into a lot of detail about our cycle in August, but trust me, it was a nightmare. My body revolted in just about every way possible and I was sick as a dog. So sick that after 13 years of marriage, I puked in my husband's car (multiple times). He still loves me though ;) I'm not looking forward to the physical torture cycling and retrieval are, but it will be so worth it when we see that little flicker on the ultrasound for the first time! I'm going to hold on to that image and pray my body takes it easy on me this go 'round. So, if you have a minute, please pray for us tomorrow morning that another step is complete and we get the green light. I promise to update as soon as I can too.

Oh, one bright spot, the same day we found out about our medical delay, our PBO was granted by the judge. No more legal hurdles! Now, we just need an embryo or two to go with that piece of paper!

A rundown of the process...

I've had lots of questions about the process surrogacy takes and where we are at in it. I've never really explained it and decided that may be best. If you are like me and the type of person who just likes to know stuff, this should help. This is not necessarily a step by step for every surrogacy in every state. Each state has its own laws regarding surrogacy, so different processes apply. Also, some things are clinic mandated rather than state mandated, so those vary greatly too. For us, this is how our surrogacies have general gone. Also, there are lots of surrogacy agencies out there that can be very helpful. We have gone independent with both our journeys. It's really a personal preference.

• Generally, the first step is medical clearance for the surrogate. This may be done before or after the contract is in place. Both times, for us, our surrogates have come to us already cleared. This mostly means that an RE (Reproductive Endocrinologist, the doctor who does the IVF procedure) has determined that medically they are a good candidate for surrogacy and an OB (obstetrician) has determined that they are safe to carry a pregnancy. Also, as part of this, most clinics require a psychological clearance for the surrogate and her husband.
• Contracts. A surrogacy attorney writes up a surrogacy contract for both the surrogate and IPs (Intended Parents, that's us) to sign. This covers things you would probably never think of in a million years...or until you've been through a surrogacy. It protects both parties establishing a written agreement of the duties both sides have. From our financial responsibilities to Ivy agreeing not to do drugs to what happens to the child if Brandon and I both pass away while Ivy's pregnant, it's all in there.
• Psychological clearance for the IPs. This was not required of us with our first surrogacy, but this time it was. Basically, we met with a psychologist and she determined that we are mentally stable enough to have another woman carry our child. 
• Legal. In Texas, surrogacy laws are very straightforward. There are criteria that must be met by the surrogate (have given birth before, be healthy, etc.) and IPs (be a married couple, have a need established by a doctor for a surrogate, etc.). Once the contract is signed by all parties, it must sit for 14 days before you can go forward with the medical stuff. Texas is a PBO (pre-birth order) state. This means that our petition is filed with the court and once a judge reviews our case and contract, we are issued a document that establishes our parentage of the child. In Abram's case, we were required to have a home study, but this is totally up to the judge. Our PBO was in hand before he even existed. In fact, before I even started medications for our IVF cycle. This document allows us to make medical decisions on the baby's behalf, as its parents. It also allows us to be the baby's parents from the moment it takes its first breath, including both our names going directly on his/her birth certificate.
• IVF. The surrogate begins medications to suppress her ovulation and prepare her uterus to receive an embryo. I begin mediation to encourage my ovaries to produce multiple eggs, rather than the one that is normal in a month. Medication protocols vary widely in IVF. This time, Ivy started her injections yesterday, Sept 30. I begin mine on Oct 12. She has one a day. I have five. I will begin going in for ultrasounds and blood work every other day from Oct. 19. When I'm ready, I will take a trigger injection that tells my ovaries to wrap up maturing the eggs. 36 hours later, I go in for surgery. I'm put under and the eggs are harvested. That day, the eggs are fertilized with Brandon's sperm. Depending on how many we have growing and how they are doing, Ivy will go in 3 or 5 days later for two embryos to be transferred to her ready and waiting uterus. The first blood pregnancy test will be 2 weeks from retrieval day. She will likely begin testing at home a week or so from transfer though. During this time, she will stay on a variety of hormonal medications to encourage her body to accept our embryo as it would a natural pregnancy.

That's the process in a nutshell. It can be really complicated and there are tons of little steps I did not include.  So, where we are...legal is done and we are waiting on the judge to issue our PBO. We've all been medically and psychologically cleared for another round. Retrieval is tentatively scheduled for the 24th or 25th of October, although I'm seriously praying it will be the 23rd, so Brandon can be with me (He'll be out of town the 24-26). Transfer is tentatively scheduled for the 29th or 30th. We appreciate all the prayers being sent up on our behalf. I'm feeling like October may be our month :) If there is anything I didn't make quite clear or any other questions, feel free to ask. I'm glad to answer.