The Upcoming Week

Today we were told that the retrieval will be Wednesday morning.  This means:

•  two injections in the abdomen tonight
• an ultrasound, thigh injection and blood draw tomorrow morning
• one more abdomen injection and my first (dreaded) intramuscular injection in the back hip area tomorrow night  

The intramuscular injection is the "trigger shot" that will make the eggs release in about 35 hours (the injection will be given exactly 35 hours before the retrieval is scheduled).  Tuesday morning I might have to go in for a blood draw, but no injections are scheduled for that day or the day of the retrieval!

During the retrieval I will receive Monitored Anesthesia Care (MAC), which is a conscious sedative with a pain reliever and amnesia-inducing medications (hopefully I'll just sleep through the process as I don't want to be one of those people that says ridiculous things!).  The procedure should take about 30 minutes and then I'll be recovering at the clinic for another 30-60 minutes.  I've read that this medication can stay in the system for up to 12 hours to I'll probably being laying low all day on Wednesday and Micah will be taking the day off to stay home with me.

At this point it is difficult to estimate how many eggs will be retrieved.  The doctor only measures the large follicles, and he says there are many others that they haven't measured (I think he's been measuring 2-3 on the left and about 8 on the right).  They will try to get the egg from each follicle, but usually they only retrieve about 65-75% of all of the eggs so the exact number is a mystery right now.

Of the eggs that are retrieved, they will fertilize the mature eggs (usually about 80% of the eggs retrieved are mature) with intracytoplasmic sperm injection (ICSI).  On Thursday we will call the clinic to see how many of the eggs retrieved were fertilized.

The lab will monitor the embryo growth and from there they will determine if we are going to do a Day 3 or Day 5 transfer.  According to the paperwork we received from the clinic, neither day is superior but they do both as there are pros and cons to each.

Day 3 (cleavage stage) is usually done:

• If the patient if over 35 (not me!)
• If there are fewer than 8-10 embryos
• Or if the embryos are not developing as expected 

BENEFIT: A three day transfer allows for the embryos to develop in the natural environment sooner.

Day 5 (blastocyst stage) is usually done:

• If the patient is under 35
• There are greater than 8-10 embryos developing

BENEFIT: A five day transfer means we will better be able to determine the higher quality embryos, and therefore we might be comfortable transferring only one embryo instead of two.

ADDITIONAL BENEFIT: The "two week wait" starts on the day of the retrieval since that is the day that the eggs are fertilized, so a Day 5 transfer means there are only nine days between transfer and the first blood test to see if it worked.

If a Day 5 (Monday, November 19) transfer is planned I will still be on "standby" for the Day 3 (Saturday, November 17) transfer in case the embryos don't develop as expected.  Personally, it seems that a Day 5 transfer would be better to me, but I guess we'll see how things go.  The day of the transfer and the day after the transfer I am supposed to be on bed rest (flat on my back all day).  I will probably take it easy two days after the transfer too, just to be safe.  And of course I can't get away from the injections that easily, so those will start again on Thursday (day after retrieval) as my body needs the Progesterone until it "realizes" its pregnant and begins producing enough on its own.

Please be praying not only for the process to go smoothly and for a pregnancy, but also that I will stay calm throughout the process.  Although I (thankfully) am not working right now, I still feel stressed and overwhelmed by this process very quickly.  I know I need to relax, but that really doesn't come naturally to me so prayers are appreciated.  Thanks!