Egg Retrieval (Oocyte Retrieval)

We arrived at the Victoria Fertility Centre a bit ahead of our scheduled 8:45 AM arrival time for my egg retrieval (oocycte retrieval) during my first IVF cycle. I was hungry and thirsty (fasting since last night).

Please feed me. Or can I at least have several glasses of water?

We checked in and were sent down the hall to the Victoria Fertility Centre lab. This is where the lab where embryos are created is located, the surgical unit for extracting eggs and transferring embryos, and a room for men providing specimens.  We checked in there and waited for a few minutes. Dr. Hudson and a nurse both checked to see if we were comfortable and how we were doing. We both felt nervous.

The lab is down the hall from the normal examination rooms of the VFC.

In the waiting room of the lab.

Eventually a nurse came out to review my past surgeries, my pseudocholinensterase deficiency, and to put hospital bands on me, one for ID and one for allergies. She then gave me a thimble of water (I want more!) to take a cup full of pills including extra strength acetaminophen (Tylenol), gabapentin, Celebrex, and Ativan. This mix was supposed to relax me and reduce pain and inflammation.

My breakfast consisted of only tablets and capsules.

An embryologist who would be extracting eggs from the fluid aspirated from my ovaries today then pulled us into her office. She explained that the fluid aspirated from the ovaries is passed through a window from the operating room to the lab and that the egg count we hear in the operating room is not final, because they double check it in the lab. They would confirm with us before we left if we want half fertilized by mixing the eggs with sperm and half by ICSI (one sperm is injected into one egg) still as we are currently down for. They want us to be comfortable with our decision and sometimes the number of eggs is odd, so choices must be made. Today is day 0 she explained, so tomorrow day 1 for embryo counting purposes. They will call us tomorrow morning to tell us how many were fertilized. Then they will call us daily to tell us how the embryos are faring and their "grades" from day 2 onward.

My husband was then pulled aside to a room to give his specimen.

The room where my husband was sent to give his specimen.

A cup of coffee beans? A strange item in the room where men are sent to give their specimens.

I waited in the waiting room for a while and then was shown to a room to change into a hospital gown which was more of a cotton nightie with lace trim. I was instructed to put a heating pad on my abdomen and lie down while I waited for my procedure and for my husband to return. The heating pad was really nice.

The room where I was to wait before being sent to the operating room.

Two new bracelets!

My husband returned bearing tales of a room with assorted magazines, a specimen cup, and strangely a cup of coffee beans (a fetish we haven't heard of before?). He changed into scrubs provided for him. I wished I had scrubs instead of a cotton nightie. I tried to relax on the bed with the awesome huge heating  over me, but it was getting near to the time appointed, 9:45 AM, and I was nervous. My husband pulled my warm rainbow coloured alpaca socks onto me (courtesy of my sweet parents-in-law). Psychedelic baby!

In my cotton nightie.

Resting with a heating pad over my abdomen as instructed.

My husband had actual scrubs to wear. I was envious.

Psychedelic socks to keep me warm in the operating room.

Waiting for the egg retrieval.

Our egg retrieval was scheduled for 9:45 AM. As the time drew nearer, we felt more nervous.

At almost 10:00, the emergency room nurse, who also works at Victoria Fertility Centre reviewed allergies with me. She said the IV sedation would be done with fentanyl (a synthetic opiate) and midaz or midazolam (a benzodiazepine). She was warm, funny, and encouraging. All the staff at the VFC seem to have a way of putting you at ease. The private clinic setting is a lot more relaxing than having a procedure done at a hospital, that's for sure.

I was taken to the operating room and an IV line was started. They couldn't get a vein in my hand, so they had to use my arm. The nurse was amazed by my low blood pressure too. I told her that was nothing. Once in emergency my blood pressure was 60/40.

Yes, they give you Crocs to wear to the operating room (my husband had to wear a pair too). What a stylish look.

In the operating room with a blood pressure monitor and oxygen on.

My blood pressure was on the low side.

Dr. Hudson joined us a few minutes later and the IV sedation was started by IV. I didn't feel that sedated, so more midazolam was added.

Looking over me to the screen where the ultrasound images will show the follicles.

The egg retrieval was then commenced. The 18 inch needle was inserted into me using ultrasound guidance. Through the vaginal walls, the needle aspirate fluid and eggs from the follicles in both ovaries. I wasn't paying attention to the screen, but my husband took lots of pictures of follicles on the ultrasound screen (dark black masses on the ultrasound screen) and the needle inserted into them, draining them of their fluid and egg (the needle looks like a silvery white point in the middle of a follicle). After the draining was complete, the follicle would largely disappear from view on the screen, no more big blackish spot.

Follicles are visible on the screen as the dark masses.

Follicles in my ovaries.

The follicle on the left has the tip of a needle in it, draining it of its fluid and egg.

The follicle on the left has been drained and is no longer visible as a large dark mass on the ultrasound. The needle tip is still visible as a silvery white mass.

The follicle on the left middle has the tip of a needle in it, draining it of its fluid and egg.

The follicle on the left has the tip of a needle in it, draining it of its fluid and egg.

The follicles are no longer very visible, having been drained.

I was uncomfortable several times during the procedure and Dr. Hudson  gave orders without hesitation for the emergency room nurse who was watching my every move, to add more fentanyl (more was added about three times) so that I would be as comfortable as possible. At the end of the procedure was the most uncomfortable and the fentanyl just didn't seem to be doing it and then suddenly it was over. Dr. Hudson was done the whole egg retrieval process in about 15 minutes.

After the egg retrieval was complete.

I was walked back to a recovery room and alternately drank gingerale, ate cookies, and slept off the midazolam and fentanyl.

I devoured the cookies and gingerale faster than they recommended (and kind of like a drunken wild animal) but I was hungry and thirsty!

I was ravenous.

The embryologist, along with Dr. Hudson, came to tell us that they had managed to aspirate 10 eggs from my ovaries during the egg retrieval, a number that they were pleased with. We confirmed half will be fertilized with ICSI (one sperm injected into one egg) and the other half by traditional mixing of an egg plus sperm in vitro. They will call us tomorrow to tell us how many eggs were actually fertilized.

In the recovery room waiting until I could leave the VFC and get some actual lunch.

I was allowed to dress. Yes, I'm really high on midazolam and fentanyl in this photo.

The nurse checked me over, before deeming me well enough to be discharged. I was groggy, but not feeling too bad (just really hungry and thirsty). The nurse walked with us all the way down to the car to make sure that I was fine. She said that she was impressed. Well, I'm a beast when it comes to drugs and alcohol (not that I drink anymore- ten years sober this coming New Year's Day). As I told them before, I can process a lot way faster than others can and I keep on ticking.

I was ravenous and it was lunch, so we picked up a burger and fries at a drive through on the way home and then ate at home. After, I passed out for a few hours with the cat beside me. No one provides nursing care like Lamont.

Yet another cotton dressing for my right arm, this time from the IV.

My bracelets are so beautiful.

After lunch I passed out with the cat beside me to keep me company.

The cat then migrated to my pillow and rested his cheek and chin on my forehead as he often does. It was a fuzzy way to wake up hours later.

I awoke ravenous again and had a snack. I couldn't sleep more, so I went to the living room to write. I felt a slight twinge of pain earlier after my nap, but had some Tylenol and so far I'm fine. All in all it's not as bad as I thought (but I did get four helpings of fentanyl and two helpings of midazolam so . . .). I'm bleeding only slightly, certainly less than with the hysterosalpingogram (HSG) or sonohysterogram that I had done leading up to this first IVF cycle during the diagnostic stage when they were confirming that we have Unexplained Infertility. In any event, another stage in this first IVF cycle, the egg retrieval, is complete.

Now we must wait on pins and needles to find out if any of the ten eggs fertilized successfully. The lab at the Victoria Fertility Centre will call tomorrow morning probably between 10-12. After that, we will be getting daily phone calls from the lab to tell us the grade of each embryo and if they have survived until it is time for an embryo transfer if there are any that survive  into the day 2-5 range when embryo transfers are done.

Trigger Shot, Acupuncture, and Waiting for the Egg Retrieval

Last night at exactly 10:45 PM, I injected myself with Pregnyl, which was prescribed as my "trigger shot." My egg retrieval is scheduled for 9:45 AM tomorrow at the Victoria Fertility Centre, exactly 35 hours after the trigger shot (Dr Hudson will be performing the procedure). Timing is crucial with this process. If the timing is off, the eggs won't be ready or they may burst forth from the ovaries and therefore cannot be retrieved via aspiration and used for IVF.

Pregnyl and other "trigger shots" like it, contain human chorionic gonadotropin (hCG). It is made from the urine of pregnant women (most of these "trigger shots" are.) It is used instead of luteinizing hormone for the final maturation of follicles and to induce ovulation. Ovulation will happen 38 to 40 hours after an injection of hCG when there are one or more mature ovarian follicles. In IVF, the shot is given and the egg retrieval (oocycte retrieval) is scheduled to happen 34-36 hours after the injection, just hours before the eggs would burst forth from the ovary (instead of ovulation, a giant needle aspirates the eggs from the ovary through the walls of the vagina).

Now with pastel colours that make you feel soothed even though you're giving yourself an injection!

Naturally, Pregnyl has some terrifying possible side effects listed like allergic reaction, blood clots, and the dreaded Ovarian Hyperstimulation Syndrome (OHSS- hisssssssssss I sound like a serpent, so you don't want to come down with me). The less extreme and more common side effects are mild swelling or water weight gain, feeling restless or irritable, depression, headache, breast tenderness or swelling, and/or irritation, pain, or swelling at the injection site. Some people get a large, raised red area around the injection site.

There are the many things that you need including the box of medication, a syringe, two different syringe tips- one for mixing and one for injecting, an alcohol swab, and of course your trusty old sharps box. Mine is almost full.

Pastels clash with syringes in my opinion.

Once the box is open, it holds an insert and two glass vials. One is liquid dilutant, the other is the medication in powder form.

Pregnyl requires some mixing like Menopur or Cetrotide (this is old hat for me now). A syringe is connected to a mixing syringe tip (really thick and scary looking). An email from the clinic told me how much of the mixing fluid to draw up into the syringe, 1.5 cc. After drawing the fluid up, I withdrew the syringe and then plunged the syringe tip into the top of the bottle with the powder in it (this is the hCG). All the fluid is injected into this bottle and gently rolled around to mix it. The difficult part came with withdrawing all of the mixed fluid out of the bottle. Unlike Cetrotide or Menopur where the needle can easily reach the bottom of the bottle and suck up the last bits of fluid, the bottle for Pregnyl is bigger, so it must be tipped upside down and angled to try to withdraw the last bit of fluid. Despite having started early to mix everything, so I'd be ready to inject at exactly the given time, I had a bit of difficulty getting the last bit of medication out and it took more than one try. It was pressure that I didn't need when I was already feeling stressed out. They should really improve their packaging (for more rants on packaging and overpackaging see my blog Overpackaging, et cetera).

A box of Pregnyl has two glass vials, one is liquid dilutant, the other is the medication in powder form.

The dilutant is sucked into the syringe.

The dilutant is emptied from the syringe into the vial of powder and then this is mixed and sucked back into the syringe to prepare for the injection.

So, as directed, at exactly 10:45 PM, I injected myself with Pregnyl. The injection did not hurt any worse than my other injections via syringe (Cetrotide, Menopur- naturally Gonal F used to hurt somewhat less, because it was in pen form with a very, very fine syringe tip). That was the only injection I had to give myself last night (before it was two per night and one in the morning, so this is an improvement).

Air out of the syringe, it's ready to be injected.

The Pregnyl is injected into the abdomen like the other hormones.

I went to bed after and had a ho hum sleep again. I woke up a few times again, had night sweats again, vivid and weird dreams, and woke up in the morning unable to sleep longer (I was going to try to catch up on some of sleep I've lost the last few days getting up early to go to the Victoria Fertility Centre, but no luck).

This morning, I took my Dexamethasone tablets and started Doxycycline with my breakfast as directed. I was definitely more swollen, especially in the abdominal area. But this means that things are working the way they are supposed to be. So that's good. Besides, a cashmere sweat suit is pretty forgiving to lounge in.

Doxycycline is an antibiotic that I have been put on to prevent infection during the egg retrieval and embryo transfer process. I will finish taking the course of Doxycycline on the night after the embryo transfer. It is supposed to be hard on the stomach (like Dexamethasone) and should be taken with food. Naturally, as with any drug, there is a list of horrifying things that could go wrong including allergic reactions, jaundice, blurred vision, and severe skin reactions, but those are not common. More common and less extreme side effects of Doxycycline are upset stomach (reduce this by taking with a meal), mild diarrhea, mild nausea, vaginal itching or discharge, and mild skin rash or itching.

Robin's egg blue pills are so pretty (until they cause side effects like diarrhea).

I cleaned the house a bit and wrote this morning, before getting ready to go to acupuncture at 12:15 PM. I was not feeling quite as terrible today as I thought that I would be after the Pregnyl (and the warning about side effects that Dr. Hudson had given me with it). In the shower, I discovered a giant bruise on my right lower abdomen, about three to four inches under the injection site of the Pregnyl. The bruise is about one inch by two inches and very blue. I wondered if this was something to be worried about and emailed the clinic. The site of the injection had no red marks or anything though as some people get, so it was curious. One of the nurses told me that this can happen with Pregnyl injections (bruising) and it's probably nothing to worry about, but they'll look at it tomorrow.

For an idea of the size of the bruise on my lower abdomen, I put a quarter next to it. It's pretty big.

Today, I drove myself to acupuncture and arrived about fifteen minutes early. I had a cup of the complementary Silk Road tea while I waited. The waiting room at Elements of Health Centre is a very calm environment and puts one instantly at ease. I went to the washroom just before (but this wasn't good enough- I've had to go pee a lot with the hormones and my session ran slightly over an hour and I was ready to die by the end of it, having to go to the pee really badly again) my session commenced.

No makeup and you can really see how exhausted I am from this whole process. It definitely takes a toll on the body and mind.

My acupuncturist, Stephanie, wondered if she could have given me the bruise on my lower abdomen, but I didn't have it yesterday, so I'm pretty sure that it was the Pregnyl injection last night (and it's on the same side as the Pregnyl injection). Stephanie is very calm, warm, and reassuring. She put needles into my forehead, stomach and abdomen, wrists, lower legs, and feet and left me to meditate in the warm and darkened room. I feel that the meditation and stress reduction/ relaxation component alone with acupuncture would be beneficial to anyone going through fertility treatments which inherently cause or contribute some kind of stress or several kinds of stress to people's lives. I felt rather drowsy and relaxed after my session (and after I had gone pee!).

The treatment bed is very comfortable with nice sheets. The room is warm and darkened and quiet when the needles are doing their work. It's a good opportunity to check in with yourself mentally, meditate, breathe, and prepare for the next big step in this very complicated process.

After the session, I asked Stephanie if the egg retrieval hurts a lot. She told me that she had had it done twice. She said that it was definitely uncomfortable, but strangely one time was much more tender than the other time even though it was the same doctor performing the procedure, Dr. Hudson. She said that some women are able to work the next day, but most need to rest. She also told me that they give you some "good stuff" and that while you're awake for the procedure, you're kind of in and out. I felt comforted being able to talk to someone who has actually been through this procedure before (more than once even). This unexplained infertility journey has been kind of lonely road.

When I find out when my embryo transfer will be, I can either go onto the website of Elements of Health Centre or call to book an appointment two to three days after the transfer. Thereafter, until the blood test to determine if the embryo has implanted or not, I will be visiting the clinic once a week for acupuncture to support my body in the IVF process.

I am noticing that the terrible headache that I've been suffering from for weeks is plaguing me again this afternoon (I didn't really have it this morning, which I attribute to not taking Cetrotide). I am bloated and somewhat crampy in the abdomen with some gastrointestinal distress, but not as much as before. As mentioned, I'm bloated, especially abdominally, but as I've stated before, the hormones have also led to swelling in my breasts. I'm somewhat irritable today, but not as bad as previous days, but I'm unclear as to if this is because I've rested at home most of the day or if it's the discontinuation of the three different hormonal injections that I was on. But all in all, so far Pregnyl doesn't seem as extreme as I thought that it would be. My lower back, around my ovaries continues to get more uncomfortable every day and night (the follicles and ovaries are swelling to far larger than their normal size). I do feel restless, but I can't attribute this to medication completely. I think that I'm just uncomfortable and I really want to get this over with.

Tonight, after midnight, I can't eat or drink anything due to being put under anaesthetic tomorrow morning for the egg retrieval (that should make for a fun morning- snaaaaarrrrrlllll!). I will take my thyroid medications and stomach pill tomorrow morning with sips of water, but the Dexamethasone and Doxycycline and vitamins will be skipped, since they are so hard on an empty stomach.

Tomorrow morning, my husband and I must be at the Victoria Fertility Centre at 8:45 AM for my 9:45 AM egg retrieval with Dr. Hudson (and my husband will provide a specimen just after that, so that they can do their magic at the clinic, hopefully creating embryos by mixing his semen with my eggs in vitro and by injecting a single sperm into an egg with the other half of my eggs- ICSI).

I am supposed to show up to the Victoria Fertility Centre not wearing any body lotion or any scented products at all (bad for eggs/embryos). I will be administered IV sedation (that's why I can't drive for 24 hours after the procedure and must have someone to watch me for 24 after, just in case). They recommend that you wear comfortable clothing and bring a pair of WARM socks with you (their emphasis, not mine). I can only imagine that the warm socks are to wear during the procedure, since surgery rooms are always freezing cold and I'll only be a hospital gown. Strangely, they also said that I could bring an iPod with me to listen to during the procedure (what is this, 2005?). 

Yesterday, I emailed the nurse coordinator to remind her that I have pseudocholinesterase deficiency, so I can’t be given Mivacurium or Succinylcholine for anaesthetic  (there are some other things that can't be used either). Usually these things are not used anymore, they're kind of old school muscle relaxants used in the anaesthetic process, but every once in a while they pop up (like the time they used one of them on me in 2003 during a surgery and then couldn't wake me up for about 12 hours after I was supposed to wake up- on a ventilator the patient is fine, but without it, they will likely die as the patient cannot process the offending drugs and it leads to prolonged and marked muscle weakness, inability to breathe). This condition is very, very, very rare and most people don't even know that they have it (unless they suddenly find themselves in surgery and the wrong stuff is used). In all of Canada, with the incidence rates listed, only about 700-11,000 people would have it (though most probably don't know they have it). Anyways, it always makes for an interesting conversation with the anaesthesiologist whenever I have a surgery (I'm like some sort of a mythical creature to them- something they studied at school, but have usually never encountered).

My husband has been very tender towards me through this taxing and distressing journey. The other night, he brought me home a beautiful black tea from Silk Road Tea with two adorable fox cups to drink it from. Tonight, he surprised me with a gorgeous bouquet of alstroemeria and sunflowers with some chocolate. I know that he's found it difficult focusing on work while he's at the office, as I have found it difficult to write and edit my work from home. We're both so preoccupied with this process so pivotal to our future. It is truly all consuming. While the Unexplained Infertility journey has been exceedingly difficult, we're lucky to have strong communication and a bond forged over almost ten years of being together. This trial has only brought us closer.

We both love foxes. They remind us of the Shinto shrines that we visited together all over Japan.

I love sunflowers and my husband brought me home this bouquet tonight.

It's impossible not to feel nervous about tomorrow (how much is this going to hurt, will they aspirate the eggs in time, will the eggs be at a good level of maturity, will there be any good quality eggs, will the semen sample be useable, will they be able to make any embryos, will any embryos survive, will any of the embryos be good enough quality to transfer back into me, will my blood work show that I am able to have a live transfer or will I have to have the embryo frozen and then transferred into me next cycle instead?). I'm trying to remain as calm as I can, breathe, meditate, distract, be gentle with myself, but in the back of my mind, the odds are still there. On average, the percentages quoted for success at any one IVF cycle are 33% to 50% for implantation (then for my age there is the 20-25% chance of miscarriage after that). I know that we've done everything that we could and that we're in good hands, but it's really hard to not be in control of your life. That is one of the most frustrating and upsetting parts of Unexplained Infertility.

The cat knows we're stressed out and not feeling well and has been spreading his purring therapy around. Last night he fell asleep on my husband's shoulder.