I went in to the doctor's again this morning. I saw my actual doctor again, and our interaction was brief as always, so I couldn't ask all the questions I wanted. He told me that I was ready to trigger, and when I asked how my left ovary was doing, how many eggs were there, he glossed over it and instead served me a bunch of platitudes, "There's nothing to worry about. We'll get at least ten. I'm not worried." Well, thanks, Doc, but that doesn't help placate someone like me who wants to understand what's going on; I don't need to be soothed.
So the nurse called me and said that I should stop all medications at this point except for the Ovidrel injection that I am to give myself at 10:30pm tonight. Since retrieval is 36 hours later, this means that I will retrieve at 10:30am on Monday morning.
I'm relieved that I can stop the injections! My lower abdomen area is a swollen, tender, angry battlefield of injections wounds. However, I still have one full box of Menopur left and a full Ganirelix shot! Wish I'd ordered more sparingly-- I could have probably shaved $500 off my pharmacy order.
I've been craving carbs, so I made myself a spaghetti carbonara last night, and I shared some pancakes at brunch this morning.
My acupuncture appointment yesterday helped, I think, even if only mentally. I was feeling tightness on my left side near my injection side from Thursday night, and the acupuncture did seem to help that discomfort go away almost immediately as he stuck in the needles. I think what also helped is that I felt like I really was doing everything I could to help my cause, so having a sense of my own agency helped me too. I'm going for a second treatment tomorrow afternoon. Even if this is only helping me with my stress levels, that's still good.
While my energy level is good, I'm sleeping a lot lately. Last night I slept a full eight hours, and I couldn't have slept more. I took a mid-afternoon catnap, and I never sleep during the day! I guess the meds are really taking their toll on me.
OK, Ovidrel shot tonight at 10:30am! Then I go back into the doctor's again tomorrow to make sure that the Ovidrel has been absorbed by my body...
It's almost over.
Saturday, July 30, 2011
Friday, July 29, 2011
Cycle Day 9: One More Day
I went to the doctor this morning, and she said that it looks like I will probably be on meds for one more day and then trigger tomorrow night for Monday AM retrieval. Missing Monday is tough as we have some big meetings that day...
I have to go into the doctor again tomorrow for another look to confirm whether I should trigger.
We took a look at my ovaries, and on the right side, it looks like there are about six follicles, one of which is ready to pop. On the left ovary, we have some less encouraging news-- looks like only three or four of them are growing to the appropriate size (whereas we'd counted six two days ago). This means that while we saw about five or six big ones a couple of days ago, only three or four have continued to get bigger. This is bad news because only the bigger ones have a chance of producing mature eggs, and so this means that it looks like I will retrieve fewer mature follicles eggs than before. There are others, but they're small, and at this late stage, I doubt they will catch up.
I was disappointed to receive this news because now it looks like at most they'd retrieve nine or ten large eggs (whereas it was looking like 12 a few days ago), and probably not all of them will be mature... Just seems like the numbers are dwindling. I wonder if dermoid cyst on my left ovary is causing problems? Am I sleeping on my left side too much or not enough? My left abdomen did feel unusually tender after my shots last night. Swollen, almost...
Anyway, what can I do? It is what it is. Awaiting the call from the nurse this afternoon telling me how much medication to take. Have made last minute acupuncture appointment for this evening. Even if it doesn't help the little ones grow, maybe it will help alleviate the stress I'm feeling.
I have to go into the doctor again tomorrow for another look to confirm whether I should trigger.
We took a look at my ovaries, and on the right side, it looks like there are about six follicles, one of which is ready to pop. On the left ovary, we have some less encouraging news-- looks like only three or four of them are growing to the appropriate size (whereas we'd counted six two days ago). This means that while we saw about five or six big ones a couple of days ago, only three or four have continued to get bigger. This is bad news because only the bigger ones have a chance of producing mature eggs, and so this means that it looks like I will retrieve fewer mature follicles eggs than before. There are others, but they're small, and at this late stage, I doubt they will catch up.
I was disappointed to receive this news because now it looks like at most they'd retrieve nine or ten large eggs (whereas it was looking like 12 a few days ago), and probably not all of them will be mature... Just seems like the numbers are dwindling. I wonder if dermoid cyst on my left ovary is causing problems? Am I sleeping on my left side too much or not enough? My left abdomen did feel unusually tender after my shots last night. Swollen, almost...
Morale is low today.
Wednesday, July 27, 2011
Cycle Day 7: I Start Ganirelix
This morning I had another ultrasound and blood test, this time with another doctor who I will call Dr. M. I really liked him! Though our meeting was brief, he took the time to show me how my follicles are doing on the ultrasound imaging monitor. On the screen, the follicles look like globules within a much larger globule (the ovary). The follicles are not all on a single plane, so you have to move the ultrasound wand around to find them all.
He said that it looked like I had six on the right and five on the left, with three smaller follicles (I forget which side) that "might catch up". On Monday (Cycle Day 5), I was told that I had five on the right and six on the left (the reverse of today). On Friday (Cycle Day 2), before I began injections, I was told it looked like "six on each side". So here's evidence that follicle count is not always consistent from ultrasound to ultrasound. Think of it like trying to count the number of golf balls and marbles held in a clear plastic bag-- you have to look at the sack from several angles to count them all, and even then, you're not entirely sure if you're counting some twice or missing the ones in the middle, etc.
The nurse called me this afternoon with my new dose:
I've asked the nurse if I have to press it all the way in, and she said I must. Once I experimented with not doing that, and when I pulled the needle out, a little bit of the Menopur bubbled up to the surface. So I'm not sure I have a choice but to plunge all the way in...
So after the Menopur, it was time for my first Ganirelix shot. Ganirelix comes in a pre-filled 0.5 mL glass syringe. Ganirelix must be refrigerated.
I did a quick side-by-side comparison of the Ganirelix against the Menopur. The Ganirelix has a slightly longer needle, maybe ever so slightly thicker, but less medication to plunge. I was not intimidated. However, I had a minor snafu trying to get rid of the air bubble. Ganirelix is a bit viscous, I guess, because when I tried eliminating the air bubble, the bubble "burst" inside the syringe and rather than fall back in, some of it spray out. So I lost a couple precious drops of Ganirelix.
Then I had trouble inserting the needle into my skin! I pressed the needle down firmly against my belly, and the needle wouldn't go in. I tried several times, once just breaking skin, but it wouldn't go any further. I might as well have been using a ball point pen. At last, I pressed down really hard and the needle finally penetrated. It didn't really hurt, thank goodness. (I'm telling you, cheap syringes...)
So here's an image of the right side of my belly, so you can see the various injection battle scars, including my first failed attempt at injecting Ganirelix.
He said that it looked like I had six on the right and five on the left, with three smaller follicles (I forget which side) that "might catch up". On Monday (Cycle Day 5), I was told that I had five on the right and six on the left (the reverse of today). On Friday (Cycle Day 2), before I began injections, I was told it looked like "six on each side". So here's evidence that follicle count is not always consistent from ultrasound to ultrasound. Think of it like trying to count the number of golf balls and marbles held in a clear plastic bag-- you have to look at the sack from several angles to count them all, and even then, you're not entirely sure if you're counting some twice or missing the ones in the middle, etc.
The nurse called me this afternoon with my new dose:
- three vials of Menopur at night (increased from two vials)
- one Ganirelix shot at night
- same dose of Gonal-F in the morning
I go back in for ultrasound/bloodwork on Friday morning. The earliest I would trigger (with the Ovidrel) is Friday for Sunday retrieval. By Friday, I'm hoping we have a better sense of my retrieval date because I have a lot of things I can't nail down at work until I know when I will be out of the office.
I was afraid that the Menopur would hurt more because of the higher concentration of medication, but I did not detect a noticeable difference. I'm now convinced that part of the reason why the Menopur is so unpleasant is because I am working with cheap syringes. While it's not painless inserting the needle, it's only when I press it all the way in that it begins to hurt. I think this is because the area where the plastic syringe meets the needle is not well-formed, and I'm inserting some of the plastic molding into my skin. Here is a picture where I've circled the offending plastic bit:
I've asked the nurse if I have to press it all the way in, and she said I must. Once I experimented with not doing that, and when I pulled the needle out, a little bit of the Menopur bubbled up to the surface. So I'm not sure I have a choice but to plunge all the way in...
So after the Menopur, it was time for my first Ganirelix shot. Ganirelix comes in a pre-filled 0.5 mL glass syringe. Ganirelix must be refrigerated.
I did a quick side-by-side comparison of the Ganirelix against the Menopur. The Ganirelix has a slightly longer needle, maybe ever so slightly thicker, but less medication to plunge. I was not intimidated. However, I had a minor snafu trying to get rid of the air bubble. Ganirelix is a bit viscous, I guess, because when I tried eliminating the air bubble, the bubble "burst" inside the syringe and rather than fall back in, some of it spray out. So I lost a couple precious drops of Ganirelix.
Then I had trouble inserting the needle into my skin! I pressed the needle down firmly against my belly, and the needle wouldn't go in. I tried several times, once just breaking skin, but it wouldn't go any further. I might as well have been using a ball point pen. At last, I pressed down really hard and the needle finally penetrated. It didn't really hurt, thank goodness. (I'm telling you, cheap syringes...)
So here's an image of the right side of my belly, so you can see the various injection battle scars, including my first failed attempt at injecting Ganirelix.
I'm running out of room...
Tuesday, July 26, 2011
Cycle Day 6: Halfway Through?
It's still not easy giving myself shots, but I'm getting used to it. I admit that the Menopur is still unpleasant, and I think that what makes it worse is the ritual of mixing it all up-- it builds anticipation, but not in a good way. I have a constellation of red dots around my belly button where I've stuck myself with needles.
In terms of side effects, I'm starting to see my belly swell a little bit. I'm not sure if it's what I'm eating or if it's the medication. My shoes felt a little bit tight today, so I think it must be due in part to the hormones, rather than simple weight gain.
I've had good energy and spirits despite the stims until yesterday. Around 6pm, I hit a wall and was so very tired. Getting up this morning was tough too. Once I get going, I'm alright, but I do get tired earlier in the day. I think it's the cumulative effect of the hormones building inside of me now that I've been stimming for four of five days. I've decided to make myself leave the office by 6pm every day this week, and lots of modified reclined bound angle pose.
Tomorrow morning I go in for yet another ultrasound and more bloodwork. We'll see how those follicles are doing and whether I need to begin the Ganirelix, which will be a new shot I take alongside the Menopur. The Gonal-F and Menopur I've been taking are supposed to stimulate the ovaries and help grow multiple follicles; the Ganirelix is supposed to suppress the hormones that would make me ovulate, allowing the follicles to grow to maturity (until I release it with the Ovidrel). When I start the Ganirelix, I'm supposed to increase my Menopur dose-- I hope that it doesn't mean it hurts more...
In terms of side effects, I'm starting to see my belly swell a little bit. I'm not sure if it's what I'm eating or if it's the medication. My shoes felt a little bit tight today, so I think it must be due in part to the hormones, rather than simple weight gain.
I've had good energy and spirits despite the stims until yesterday. Around 6pm, I hit a wall and was so very tired. Getting up this morning was tough too. Once I get going, I'm alright, but I do get tired earlier in the day. I think it's the cumulative effect of the hormones building inside of me now that I've been stimming for four of five days. I've decided to make myself leave the office by 6pm every day this week, and lots of modified reclined bound angle pose.
Tomorrow morning I go in for yet another ultrasound and more bloodwork. We'll see how those follicles are doing and whether I need to begin the Ganirelix, which will be a new shot I take alongside the Menopur. The Gonal-F and Menopur I've been taking are supposed to stimulate the ovaries and help grow multiple follicles; the Ganirelix is supposed to suppress the hormones that would make me ovulate, allowing the follicles to grow to maturity (until I release it with the Ovidrel). When I start the Ganirelix, I'm supposed to increase my Menopur dose-- I hope that it doesn't mean it hurts more...
Monday, July 25, 2011
Cycle Day 5: I Finally See My Doctor and Learn about the 10:1 ratio
After my morning Gonal-F injection, I went in for my Day 5 ultrasound and bloodwork.
Today was not as crazy as Friday at the office, so I was seen pretty quickly, and I had my bloodwork done and went in for my ultrasound immediately thereafter.
I was mildly surprised to see my doctor come in to perform the ultrasound. He was not great at wielding the pelvic ultrasound wand (maybe I don't want him doing my egg retrieval after all...), and he said that he saw five follicles on the right side and six on the left. Say what? I thought there were 12 the other day? I asked him if it was possible for us to grow more, and he reassured me that I was doing fine, but that he didn't think we'd grow more. I asked him flat out what this means, probing him on what this might mean for me. This is basically what he said, "If we retrieve ten eggs, let's say eight of them are mature eggs. Among those, at least six or seven should survive freezing and thawing. And then let's say about four of them fertilize, and we get two good embryos out of it. That gives you a great chance of pregnancy. So it's the same as IVF-- ten eggs usually results in one pregnancy."
???
He acted like I had heard that stat before. I was bummed. Even if I got pregnant off of these numbers, carrying a baby to term is another matter, and I really wished I had more chances...
So when I got home tonight, I started researching follicle count some more and learned a few things.
Antral Follicle Count (AFC) refers to the number of antral follicles detected by ultrasound. AFC is a good indicator of ovarian reserve, and the more you have, the more likely you are to respond well to hormones during hormone stimulation. I thought that the Chicago Fertility Clinic had a really good explanation of AFC (specifically for IVF, but one can extrapolate a lot of the results for egg freezing), and what you might expect from your cycle depending on your AFC count. Unfortunately for me, according to this resource, I am a normal-to-low responder...
I began to wonder if my doctor is taking a conservative approach to stimulation. No judgments, because I've read that sometimes lower hormone stimulation can lead to better quality eggs, but at the same time, I wish I produced more eggs!
I also wonder if it's possible to get an accurate and meaningful antral follicle count during your initial consultation. Ladies, if I knew then what I know now, I'd drill down on the follicle count during the consultation, ask how many follicles the doctor sees, and corner him or her on what this might mean for your chances of pregnancy. During my consultation, my doctor said, "You look like you've still got a lot of eggs, and you'd be a great candidate for egg freezing." Sales pitch.
The thing is that AFC is somewhat subjective-- different doctors and technicians might interpret the same ultrasound slightly differently. Also, while a good AFC is an indicator that the patient is likely to respond well to hormones, follicles don't grow uniformly. As ovulation nears, certain follicles will grow more dominant, so even if you started out with, say, 17 follicles at the very start of your cycle, it is possible that by the time you go to retrieve the eggs, there are only 12 dominant follicles (the remaining follicles being smaller and immature). It is also possible for some that more follicles will sprout up out of seemingly nowhere as the cycle advances (too small to count at the start but caught up with the bigger ones later), but I don't think this usually happens.
Anyway, I'm trying to remain positive because I know that no good will come of fretting about this. It is what it is, and all I can do at this point is focus positive energies on producing good quality eggs! I can hope that I beat the odds on subsequent stages of this process (freezing, thawing, fertilization, good embryos, transfer, full term pregnancy). The number of eggs retrieved is but one factor.
Meds Update:
Gonal-F this morning was slightly painful, but OK.
I got the call from the nurse post ultrasound/bloodwork to say that I should stay at the current hormone levels-- 150 IU of Gonal-F, 150 IU of Menopur. I asked the nurse if it was normal for the Menopur to sting, and she suggested that I inject in my thigh instead because she's heard that it hurts less.
She lies. It hurts about as much, and now my left leg is pretty tingly as if it's been asleep. Nothing to be alarmed about, but I think I'm sticking to injections in the ab area.
I couldn't help it-- I asked the nurse if bubbles in the Menopur syringe was OK. She said yes. Fine.
Today was not as crazy as Friday at the office, so I was seen pretty quickly, and I had my bloodwork done and went in for my ultrasound immediately thereafter.
I was mildly surprised to see my doctor come in to perform the ultrasound. He was not great at wielding the pelvic ultrasound wand (maybe I don't want him doing my egg retrieval after all...), and he said that he saw five follicles on the right side and six on the left. Say what? I thought there were 12 the other day? I asked him if it was possible for us to grow more, and he reassured me that I was doing fine, but that he didn't think we'd grow more. I asked him flat out what this means, probing him on what this might mean for me. This is basically what he said, "If we retrieve ten eggs, let's say eight of them are mature eggs. Among those, at least six or seven should survive freezing and thawing. And then let's say about four of them fertilize, and we get two good embryos out of it. That gives you a great chance of pregnancy. So it's the same as IVF-- ten eggs usually results in one pregnancy."
???
He acted like I had heard that stat before. I was bummed. Even if I got pregnant off of these numbers, carrying a baby to term is another matter, and I really wished I had more chances...
So when I got home tonight, I started researching follicle count some more and learned a few things.
Antral Follicle Count (AFC) refers to the number of antral follicles detected by ultrasound. AFC is a good indicator of ovarian reserve, and the more you have, the more likely you are to respond well to hormones during hormone stimulation. I thought that the Chicago Fertility Clinic had a really good explanation of AFC (specifically for IVF, but one can extrapolate a lot of the results for egg freezing), and what you might expect from your cycle depending on your AFC count. Unfortunately for me, according to this resource, I am a normal-to-low responder...
I began to wonder if my doctor is taking a conservative approach to stimulation. No judgments, because I've read that sometimes lower hormone stimulation can lead to better quality eggs, but at the same time, I wish I produced more eggs!
I also wonder if it's possible to get an accurate and meaningful antral follicle count during your initial consultation. Ladies, if I knew then what I know now, I'd drill down on the follicle count during the consultation, ask how many follicles the doctor sees, and corner him or her on what this might mean for your chances of pregnancy. During my consultation, my doctor said, "You look like you've still got a lot of eggs, and you'd be a great candidate for egg freezing." Sales pitch.
The thing is that AFC is somewhat subjective-- different doctors and technicians might interpret the same ultrasound slightly differently. Also, while a good AFC is an indicator that the patient is likely to respond well to hormones, follicles don't grow uniformly. As ovulation nears, certain follicles will grow more dominant, so even if you started out with, say, 17 follicles at the very start of your cycle, it is possible that by the time you go to retrieve the eggs, there are only 12 dominant follicles (the remaining follicles being smaller and immature). It is also possible for some that more follicles will sprout up out of seemingly nowhere as the cycle advances (too small to count at the start but caught up with the bigger ones later), but I don't think this usually happens.
Anyway, I'm trying to remain positive because I know that no good will come of fretting about this. It is what it is, and all I can do at this point is focus positive energies on producing good quality eggs! I can hope that I beat the odds on subsequent stages of this process (freezing, thawing, fertilization, good embryos, transfer, full term pregnancy). The number of eggs retrieved is but one factor.
Meds Update:
Gonal-F this morning was slightly painful, but OK.
I got the call from the nurse post ultrasound/bloodwork to say that I should stay at the current hormone levels-- 150 IU of Gonal-F, 150 IU of Menopur. I asked the nurse if it was normal for the Menopur to sting, and she suggested that I inject in my thigh instead because she's heard that it hurts less.
She lies. It hurts about as much, and now my left leg is pretty tingly as if it's been asleep. Nothing to be alarmed about, but I think I'm sticking to injections in the ab area.
I couldn't help it-- I asked the nurse if bubbles in the Menopur syringe was OK. She said yes. Fine.
Sunday, July 24, 2011
Cycle Day 4: Getting Used to It
The morning Gonal-F shot was a breeze. I even primed a new pen, and I didn't have to read the instructions. I'm a Gonal-F pro.
I was not looking forward to the night time Menopur shot, but I came home straight from watching Harry Potter and the Deathly Hallows Part II, and I must have had Harry, Hermione and friends on the brain, because I mixed the Menopur like a medical professional and wielded the syringe as if it were a basilisk tooth and my stomach were a horcrux. (For those of you who don't get the reference, horcruxes are evil things that must be destroyed, and stabbing it with a basilisk tooth is one of the few ways to do the job). I still had felt that unpleasant stinging at my skin, but I plunged away like a pro. I didn't even ice the injection site beforehand.
I go in tomorrow morning for my Cycle Day 5 ultrasound and blood test. After we see how my follicles are progressing, I will be given new instructions on my dosage amounts (which may stay the same or may increase/decrease).
I was surprised to get an e-mail back from my doctor today since it is Sunday. His response to my request that he contextualize my treatment strategy was:
I admit that I wasn't totally happy to read that e-mail. I know that he's trying to manage my expectations, but as someone undergoing egg freezing at a relatively young age, I do want somewhere near 12 eggs. I know that there's nothing I can really do to control this, and I have to be OK with the potential disappointment that my "harvest" may not be especially bountiful, but I have to hold out hope.
Tomorrow, I plan to take advantage of my short time with the doctor (whichever doctor I see during the ultrasound) to drill down on a few questions:
I was not looking forward to the night time Menopur shot, but I came home straight from watching Harry Potter and the Deathly Hallows Part II, and I must have had Harry, Hermione and friends on the brain, because I mixed the Menopur like a medical professional and wielded the syringe as if it were a basilisk tooth and my stomach were a horcrux. (For those of you who don't get the reference, horcruxes are evil things that must be destroyed, and stabbing it with a basilisk tooth is one of the few ways to do the job). I still had felt that unpleasant stinging at my skin, but I plunged away like a pro. I didn't even ice the injection site beforehand.
I go in tomorrow morning for my Cycle Day 5 ultrasound and blood test. After we see how my follicles are progressing, I will be given new instructions on my dosage amounts (which may stay the same or may increase/decrease).
I was surprised to get an e-mail back from my doctor today since it is Sunday. His response to my request that he contextualize my treatment strategy was:
"Your follicle count was good and your hormone levels were normal… 12 eggs would be above average for a single cycle of egg freezing.
Let’s take a look this week and we can get updated information.
So far so good.."
I admit that I wasn't totally happy to read that e-mail. I know that he's trying to manage my expectations, but as someone undergoing egg freezing at a relatively young age, I do want somewhere near 12 eggs. I know that there's nothing I can really do to control this, and I have to be OK with the potential disappointment that my "harvest" may not be especially bountiful, but I have to hold out hope.
Tomorrow, I plan to take advantage of my short time with the doctor (whichever doctor I see during the ultrasound) to drill down on a few questions:
- What is the follicle-to-mature-egg retrieval ratio?
- What is the average number of mature, viable eggs retrieved?
- Do they screen to make sure that eggs are "spindle positive"? (I suspect yes.) Does this screen for chromosomal abnormalities? (I think not).
- What are the stats these days for converting retrieved eggs into successful IVF babies?
- When am I likely to retrieve?
In terms of side effects so far, I don't feel like I have many. I did some light yoga today (doing the modified poses I've written about here), and I did feel like my ovary area felt "heavier" than usual on the left side. I hope that means the hormones are working...
Healthy Eggs
I've been thinking about whether I should adjust my diet at all in order to encourage "quality egg production". One way to measure a successful egg retrieval outcome is the number of eggs (though not too many or else you risk OHSS), but perhaps more important is the egg quality. What good is retrieving 20 eggs if very few of them are of sufficient quality to progress to the next stage?
Quick flashback to high school biology: the human cell is a diploid cell and has 46 chromosomes (which hold your DNA). However, ovum (what I've been calling my "eggs") and sperm are reproductive haploid cells (aka gametes), and each only has 23 chromosomes (half of what we need to create a full cell). When the sperm fertilizes the egg, the 23 chromosomes from each haploid cell fuse to form a single diploid cell containing 46 chromosomes. This cell now has a unique set of genes, and it subdivides by mitosis to grow and become an embryo. One of the factors in embryos not progressing beyond a certain stage may have to do with chromosomal abnormalities (Mother Nature's way of saying that that particular fertilized egg is just not meant to be).
The "egg spindle" organizes the 23 chromosomes in the ovum ("egg"). It's normal for a certain number of eggs to have abnormalities, but the occurrence of these abnormalities increase with age. I found a summary explaining potential spindle abnormalities accompanied by images of what a healthy egg spindle looks like compared to an abnormal one. I guess if an egg's spindle doesn't exist or looks highly fragmented, they won't freeze the egg.
When they retrieve my eggs, they will look for eggs that are "spindle positive" (good-lookin' spindles). Here is video that shows you how technicians detect spindles. At this stage, I don't think they will do a screen for chromosomal abnormalities-- they probably do this as an extra step (and cost) when I thaw and fertilized my eggs, before embryo implantation. (I will ask my doctor to confirm this.) The fact is that the cryopreservation process can result in additional spindle and chromosomal damage, which is why you end up with fewer usable eggs than you freeze. Recent advances in egg freezing have helped improve the post-thaw yield rate, which is one of the reasons why I am choosing to undergo egg freezing now. I am also hoping that technology in thawing and fertilization continues to improve, and that we're even further along by the time I'm ready to use these eggs.
What am I eating?
So-- back to the matter at hand. What do I eat (or avoid)? Many post-ers on IVF forums seem to promote a high fat, high protein, low carb diet, the reasoning being that such a diet encourages cellular development. Some also say to cut out dairy (not sure why). Some say pineapple is good for IVF transfer (less relevant to me). There is the soy controversy. Plenty of hydration is essential. Some say B vitamins (which are said to help reproductive organs). Chinese medicine says that women should only take in warm foods (no ice cream!), and meanwhile, my yoga instructor warned me not to overheat my body (ice cream, hooray).
OK, so no one really knows for sure. What makes sense to me is to eat a well balanced diet rich in fruits and vegetables, heavy on protein and "good fats", and if eating carbs, choosing whole grains. This works better for my body type, so this is what I'm going to pursue. I am also taking a B vitamin complex supplement (which includes folic acid) and one Viactiv calcium chew a day (which is part of my regular diet). I will not give up my ice cream; it is my foil to the Menopur.
This morning, I took advantage of the fact that it is Sunday and made myself a nice brunch of eggs, avocado, bacon, and multi-grain toast with raspberry jam:
I know I can't eat like this every day, but I've got to feed my growing eggs.
Smoking, Alcohol, and Caffeine
I've read a lot about the negative effects of alcohol on egg retrieval success. The Guardian article says that in a Harvard study, women who drank one or more alcoholic beverages a week had an 18% less likelihood of success at producing an IVF baby as compared with women who did not drink at all. White wine for women and beer for men seemed especially detrimental. Another UK article from the Daily Mail says that eliminating alcohol, caffeine, and smoking can help women conceive "naturally" instead of resorting to IVF, providing further evidence that these substances just aren't helping women conceive.
Now, women undergoing IVF have more factors to be concerned with than women going through egg freezing-- namely, IVF patients need to prepare their body for egg retrieval and embryo implantation (whereas I can worry about embryo implantation later). It is possible that alcohol and caffeine interfere with implantation, and maybe it has little effect on healthy egg production itself. And to be fair, you're born with all the eggs you've got-- you've already subjected your poor ova to years of college drinking and whatever other substances you may have abused in your less responsible years (or even now).
As someone who likes to drink at least two glasses of iced tea a day and enjoys wine with dinner several nights a week, I would like to believe that this is the case, that I don't need to worry about alcohol and caffeine consumption, but since no one can assure me that it's OK (my nurse said, "the occasional glass of wine is fine; one small cup of coffee a day is acceptable"), I've chosen to avoid both. I figure that since I'm spending over $15K of my hard-earned money to undergo this procedure, it seems foolish to run this risk. It is also makes sense-- your body doesn't actually require alcohol or caffeine to function, and both are known to have some negative effects on your body; why marinate your eggs in a toxic brew while you're going through this expensive and sensitive procedure? And what if these substances interfere directly or indirectly with the hormones I'm taking? I want to provide as regulated an environment as possible so that the hormones work optimally and my body is appropriately reactive to any adjustments my doctor may make to my course of treatment.
I began drastically reducing my caffeine and alcohol intake about one month ago. In the last month, I've only had four glasses of iced tea (heavy on the ice, very little tea), and none in the last 10 days. In terms of alcohol, I've reduced my intake to "a few glasses of wine per week" in the last month (all red wine, no white), and in the last ten days, I've only had one glass of rose (I was desperate, on a terrible blind date, what was I to do?). I have vowed to eliminate alcohol and caffeine entirely during my cycle, and I've been sticking to it.
Cutting down alcohol to a few glasses a week has had a few immediate positive outcomes-- my skin looks great, and I think I even lost a little weight since I've stopped drinking hundreds of wine calories a week! Plus I don't spend as much money when I go out, which is good, because I'm spending $15K on this procedure and every little bit helps. I think I may make the reduced alcohol consumption a regular part of my life, though I can't wait to have my first glass of rose post-retrieval.
Quick flashback to high school biology: the human cell is a diploid cell and has 46 chromosomes (which hold your DNA). However, ovum (what I've been calling my "eggs") and sperm are reproductive haploid cells (aka gametes), and each only has 23 chromosomes (half of what we need to create a full cell). When the sperm fertilizes the egg, the 23 chromosomes from each haploid cell fuse to form a single diploid cell containing 46 chromosomes. This cell now has a unique set of genes, and it subdivides by mitosis to grow and become an embryo. One of the factors in embryos not progressing beyond a certain stage may have to do with chromosomal abnormalities (Mother Nature's way of saying that that particular fertilized egg is just not meant to be).
The "egg spindle" organizes the 23 chromosomes in the ovum ("egg"). It's normal for a certain number of eggs to have abnormalities, but the occurrence of these abnormalities increase with age. I found a summary explaining potential spindle abnormalities accompanied by images of what a healthy egg spindle looks like compared to an abnormal one. I guess if an egg's spindle doesn't exist or looks highly fragmented, they won't freeze the egg.
When they retrieve my eggs, they will look for eggs that are "spindle positive" (good-lookin' spindles). Here is video that shows you how technicians detect spindles. At this stage, I don't think they will do a screen for chromosomal abnormalities-- they probably do this as an extra step (and cost) when I thaw and fertilized my eggs, before embryo implantation. (I will ask my doctor to confirm this.) The fact is that the cryopreservation process can result in additional spindle and chromosomal damage, which is why you end up with fewer usable eggs than you freeze. Recent advances in egg freezing have helped improve the post-thaw yield rate, which is one of the reasons why I am choosing to undergo egg freezing now. I am also hoping that technology in thawing and fertilization continues to improve, and that we're even further along by the time I'm ready to use these eggs.
What am I eating?
So-- back to the matter at hand. What do I eat (or avoid)? Many post-ers on IVF forums seem to promote a high fat, high protein, low carb diet, the reasoning being that such a diet encourages cellular development. Some also say to cut out dairy (not sure why). Some say pineapple is good for IVF transfer (less relevant to me). There is the soy controversy. Plenty of hydration is essential. Some say B vitamins (which are said to help reproductive organs). Chinese medicine says that women should only take in warm foods (no ice cream!), and meanwhile, my yoga instructor warned me not to overheat my body (ice cream, hooray).
OK, so no one really knows for sure. What makes sense to me is to eat a well balanced diet rich in fruits and vegetables, heavy on protein and "good fats", and if eating carbs, choosing whole grains. This works better for my body type, so this is what I'm going to pursue. I am also taking a B vitamin complex supplement (which includes folic acid) and one Viactiv calcium chew a day (which is part of my regular diet). I will not give up my ice cream; it is my foil to the Menopur.
This morning, I took advantage of the fact that it is Sunday and made myself a nice brunch of eggs, avocado, bacon, and multi-grain toast with raspberry jam:
Smoking, Alcohol, and Caffeine
Smoking-- I mean, that just seems dumb. I mean, whether you're undergoing egg freezing or not, just-- no. Moving on.
Now, women undergoing IVF have more factors to be concerned with than women going through egg freezing-- namely, IVF patients need to prepare their body for egg retrieval and embryo implantation (whereas I can worry about embryo implantation later). It is possible that alcohol and caffeine interfere with implantation, and maybe it has little effect on healthy egg production itself. And to be fair, you're born with all the eggs you've got-- you've already subjected your poor ova to years of college drinking and whatever other substances you may have abused in your less responsible years (or even now).
As someone who likes to drink at least two glasses of iced tea a day and enjoys wine with dinner several nights a week, I would like to believe that this is the case, that I don't need to worry about alcohol and caffeine consumption, but since no one can assure me that it's OK (my nurse said, "the occasional glass of wine is fine; one small cup of coffee a day is acceptable"), I've chosen to avoid both. I figure that since I'm spending over $15K of my hard-earned money to undergo this procedure, it seems foolish to run this risk. It is also makes sense-- your body doesn't actually require alcohol or caffeine to function, and both are known to have some negative effects on your body; why marinate your eggs in a toxic brew while you're going through this expensive and sensitive procedure? And what if these substances interfere directly or indirectly with the hormones I'm taking? I want to provide as regulated an environment as possible so that the hormones work optimally and my body is appropriately reactive to any adjustments my doctor may make to my course of treatment.
I began drastically reducing my caffeine and alcohol intake about one month ago. In the last month, I've only had four glasses of iced tea (heavy on the ice, very little tea), and none in the last 10 days. In terms of alcohol, I've reduced my intake to "a few glasses of wine per week" in the last month (all red wine, no white), and in the last ten days, I've only had one glass of rose (I was desperate, on a terrible blind date, what was I to do?). I have vowed to eliminate alcohol and caffeine entirely during my cycle, and I've been sticking to it.
Cutting down alcohol to a few glasses a week has had a few immediate positive outcomes-- my skin looks great, and I think I even lost a little weight since I've stopped drinking hundreds of wine calories a week! Plus I don't spend as much money when I go out, which is good, because I'm spending $15K on this procedure and every little bit helps. I think I may make the reduced alcohol consumption a regular part of my life, though I can't wait to have my first glass of rose post-retrieval.
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