IVF with PCOS

I was diagnosed with “mild PCOS” when I was 16 and I knew at that point that it would be hard for me to conceive naturally, so it wasn’t a surprise when I had to resort to in-vitro fertilization, or IVF. I don’t feel bitter about the situation and never felt the way a lot of infertile women do – I think that’s partly because I  had been expecting fertility problems for 10 years, so I wasn’t surprised. Of course, I didn’t like that it took so long and I had to go through so many medications, but when the outcome is a handsome, sweet, little boy? It’s not so bad.

I started my IVF journey for the first time when I was 24 years old.

My PCOS symptoms were/are:

  • Started a period very late (16 years old)
    • It lasted just 2 days; my next one came about a year later!
  • Irregular periods
    • I usually bleed lightly for maybe 2 days.
    • My periods are usually 10+ months apart
  • Ovarian Cysts
    • I always have cysts on my ovaries and at some point they rupture, causing a lot of pain and nausea for ~24 hours. These can be seen on a sonogram and aren’t harmful unless they get too big.
    • They occur when my body starts preparing an egg and then I never ovulate, so the egg just sits on my ovary and continues to grow and eventually turns in to a cyst. These aren’t painful unless they rupture.

Trying to Conceive with PCOS

Having never been on birth control and not getting pregnant over 4 years, once we decided we wanted a baby we knew we would need to see a fertility specialist. We first tried Clomid through my OB-GYN. What finally worked for us was IVF, but here is what we tried:

  • 3 Clomid Cycles
  • 2 Clomid + Trigger Shot Cycle
  • 1 Clomid + Injections + Trigger Shot Cycle
  • 1 Clomid + Injections + Trigger Shot + IUI Cycle
    • IUI didn’t work for us because my pH level was too high and wouldn’t allow the sperm to live.
  • 1 IVF Cycle

What’s Supposed to Happen

Each month your body releases the hormones FSH and LH which tell your body to start preparing eggs in small follicles on your ovaries. One egg matures and this is the one that is release during ovulation when the surge of LH causes the follicle to rupture and release the egg. The empty follicle is now referred to as a corpus luteum.

The corpus luteum produces the hormone progesterone which aids in thickening your uterine lining.

The egg then travels through your fallopian tubes and will live for ~48 hours after ovulation. At the end of the tube, fertilization may occur if the egg meets with sperm, which lives in a woman’s body for ~5 days.

Once the egg is fertilized it will implant itself onto your uterine lining which will have thickened up with the progesterone created by the corpus leteum. Once the egg becomes fertilized it is now referred to as an embryo. The corpus leteum will recognize that the embryo has been implanted and will continue to produce progesterone to keep a thick uterine lining.

My Problems

I learned that I had quite a few problems that were hindering my ability to conceive. These were all issues that couldn’t really be “fixed” which is why we ultimately had to resort to IVF to force my body to get ready for embryo implantation.

  • My eggs do not mature each month and instead turn to cysts
  • My matured eggs never drop (which is called ovulation)
  • My pH level is too high and most sperms die before they reach my uterus
  • I don’t make much progesterone so my uterine lining does not get thick

IVF

The first appointment:

I went in at met my doctor and was very pleased with everything. She told me exactly how it works and what the typical timeframe would be, but informed me that mine may vary depending on my exact situation and what the test results and imaging results show. I’ve lined out below what medications I took for IVF, what the costs associated were, and what my timeline looked like.

The injections:

  • Progesterone (intramuscular injections in your upper buttocks quadrant)
  • Lupron (subcutaneous injections in your abdomen)
  • Follistem (FSH subcutaneous injections in your abdomen)
  • Menopur (subcutaneous injections that you mix and inject in abdomen)
  • Novarel (subcutaneous injection in abdomen, done 1 time, for egg retrieval)
  • 12.19.12 Shot Bruises
    I sometimes would get bruises on my abdomen from all these injections!

The cost of IVF:

  • My Fertility Specialists Service Costs were $7,650 (this was in 2012)
  • Medications were $4,000
  • Anesthesia was $600
  • Embryo Cryopreservation was $800 for 2 years of freezing/storing
  • Semen Analysis was $90
  • Sono Hystogram was $500 (to make sure everything looked good inside, prior to starting treatments)

The timeline with my 1st IVF attempt (Success)

My first appointment ever with the fertility doctor was on November 30th and I started treatments December 27th. So, from “first appointment” to “pregnancy test results” it was just 55 days! My due date was October 3rd and my son was born on September 17th.

This was considered a “fresh cycle” because we retrieved the eggs, created the embryos, and transferred one into my uterus before it was ever frozen, hence: fresh cycle.

1.15.13 Embryo Transferred

Below is a timeline of home my first IVF went, which was successful.

  • 12/27/12: Lupron 10 units
    • These are abdominal injections
  • 12/28/12: Lupron 5 units
  • 12/29/12: Lupron 5 units
  • 12/30/12: Lupron 5 units
  • 12/31/12: Lupron 5 units
  • 1/1/13: Lupron 5 units, Menopur 75 IU, FSH 150 units
    • These are 3 separate abdominal injections
  • 1/2/13: Lupron 5 units, Menopur 75 IU, FSH 150 units
  • 1/3/13: Lupron 5 units, Menopur 75 IU, FSH 75 units
  • 1/4/13: Lupron 5 units, Menopur 75 IU, FSH 50 units
  • 1/5/13: Lupron 5 units, Menopur 75 IU, FSH 50 units
  • 1/6/13: Lupron 5 units, Menopur 75 IU, FSH 50 units
  • 1/7/13: Lupron 5 units, Menopur 37.5 IU, FSH 25 units
  • 1/8/13: Lupron 5 units, Menopur 37.5 IU, FSH 25 units
  • 1/8/13: Novarel 10,000u SQ at 9:15pm
  • 1/10/13: Egg Retrieval
    • I was put under anesthesia for this and it took less then an hour. Once I woke up from anesthesia I was very hungry!
  • 1/14/13: OHSS
    • I was diagnosed with Ovarian Hyper Stimulation Syndrome which meant that since I had produced SO MANY MATURE EGGS my ovaries were overstimulated and swelled up to more than double their normal size. This caused bloating (I looked 4 months pregnant!), severe lower abdominal pain, and nausea! I was throwing up all night and having horrible pain.
    • This is not common, but is more common in patients under 30 who are doing fertility injections. It typically happens within 10 days of egg retrieval if it’s going to happen.
  • 1/15/13: Transfer Day
    • We originally planned to transfer 2 embryos to have a better choice of one of them implanting, however with the OHSS I was only able to transfer 1 embryo because the hCg production that would occur if they both stuck could be very harmful to my ovaries.
    • 1.15.13 Embryo Transferred
      This is the embryo we transferred that would turn out to be our Hudson!

      1.15.13 Egg Transfer (1)
      This was Embryo Transfer Day! My husband got to scrub-in and come with me. They don’t put you to sleep for this part, they do it through your cervix, and you get to watch the embryo leave the needle inside your uterus via a sonogram machine!
  • 1/16/13: Pain
    • I was still in a lot of pain with the OHSS and couldn’t even hardly walk. I had to sit very still and stay propped up, drinking gatorade and eating pickles for sodium.
    • 1.15.13 OHSS (Post-Egg Retrieval)
      This photograph shows the swelling in my abdomen after the embryo transfer, due to the OHSS. This is not typical.
  • 1/18/13: Better
    • I finally felt batter today and my sister drove me to do the doctor to check out the OHSS and blood results – everything was good but I still had a lot of fluid from the OHSS.
  • 1/20/13: Horrible
    • I started feeling really horrible today. It hurt again to walk, move, stand, and eat. My belly felt so full that I couldn’t hardly breath!
  • 1/22/13: Fluid
    • I had a lot of fluid in my belly causing these feelings, but the doctor didn’t drain it because it was more of a risk and it was too bad yet. He didn’t want to risk infection when he thought I would be alright .
    • I had to start blood thinner injections because my hemoglobin was too high (my blood was too concentrated) and then I got very sick with nausea, aches, headache… so I was prescribed Zofran which helped tremendously.
  • 1/23/13: Pregnancy Test At-Home
    • An at-home pregnancy test said YES! The doctor said this wa probably correct, but that it could be a false positive from all the hormone injections i had been doing.
    • 1.23.13 Positive Test
      This was my at-home pregnancy test that I did after my embryo transfer through IVF. What an awesome sight.
  • 1/24/13: HCG Blood Pregnancy Test
    • It was confirmed at 11am that I am, in fact, pregnant!
  • 1/26/13
    • Still having pain and swollen abdomen. It’s now splotchy looking, which is a part of OHSS.
    • 1.26.13 Belly
  • 1/31/13: HCG Blood Test
    • I had 2nd blood test to confirm that the pregnancy remained viable and the numbers were still increasing!
  • 1/31/13: Progesterone
    • I started progesterone in Ethyl Oleate 50 mg/ml injections daily. These go in you upper buttocks – sometimes they hurt, sometimes I don’t feel them! You have to warm up the liquid before injection or it’s too thick to go in. This needle is big, long, and scary! I did progesterone injections throughout the first trimester.
    • I stared low dose Aspirin, too.
    • 1.31.13 Our Progesterone X's  (2)
      This is where I did my progesterone injections – alternating sides each day. My husband did it for me, and the doctor drew the circles so we knew where to inject.
  • 2/14/13: Heart Beat
    • We got to hear the baby’s heartbeat for the first time today!
    • 2.14.13 Sonogram (Yolk Sac)
  • 2/21/13: Graduation
    • We graduated from Fertility Specialist to Regular OB-GYN!
  • 9/17/13: Hudson’s Birth!
    • 3 (1)

 

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