Thursday, June 25, 2009

Suppression check and information overload

Today was my suppression check. I ran the gauntlet at the clinic giving away body fluids and showing off my "private parts" to every one. In exchange I received the most information ever. Today I was most impressed by my clinic, in fact very very impressed.

First stop was with Dracula for blood draw. She was a bit grumpy to begin with. But we both warmed to each other when my blood flowed on the first jab. The blood draw was to check my estradiol levels. Supposed to have those results by 3:30 this afternoon.

Next stop was a visit with Wanda. She confirmed that both my ovaries were peachy suppressed. Lining very thin at 5.1 whatever the unit of measure is. It is so strange. During all those Ferma cycles my prayer was for the lining to be thick and follicles to be large. Not so today. The desired results of a suppression check being so opposite of a "normal" follicular ultrasound check that I didn't even wear my fertility socks. I didn't want the socks to somehow bring forth thick lining and a single well developed follicle. Very, very strange. Wanda did reveal a para cyst on the left ovary. But I was told that it was tiny, normal and nothing to stop the big show.

Next I was ushered to an exam room for a visit with a nurse practitioner who I had never met. Nurse Through was very through with my comprehensive exam. We went over ever medical condition that I had ever had. We talked about anesthesia. We reviewed how to give the Brevelle injections. We talked about the day of retrieval and the day of transfer. I asked how the sinusitis that I am suffering now is going to affect the cycle. (Thank goodness it won't! I was scared that I would be canceled due to my runny nose, hurting ear, and difficult breathing.)

Nurse Through also did a trial embryo transfer. Which I think is a stupid description and much prefer the term uterus mapping. Absolutely nothing was "transferred" to me. Only a catheter was inserted to measure the depth of my uterus. See why I think trial embryo transfer is a stupid description? Only a slight cramping sensation. And because Nurse Through is so through, she measured it twice. Two slight cramping sensations. But good news a stitch will not be required on the day of retrieval.

Next I met with Dr Wizard from the lab to discuss what was going to happen to my eggs and hubby's sperm while they were behind the curtain (are you getting all the Wizard of Oz references here?) and out of our bodies. I really, really loved Dr Wizard. I will trust my embryos to her. She showed up with books, pictures, and a huge nerdy knowledge of all things microscopic. She was everything I dreamed of in an embryologist. She had a spill planned but I kept asking questions so I think I got more information than we both bargained for.

In no particular order here are some of the things that I learned. . .
  • My clinic uses one type of medium to grow eggs and embryos. It is made for and delivered to the clinic every two weeks. Just in case there is something wrong with a batch, the eggs are divided and stored in two different lots of the medium. I like this modern day take on the old fashion term "don't put your eggs in one basket".
  • All containers, vials, and dishes are single use. The dishes that contain my eggs/embryos will be engraved with my information. They don't use stickers or ink to write on the containers because they don't want any reaction from dyes or glues. My containers will be stored on a shelf by themselves with my name on it in the incubator.
  • Each lab person works with only one couple's eggs/embryos and sperm at a time. No multi tasking allowed.
  • During ICSI there is some selection of the strongest and fastest, just as in nature. The sperm are placed in the bottom of a dish. Solution is added on top of them. Whoever swims up first is grabbed and selected for implanting in the egg. (Of course, if a two tailed monster swims up first they are going to go to the next one.)
  • Despite the little exercise described above, ICSI doesn't lend itself to creating children of one sex or the other. You would think that it would with all the old wives tales of girl sperm swim faster and boy sperm live longer. But Dr Wizard said no and I tend to believe her, otherwise most ICSI's would produce girl babies.
  • Contrary what I read on someone else's blog, they do not cut the tails off of sperm during ICSI. Sperm move/swim due to 9 little hairs on the tail. Disrupt the hairs, the sperm don't run away. No cutting off/removing the tails required.
  • ICSI does not fertilize eggs. ICSI penetrates the oolemma and places the sperm into the inner part of the egg. It is still up to the egg to divide it's 46 chromosomes (packing 23 away into a little suitcase) and incorporate the sperm's 23 chromosomes into it's growth.
  • After eggs are retrieved they are allowed to continue/fully mature for 1-2 hours before they are placed with sperm. With the trigger shot and retrieval they knowingly removed immature eggs because they don't want the body to ovulate and release the eggs. But after retrieval they have to let the eggs finish maturing before they introduce the sperm.
  • Not dissing 3 day transfers but with a 5 day transfer, embryos have already divided themselves numerous time and cells within the embryos have already been assigned one of two jobs, 1) become part of the baby or 2) become part of the baby's support system. The division of these two types of cells are viewable with microscope, they just don't know which clump of cells has which job.
  • Day 6 the cells really do burst forth and hatch. They send out little slim feelers searching for a uterine wall to implant in. The pictures are amazing.

The list above is not all inclusive of the things Dr Wizard and I talked about but they are some of the most interesting. Do you see why I liked Dr Wizard? I am really glad that she is on my team.


After Dr Wizard, I met once again with Dumb Ass Bitch financial manager. I had to sign a form that said that I would pay for everything that insurance didn't pay for. She made such a big deal of "everyone has to sign this waiver on suppression day" that I got the drift that I probably should have been required to sign the waiver when I paid my bill but Dumb Ass Bitch made another mistake and didn't present it to me to sign at the correct time. Also I believe that the fact that she had whited out the date and filled in today's day as a clue to what day I was supposed to sign the form. Needless to say, she remembered me and was glacierly cold.


For a grand finale, I was assigned a voice mailbox to check everyday by 3:30 (hence how I will be told my E2 level this afternoon) and scheduled for 3 more E2 and ultrasound checks. I think that we are underway.


Update: I was told to check my voice mailbox when I got home to make sure it worked. It doesn't work. Sigh. Another example of bumbling. . .


callmemama said...

Wow, that's one of the most descriptive posts on ICSI I've ever read. So glad your doctor is so willing to spend the time with you and give you all that information.

I'll never get people who can't manage a little kindness or at least a generally non-abrasive attitude when working with others. Especially people going through something as tough as IVF...

Katie said...

Wow- you got such a wealth of info, your head must be swimming! Can't wait to hear the suppression check news!

Courtney said...

Sounds like a great appointment! Thanks for sharing the info from the embryologist. Very interesting!