The way Forward

After my canceled IVF early this month i felt like i have lost another pregnancy, I really believed that this is it for us. Everyday when i inject myself, all i was thinking about is pregnancy for Christmas it will have been a nice gift. I couldn't believe what i went through, my hormones where all over the place, poor DH .

Last week Friday i did a scan, my ovaries are still big. I am patiently waiting for AF then need to phone VL. All this time i was trying to figure out why things went so terribly wrong, we even cancel our holidays .

At least today i can thing clearly, i need to get my life back on track do what i do best GIVING. I am done with feeling sorry for myself it really doesn't help. I have gain 3kg of weight, i am emotional eater. So tomorrow I am hitting the shops to spend the holiday money on the least fortunate. I going to buy food for street kids.

The way forward: Spend time in Prayer for God guidance and Strength.

IVF CANCELLED

This morning i did E2 blood test which still show the high levels, Dr J decided that we must cancel the IVF. My heart was so sore it was like something has been riped out of my chest, I really lost it infront of Dr J.



The main reason why dr J decided to cancel the IVF is because i am at risk of having OHSS after the ER. I google OHSS and found this info

Symptoms
Symptoms are set into 3 categories: mild, moderate, and severe and some others. Mild symptoms include abdominal bloating and feeling of fullness, nausea, diarrhea, and slight weight gain. Moderate symptoms include excessive weight gain (weight gain of greater than 2 pounds per day), increased abdominal girth, vomiting, diarrhea, darker urine and less in amount, excessive thirst, and skin and/or hair feeling dry (in addition to mild symptoms). Severe symptoms are fullness/bloating above the waist, shortness of breath, urination significantly darker or has ceased, calf and chest pains, marked abdominal bloating or distention, and lower abdominal pains (in addition to mild and moderate symptoms).

Classification
In mild forms of OHSS the ovaries are enlarged, in moderate forms there is additional accumulation of ascites with mild abdominal distension, while in severe forms of OHSS there may be hemoconcentration, thrombosis, abdominal pain and distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. Early OHSS develops before pregnancy testing, and late OHSS is seen in early pregnancy



Complications
OHSS may be complicated with ovarian torsion, ovarian rupture, thrombophlebitis and renal insufficiency. Symptoms generally resolve in 1 to 2 weeks, but will be more severe and persist longer if pregnancy is successful. This is likely due to the role of the corpus luteum in the ovaries in sustaining the pregnancy before the placenta has fully developed. Typically, even in severe OHSS with a developing pregnancy, the duration does not exceed the first trimester.

Pathophysiology
OHSS is characterized by the presence of multiple luteinized cysts within the ovaries leading to ovarian enlargement and secondary complications.
As the ovary undergoes a process of extensive luteinization, large amounts of estrogens, progesterone, and local cytokines are released. It is held that vascular endothelial growth factor (VEGF) is a key substance that induces OHSS by making local capillaries "leaky", leading to a shift of fluids from the intravascular system to the abdominal and pleural cavity. Thus, while the patient accumulates fluid in the third space, primarily in the form of ascites, she actually becomes hypovolemic and is at risk for respiratory, circulatory, and renal problems. Patients who are pregnant sustain the ovarian luteinization process by the production of hCG.

Epidemiology
Sporadic OHSS is very rare, and may have a genetic component. Clomifene citrate therapy can occasionally lead to OHSS, but the vast majority of cases develop after use of gonadotropin therapy (with administration of FSH), such as Pergonal, and administration of hCG to trigger ovulation, often in conjunction with IVF. The frequency varies and depends on patient factors, management, and methods of surveillance. About 5% of treated patients may encounter moderate to severe OHSS.
Mortality is low, but several fatal cases have been reported.

Treatment
Physicians can reduce the risk of OHSS by monitoring of FSH therapy to use this medication judiciously, and by withholding hCG medication. Once OHSS develops, reduction in physical activity, closely monitoring fluid and electrolyte balance, and aspiration of accumulated fluid (ascites) from the abdominal/pleural cavity may be necessary, as well as opioids for the pain. If the OHSS develops within an IVF protocol, it can be prudent to postpone transfer of the pre-embryos since establishment of pregnancy can lengthen the recovery time or contribute to a more severe course. Over time, if carefully monitored, the condition will naturally reverse to normal - so treatment is typically supportive, although patient may need to be treated or hospitalized for pain, paracentesis, and/or intravenous hydration



My ovaries are still producing eggs even though i stop with the medication on Wednesday. Here is the breakdown of

Monday 10 follicles

Wednesday 14 follicles

Friday 16 follicles

Saturday 20 follicles

I used 4 amps of menopur per day for 10 days.

To think that i went throught this , for nothing all i am left with is painful ovaries. And to top it all about R10 000.00 down the drain. This is really not fair.

SKY HIGH LEVELS

On Wednesday i did the second scan and Dr J was so impressed about the growth and the lining, the number of bigger follicles increased from ten to fifteen. Yesterday I did the E2 blood test and the result came back sky high, so i went for another scan and the blood test . The level are still high, praying very hard that my level go down tomorrow. I have already stopped with the menopur my last shot was on Wednesday. Dr J was hoping to do the egg retrieval on Sunday but it seems like my ovaries are working very hard.



I always wonder that what will happen if is see someone that i knew at VL particularly from black community(I hate to classify people by colour). Why i am saying this is because within the black community infertility is deemed as a curse, people don't talk about it. The is still a stigma around this. Yesterday when i went for the bloods i saw someone that i knew, i could even see that she knew me but i couldn't remember from where. Well when the sister call her name i remembered her.



For me is so easy to talk to a white lady about this, even if the are fertile but they have an open mind. When i went for Lap in October i told my friend about it, she did understand why must i expose my body to this . She even bought me a book by Pastor David Oyedepo, he says i quote" until you become a committed seeker of God, your search for children will be futile''



Is the something wrong about my faith to God, no i don't think so. Is God punishing me, no i don't think so. I love God and I know that he love me so much and he will give me my miracle children.

First Follicle scan

I had a great weekend the bridal shower went well and my friend was so happy for what we did for her. So this morning I went for my first scan and we found ten follicles, five from each side measuring 13mm. The scan queue was so long , it was full at VL. The one thing that i hate is a queue but this is for good course , i will do anything just to have the baby even sit on a queue for all most 2hrs. fortunately for me i had a book that i was reading, it was not a good book but at least it keep my mind occupied.

I saw this book from a friend, what attracted me is " After trying for Six years Now I am pregnant with twins".