The One-Day Workup (ODWU) at CCRM

I want to be sure I tell you about the One-Day Workup (ODWU) at CCRM before too much more time passes. I went to the ODWU more than a month ago! (So much has happened since then, which I will describe in the coming days.)

First off, my ODWU was supposed to happen in September, but I got pregnant a fifth time (accidentally) and lost it at 5 weeks, as I’ve described in previous posts, so moved my ODWU to October, losing a good deal of money on plane tickets in the process. It is hard to predict when you will get your period after a miscarriage, but luckily, my prediction was correct. We arrived in Denver in mid-October, scheduled for a ODWU on my Cycle Day 10.

  • Your ODWU must occur somewhere between Day 5 and Day 13 of your menstrual cycle.
  • You must not have caffeine in any form three days before your ODWU. The caffeine affects blood flow to the uterus and will affect the Doppler reading of your blood flow during the ultrasound examination.

We decided to arrive on a Saturday for a Monday ODWU. This gave us some buffer time, in case we had any problems with flights. We ended up using that time to actually enjoy ourselves in Denver and the Rocky Mountains.

If you are considering CCRM, I highly recommend trying to schedule at least a couple of days to explore and enjoy the area. Create a mini-adventure out of it. Make the journey about more than IVF.

We checked into our hotel first.

  • We stayed at Staybridge Suites in Centennial, CO. 
  • Our room was $90/night and included a living room with fold-0ut couch, kitchen, bedroom, and bathroom. They provide these rates and rooms to CCRM patients.

Then we drove into Denver. It was rainy, and I was really hungry, craving good food. We went to a vegetarian restaurant called Watercourse, where I was served a small portion of not-so-great food for way too much money. I didn’t realize until that point how sleep-deprived I was (we’d had to get up at 5 a.m. for our flight) and how nervous I was about why we were there—my disappointment in the meal completely undid me, and I had to run into the bathroom, and then outside to the sidewalk to cry and cry. DH paid the bill and came out to comfort me. When he asked me if I wanted to talk, I shrugged and said: “There’s really nothing to say. It’s the same old stuff.”

I recovered somewhat, wandering around that big, warm, beautiful shop, dark wood all around me and tall walls filled with my old friends, books. I tried to lift my thoughts up out of the negative superhighway that has been immaculately upkept by me and circumstances during the past year and a half or so.

When we emerged from the bookstore, the sun was shining. That helped! Across the street was beautiful Union Station, and down the street, we bumped into one of the bridges along

I’d researched it a bit, but because of the seemingly severe rain and wind, I had given up on the idea of exploring it. But then came sunshine and serendipity!

We happened across bicycles—Denver B-cycle— that you can rent for cheap just by inserting your credit card. And we rode on the High Line trail around the city. It was truly magical. An ideal mix of natural and urban beauty.

We fell in love with Denver during that bike ride and began to talk about the possibility of moving there someday (Denver has a VA Hospital, where DH and I could apply for jobs). We looked at the condominiums with balconies overlooking the Platte River Canal and fantasized about what it would be like to live in them. Over fish tacos that night, we congratulated ourselves for, once again, finding the perfect adventure, as we always do when we travel together.

The next day, Sunday, it was sunny, so we decided to drive into the Rocky Mountains. We drove maybe an hour and a half to Estes and then on to the

where we began our hike up the gorge past Bear Lake, Nymph Lake, Dream Lake, all the way up to the end of the trail, and Emerald Lake. As we ascended, snow appeared on the ground and the winds got colder and colder. It was breathtakingly beautiful and exhilarating.

Below is a slideshow of our bicycle ride along Denver’s High Line Canal and our hike up Tyndall Gorge past four lakes at the base of Hallet Peak in Rocky Mountain National Park. The photos you’ll see of the cute little town with cafe and folk art (and me on a giant chair) are in Lyonsbefore you get to Estes, where I highly recommend you stop for good organic food and coffee (I couldn’t drink it, but DH could!).

You’ll also see photos of the herd of wild elk (!) we stumbled across on our way out of the park—countless elk, resting in a roadside hotel’s front yard. One enormous bull with huge antlers and a lot of lady-friends—October is mating season. The elk seemed to be an auspicious sign.

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I asked the natural world for signs, for fulfillment of my wishes, while up in the mountains. I used to do that sort of thing as a kid—I was an Ohio tomboy who ran around in the woods and swam in the creek and developed a special relationship with nature, so I called upon that part of me. At Dream Lake, I closed my eyes and whispered into the wind, “Please grant our wish to become pregnant and have a healthy pregnancy, a healthy child,” and when I opened my eyes, this blue bird swooped directly in front of my face, close enough to touch, and alighted on a tree branch an arm’s length away from me.

When I reached the last lake–Emerald Lake–and stared up in awe at the severe snow-capped beauty of Hallet Peak, freezing wind in my face, I sent out the request again. Then I closed my eyes and said: “I will manifest this child.” And smiled.

On our way back to Centennial, we stopped in Boulder, CO. We were enchanted by the pedestrian mall, crowded with people–bearded folk singers with guitars among them—and shops and restaurants. We had the best BBQ ever, sitting at an outdoor table at one of the restaurants, thoughts of the ODWU we would be going to the next morning pretty far from our minds.

***

The next day began roughly, as I had not slept more than a few snatched minutes at a time the night before. It wasn’t insomnia but the cold I’d caught a few days before I left, combined with my allergy to something in the Colorado air that doesn’t float around in the air on the east coast.

But I knew I could rally. We got to the appointment at 7:15 a.m., and from there, we hit the ground running.

Here is a PDF of my appointments for the day:

  • ODWU appointment schedule

7:30 Orientation to IVF at CCRM

What sticks in my mind:

  • Please allow the doctors and nurses to do their jobs—don’t try to dictate your own care, and don’t go rogue with your care.
  • Don’t read blogs. (Ha ha.)
  • Don’t write disparaging things in your own blog.
  • Always possible a doctor other than your own will do your retrieval. Same goes for your transfer.
  • Stress hormones are bad for fertility.
  • American Fertility Association, SART, March of Dimes, and CDC are the best websites to go to for information.
  • Your estrogen level during a normal cycle is 200 (it’s 200 per follicle). During IVF, it will be 2000 – 4000.
  • Your Day 3 bloodwork should be: Estrogen under 50; FSH under 12 (and under 10 is better); FSH must be 3 x higher than LH (if not, you have PCOS).
  • AMH should be over 1.
  • Retrieval day, must have someone with you for 24 hours.
  • Their target numbers during cycling are 18 mm follicles and an 8 mm lining.
  • You come in exactly 35 hours after your HCG Pregnel shot for retrieval.
  • During the plane ride home after the procedure, do not cross legs. Get up and walk around a lot. You are at risk for blood clots
  • Keep your activity quite low during stimulation.
  • Stop fish oil & Advil during stimulation.
  • Biking: limit during stimulation.
  • Your ovaries will go from the size of golf balls to grapefruits (!!!). Wear yoga pants.

8:30 Business Office

We found out how much treatment was going to cost and I tried not to faint.

9:00 New Patient Consult

Dr. Schoolcraft, I found out days before I was to show up, was not going to be in the office during my ODWU day, so I ended up having the consult with Dr. Surrey. He said:

  • Only 1 in 6 couples have NO normals.
  • If you have no normals, chances are you will have no normals again should you try cycling again. There is, however, a 20% chance that you will have normals the next cycle.
  • Data is showing that success rates are better for frozen embryo transfers.
  • Because of my Factor V Leiden heterozygous, I will be on Lovenox during stims (and will stop baby aspirin), will stop before retrieval, and will restart after retrieval. I will stay on it for at least 12 weeks. Bleeding is a possible complication.
  • When they do the suppression check at the beginning of the cycle, the AFC really doesn’t indicate how many eggs I will produce. A cyst, at that point, however, will delay the cycle.
  • 65% chance of success if they transfer a euploid (normal) embryo. [Note that Dr. Schoolcraft later told me there would be a 45% chance of success if we transfer a normal embryo.]
  • He thinks it is unlikely that I won’t have at least *one* normal embryo.

10:00 Baseline Ultrasound + Doppler

I have never received such a high-tech ultrasound. I gazed up at an enormous screen that showed my uterus from various angles, and the technician explained everything she was doing, and everything I was seeing. A sound wave on the screen measured my blood flow which was, apparently, excellent—this was the Doppler reading, for which I’d had to abstain from caffeine for three days. Because of the good blood flow, they did not recommend acupuncture—unless, that is, I like it for other reasons, such as relaxation. I was relieved to hear this because acupuncture is expensive and since I left Brooklyn, I haven’t found a Hope Hathaway replacement.

The technician also found 11 resting follicles—an AFC of 11 is pretty good, and I had been worried because my AFC has ranged from 3 to 12 during the past year and a half

10:30 Nurse — IVF Consult with CCS Overview
My IVF nurse, H, is young and practical, and has a wry sense of humor. I like her.
Some points from that meeting:

  • Day 3 Bloodwork can be drawn on CD2 or CD3. If drawn on a Sat., can be frozen for a day.
  • PAP: They need it to be current. Physical exam notes and pathology report to be faxed.
  • Mammogram: They need a baseline mammogram. Radiology report to be faxed.
  • 1 local monitoring appointment pre-IVF calendar start: Must at least have the 1st ultrasound suppression check, before stimulation and retrieval, done locally, to ensure there is no dominant follicle, estrogen and progesterone are low, and there are no cysts.
  • 3 local monitoring appointments between retrieval and transfer: ultrasounds and bloodwork.
  • Caffeine: None at all for the 6 weeks of stimulation. (Gahhhhhh…) But can have caffeine now without any ill effects on fertility, H said. “Remember that the effect of stopping caffeine on blood flow is immediate,” she said, referring to the 72 hours I had to stop caffeine intake before the Doppler.
  • Alcohol: Occasional glass of wine is okay. But 2 beers a day is not okay.
  • Multiples: More than 30% of IVF cycles result in multiples.
  • Psychologists: On-call for counseling throughout procedure and are easy to get ahold of.
  • Medications: H will select and place all orders for me, if I want her to (and I do, I do, I do). The pharmacy will call me to get my details and I’ll set up delivery and payment with them. Whew.
  • While I am in Colorado, I can have my morning injections done for a $20 fee. I can have my evening injections done by a nurse who will come to my hotel for a $70 fee. (I think I will consider that evening service for at least the trigger shot, which I want to do precisely right.)

12:15  Semen Analysis

DH and I have now collected his semen in cups in three different places. In a “collection room” at Columbia. Twice. At home into a plastic cup for RS of NY, a cup I had to keep under my shirt and between my breasts during the twenty minute taxi ride to the clinic (you don’t want the swimmers to get cold before an IUI).  And now in the collection room at CCRM.

When we went up to the front desk to check in for our next appointment and the receptionist directed DH downstairs, I said, “Oh, what’s he got to do down there?” And she replied: “It’s, well, it’s his special time,” and all three of us cracked up. CCRM’s room was okay, but there wasn’t enough room for me in there to sit down beside him, so I ended up leaving DH by himself. Quite unlike the rooms at Columbia, which are by comparison spacious, and which have little loveseats (vinyl, covered with white paper) big enough for two. DH and I have a ton of inside jokes by now—“Do you have a bigger collection cup than this?” or “No thanks, I brought my own porn.”–to keep us laughing.

His sperm checked out normal, but the motility, this time for the first time, was a bit slow. One thing that increases sperm motility is gang-bang pornography featuring one woman and many men! This has actually been researched and documented. Competing with other men (even just in fantasy) gets the sperm moving more quickly. Amazing. So we know what DH is going to pack and bring for IVF retrieval day…

12:45 Hysteroscopy

This was painful. I was on a table with my feet in stirrups, and Dr. Surrey put a very long instrument up into me, all the way to the uterus. I did not like seeing that instrument afterward. But the good news is, all is normal.

1:15 Consent Review

I’ve never signed so many consents in my life! We sat at a big desk with our nurse, H, and discussed and signed them, seemingly endlessly…

1:30 Blood draws

We had to have our blood drawn for tests we’ve had done before, like communicable diseases. The woman who drew our blood was a pro.

***

After it was all over, we hopped in our rental car and zoomed straight to the airport for our flight home.

Overall, it was a good experience, if incredibly rushed. I would advise anyone about to go through this to bring plenty of dried fruit, nuts, and drinks, because there is almost no time to visit the concession stand. If you plan on ingesting caffeine as soon as you have your Doppler, bring your caffeinated beverage in your purse.

And I think I will leave this post at that, as I have much more to relate in the coming days.

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2 Comments

  1. Just fyi for anyone reading this. You can do ur day 2/3 labs prior to your one day workup to speed things along and not wait another month… Can set up an initial appointment to get the kit ahead of time.

    Reply
  1. Mosaiculture earth goddess and other wonders of Atlanta | the unexpected trip

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