May 2017 - FET #2, Disappointment

Disappointment 

can bring you 

closer to yourself.

Closer to your breath. 

To the weight of your body upon the Earth.

To the sounds of the afternoon. 

To the evening's song. 

You've been lost in your head, friend. 

Return to the heart now.

Soften into the moment. 

Return Home. 

Let expectations melt. 

Into silence. 

Into a new beginning. 

- Jeff Foster

May 2017 - FET #2, The Wait

The transfer on May 3 went perfectly. Things were a little behind schedule, so by the time they called my name, I had been sitting in the prep-room with my gown and "Totally Fucking Awesome" socks on for about an hour and a half. My bladder was very full by then, making the transfer process quite a bit more uncomfortable than the first time. 

Before taking me to the operating room, my doctor gave us some pictures of the Lone Ranger. One from 9am and one from 1:00pm, showing the nice expansion and continued growth since thaw. The Lone Ranger had not yet hatched like Schrodinger had, which didn't concern him at all since Schrodinger had more time in the dish due to the 24hr genetic testing. He said TLR would likely hatch later that day, after transfer. 

 

The photo above shows the embryo at two different times, then the black image below shows a tiny white arrow pointing at the white blob that is the embryo and some fluid and bubbles that have been transferred into my uterus. 

Today is 7 days after transfer. The wait is always hard. This time has been no exception. One of the best descriptions of the "two week wait" I have seen can be found here. For your convenience, and in case it ever gets moved or deleted, I've pasted the excerpt below:

The following is from the blog of Aela Mass, who is hilarious and describes essentially what I have gone through during every two week wait ever:

The dreaded two-week wait. Those of us in this game know it as the 2ww. Those awful days between your pregnancy attempt — whether that be a natural try at home or a medicated attempt at the fertility center — and the day you get your pregnancy test results.

There are a few things to know about the two-week wait, but the most important is: Time will never move more slowly in your entire life than it does here. There are a handful of “stages” of this time period that women go through, each one solidifying this waiting game as a time of utter insanity.

1. The NBD Stage

This is how we all go into the 2ww. Positive. Hopeful. But, and especially if it’s not your first one, you also know to keep your cool. It’ll be what it’ll be. There’s nothing more you can do at this point. It’s now in God’s or the Universe’s or anyone else’s hands but your own. You’ve done all you can do, so now you just wait. No big deal. This stage usually lasts the first day, or maybe a full 36 hours. But that’s it.

2. OMG I Just Know I’m Pregnant Stage

This stage usually begins on the second or third day. You just know that you’re little embaby (the loving term you now call a fertilized egg) has found its way into your uterus lining and is busy making its home there. You tell yourself and your partner that you really think you’re pregnant. And you desperately find pregnancy symptoms in your daily routine:

Oh my God, I farted! It must be the baby.

I had a dream last night (doesn’t matter about what). It must be the baby. 

I just yawned. Wow, this first trimester exhaustion is serious!

3. UGH, I Just Don’t Think I’m Pregnant Stage

After a few days of convincing yourself that you’re definitely, definitely pregnant, you begin to doubt that you are. You just don’t “feel” it. Of course, at this point it’s impossible to feel anything, but you know that if you were pregnant, you’d be one of those women who just knew. But you don’t feel anything, and so you must not be pregnant.

4. Google Is My BFF Stage

It’s probably only five, maybe six days, since your attempt and you can’t do a single thing in the world except Google everything. What’s the earliest you can take a pregnancy test? When does implantation occur? How soon after implantation can you get a positive pregnancy test? Earliest symptoms of pregnancy — no, not at six weeks, I want the symptoms for three weeks one day! Oh, there aren’t any.You read pages and pages of fertility boards from 2009, even though you know treatments are totally different now. You search for any woman who had a dream like you did with the color tourmaline in it during their 2ww and ended up being pregnant.

5. The Boycott Google Stage

You realize all this Googling isn’t really helping, so you quit it. This lasts for an hour. Maybe two.

6. OK, Let’s Take a Home Pregnancy Test Stage

It’s way too early to get a positive response, but that one woman on the 2ww message board from 2011 got her first positive pregnancy test eight days into the wait, so if you’re pregnant, you will too. You don’t. But the test could be wrong. It’s too soon. No big deal. You shouldn’t have tested anyway. I mean, if you could find out sooner than the 2ww, the doctors would have you come in sooner. They are doctors, after all. That woman on the 2ww message board from 2011 was probably a lying troll anyway. You’ll never admit it, but later you dig the test out of the bathroom garbage to see if it changed. It didn’t.

7. Gloom and Self Pity Stage

At this stage, you’ve only got a few days left until your blood test. You’ve taken more than a handful of home pregnancy tests, maybe even bought them in bulk on Amazon. You wonder why you even bother. Why you put yourself through this. AGAIN. You think of ways to escape your reality. Maybe I should go live in a foreign country for a year doing something meaningful.Ugh, but it’s just all so unfair! Jill has FIVE kids and she doesn’t even appreciate motherhood. Really, who the heck has five kids these days? What’s wrong with me? What did I ever do to deserve this?

8. Total Insanity

You walk into your blood test feeling 100% insane. The last two weeks have made you question everything about your mental state. You tell yourself, like you did that first day, that it’s (still) out of your hands. You also tell yourself that you’ll be okay no matter what the test reveals. But you won’t be. You didn’t get into this to get a negative. You want out of this cycle of insanity so badly. If that test is negative, you’ll relive these two weeks again. And each time will pluck more bits of yourself from you.

--------

At this point I've hit stages 1-7, bouncing back and forth between 2 and 3 for a few days this past weekend. As we approach Friday's blood test, I'm gradually building up to stage 8. 

Yes, I have tested. This morning. And it was negative. It's not looking good at this point for The Lone Ranger.

May 2017 - FET #2, Neupogen Infusion (Last Week) & Transfer Tomorrow

This one jumps back in time about a week and is a bit up-close-and-personal.  Just a warning for those who prefer not to read about my plumbing.  I'm documenting this in a bit more detail because it's not a very common procedure, and there are others in my IVF network that have been interested in how it works and what it's supposed to help.

Earlier in this cycle, I wrote about the Neupogen infusion option that my RE recommended we try, depending on the results of my first lining check.  Neupogen is a liquid medicine that stimulates the growth of healthy white blood cells.  It is often used in cancer treatment to stimulate bone marrow production of white blood cells in someone whose immune system has been weakened.  How does this apply to my uterus?  Good question!

Both the Neupogen and the Plaquenil were changes to my protocol which would help address undiagnosed issues with immunologic implantation dysfunction (IID).  There is a lenghthy 3-part explanation of IID that can be found here, and if you're into that level of detail, go for it!  The short version is that there are a few different ways a uterus might reject a healthy embryo.  The common underlying response is an immune response that either prevents implantation or attacks the embryo as it tries to implant.

There's a set of tests one can take to prove the presence of one of these factors, however, to head that off, my RE simply added the Plaquenil (to head off any autoimmune causes) and the Neupogen intrauterine infusion, to stimulate the production of the welcoming and healthy, welcoming, embryo-friendly white blood cells in the lining of my uterus.  Doing these two things have little to no negative effect, and have the potential to offset any existing IID issues.

At my first lining check, he reemphasized that there is no evidence (like a thin uterine lining) to indicate I need the Neupogen infusion, but in the spirit of doing everything AND the kitchen sink, he recommends trying it because it could only help things.  I agreed.

I was to go get the prescription filled ($389, since my prescription coverage doesn't approve this use of the drug) and bring the medicine for infusion ~3 days before starting my progesterone. So last Tuesday, I marched into the office with my chilled Neupogen in hand, in the bulky bag I got from the pharmacy. My doctor tore open the bag, and inside was an orange plastic pill container container of a larger than normal size. Inside that was a plastic bag, and inside the plastic bag was a teeny tiny vial of liquid. "Is that it? Well, that was anticlimactic!" I said. "Yeah, you'd think for that price there'd be gold flakes floating around in it, right?" Dr. S chuckled. 

Similar to the transfer procedure, after positioning a speculum, he used a syringe and a small catheter to infuse the medicine through my cervix into my uterus.  I stayed flat on the exam table for ~15 mins afterwards to ensure the medicine had time to sit in place, then it was done!

7 days after the infusion -- 21 estrogen pills, 2.6 estrogen patches, 14 Plaquenil pills, 5 progesterone IM shots, 2 sub-q Lovenox shots, and 2 acupuncture sessions later -- we are now at the eve of our transfer, which is scheduled for 12:15pm, Wednesday, May 3.  It is a special day because one of my closest IVF friends had her transfer on that day 2 years ago, which led to the birth of her twin girls.  Good vibes right?  Let's hope so.

For the moment, I feel somewhat at peace with what is going to happen.  Maybe because we don't have the 24 hr genetics this time and already know The Lone Ranger is normal.  Maybe because we've done this once and it's not as new and scary.  Maybe, as Michael put it, because all our chips are on the table, our cards are shown, and we've done everything we can to make this hand a winner...we just have to wait for the river.  We have thrown everything and the kitchen sink at this transfer.  No regrets.

This feeling of peace may very well disintegrate into anxiety and impatience over the course of the 9 days of waiting following transfer.  The goal is to hold out on POAS (peeing on a stick) as long as possible.  Last time the false positive threw me for a loop, and testing starting on day 6 was in fact more stressful than waiting.  That said, it's incredibly difficult to think that you're flushing potential evidence of success down the drain...

In the meantime, we still need TLR's thaw to go well tomorrow, and we need the transfer to happen according to plan (i.e. no peeing on the doctor with my full bladder).  A little ironic to start out terrified about peeing, then over the course of a few days it's everything you can do NOT to pee on something?

That is the question...

May 2017 - FET #2, Plaquenil Pills & PIO Reaction

Today is day 17 of the estrogen (aka: Estrace) pills and patches combined with the hydroxychloroquine (aka: Plaquenil) pills, which is our new addition for FET #2 protocol.  The estrogen combo of pills, 3x / day, and patches, whcih change out every 3 days, is pretty easy and routine at this point.  The Plaquenil is a pill 2x per day, and it's not much fun.

First, Plaquenil is meant for treating malaria (irony!!), lupus, rheumatoid arthritis, and other kinds of autoimmune issues.  It has some common immediate side effects, which I can vouch to, including nausea, loss of appetite, exhaustion, and headaches.  The estrogen pills/patches already induce this kind of reaction in me, so the Plaquenil has just upped the ante this time.  It also has some scary longer-term side effects, like "irreversible damage to the retina of your eye."  Yipes.  Thankfully this is typically the case with longer-term use to the tune of years vs. the weeks that I will be on it.

Some mornings I wake up and all I can focus on is whether or not I might vomit.  This lasts sometimes until about lunch time, then often presents itself again around dinner time.  Delightful, right?  It's days like these I am so incredibly thankful to have a job that is flexible and allows me to work from home, in my pjs, mere feet from the bathroom.  It has gotten better over time, but the first ~2 weeks or so was a bit rough.

On day 14, I started progesterone intramuscular shots (this time in ethyl oleate, not sesame oil), and tonight, I added in the blood thinner (Lovenox).  If you've been following along exceptionally closely, and have a memory like a steel trap, you might say, "Wait, why did you switch progesterone oil types?"  Well, let me tell you.  (More likely you didn't notice, but go with it...)

Flashback to FET #1 (queue the harp music):

After about 10 days on the sesame oil version during FET #1, the space between my alternating injection sites developed half a dozen large welts that were like enormous mosquito bites.  This is essentially the centralized area around my upper cheeks and lower back around my waistband.  I asked Michael to look at it, and since they weren't around the injection sites, more in between them, our first thought was that I had somehow gotten bitten by something while sleeping.  A couple of days later, it had only gotten more swollen and itchy, and I called the nurse, who called me in for a quick visit to have a look (at my butt...for the record, minimal modesty remains at this juncture).  She said, "Yep, that's a reaction to the sesame oil...poor thing, let's switch you over to ethyl oleate."  She says that, when injected, the oil spreads with the direction of the muscles in the area, and she's even seen women with these lumps that spread down their cheeks and upper thighs.

Turns out that the progesterone in ethyl oleate needs to be compounded, and there are only a couple pharmacies in the area that do that kind of thing.  This came up once before with the progesterone suppositories (vaginal) during my second pregnancy.  My nurse was able to call it in that morning and it was filled by lunch time, giving me the chance to switch over for the shot due that evening.

Flash forward to today:

It has taken about a month for the itchy lumps to dissipate.  Much longer than I expected, and I was starting the FET #2 round of PIO shots just around the time my backside was returning to normal.  So far, the ethyl oleate PIO hasn't caused that reaction, but since the first reaction didn't start until 10 days in last time, I'm keeping an eye on it...awkward angle though it might be.

April 2017 - FET #2, Everything and the Kitchen Sink

90% of IVF (or trying to conceive, aka "TTC" if you're in the know) is waiting.  And a substantial part of the waiting is waiting for your period to either come or not come.  Aunt Flo, The Red Barron, Cycle Day 1, The Crimson Tide, whatever you want to call it.  More often than not you're waiting on it to come or not come.

After stopping the progesterone (and estrogen, but really it's the progesterone that does the trick), it was going to take anywhere from 2 days to 2 weeks for my cycle to start again.  That's delightfully awful forecasting, right?

And the longer it took, the more the denial gremlin whispered in my ear that maybe, just maybe, there would be a miracle and Schrodinger would work things out.  They would write medical journal articles on me and my miraculous pregnancy...  The only way to be certain it failed is if my period came, and it hasn't come yet, right?  Cough..cough...

Ultimately it was Wednesday, 5 days after the day I stopped meds.  I cried again.  I know, you might be growing tired of hearing about how much I cry, but it was the final confirmation of failure for Schrodinger.  It was most definitely over now.  Plus, if we really were serious, it meant we would be getting started on FET #2 very soon.  I was to call in and get an appointment right away for an ultrasound and blood test during my first day or two of my new cycle.

"Wanda", my hot lunch date.

I called and set up a date with "Wanda" along with a blood test.  I went in on Thursday, April 13, and saw my own RE for the first time since the news of the failure.  He walked in and said, "Hey there, how are you holding up?"  He was still disappointed, I was trying to hold it together, but I just squeaked, "Not so well, but I'm ready to go again."  He gave me a big hug and let me cry into his scrubs for a moment.

I asked if there was anything else we could do.  I would stand on my head indefinitely after the transfer, if he thought that would help.  Let's throw the kitchen sink at it, please...as long as we aren't doing any harm, I want to try everything.  This is our last normal embryo.

He said he'd think about it, look at my blood tests, and consult a couple of the other doctors at the practice if there was anything else we could try without hurting anything.  The one thing he could think of was taking a longer-term steroid (Plaquenil) for the full duration starting with the estrogen, instead of a short term predinsone for the few days right around the transfer.  Later the nurse called and said he was also considering something called Neupogen, which would be an infusion into my uterus before starting progesterone to help the lining be extra sticky.  The Neupogen would be a decision made after my first lining check, and would depend on how I am progressing.  Trying to learn more about this one before the time comes...

Overall, the message was that I am clear to start estrogen pills (Estrace) and patches (Minivelle), as well as the Plaquenil, on Saturday.  This puts my Progesterone starting on April ~28, and my transfer on May 3.

It's amazing to think that two years ago, we were only just about to start trying with Clomid, and here we are approaching our 9th IVF-related procedure.  Back then we called IVF the "nuclear option", not to be confused with what just happened in government recently.  It really did seem like the big guns at the time.  I guess it's true what they say...

April 2017 - FET #1, The Beta

Starting Tuesday evening, my friend Katie came to stay with me and give me my progesterone shots every evening (as well at eat ice cream and watch TV, slumber party style!).  It was wonderful.  We've been close friends since elementary school, and are essentially sisters from different parents.  She lives and works about 50 miles from my house, which was really out of the way for her, but I was so glad she was willing.  There was no way I was going to be able to do my sesame oil progesterone shots comfortably on my own.  Plus, the craziness of the waiting gets exponentially worse when I'm alone.

After Thursday morning's pee test (8 days past transfer), I had a rough day.  I was beginning to think this wasn't going to work.  The chances are getting slimmer.  By this point, the pee sticks I use should be ~80% accurate.  Katie was at work.  Michael was in meetings back to back all day in Vegas.  I was feeling alone, frustrated, and fairly certain this was all about to fail.

I was sick of Netflix, of TV, even of air conditioner.  I went outside and sat on the back porch in the sun.  It was really a beautiful spring day.  Light breeze, birds singing.  I cried quietly.  I needed to let it out...all the anxiety and pent up emotional investment in this effort.  This transfer was half of our embryo inventory.  We got good news on the genetics, and all my measurements were good...why is this not working yet?

The waiting is torturous for me.  Flashback to the Friday before my transfer, when I saw a substitute acupuncturist.  The lady I usually see was on a well-deserved vacation.  The lady subbing in was from the Katy clinic, and had a more Buddhist approach to things.  She asked how things are going...and at my clinic, they mean symptoms and general mental state.  I was stressed, the transfer was less than a week away, and I was just so worried it wasn't going to work.  The exhaustion of the whole 18 month process was catching up with me, and I was just so exasperated with it all.  I either wanted to be able to do more to make this work, or I wanted to jump to the end and know what's going to happen already!

She sat back in her chair, smiled, and said, "You know, you have a strong warrior spirit!"

"Is that a nice way of saying I'm an anxiety-ridden control freak?" I said.

She chuckled, "Hahaha, no! You are strong, and that's why you've lasted this long.  Many do not.  I probably wouldn't."  She gestured at my chart and the long history of what I've been through.  "You're a fighter.  Try to remember, your 'higher self' -- some people refer to your higher self as God, but I say 'higher self' -- is doing all of this for you.  This will continue to make you who you are meant to become.  Your higher self is doing this FOR you, not TO you.  The outcome will be what it will be.  It's already in motion.  You are doing everything you can already. Try to find peace in that.  It helps sometimes to think of this as your journey to who you are meant to be."

I teared up...she was right.  It was going to be what it was going to be.  After the needles were placed, she turned on the usual music, and left the room.  My mind started to drift.  I thought of being a child and visiting Colorado in the winter time.  There are times in the deep of winter when it's exceptionally cold...-20F cold.  We would wake up early, and the valley would still be in shadow.  The cabin would be warm, but the minute we left and loaded into the old yellow Scout, my brother and I would shiver in the cold...it felt uncontrollable.  So cold.  Why were we doing this?!  It was so warm in the cabin, under the covers with the scratchy electric blanket or in our slippers by the fire.  Now, my entire being, every muscle was fighting the cold.  My father would tell us, "Just relax.  Take a deep breath, and relax into the cold.  You'll warm up and it will be fine."  It seemed impossible at first, but inevitably, we would take that deep breath of cold air, let it out very slowly, and focus on relaxing every muscle.  It would always work.  In a few moments, we would feel less cold and more in control of our little bodies.

In the acupuncture room, I'm under a heat lamp with a blanket on my pincushion legs, but I took a deep breath and let it out slowly, relaxing into the anxiety...into the stress.  And again and again...it helped.  It was going to be what it was going to be.  I'm doing everything I can.

So fast forwarding to Friday morning.  The morning of the blood test.  I got up early and peed in my little Dixie cup.  I was scheduled for the first appointment slot of the day, so hopefully there would be no delay in my results in the afternoon.  I nevertheless wanted to test before I went.  There's still a part of me that longs for some normalcy in this process...finding out in private vs. from someone else over the phone.  I've had plenty of that with all the embryo growing updates.  No offense, Michelle.

I dipped the final test in the box and counted to 5 elephants.  I waited.  I was stunned.  I could see something.  I held it to the light.  It was THERE!  I waited and it got a little darker.  The adrenaline was coursing through my veins and goosebumps were rising on my arms and neck.  It was a feeling of shock.  I cried happy tears and called Michael.  "It's positive this morning!  It's barely there, but it's POSITIVE!  This really might work!"  It was 5:45am in Vegas.  He was exhausted, but moderately happy.  He still didn't think I should be testing, but I wanted him to be the first one to know.

I ran down the hall with the test and caught Katie as she was finishing her shower.  I told her and we had a jumping up and down, super excited, tears rolling hug.  We had stayed up late the night before and I had shared my frustration and fear of nearly certain failure, but now there was evidence that this might be working.  ANY sign of a second line can be considered a positive, and she saw it, too.

I know, it's barely there, and you almost have to not look directly at it to see it.
It was darker in person, it did not photograph well, and ANY sign of a second line is defined as a positive.
It's okay if you think I'm crazy, but I did in fact have witnesses! 

I left the house with my pee stick (in a sandwich bag) in my purse and headed to my blood test.  I was feeling good about it for the first time in a few days.  I knew it might not be enough.  It could be a chemical pregnancy, given how late and light the line came in.  At least I had some confidence that there was something there to actually measure...

The call came in at 1:45pm.  Since I was feeling pretty good, and since being alone sounded pretty awful, I had gone to lunch and out to an arts festival with, Kim, one of my mother-in-laws.  The phone rang and I stepped to the side.  My nurse had a dismal tone in her voice.

She said, "I'm so sorry, Kelly.  The test came back negative."

"What?  There wasn't anything?  Zero?" I couldn't believe what I was hearing, surely there was something there...even if it is indeed bad news.

"Yes, I'm afraid so.  Dr. S says you should stop your medications.  He likes to call his patients after these tests, so he will probably be in touch later this afternoon.  He will help walk you through it and what might have happened."

"Okay.  Thank you." I said and hung up. "Can we go home now?  I don't think I can be here now.  I thought I could, but..." I explained to Kim.

We walked out of the nearby gate, and found a bench where I could sit and call Michael.  He was as devastated as I was, and asked if he should try to come home sooner...he could skip meetings and get on the next flight if he left right then...I told him no and that I would be fine until he got home.  Stick with the plan, we knew this was a possibility, and arriving home at 6am the next morning was good enough.

Kim drove me home and she and Jimmy, Michael's dad, stayed with me the rest of the evening.  It was nice not being alone.  There were two things I needed to do.  I needed to hear what the doctor had to say, and I needed to do one more test to be sure.  My eyes were pink and swollen...so much effort, pain, and money just resulted in failure...but I couldn't help but wonder which result was false.  I had heard of false positives on the pee tests, but knew they were very rare.  Before I stopped all the medicine, which was the life support for my embryo, I had to test one more time to be sure.  I drove to CVS and Dr. S called on the way.

He said there was nothing we could blame it on.  No reason he could see that it wouldn't or couldn't work.  "Just more shitty luck," he said grimly, "Everything looked great, the conditions were perfect, but there is always a chance it just won't stick, even for normal embryos it's still a bit of a coin flip for single embryo transfers.  You did absolutely everything you could.  I can tell you, it was a bummer of an afternoon in the office today.  Everyone was rooting for this to work for you guys and they are feeling this with you."

He said the only other thing he might consider is that the 24hr testing might have put some extra stress on the embryo.  "There's no data or science to support that really, I just know I've done 5 of these in the last couple of weeks, and none of them have panned out.  It was the right thing to do to test it, and if we hadn't tested it and it failed, we would probably think it was abnormal.  Unfortunately there are no easy choices or answers in these things.  What this does do, is give me some good confidence in our second embryo, which was tested normal before freeze.  If you and Michael are ok, I'd like to see us try that one with your next cycle.  If you need some emotional time off, that's perfectly fine and won't hurt anything, though."

I told him I would talk with Michael when he got home and get back with him later on what we decided.  Part of me knew instantly that an extra month (or months) of waiting to give ourselves a break wouldn't really be that restful.  We would mourn this loss longer, and we would live with the anxiety of the next big question mark for longer.  While jumping into the second (and very likely, final) FET was scary and gut-wrenchingly painful, at a bare minimum, we would have a resolution in the end.  We'd have an answer to the 18 months of trying this path and to everything we've worked for thus far.  In the cast of failure, it would at least be over and allow us to move on to another option.  I was fairly sure I knew what I wanted to do, and nearly certain Michael would support that decision.

When I got home with Kim and Jimmy, I excused myself to take the test.  I used my Dixie cup and took two different styles of test.  They were both negative.  I was ready to stop the medicine.  There was nothing more to negotiate or fight.  My warrior spirit had been defeated.

I didn't set an alarm, but woke up about the same time Michael's flight touched down.  There was a car hired to pick him up from the airport so I didn't have to, but I met him at the garage when he arrived at the house.  It was hard, and it was a long morning of crying and talking through it all before we slept.

We had rolled out the hormonal red carpet for him, but Schrodinger was lost, and we had to decide if/when we were ready to move forward.  I was still in some level of denial and grief, but knew that in the end, he wasn't meant to be our son.

Yep.  Pretty much.

April 2017 - FET #1, The Waiting...Pregnant Until Proven Otherwise

Michael and I have lamented on a few occasions that the path to having kids will never be normal for us.  During my second pregnancy, which ended in miscarriage like the first, we were already feeling the egg shells beneath our feet.  Every blood test, every scan, every step felt precarious.  We have joked that we can relax when the baby is finally born, which then, we won't get to relax for the rest of our lives!

The waiting period from transfer until beta (HCG blood test to confirm pregnancy), started off fairly easy.  We left the operating room with the wonderful status of "Pregnant Until Proven Otherwise!"  We coasted on the good vibes from the normal genetics test on Schrodinger, the flawless transfer, and my wonderfully thick and healthy uterine lining.  Everything felt good for a few days.  I was determined to ride this feeling out all the way to my blood test and NOT try to do an at-home pee test (POAS - Pee On A Stick) at home.

Indeed.

Michael was due to leave town Tuesday evening for a work conference in Las Vegas.  Not something he could reschedule, and something he really shouldn't miss for his new role.  I started to get the itch to POAS around Sunday.  I polled an IVF group on Facebook...  Let me clarify, if you haven't already noticed, there's quite a bit of fertility lingo and acronyms, here are a few I'll use now:

BFP = "Big Fat Positive" referring to a positive pregnancy test

DPT = "Days Past Transfer"

POAS = "Pee On A Stick"

beta / beta test = HCG blood pregnancy test done at clinic

As you can see, a majority of this group was able to get a positive POAS test
by 6 days past their transfer of a 5-day old embryo

Granted, this isn't a full-on official set of data, just the ~100 or so ladies who responded, but 100 ain't bad to get a feel for what to expect.  And more than half of them were able to get a positive POAS test at home by the 6th day after their transfer of a 5-day old embryo.  For me, 6 days past would be Tuesday before Michael needed to leave for Vegas.  Hmmm...  Additionally, it's still possible, though not likely to get a positive test all the way out to 10 days past.  My beta was scheduled for 9 days past, so thankfully I wouldn't have to wait that long.

I will say, Michael didn't want me to test.  He said I would just then be stressed about the levels going up, and the next step, and the next step.  Why not just relax?

I couldn't help thinking I was peeing evidence of success down the drain every morning.  Tuesday morning, I tested.  Now, I've done many of these tests over the 3 years we've been trying.  I've researched which ones have the best sensitivity and figured out my own POAS tricks.  My process goes something like this:

Kelly's Pee On A Stick (POAS) Methodology

1. Try to use morning pee, better concentration of hormones (I know, ew...)
2. Use a little cup to collect your pee; enough to run a couple of tests, if needed.  Think a small plastic Dixie cup.  If you get a questionable result or it doesn't work right, you won't be stressed out downing Gatorade until you are able to pee again.
3. Don't overfill the cup.
4. Dip the stick into pee cup for the instructed amount of time on the POAS box.  It varies.  Read the instructions.  Put the cap back on the wet end.
5. Lay the test flat.  Under good light...really good light, because you're NOT going to be able to NOT look at it.  I promise, you might find yourself not breathing.  Breathe.
6. Check the box again to be sure you know how long to wait...usually 3 mins, but you never know, and in the moment, you will forget, even if you looked at it two seconds before.  Set a timer, if you're really worried.
7. Lift pee stick, keeping it flat, and focus on the little window...is there a second line?  Maybe if you move your head around and look from an angle?  You might look a little like a crazy chicken bobbing your head around this stick, but don't worry, we all do it.  The new curved sticks are awful for angle viewing.  Whoever redesigned it that way should be slapped repeatedly.  
8. How long has it been?  30 seconds?  Jesus...Breathe.
9. Try to do something else.  Wash your hands.  Play a game on your phone.  Your eyes are still on the test.  Breathe.
10. Ok, it should show something by now.  All of my positive tests showed after only about 20-30 seconds, at least faintly.  But I always give the negative ones the full time.
11. When I'm fairly sure it's negative and the second line is non-existent, I make myself walk away.
12. You return about 10 mins later to check again, maybe under a different, brighter light?  Nope.
13. You throw it away.  You don't want to look at it anymore.
14. 20 mins later, you dig it out of the trash and hold it up to the light, just under your nose to be sure.  You know the results are technically not valid at that point, but if it shows ANYTHING, then maybe you should use your Dixie cup and a different test, right?! 
15. Inevitably, in my experience, the test just goes back in the trash.  As I said, the few positives I've gotten have shown up early, regardless of now faint they are.  Sigh...
16. Calculate how many sticks you have left and when you could / should test again.  Maybe by tonight?  Sometimes 12hrs is enough, right?

Last Tuesday morning, the test was negative.  The above list was my routine.  I was ever so slightly more stressed now, because most of the ladies in my unofficial anxiety poll would have already had a positive pee test by now.  Not to worry! I thought...maybe tomorrow.  I was feeling cramps pretty regularly, which is a symptom of implantation.  With every twitch, cramp, and twinge, I can't help but feel like it's definitely happening.

And I proceeded to test every morning until the morning of my beta (blood test)...and sometimes in the afternoon.  Maybe Schrodinger is just procrastinating?  Google search, "How late can an embryo feasibly still implant?"  Ironically, Schrodinger is still living up to the name...it was going to come down to the last minute to find out if the cat is alive or dead.

Pretty mush, yes.

April 2017 - FET #1, Progesterone in Oil Shots

For those who are curious, the progesterone shots are different from the other shots I've taken up to this point.  All the stimulant medicines, trigger shots, blood thinners, etc. have all been subcutaneous injections, meaning they are administered by pinching some fat (usually on the stomach) and injecting the fluid through a short, small needle into the fat.  If you're ever in a tight spot and need a tutorial, follow the link above for a demo!

Progesterone shots are intramuscular shots.  The medication needs to be injected into the muscle for proper absorption and/or time release.  The needle is longer.  Most sub-Q needles I have used are an inch or less, whereas my progesterone in oil (PIO) needles are 1.5 inches long.  Here are a couple videos Michael and I found hugely helpful as we got ready to start these:

Progesterone in Oil Overview

PIO Injection Placement

This lady rocks.  Very practical and frank about it, and it helped us get over the nerves of doing this injection.  Thank you, Nurse Linda!

The progesterone itself is mixed in an oil solution.  In my case, it's a sesame oil, but there are other options out there.  When I look at it in the vial, it looks a bit like it has the consistency of a thin cooking oil, but when I go to draw it into the syringe, it's a tug of war exercise.  Now, they key to drawing any liquid out of a vial is to put some positive pressure into it to the same tune of what you are aiming to get out of it.  My dosage for PIO is 2mL, so I push 2mL of air into the vial as I go in to draw the oil out.  It still takes about 20-30 seconds for it to slowly fill the syringe to 20mL...and that's after I have heated the oil in the vial to make it as runny as possible.  Feels like trying to drink maple syrup through the world's tiniest straw.

I've now got a routine with my microwave heating pad.  The heating pad serves two purposes, warming the oil and soothing the injection site afterwards.  I heat it for a couple minutes in the microwave, then tuck the PIO vial into it while I give myself my Lovenox shot (sub-Q tummy shot), then with the oil warm, I fill the PIO syringe.  I tuck the syringe back into the heating pad and husband and I assume the position for the shot - me lying down on my stomach, him standing above.  He cleans the spot with an alcohol swap, takes the warm syringe and quickly (which helps a lot) pops it into the muscle.  It takes about 15-20 seconds to squeeze the oil back out of the syringe and into my muscle.  Surprisingly, when done in the right spot and even as he's squeezing the oil in, there's very little pain, and mostly just pressure.  Feels like someone is poking you with a plastic stick.  When it's empty, he recaps the needle, rubs the spot for a little while to distribute the oil, then applies the heating pad.  I lie there for about 15 mins with the heat and then I'm done!  The soreness comes in the next day, but it's similar to a flu shot or sore muscle from working out...not debilitating.  Alternating sides gives one side a chance to rest a little each day.  So far this has been working very well.

Damn right!

So, I tried it solo for the first time last night.  In the beginning, I stabbed myself, no problem!  But then as I strained to push the oil in, I was shocked at the resistance, even with the warm oil.  I ended up pushing hard at a funny angle on the syringe and making it pivot in place, which was not pleasant.  (Pause for cringing...yes, it hurt)  Remember, these are in the lower back / upper butt area, so not the best angle for dexterity from the get-go, but in the end, Michael had to finish the last 1mL.

You may be wondering, "Why on earth would you try to do it yourself if Michael's so good at it??"  Right you are, however, the reason I tried to do it myself last night is that Michael is leaving town for a business trip and will be gone for the Tuesday - Friday night shots.  He seriously debated staying, but really and truly, this is for a conference for his new promoted role, and he needs to go on this one.

So after the rocky solo try, tonight my best friend since 6th grade, Katie, is coming over to help give the shot and stay the night.  Come for the needles, stay for the slumber party!  While I am feeling brave about having done it at least in part last night, and know I could probably improve tonight, it's quite a relief to have someone here with me.  Thank you, Katie!!!  You're really (literally) savin' my ass!

Here's hoping for many more weeks of these!!!

April 2017 - FET #1, The Test & The Transfer

The weeks of lead up to transfer went by slowly.  I started the estrogen on March 8 (pills and patches), then took my first progesterone in oil shot (in the upper butt...think love handle area) on March 23.  Michael has been giving me those every evening since, partly due to the awkward angle and partly due to the 1.5-inch needle that has to go into my muscle in order to do it successfully.  He is really good at it, and I rarely feel much more than just pressure.  There's definitely residual soreness.  Kind of like a flu shot is, but in your lower back.  At this point (11 shots in as of Apr 3 morning) the dull ache is pretty evenly distributed on both sides.

The Monday before transfer (March 27), I started Lovenox, which is a blood thinner.  It's politely packaged in a pre-loaded syringe, and it even has a nifty little safety mechanism which pops out and covers the needle after you've given the shot.  The first one went fine.  I gave it to myself, since it was a stomach injection and those are no big deal anymore.  Then it hit.  About 1-2 mins after the injection, it stings like a bee sting.  Weirdest thing.  After about 10-15 mins, the sting fades away.  Lovely.  Michael and I had just joked the night before about which we would prefer...a shot like the progesterone, which doesn't hurt much when being given, but leaves sore muscles for a couple days after, or a shot that hurts while giving it, but then after that not at all.  Well folks, I have a bit of both worlds!  And if this transfer is successful, we will keep going on both of these until 10-12 weeks of pregnancy.  Here's hoping for lots more shots!

The transfer was scheduled for March 29 and we were told to arrive at noon.  The day before, I added in prednisone (a steroid), which is supposed to help encourage the embryo to stick.  I also had a special pre-transfer acupuncture appointment.  As I sat in the dark with the tingle of the electro-stimulant machine tickling my lower abdomen, I thought about Schrodinger, our target embryo for this transfer.  From what they told me on Monday, Schrodinger would be thawed (defrosted?) on Tuesday morning, sampled for genetic testing, and the sample sent off to the lab for 24-hr turnaround results.  They said the lab would call if something bad happened, so no news was good news.  My brain was cycling on this as I laid there in the dark listening to zen music.  Was Schrodinger ok?  Would he/she be normal?  Could I cope with it being abnormal quickly enough to turnaround and be positive about having to thaw and use The Lone Ranger instead?  Ugh...why does time go so slowly?

I was worried about Schrodinger, but was assured by my nurse that we would get a call the morning of the transfer with the results before we had to come in, so we could deal with it in private if we needed to.  Sometime between 9am and 11am Michelle would again call.  This was a small blessing.  If it was bad news, I didn't want to find out when we were already there.

I didn't sleep too soundly the night before, but that's pretty routine for me when it comes to these procedures.  Too much to think about, too hard to relax.  I woke up around 3am and couldn't go back to sleep until 6.  Michelle called at 9:48am.  Schrodinger tested NORMAL!!!  Such amazing relief!  I laughed and cried, she was so happy to give us the good news.  After hanging up, all the tension about this step released and happy tears poured down.  Michael was thrilled.  The good news made facing the imminent transfer so much easier.  I started chugging water (full bladder required for the procedure) and hurried to shower and get dressed so we could get down there and put Schrodinger IN!  

Of course, the day of transfer was a day of thunderstorms and tornado warnings.  We left a little time to spare, but this isn't the first time we've been heading to Piney Point (just west of the Galleria area) in a storm.  We got there in plenty of time, checked in, and for the first time, they brought Michale and I back to the prep room together.  We changed into transfer attire.  Michael wore a lightweight, white jumpsuit and hair net (sorry, he wouldn't let me take a picture), and I wore a hospital gown and some big, warm, fleece-lined purple socks.  The acupuncturist said to keep my feet warm...warm feet = warm uterus.  I took a 800mg ibuprofen they had prescribed when the nurse gave me the go-ahead.

Our RE came in and gave us both a big high-five.  We were due for good news, he said...it was about time!  He walked us through the procedure, asked me how my bladder felt, and said we'd get started soon.  All 3 of us were smiling ear to ear the whole time.  It was at this point he gave us a photo of our lovely, little, hatching Schrodinger, looking awesome and still thriving in the dish.

Schrodinger, hatching.  The part that will hopefully become the fetus is the dark black blob.

He left, and it wasn't long before the nurse came to escort us into the operating room.  I had been in this one at least once before, maybe twice.  It's hard to keep track.  I assumed the position on the table, and they deployed the leg braces.  It was so much better with Michael there.  We were both happy, he held my hand, I didn't have to be IV-ed this time, and before too long, our embryo would be where it's supposed to be! 

I've heard it said, "Well, it takes 2 to make a baby!"  In our case, on March 29, it took 6, thankyouverymuch.  Our RE, the ultrasound tech, the embryologist, his assistant, and of course, Michael and me.  I asked our RE if anyone had ever peed on him during the procedure, he said, "Not yet."  "Oh, so I might be the first, eh?  Also, where's the Barry White music?"

The ultrasound tech, a tall guy named Nate, pressed on my bladder with the device until he could get a good picture of my full bladder and, below it, my uterus.  Lining over 14mm.  Last measurement was March 17, when it was over 9mm and they were happy enough with the progress not to require measuring it again until the procedure.  Our RE positioned the speculum and then a small tube to open my cervix.  Similar discomfort to a pap smear, really, only a bit prolonged.  He said, "This will seem anticlimactic, but in a minute, the embryologist will bring in your embryo in a small tube with some fluid, I will position that tube in your uterus.  Then if you blink you'll miss it, I'll push the embryo, some fluid and a few bubbles into the far corner of your uterus."  Nate was looking at me with some level of concern, as he was still pressing firmly on my full bladder.  Perhaps he took me at least partially seriously about the peeing...  "Don't worry, Nate, I'm ok, do what you've gotta do to get a good view," I said.

Sure enough, a few minutes later, we saw it happen.  I couldn't feel anything special or unique about it, but there it was.  The embryologist took the tube back into the lab to check it under a microscope and be certain Schrodinger had been evicted (the embryo is smaller than a grain of salt at this point, so good to check thoroughly to be sure...it is an expensive little thing!).  He confirmed back a couple moments later. "And we're done!"  The whole thing lasted about 20-30 mins.

This is a tough one to decipher, but here's the ultrasound scan of the embryo after having been placed in my uterus.  There is a small white arrow (near the center of the image), which points at the little white mass.  Please don't worry if you don't see it.  We were there listening to the instructions and watching it in live motion, and it was pretty challenging to see.

Large black oval in top right is my full bladder, below the white horizontal streak is a small white arrow they added.
It points to the cluster of bubbles and liquid that contains our embryo after it was placed successfully in my uterus!

We told them all thank you as I was transferred to a gurney and moved to the recovery room.  I was to lie there for 15-20 mins, full bladder...giving it time to settle in, I suppose.  At that point, the nurse allowed me to put my clothes back on and escorted me to the restroom.  Michael signed the discharge papers and took me home.  It was a little before 2pm when we got in the car and headed out.  It all seemed so easy and brief compared to an egg retrieval and strange to be fully conscious and un-drugged after a procedure!

As usual, now there's just the waiting.  I'm pregnant until proven otherwise!!  I'll keep up with the shots, pills, and patches through Friday, April 7, when I get to take a blood test to see if the embryo has taken the opportunity to hang on for the next step.  Hopefully we get to keep going from there.  

Thank you to everyone continuing to root for us and for Schrodinger! 

March 2017 - FET #1, Like jumping out of an airplane

Wednesday, March 8, I began the medicines for our Frozen Embryo Transfer (FET).  This was preceded, as usual, with a baseline ultrasound and blood test on March 3 to be sure my body is ready and the customary prescribing and ordering of medications, which arrived in a FedEx box on the porch with a heavy thump.


I was working from home to be sure to be there when it arrived and our office is right next to the front porch.  My heart sank when I heard the thump.  That whole day, I had felt uneasy, and that sinking feeling when the package arrived affirmed that I really wasn't ready for all of this.  I felt guilty and sad.  Since we kicked our infertility battle into high-gear with IVF about a year and a half ago (when we got tested and diagnosed), I always thought this part would be exciting and hopeful.  I'm feeling none of that.  On the contrary, I've been feeling dread and anxiety over the choice.  In fact, since coming back from my business trip in early February and scheduling the official date of transfer (March 29), there have been several moments of doubt and internal renegotiation about what we are about to do.  A psychological fight-or-flight response to my fear of all of what we've done so far failing and my fear of giving up on my ovaries.


The past couple of months and particularly the last few weeks have been as hard for me as the hardest weeks of 2016.  It's been as hard as when we went from 5 to 1 embryos in round 1, as hard as when we had completely failed rounds (rounds 2, 3, and 5), and as hard as starting round 4 after so much bad luck and lack of success.  And I hadn't even started the transfer protocol / medicines yet...literally only the date has been scheduled and I haven't even started the uphill march yet.  I kept thinking, "It could be rescheduled in a heartbeat.  Why am I feeling such panic?  Shouldn't I wait until we get started to freak out?"


The feeling has moved from terror to panic to depression to cautious hope and back again a multitude of times.  Starting the medication has helped a little.  There's some amount of commitment and action in taking my estrogen pills and applying and wearing the estrogen patches.  When I went in for the March 3 baseline check, my scan was done by the other RE in the office (not my usual one, but one I see fairly often).  He asked how I was feeling about getting started, and my reply was, "Terrified."  He chuckled and said, "Well, it's been 3 years...time to jump out of the airplane.  It gets easier once you're through the door, plus you can't ride in the plane forever."  While an odd metaphor for IVF transfer, I get his point, and tentatively agree.


I'm now a week into the estrogen patches and pills.  The patches are stickers the size of a quarter that I stick below my belly button and replace every 3 days. So far, I've found they don't stick too well on their own, and need an additional tegaderm / sticker / dressing on top of them.  Other than that, they've been pretty easy. The pills (Estrace, 2mg) are the same ones I've taken in the past for estrogen priming.  They dissolve under my tongue (as opposed to swallowing them), and they have traditionally caused some pretty heavy nausea for me.  Previously during retrieval rounds, I only took 1x day, but now I'm taking them 3x daily - 6am, 2pm, and 10pm.  It hasn't been terrible so far, but there have been some rough days.


This estrogen course will go for 17 days before I'm instructed to add in progesterone injections (on March 24).  Those will continue (1/day) through the transfer and on until scans and tests either prove that we have failed or through the 10th week of pregnancy (sometime mid-May).  This 50-some-odd shots are to be given intramuscularly ("IM"), usually in the upper-rear / lower-back area.  So far all my shots have been subcutaneous ("Sub-Q"), meaning just in a pinch of fat / skin (usually in the stomach region).  The IM shots have a 1.5-inch needle that goes all the way into the muscle where the medicine, which is an emulsion in oil, is then injected.  This oil is fairly viscous, and has been known to cause lumps, bruises, and soreness at the spot of injection.  Getting my game face on for this part.


Overall, I'm feeling a bit better about the whole process...better than I felt during the "jumping out of the airplane" talk.  I have to admit, it was pretty rough for a few weeks.  The stress / anxiety is there because it's such high stakes for us, but the stakes are high because science is actually giving us this small chance for success.  Without this whole process, we would have next to 0 chance of getting pregnant naturally.  Still, it's hard to face the real possibility that the 3+ years we have spent working on it up to now, particularly all the effort, time and expense of the last 16 months, could realistically end in failure.

January - February 2017 - A pause, the last couple of months

I'll start by saying sorry...I've had an awful time getting started on this blog again, though I've needed quite badly the therapeutic exercise of writing it.  Several friends and family have checked in and asked how things are going, which by the way, is completely ok to do!  Thank you so much for your concern and curiosity as to how things are progressing.

After the hysteroscopy in December, the stress of the holidays, the death of my grandfather, and a 3-week long business trip, I had pretty much checked out on this process until I had to get back to it.  So much was going on that stepping away from writing the blog and thinking too deeply about the process was easier than I thought.  Almost like putting a book on the shelf.

It wasn't completely set aside and haunted me a few times, and more recently as we've started to move toward the next steps.  It was very present in mind during my grandfather's funeral.  He was 94 and the day he passed, there was record snow fall at Crested Butte, CO, arguably his favorite place in the world.  I thought back to all the time spent with him there, from the ski lessons to the fly fishing philosophy and "big" fish stories, and how my children would never get to meet him.  He was larger than life in so many ways, and his funeral reflected that with standing room only attendance spilling out into the foyer at the First Presbyterian Church in Roswell, NM.

My mother gave a touching and humorous eulogy fondly reflective the man he was.  As the oldest grandchild I stood to add to that and the tears started rolling as I faced the full church.  So many people who knew, loved, and/or respected my grandfather enough to show up that day.  I forgot my funny stories and just went with the one I could remember.  More of a theme, really.  I choked on the words a bit, but in the end, my grandfather was all about "winning".  Yet, it wasn't in the traditional binary way.  In order to win, there didn't have to be a loser.  He would always encourage everyone to do their best and to go "full-tilt", as my mother put it, into a problem or challenge.  If you gave it your all, you were a winner.  Going through life, everyone could be a winner in their own way and on their own path, and he took it upon himself to be sure everyone around him was giving it their all at all times.  They were hard words to say, given the struggle we have had these last few years.  My brother then spoke and told a perfect story about how Grandpa would always be asking, "So, what's next for you?"...always looking forward, looking ahead to what can be acted on vs. what was behind you.  So very relevant, and a habit I should practice far more often.

I departed for my business trip the same day that Michael and I arrived back in Houston from Roswell.  3 weeks away to Wales, Belgium, and Czech Republic.  It is likely my only international business trip this year and to 2 new places, so I didn't want to waste the opportunity feeling down on myself.  As Michael dropped me off at the airport, I cried.  I was already missing him.  He's my rock and I have been feeling so fragile that there was a part of me that wanted to call off the whole damn trip right then and there.  In the end, I'm glad I went.  I accomplished all my business objectives and felt in control of SOMETHING by doing so.  I met lots of people face-to-face and built relationships I had only had on the phone up to that point, which was fulfilling.  I also made it a point to get out all day during my free weekends to sight see and take on some culinary adventures.  Retail therapy is also a wonderful thing.  I believe this is the earliest I've ever been ready with my Christmas shopping list, EVER.

It was a good trip, and similar to our August vacation to California, a very helpful break from the process.  At the end, I was thrilled to be going home to see Michael, yet I felt the anxiety creeping back into my chest about finally having to make an official decision about our next steps in our fertility journey.

One of my favorite stops on the trip was an old church in Bruges with a sculpture by Michelangelo called "Madonna and Child".  It is one of only a few of his works (perhaps the only?) that can be found outside of Italy.  I read that it was sold to the Flemish way back when due to the fact that both the Madonna and Child are posed in a way with their heads tilted downward, rather than up toward God, making them less desirable.  I'm not Catholic, but I paid to light two candles, one for each embryo on ice.  I figured it shouldn't hurt to do so...no one was standing there checking for Catholic IDs (is that a thing?) and the Holy powers-that-be surely have more important things to worry about than my specific religious education as it pertains to candles.  I sat in the cold church (no heating) studying the sculpture until I couldn't feel my hands or toes.  It was January in Belgium, after all, and only just above freezing outside (and in the big stone church) that day.  It may just be me, in the baby-related circumstance in life where I find myself, but I loved that sculpture and felt sad it was "rejected" back in it's time.  I guess it's easy to be picky about your Michelangelo statues when they come so easy?  When you have so many?  I wonder if the Flemish, who purchased it at the time, saw it as wonderfully rare, prized, and special.  The downcast stares of both figures are peaceful, and their postures are relaxed.  A pair who went through the ringer to be just where they were in that imagined and rendered moment.  They were wonderfully at peace just "being" together.  My two little candles flickered in the cold, representing my two frustratingly rare, prized, and special embryos that might come so easy and mean much less to someone else.  I longed and prayed to be at peace like that, to find some form of peace in our upcoming decision.  To be ok with these two possibly being all we can get from me.  Lots of emotions, some tears, as my moment of alone time in the cold pew passed.  My cold fingers and toes led me out to find a cafe and a warm mug of hot chocolate.

Side note: I will always be able to find (momentary) spiritual peace in a warm mug of hot chocolate.

December 2016 - RE Regroup, Hysteroscopy & Holiday Hermits

About a week after the failure of round 5, we scheduled a consultation with my RE and chatted for a while about the disappointing outcome.  "Oftentimes with embryos, the genetic flaws that cause failure don't show themselves until a certain point in the repetition of cell division," he said, "and as you know, this is usually around Day 4-5 of growth.  Unfortunately that means we get situations like this where we lose a larger number of embryos right at the end."

My heart felt hollow.  This isn't at all what I had expected to happen, I was realizing.  Despite treating this round outwardly as "nice to have", somewhere along the line I allowed myself to expect it was going to work out.  We had figured out a good formula...we had a great number of follicles!  The "odds" were in our favor.  RIGHT?!

My eyes were puffy.  I had been crying off and on since the results came in.  I could easily recognize the stages of grief.  My first reaction had been denial mixed with anger and bargaining...lol.  As we chatted with the RE, I asked more questions about other options, other protocols, any other levers we might be able to pull.

Me:

"So we are fairly certain the embryos are aneuploidy.  

Are we sure we think the sperm is ok?  

We only checked it way back over a year ago...

and I heard about this other couple in our support group who had an issue with white blood cells eating away at the DNA of the sperm, 

so maybe it's not all my eggs' fault?  Maybe?  Is this something we should check?"

RE:

"I'm sorry, but this is highly unlikely, 

and how we would address it is by doing ICSI, which we are already doing.  

There's nothing more we would do, even if this was the case."

Me:

Sigh...  "Ok, how about this protocol I came across online?  

It focuses on suppression of testosterone to encourage highest egg quality.

Remember when we did round 2 with the testosterone cream and it was a terrible round?

I also stopped taking the DHEA after round 2 and 3 were so bad and our results were better.

Could this mean I have counterproductive levels of testosterone

which are negatively impacting both quantity and quality of eggs?"

RE:

"Not likely.  I don't think this will help you.  Everyone is different.  

We have no way of knowing if this would be better or worse for you unless we try it, 

and we have already tried 5 rounds of different combinations of protocols.  

You have given it an exceptional effort.  No one can say that you haven't tried your best.

This protocol isn't likely to help you any more than the ones we already did.  

Remember, Diminished Ovarian Reserve (DOR) is often correlated with low egg quality, 

less so in younger women, like you, but still can be an issue.  

I'm afraid that's what we are up against."

Michael:

"I think we just want to be sure we aren't leaving anything on the table here.

Is there anything you'd recommend that we try that we haven't tried yet?

Or should we really start focusing on transfer for the two we have?"

RE:

"I could get on board with trying another round with a fresh transfer at day 3 or 5.
There is a small chance that your embryos don't like to sit in the dish, but I think that's fairly unlikely.
I would rather us try to transfer one of the two that we have and see how it goes.
These two might be all you need, if we're lucky.
If they fail, we can come back to the drawing board, or examine Donor Eggs."

We talked a bit longer, but Michael and I both knew that if he shot down both the sperm and alternative protocol idea that we probably should move toward transfer.  My head was spinning a bit.  I wasn't ready for this, but more waiting, more indecision would just be worse.  If  we were on board with trying a transfer, or even a fresh round, our RE wanted to do a new hysteroscopy, since our last one was a year ago, just to be sure everything is gold-plated and ready to go.  

We got on the calendar for Dec 21 hysteroscopy.  It kept us from travelling for Christmas, but that was a bit of a blessing.  Being around people, especially celebrating people, felt inauthentic for us this year.  The last two years we have been mourning miscarriages around the holidays...it's really hard not to relive them as all the decorations go up.  For the last three years we have kicked off the holidays with the hope that this would be "the last Christmas just the two of us!"  Ugh.  Looking back at that sentiment makes my stomach turn.

We agreed to just lay low, no decorations at the house, and minimize the commitments on gifts / social engagement.  It was restful.  The hysteroscopy including endo scratch went very well.  All the plumbing is in good shape for 2017!  

It was hard telling family we just needed to stay home.  They really want to pull you out and help you feel better.  It's very difficult to explain how drained, weary, and fragile this process leaves you.  There's little joy in getting out and go- go- going...so much energy just to collect yourself and put on a happy face...to add to the long list of things to do, obligations to manage.  Don't get me wrong, I would have loved to spend that time with my family, but it was just too much.  The packing, the airports, the people with kids, the pregnant women EVERYWHERE, the spending of more money on airplane tickets, the round trip flying...veto.  I'm sorry.  We love you all, but veto.

This is how I knew what we did was the right thing for us.  A good example of what it all feels like right now.  

On Christmas Eve, I woke up early.  My heart was thumping hard in my chest.  Not full out panic, but tension and adrenaline that I couldn't calm.  Michael was sleeping soundly, and I didn't want to wake him.  I practiced breathing deeply.  Breathe in and think "Relax", breathe out and think "Calm".  I did this for half an hour.  No help.

I got up and made cinnamon pull-apart bread from some biscuits in the fridge.  Not Gluten Free...screw Gluten Free, it's Christmas Eve!  I put it in the oven, made a tasty vanilla bean icing, and it was already smelling good.  "Maybe I'm just hungry," I tried to convince myself.

I made an eggnog latte.  Yum.  Still not relaxing.  Cinnamon bread done.  Wake up Michael.  Eat the bread.  Merry Christmas Eve!  Hugs.  

The anxiety / panic is still there in my chest.  I just can't shake it.  I had told M about it when we were eating, and he asked what he could do.  I told him I didn't know.  Just wanted him to know what I was feeling.  He was concerned, but not annoyed, and thankfully didn't take it personally.  It wasn't anything he was doing or not doing at all.

A short while later, he's sitting on the couch watching football.  I walk into the room to join him and stop dead in my tracks.  It dawned on me.  "I think I just need to cry,"  I said.  He jumped up and held me as I broke into a full body shaking cry.  As I sobbed, the adrenaline started to release...my pounding heart slowed...and a rush of endorphins started to loosen my muscles.  This is exactly what I needed.  I looked up at Michael as I pulled out of it.  I just yanked him away from the game and soaked his shirt in tears and snot and he just looked at me with love and understanding.  He held me a bit longer and stroked my hair.  I felt so much relief just getting that out.  We sat down and kept watching the game.  I fell asleep after a short while, finally relaxed enough to rest.

I did this about half a dozen times over the last two weeks of holiday time.  I just needed to so I could feel better.  Many people wouldn't understand that.  Being out and around others would be hard...there's part of me that would feel like I had to contain or hide what happened.  Thanks to our rest, I'm needing this less and less.  It's still not easy to explain to family...how you just aren't up for it all and need to just...be.

Hermit Holiday FTW!

December 2016 - Final Results Summary, All Rounds

Now including the outcome from Round 5

Eggs to Embryos to Blastocysts, All Rounds