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.