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

December 2016 - IVF #5, Day 5-6

I haven't kept up with my posts this time. This time has ended up quite a bit harder than I expected it to be. 

We are now at the end of round 5. The round we hoped and were fairly sure could be our last. And we have nothing to show for it. 0. 

All 3 embryos made it to Day 5 and were still growing. This was better than I expected since we had that 1-cell embryo on Day 3. I thought that one was not going much further, but it did. That gave me hope. Surely this is good enough news to allow us some confidence in the 7-cell, right? Wrong. 

We were strung out to Day 6, yet again. Michelle reiterated not to get too hopeful for the 1-cell, even though it was still somehow in the mix. Than she called around lunch time on Friday. I was at my desk, and everyone else around me was at lunch. 

"Kelly, I'm not calling with good news," she said, "None of the embryos made it. They all degenerated overnight. I'm so sorry."

I said something in response. It included "Oh no," and "Thank you for hanging in there with us, Michelle."

"I have told Dr. S. He will call you soon, I'm sure. Try to have a restful and good weekend, ok?" she said. We hung up. I sat there a second, realizing how much I had both wanted and even (a little) expected this round to work out. We had figured out a formula. We had like 7 follicles! Shouldn't that have made it ok to assume the odds were good. 

IVF = Isn't Very Fair

Yep. That about covers it. 

My eyes pricked. I called Michael. He had taken the day off and was at home. He knew by the sound of my voice when he answered the phone. 

I still had meetings and a couple things that had to get done at the office before I could leave. No one would have blamed me for chucking it all and just going home. I went to the restroom and cleaned up my eyes in the time I had left before my meeting, which wasn't long. I pushed it all down. Got my emotional shit together and buckled down for the next 3 hours. 

As I pulled out of the garage, I pictured Michael's face waiting for me as I came through the door. The tears started streaming. He was right there when I pulled in and wrapped me in a big warm hug. I cried hard and long. Didn't have to hold it in any longer. 

I didn't know how much this round meant and how much I thought it would work out until that point. My gut reaction to myself when Michelle told me of the total failure was something to the effect of:

"No, this can't be it. 

I'm really not ready to call this the end for my ovaries.

2 might not be enough. I can do it again. 

Can I do it again? 

I just told Michael SEVERAL times this week through tears that I CAN'T do it again. 

Are you crazy? Masochistic? Maybe. 

I bet I can do it again. 

Will Dr. S let us do it again? 

Should we just stop? Oh, God, is this really it?

I can't think about this right now.

I'm just not going to think about it until I get home."

So that's the current question. And I don't know the answer. What will we do? What's next? I don't know and it's a little scary. In so many ways, I don't want to quit, but I'm also exhausted. Thankfully we have lots of options. We'll meet with our doctor sometime in the next week or so to talk about it. Meanwhile we're dealing with the loss of hope from this round. The loss of our 3 little embryos. We've lost so many in this process and it's never easy. 

For all of you who are checking in frequently, thank you for your patience and prayers. I'm sorry I didn't keep up this week. It's been a doozy. I don't have anything snarky or any memes to make it easier. Not there yet. More to come soon, though. 

We are tentatively attending our first IVF support group on Monday night. Not sure how it will go, and it would have been much easier to go with a recent success vs. our now very real failure. But maybe that's the point of going.

December 2016 - IVF #5, Retrieval and Day 1 & 3 Reports

Retrieval went very well, and they were able to get 5 eggs from my follicles.  4 of them were mature enough to attempt fertilization, and 3 of them made it through the first 24hrs.  The attrition has officially begun.

Right now I'm waiting on the Day 3 report.  It's 1:15pm, and still no word from Michelle.  Even though it's just a mid-point report, I still get anxious about what it will reveal.

10 mins later...

Apparently writing about it did the trick!  Michelle called at 1:25pm with the Day 3 update, and it's a mixed bag.  We have gone from 5 eggs, to 4 mature eggs, to 3 fertilized, and now it looks like only 2 are progressing.  We have 1 7-cell embryo, which is perfectly in range and has a 0% fragmentation score, and we have 1 3-cell embryo, which is quite a bit slower and also with 0% fragmentation.  Our 3rd embryo is still at 1-cell stage, which means it has likely failed.  They will keep watching it, but in all reasonable likelihood, it's finished.

With an update to the chart I showed last round, this is where we stand:

Updates with Round 5 Day 3 info included.

Round 5 data added, the dark green stripes indicate embryos that made it to blastocyst stage
(recall, however, that the Round 3 blastocyst failed genetic testing)

We have not been successful with any embryo that was <6 cells on Day 3.  That doesn't make it impossible, just highly improbable that anything but our 7-cell one will make it.  We have also had an 8-cell and 2 6-cells fail between Day 3 and Day 7, so we have had embryos of similar size not make it to the end.  Only time will tell if we will have any success from this round.

The next update is Thursday.

December 2016 - IVF #5, On the way

Alarms went off around 6:15 this morning and now we are driving down the tollway to Piney Point Surgery Center, which is about an hour away. It's raining. It was raining on our trip in for round 4 retrieval. Feels a little de ja vu, of course that seems to be the theme of the last (nearly) 3 years. Though maybe today it's a good sign?

It's been a little over a year since my first procedure on this journey, my D&C.  That day I carried, though Michael ultimately carried, a large Orvis totebag we had gotten as a Christmas gift from my parents a number of years back. It was full of the "just in case" type items: wallet with ID and insurance, chapstick, all my prescriptions in the event they needed to see them, phone, pen, paper, my Kindle, a pair of socks to wear in the procedure, snacks and a bottle of water for Michael and for me afterwards, and a change of underwear (because you never know).  It was a Girl Scout's outpatient kit. 

Today, I carry my phone and a pair of socks in one hand.  Michael carries my ID and insurance.  Done. 

What a difference a year makes. 

Well, here we go.  We will find out how many eggs they get before we leave the facility and what their maturity grading is.  Then The Waiting begins. 

I very much want this to be the last retrieval. 

December 2016 - IVF #5, Trigger Time!

So my estrogen is plateauing and we have a couple 20+ mm follicles, which makes it go time!  Tests today went well, and I got to see my doctor in person, which was reassuring.  As promised, here's some data:

Round 5 blood test and ultrasound results

We have a total of about 7 follicles that are over 10mm as of today, but 1 of them is the "inactive" follicle on my left ovary (hard to tell which one it is now), and only 5 of these are in good range for retrieval of mature eggs.  Dr. S said he would like to see us get 3 good eggs out of the retrieval, given what he saw today.  He will unfortunately be out of town this weekend, so I will have a different doctor doing the retrieval.  Queue the revolving door sound effect as more people get up close and personal with my lady bits.  Sigh...modesty was out the window long ago, I'm afraid.

Here's another bit of interesting data (if in fact you, like me, consider data to be interesting):

Comparing the estrogen trends across all my rounds

This shows that my 4th and 5th rounds have the best and second best estrogen trends, followed closely by the trend from round 1.  And also, that my round 3 was 20 full days of shots...man that was a long round.

So tonight I will take 3 shots at exactly 10:00:00pm.  2 Ovidrel shots and 1 Lupron shot.  Tomorrow morning at 10:00am (at the office, yay!).  If you recall, these are for inducing the final maturation of the eggs over the following 36 hours, so they can be retrieved at their best possible state and ready for fertilization.  My retrieval is scheduled for 9:30am on Saturday.

Next week is the week of waiting.  I'd rather they just keep me under anesthesia until they know the outcome, honestly...

Yep.

November 2016 - IVF #5, Getting Closer

Yesterday was my weekly acupuncture appointment, as well as my weekly chiropractor appointment.  Acupuncture during stims includes the e-stim machine (aka: electroacupuncture), where an electric current is run through two needles positioned over each ovary, which increases blood flow and massages them with electric vibration.  Similar technology to what is used in physical therapy / trainer sessions for sports injuries, just through needles!  This is a once a week thing starting the week before stims and going until retrieval.  Studies say this increases my odds of success, and it is indeed all about the odds.

Like this, but a pair positioned on my stomach above each ovary.

The chiropractor visits started during round 4 when my back became so uncomfortable that I could only gain some relief by lying flat on my back on the ground.  Turns out that compensating for the stomach discomfort and stress throws my spine all out of whack.  I've been getting weekly adjustments since then, and I have to admit, it feels better than getting a massage.  I'm hoping it might also help with nerve connections and blood flow to my ovaries.

Today was day 11 of shots / "stims", and our scan is looking pretty promising.  The ultrasound showed 9 follicles (excluding the cysts), but before you get too excited, only about 5 of them are reasonably in range to develop fully mature eggs (~10-17mm diameters).  The other 4 are in the 5.5-7mm range and probably won't get big enough to produce good eggs.  It would be really nice for the ones closer to 10mm to get closer to 15mm before we trigger.

This is, however, the best follicle showing we've had.  Even better than round 1.  I hope this is foreshadowing a good retrieval and day 1 fertilization report.  I'm actually getting a little excited about it all.  We could still come up with a big goose egg at the end of this round, so it's hard not to proceed with a little bit of caution.

The clinic wants me back again tomorrow for another check, since we're getting close.  They want to monitor the estrogen levels closely and make sure to trigger if they start to plateau.  The follicles are responsible for generating the estrogen, and they do so most aggressively while they are growing strongly.  It should be at least a straight line, if not an exponential growth rate.  Once that growth rate starts to slow or plateau, that indicates that the follicles are finishing up with growing and are running the risk of becoming post-mature (i.e. over-ripe).  It's a bit of a delicate balance between growing enough and aging too far.

As you may remember from the other 4 rounds, they want to see the lead follicles reach 20mm or so before trigger, but that seems to be of secondary importance to the estrogen level.  Estrogen rules all during this phase, which is why we can feel pretty good about the scan results, but always wait for the final word on the blood tests before knowing the actual plan.  At this rate, retrieval is most likely going to land on Saturday, Sunday, or Monday.  We should know a little more after tomorrow's appointment.

My arm (and stomach) is sore and bruised, but I will tough it out.  My body is weary, achy, and bloated. It's uncomfortable to sit and stand. My ovaries feel...pinchy. That's the swelling and the crowding of the follicles making me feel like something is pinching me on the inside when I move around.   I really don't like feeling like such a wuss at this point.  It helps when Michael tells me I'm being tough and that I feel this way because it's working.  He has to be the one to lift,  carry, bend, and do anything twisty this week and for two weeks after the retrieval, and he takes this job very seriously.  He even carries my work bag to and from the car for me.  Feeling a little pampered really helps offset how uncomfortable and unattractive I feel.

More info (and some charts, in case you were craving some data) tomorrow!

November 2016 - IVF #5, It was bound to happen

The follicle checks so far have gone fairly well.  Tonight will be my 9th day of shots.  As of this morning, we have 2 good ones on the right (~15mm each) and about 3 on the left (~8mm, 9mm, and 14mm).  Not the most even growth, but not bad either.  This excludes the two cysts we knew we had from the beginning, which are not likely to produce any eggs.

There has been little drama over the last 9 days...until this morning.  I woke up feeling sore and tired (as usual at this stage), but also fairly confident.  I have had a few mini-crises of willpower / motivation this round, but so far I felt like I had been (on average) kicking butt this cycle.  Michael had left for work early, and as I was turning on the shower I was thinking about how mixing my shots last night only took 7 minutes...7 minutes, for 2 shots...

WAIT.  NO. OH GOD.

I was SUPPOSED to do 3 shots...OH GOD, NO.  My instructions Friday said to start including my Cetrotide (the one that keeps me from ovulating while my follicles keep growing) on Saturday night.  I read the instructions twice Friday to confirm.  That should have made 3 shots per night Saturday and Sunday.  I had only taken my usual 2 both nights - 1 Menopur, 1 Gonal-F.  My blood ran cold.  The water was steaming, and I was standing there waiting to get in as I realized what I had done.

I felt sick.  The doctor's office wouldn't open until 8am, which is when my appointment was anyway, so there was nothing I could do to find out how bad this was any sooner than I already would.  I ran to the kitchen wrapped in my towel and pulled one of the long Cetrotide boxes from the fridge.  Mixing it quickly as tears ran down my cheeks.

I berated myself out loud as I mixed and sobbed.

"Two months of prep for this round, and you might have just ruined it.  How big of a flaky, hormonal idiot do you have to be to miss this?!"

"What is wrong with you?!  You read it...you read it TWICE!  And you thought you were doing well with this cycle?!  It's not like this is your first time! You KNOW this, but you still screwed up."

"We stayed home from all the Thanksgiving travel, didn't cook, tried not to stress so that this round could have the best chance possible, and you might have just ruined it ALL!"

I jabbed myself with the needle before realizing that I hadn't primed the air out yet.  I pulled it back out to get rid of the bubble, then stuck myself again and squeezed in the fluid.

Michael was texting me that it would all be ok, no matter what happened.  It was going to be fine, try not to panic.  I repeated, "You don't know it's ruined yet.  It might be fine.  If it's not fine, it's still fine...If it's not fine, it's still fine..."

The panic wasn't subsiding.  I cried as I showered.  I pulled my wet hair back in a knot, threw on some work clothes, grabbed an extra Cetrotide kit in case they wanted me to double down, and ran out the door.  It was raining hard as I pulled out of the driveway, taking deep breaths to clear my mind and vision so I could drive.  Does the weather know how much I had screwed up?  Was it being sympathetic?  Or is it just trying to delay my commute to the clinic when I could actually find out the consequences to what I had (not) done?  I squint accusingly at the clouds as my wipers swipe and my garage door closes.

The radio played "Don't Let Me Down" by The Chainsmokers...it's like an ode to my ovaries.  They probably didn't write it with my ovaries in mind, right?  Who's to say...

"I need you, I need you, I need you right now

Yeah, I need you right now

So don't let me, don't let me, don't let me down

I think I'm losing my mind now

It's in my head, darling I hope

That you'll be here, when I need you the most

So don't let me, don't let me, don't let me down

Don't let me down" 

Yep...definitely losing my mind, but have to get to the clinic first.

I got there on time, in one piece, and the rain stopped as I parked.  I told my nurse what happened.  Sharon was a little shocked when I told her what I had done, "You're kidding! But you're a pro at this!" she said.  Seeing my puffy eyes that were about to spill over again, she told me, "It's fine...well probably fine.  We'll take a look and see."  She's an eternal optimist, which is just what I needed.  Blood draw was first, and the tech poked a fresh hole in the middle of my right arm bruise to get a fresh dose for testing.  Then the scan.  Sharon showed me that all the follicles were still there.  They hadn't all ovulated over the weekend.  She smiled and reassured me with a story of another lady who had done this recently...much further along and with her estrogen in the thousands...and she was completely fine.  My estrogen on Friday was close to 300, and since my follicles all still look intact, I could relax a little.  The blood test would be able to show for sure, but she told me I shouldn't worry.

After lunch, she called and said all was fine.  "Be sure not to forget the Cetrotide tonight and tomorrow night, and we'll see you back on Wednesday morning."  Relief and embarrassment, but mostly relief. All that was hurt in the end was my pride.  I kicked myself a few more times, just for good measure.

I suppose it was bound to happen at some point.  I've read enough stories from other couples going through this.  Obscenely expensive medicine left out of the fridge...panic.  Forgot to take the stim shots on time...panic.  Poor husband spills sample in donation room on retrieval day...super panic.  All of them go through the same reaction.  Bone-chilling, gut-wrenching panic...only to be told it's happened before and there's still a path that makes it ok.  They usually feel a little foolish and a lot of relief in the end.  Most have found the humor in it and shared it for others to be able to relate.  Even having read and laughed along with so many of them, I still had the identical what-have-I-done reaction to my mistake.

Ha!  I'll remember this one for next time...

November 2016 - IVF #5, SHOTS!

Tonight was the first night of shots for round 5.  I updated my alarm ringtone with the chorus from LMFAO's "SHOTS!", which will go off nightly at 7:45pm to give me enough time to mix and prime up the shots for injection around 8pm.

I've used this meme before...and oldie, but a goodie!

This protocol so far is the same as our first round (birth control, then Menopur & Gonal-F, 300 iu each), but adds in the double Ovidrel and Lupron triggers like in round 4.   I'm expecting 12-15 days of shots before we trigger, putting retrieval sometime around the first weekend of December.

Since I have ultrasounds and blood tests Wednesday and Friday this week, we are staying home for Thanksgiving.  Michael & I knew this was likely about a month and a half ago.  He knew I was pretty bummed about not getting to go to my brother's house for Thanksgiving.  The two of them pulled off quite a surprise last weekend...

I thought Michael's college roommate Pat was coming to down on business and we were picking him up from the airport to stay with us for the weekend.  We were really picking up Matt and Lauren!  As soon as I realized the trick, the tears started rolling.  The weekend with them was a full-on surprise for me.  One that everyone else close to me knew about!  We went out for Mexican food (straight from the airport, of course), shot sporting clays, took a cooking class with two of our best friends who arranged for a private chef to came to our house, and played lots of corn hole while watching football before they had to head back to Salt Lake City.

It was such a wonderful and happy weekend for me, and I felt so overwhelmed and special that everyone would work together with Michael on surprising me.  I understand there were code texts involved...even Pat (all the way in VA) was in on it, in the off chance I texted him about his "visit".  Quite the comprehensive ruse, and I was delightfully and fully fooled!  Not being able to go anywhere for Thanksgiving (except to the clinic to visit "Wanda") suddenly didn't seem so bad after the surprise weekend visiting with family and friends.

Such a WONDERFUL surprise!
Thank you, Michael, Matt, Lauren, Ryan, & Colby!

November 2016 - IVF #5, The Climb

Here we go again.  This time a little less scary.  A little less sink or swim.  Even if round 5 doesn't get us anything, with 2 embryos, the product of 10 months of advanced fertility tactics, we have a pretty decent chance of getting pregnant.  In a single-embryo transfer, we have about 30% chance with or first embryo (we're calling "Schrodinger" since we don't know if it's genetically normal or not), and about 50/50 with our round 4 normal embryo "The Lone Ranger".  Not shabby.

I suppose there could be reasons we might try a round 6 after this one...it's not written in stone that this is our last round.  I've come to know very intimately that we really don't know what we will be doing in more than 1-week to 1-month increments.  It just feels like we might try for transfer after this, regardless of what we get out of round 5, which we are finally about to start.  Don't get me wrong, I'm exceptionally hopeful we can add one more normal one to our inventory.  If we get 2, I would be thrilled and surprised, but it's not something we've been able to do yet, so I'm trying not to let myself get too excited about the chances of that happening.

I probably don't have to remind you because I've said it a dozen times...if we go toward transferring with only the two we have, we could use both of them in the same day.  Summary for those who might need a refresher, if no refresher needed, feel free to skip down:

• They plan to perform a 24hr turnaround genetic test on Schrodinger the day before transfer (after days of shots and weeks of timing to prepare).
• If S is viable, and sticks, AMAZING!
• If the test shows that S isn't a viable embryo, they will defrost and transfer TLR instead on the same day.  
• At that point, if TLR sticks, wonderful!  
• However, that will likely mean the end of my egg supply.  
• 18-24 months later, my chances of producing a good set of eggs is much less than it even is today.
• If TLR doesn't stick, or we miscarry, we are back to nothing with some big choices to make.

So, it's possible for us to use up 10 months of hard work in 24 hours.  An extra would be an amazing cushion to have.  To be able to fail with both of the ones we have, if it comes to that, and still have a shot...or, maybe, to give us a small chance at having more than 1 child.  All of this assuming no issues  or obstacles with the actual implantation / carrying a pregnancy part!  Hopefully my RE is right about my sticky uterus (see posts related to second miscarriage for reference).

So you're probably thinking, gee thanks for the review, but get on with the round 5 stuff already!  Ok...here goes.  I went in for a check on Nov 7 and all the cysts from October had resolved themselves in our month off.  A few decent looking follicles were forming, which was all good news.  The RE put me on birth control and told me to come back in 10 days.  10 days was yesterday / Wednesday morning this week.  They took their usual dose of blood, then I went to visit "Wanda"...a delightful nickname for the ultrasound machine courtesy of another friend going through the process.  Wanda showed quite a few really amazing looking <5mm follicles on my right and even more on my left...counted about a dozen of them, all sitting there ready to grow with the stims.  It also showed a big, fat, 15mm black orb on by left ovary.  Looked very much like a belligerent, dominant follicle.  Damn.

There are times when you want big follicles and times when you don't.  True to form, my ovaries are now giving me a big follicle when we DON'T want any big follicles...right now we want them all to be at the baseline level - small (<5mm), uniform, and many...NO dominant ones.  The nurse said it will mean one of two things:

1. If it's an "active" follicle, I will probably need another week of birth control pills.
2. If it's "inactive" (aka: just a cyst), we can go ahead and start the shots.

In order to tell which kind it is, we had to wait for the blood test to come back.  An "active" follicle would produce estrogen, which would show up in the test.  Thankfully, my estrogen levels came in nice and low, and I've been given the go-ahead to start shots on Sunday.  My first check will be the day before Thanksgiving and the second will be the day after.

So we start the climb again.  It's a bit like the first phase of a roller coaster...tick, tick, ticking up to the first peak as you check your harness to be extra sure you're locked in tight enough to survive the whole ride.