Our best and worst moments...

It’s been a long time since I updated this. It’s been a tough few months and it was hard to sit down and tell it all…

Not long after we rang in 2014, we returned to RMA to begin another round of IVF – what we knew could be our last round. I was feeling so tired of it all and ready to move on with my life. I took birth control pills for about a week and then began “stimming” January 12. After the stress associated with the previous month’s progesterone injections, doing these tiny shots in my belly was like nothing. And, as always, it didn’t take long at all to get used to all the mixing and the routine again. Things progressed pretty much like before – when I compared my estrogen levels each appointment to where they were at the same time in the last cycle, I was only about a day or 2 behind. Dr. N wanted me to have a “slow and steady” cycle in an effort to keep my estrogen levels lower and reduce the risk of hyperstimulation in hopes that we could do a fresh transfer this time. In my mind, unless I was already physically sick before transfer day, I was doing a fresh transfer. I really regret that we didn’t last time.

Before I knew it, we were coming for daily visits (the last 2 of which were on the weekend so we had to go to Harrisburg Hospital – always an adventure – ugg!). By January 26 I was ready to trigger and my egg retrieval was scheduled for January 28. Again, Jared and I drove to KOP the night before to stay in the nice hotel across from the office.  This trip includes the funny story where we are 50 miles from Harrisburg on the turnpike and Jared realizes he forgot his overnight bag at work – HA! Despite the extra long time in the car, I was much more relaxed this time. It was nice going into the procedure knowing what to expect. I was even able to warn the anesthesiologist that my arm, not my hand, was the way to go for my IV.

When the anesthesiologist was running through my health history and I was saying to no to all the questions (no heart problem, lung problems, etc), she said, “So generally you’re in pretty good health” and I responded, “Yeah…except I can’t have a baby.” The look on her face was so sad I almost felt bad for saying it. I also remember that while we were waiting to get started in the OR, she asked, “What happened to all your eggs from last time?” She and the nurses were shocked when I told them we went from 33 eggs to 1 embryo. Apparently, my crappy eggs are quite unique.

I think I might have started to wake up during the procedure, or at least I dreamed that I did. When it was all over and they wheeled me into recovery, I was in more pain than I remember from the previous retrieval. (Although last time I might have been so relieved that it was over that it seemed that I was in less pain.) I also felt that I had a harder time waking up this time – I was still dozing in and out when sitting in recovery. We got 26 eggs – I was perfectly pleased.

In recovery...

The next day, the lab called to report that 15 normally fertilized. I was also okay with the number but realized quickly that at this time last cycle we had 26 fertilized embryos and wound up with 1 – not good odds for this round. We just had to hope that my eggs were better quality this time and that more would make it. I was beyond anxious about the next day’s call because this is when things had really started to fall apart in the previous cycle. The report finally came – we had 11 left but not all of them looked good. A few looked good and a few okay. She said that depending on how they looked the next morning, there is a decent chance they’d want us to come in for a day 3 transfer. (Day 3 transfers are done when the embryos are not doing well – the hope is they will grow better back in the uterus. Day 5 transfers are considered optimal by most doctors but day 3’s used to be the norm.) Honestly, I was totally fine with this – I was just happy that we were going to have anything to transfer at all. As an aside, this call pretty much proved that I do indeed have an egg quality issue that would continue to plaque us as long as we continue with treatment.

The next morning we were up early waiting for the call…they told us they would call by 8 because we had so far to travel. It was a little after 8 when Dr. N called. She said that she wished things were more conclusive but that we had 2 options: do a day 3 transfer that day of the 3 best embryos (more embryos since 3 days transfers are less than ideal and the embryos were less than perfect) or wait for the 5 day and hope that we have something good left. She said the embryologist told her we could end up with at least 1 or 2 on day 5 (but they, of course, couldn’t guarantee we would have anything left). I was so irritated that this decision was being put on our shoulders and that we had zero time to think about it. In the end, I had one overwhelming thought – we cannot take the risk that we won’t have anything on day 5. So off to King of Prussia we went!

While I was being prepped for the transfer, one of the embryologists came down with the picture of our best 3 embryos that we were transferring. She also had our lab worksheet and went over everything from start to finish, including what we had left. She was so kind and reassuring (needless to say, she was NOT the same embryologist we dealt with last time). She must have been able to tell that we were kind of bummed because she said that we should not be upset about these embryos, particularly the one in the middle that had no fragmentation. And the others had the better type of fragmentation, where it is all contained to one area. She said that she has seen embryos worse than this make a baby. That definitely felt good to hear.

 

 Embryo transfer day!

 

A bonus to this embryo transfer is that Dr. N, who is mostly only in Mechanicsburg, was in KOP for procedures for that weekend so she was the one to do it! It was so great having her there. Everything went totally smoothly. It was just as uncomfortable as last time because my bladder is so full. But we felt that we had made the right decision and we felt at peace. Dr. N even printed us a picture of the ultrasound and pointed out the spot where the embryos were placed. I loved the idea that, as unlikely as it was, there was a physical possibility that I could get pregnant with 3 babies. I didn’t feel scared about it because I knew the odds were so unlikely. But twins would be heaven!

Our 3 little ones...I so hoped they would all be girls who would make us crazy!

 

 

 Pic of my uterus when the embryos were transferred

(the big black blob is my full bladder!)

 

After 2 days of “lay around and be lazy house rest,” it was pretty much back to life. I was recovering pretty well from the retrieval but, of course, was on a litany of meds and hormones. I decided not to exercise at all this time during the wait for the blood test. I figured it was only 9 days or so – not a big deal. Also, during the wait, I began to have second thoughts about not trying again. I knew I definitely wanted to wait several months but I began to be open to this not being the total end. 

Last cycle, I had period-like cramps the day before the test which I attributed to my period trying to break through the progesterone I was on (which stops the uterine lining from shedding). This time, 2 days before the test, I started to just have that “feeling” that my period was coming – not cramps per se but just heaviness in my abdomen. I was so upset – I kept breaking into tears at church that morning and just moped around the house. The way I was feeling I thought maybe my period would come despite the progesterone (as it had once before, after my last IUI).

The day before the blood test I felt pretty much the same but still no period. I pretty much resigned to myself that it was all over. I started pinning new treadmill workouts and was planning how I was going to lose all the weight I had gained doing IVF. That night, I was awakened in the night by what I recall as some of the worst cramps I have ever felt. I thought for sure my period had arrived. It hadn’t. I was so mad thinking that I had to deal with this pain now, and then again in a few days when my period came for real. I broke down and took 3 ibuprofen to kill the pain (which is a no-no during the wait, Tylenol only). The next morning, I put a bottle of wine in the fridge and was planning to drown my sorrows after the call.

When I went into the RMA office (I have to go get a lab sheet to take when I get my blood drawn), I asked one of the nurses if Dr. N would leave the results in a message if I didn’t answer. I don’t think I was planning to intentionally not answer, but I didn’t want to have to worry about missing the call. She said that she would leave a message if that’s what I wanted. After the draw, I did a little shopping around Mechanicsburg and then headed home.  I was so much calmer than last time because I felt there was no hope. I even got a half regular coffee on the way home (instead of all decaf)! I felt mentally prepared to move on.

Around 2:00 Jared called from work. He told me that Dr. N had just called him – she said she was going to call me in a few minutes and asked if he would call me first and try to get me to answer when she called (since I had asked about leaving a message that morning). Immediately, my heart skipped a beat. Of course, my first thought was that she wanted me to answer because she had good news. But then, trying not to get excited for nothing, I reasoned that she might just be worried about how I would take the bad news and wanted to talk to me about it.

Waiting for the phone to ring was excruciating. Luckily, it was only a few minutes.  When it finally rang, before I answered, I saw aloud to myself: “It’s going to be okay.” It was Dr. N – she said she was so glad that I answered and that she was calling with good news. Then I heard a bunch of voices yell, “Congratulations!” She told me it was all the girls in the office calling to tell me that I’m pregnant. I cried. I felt in that moment like I had floated up out of my body and was just watching myself have this moment – this moment that I have dreamt about so many times.  She said everything looked good, my HCG level was 50, and that I needed to come back in 3 days for another test to make sure the number is doubling. I am sure she said some other things too, but I was on such Cloud 9 that I don’t really remember.

I cried when I called Jared. Just saying those words: “I’m pregnant.” It was out of this world. He was also shocked and, I think, a little overwhelmed. We have waited and waited for this moment and it was finally here.

That afternoon was so surreal – I just sat at home, watched TV, and played on my iPad. I was a relaxed pregnant woman. I immediately felt like an eggshell too (and felt guilty about the ibuprofen and caffeine I had ingested earlier – whoops). My mom (who was, of course, elated) stopped by later and invited us to go to dinner with her and my stepdad to celebrate.

Then, after the total joy of the news calmed down a bit, a new sensation began – absolute fear. I was now overwhelmed with worry that something would go wrong – chemical pregnancy or miscarriage. Jared and I decided that maybe we could relax a little more after my second blood test showed that my number was improving. It was a very long 3 days! Friday’s level was 108.1 – ugg. So, yes, it doubled but barely. (Not to mention, stupid Googling me read that some say levels should double every 48 hours and other say doubling every 48-72 hours is okay – so I felt concerned that my level did not double in 48 hours.) The office said this number was good but they wanted to see me again in another 3 days for another test.  More waiting!

First positive test I've ever had!

 

I felt even more anxious waiting for the results of Monday’s test. I think I had myself convinced that something was wrong. They finally called – HCG was up to 308.6. I was so relieved! I felt for the first time like I could breathe a little bit. My first ultrasound would be in a week (though she warned me that we shouldn’t expect to see much other than a dot in my uterus).

I continued to feel scared every day. We were so excited to tell people the news but tried to keep it close in case something happened. I also felt pregnant – mostly tired. I wasn’t sick at all but my boobs were terrible sore and felt huge. I was anxious waiting for the nausea to kick in. February 24 we had our first ultrasound and saw the gestational sac. Dr. N said everything looked good and that we should be able to hear the heartbeat the next week.

We were so proud of our little bean...

 

At the next appointment, she began the scan and when I looked up at the screen, I knew right away something was not right. It looked exactly the same as the previous week – just the black dot. Dr. N explained that, at this point, we should be able to see the fetal pole and the heartbeat and she wasn’t seeing either. The pregnancy had stopped developing.

Just like when they told me I was pregnant, I felt like I floated up out of my body and was watching myself in this moment…except this time, it was the worst moment of my life. I kind of thought that if I remained scared throughout the pregnancy that something bad could happen, that nothing bad actually would happen. But not the case – it was my very fears come true.

Dr. N. went on to explain that it was likely due to a chromosomal issue (ie. crappy eggs!) and that we had a number of options – we could wait and miscarry naturally, they could give me meds to help the miscarriage happen faster, or I could have a surgical procedure (ie. an abortion) to remove the remaining “products of conception”. Everything was so surreal - like this couldn’t be happening to us, not after all we had been through.

We opted to do nothing – to “let nature take its course.” A part of me just didn’t want to deal with it so doing nothing was the obvious option. The rest of the day was horrible. Jared took off work and came home with me. We decided being alone at home was probably not the best idea so we went to lunch and then went shopping for our bathroom update project we had been working on. We just did our best to distract ourselves. There was also the dreaded task of information those who knew I was pregnant that, in fact, I was no longer. I remember saying to Jared that I wish I had known today was going to be the worst day of my life so that I could have mentally prepared for it.

Over the next days and weeks, I tried to focus on work and we both threw ourselves into the bathroom project. There were definitely days that I did not want to get out of bed – but I always did. I slowly began to just feel ready to move on from everything related to getting pregnant.

One thing that was particularly hard about the loss was how people acted. When we found out we were pregnant, I felt like everyone we knew wanted in on it – I was getting texts all the time…”So excited!” “How are you feeling?” etc. But as soon as it was over, the silence was deafening. I have definitely learned a lesson from this for my own life – even when you don’t know what to say, saying SOMETHING is always better than saying nothing.

"The friend in my adversity I shall always cherish most. I can better trust those who helped to relieve the gloom of my dark hours than those who are so ready to enjoy with me the sunshine of my prosperity. - U.S. Grant

This past weekend I had the miscarriage. It started late Saturday and Sunday was the worst of it. I am thankfully that my loss happened very early so there was very little to miscarry. It was still the top 3 worst pain I’ve ever had (next to my HSG and SIS procedures) – there was about 15 minutes that I was just on the floor crying. It was very frightening to go through and I am so relieved that it’s over.

So what now? Number 1 on my agenda is to lose my IVF/pregnancy pounds and get back in my pants – I have had a very serious relationship with my 3 pairs of yoga pants for way to long! I am beyond ready to feel physically like myself again. After that, it’s all about continuing to heal and taking time to enjoy our life and to decide what our future holds. Will we do IVF again? At this point, I really don’t know. I hope that in a few months I will feel renewed and capable of trying again. But right now, I couldn’t consider it. The pain and gut-wrenching sorrow we have been through over the past 2 and a half years – it’s just too much.

"Sometimes you may wish you could go back in time, to when it was easy to smile, and your heart wasn't broken into a million pieces."

In my perfect world, my body will right itself over time and we’ll get pregnant on our own. I’m also working on my relationship with God and coming to terms with the possibly that having biological children is not in His plan for us. I still struggle everyday –seeing pregnant women, seeing baby pictures on Facebook, seeing anything maternity or baby related on Pinterest – it still hurts so much. I pray someday that will go away – that I won’t get sick in my stomach when I see someone’s pregnancy announcement. But for right now, it’s all about one day at a time.

"Fear not, for I am with you." Isaiah 41:10

Farewell 2013...and good riddance!

When Friday evening before our embryo transfer rolled around, I was feeling surprisingly calm. Jared and I stayed in – I made dinner and then baked a chocolate cake (from scratch! – so indulgent and so fun). We knew the call would be coming Saturday between 7 and 8 – letting us know if our embryo had survived. The transfer was scheduled for 10:45. I just kept praying.

 

My 'night before transfer' therapy!

I was thankful that I fell asleep right away that night. Unfortunately, it didn’t last. At about 2 am I was awake – with cramps. In my half sleeping-half awake state, I was in a panic that I was going to lose my lining. (In retrospect, it was probably a side effect of the progesterone.) I was also stressing about the fact that we must have nicked a nerve during my shot that evening because the side of my right thigh had gone numb. It was just an anxious night. I gave up on sleep around 5 and got in the shower. Once Jared got up, I put our bed sheets in the washer. I figured I’d want fresh sheets to either relax after the transfer or lay around in all day miserable.

When 7 am rolled around, my heart was raising. Jared and I were treating my phone like a bomb – scared to look at it. I was upstairs putting the fresh sheets on the bed when the bomb rang. It was the embryologist – the one I don’t really like who delivered the first bit of bad news after our egg retrieval. She said the embryo was thawed and it “looks pretty darn good.” I could breathe again. I yelled down to Jared, “She made it!”

Because nothing is ever easy, another issue we were dealing with on this day was an impending snow storm. Luckily it hadn’t started yet but we packed bags in case it got bad and we had to stay over down in King of Prussia. But our embryo had survived and we were off!

In a few hours, we arrive in KOP and I already had to pee like crazy! Of course, this was as instructed – my bladder had to be full for the transfer. I actually overdid it with a peach Snapple and ended up having to cheat and let a little out. No matter what, it was miserable. When it was time they took me back to the same little changing area as when I was there for my egg retrieval. This time Jared got to come and was outfitted with covering for his clothes, shoes, and head. I had to change into a cloth gown and put on surgical socks and head covering. They reviewed all my vitals and the doc doing the transfer (not mine, another from the practice who I had met before) came and said hello. Finally, the embryologist came in with a pic of our little embryo. I remember her saying “I know you guys have been through a lot…” I guess our horrible cycle is infamous. After all this, she looked good and we were so ready to get her in my uterus.

All ready for the embryo transfer!

 

When it was time, they walked us back to the same big, scary room where I had my egg retrieval. I was actually so glad Jared got to see it! They put the embryo up on the screen quickly so we could see it live before the transfer. It was pretty blurry though. From here everything happened so fast. I was trying to savor the special moment but all I could think about was how badly I had to pee. The process is super simple – just like an IUI but with a sonogram scanner being pushed into your belly. The doc apologized in advance for how uncomfortable the pressure on my bladder was going to be but she told me the worse it is for me, the better it is for her to see. I let out a couple “oohs” and “aahs” but really tried to be a trooper. We watched on the screen as they put our little bean in my belly and it was all over in 2 minutes. They had me lay there for about 10 minutes and then we were free to go. The embryologist assured us that the embryo cannot “fall out” and equated it to a grain of rice in a peanut butter sandwich, haha!

Our little grain of rice...

 

We were so pleasantly surprised that the snow actually held off for us – we made it home right before it started! I was to take it easy for the next few days and it was nice being able to relax at home, hoping and praying that our embryo was continuing to grow and thrive. 

Luckily the wait for my blood test was only 9 days. I wasn’t really watching for any symptoms this time around because I knew it was just too early for there to be any. I was following some food and lifestyle protocols that I had read about: eating pineapple, walnuts, avocado, and lots of protein; keeping my feet warm at all times; abstaining from caffeine (and alcohol, of course); trying to eat and drink warm foods. I also was just walking and not running as the doctor said no strenuous exercise until after the test.  And, of course, I was praying and praying.

I did start to get frustrated as the days went on, especially because it was Christmas. I missed out on drinks at my office Christmas party and at a good friend’s 30^th birthday party. It’s even worse when people notice you aren’t drinking and want to know why. Like I have said before, it’s one thing to be “the pregnant one” but it just isn’t fun to be the “might be pregnant one.”  I also missed my morning caffeine and running. I was just having moments here and there that I began to grow weary of everything putting my life on hold.

Based on extensive internet research, I knew that I COULD potentially test positive on a home test at 6 days after my transfer. I peed on sticks Friday and Saturday (6 and 7 days post transfer) and they were negative. But I also knew that I could have a negative this early and still be pregnant, so I didn’t get too worked up about it. Nonetheless, I was tired of negative tests so I opted to hold off and wait for the blood test (9 days post transfer, that Monday).

Early Sunday morning I was awakened by cramps. I was devastated. It was just like every other cycle – so much hope and then it all falls apart right before test day. Even though I continued to cramp, my period never showed. My mom was convinced it was pregnancy cramps but I have read too much and knew it was likely just my period trying to come but the progesterone injections keeping me from bleeding. In the end, I decided there was nothing I could do and that it was in God’s hands. The blood test would be the only answer.

On Monday I was still having cramps but no period so I drove to the doctor for my blood test. I was actually happy that I had made it to this day…every other cycle my period arrived before the test. Since I wouldn’t be getting the call until that afternoon and work was dead with it being so close to Christmas, I spent the day doing one of my favorite things in the world – baking! I knew that if anything was going to distract me from awaiting the phone call, it was making cookies.

I knew the office usually called anywhere between 2 and 4 with blood results. So around 2:00, my heart started to race and I couldn’t concentrate on anything. I started to do things here and there but I was just shaking. It was late – around 3:30 I think – when that bomb rang. It was Dr. Nguyen. She told me she was not calling with good news. The test was negative.

In that moment, I was thankful for the cramps – that they had allowed doubt and preparedness for this moment to get in my head. I think if my heart had been totally full of hope, I would have been heartbroken. Of course, I was sad…but it’s almost like I knew what she was going to say before she said it. I was just hoping I was wrong.

I told her we were probably going to go right into another round of IVF but that I would talk to Jared about it. Then it was my turn to make an awful phone call…to Jared who was at work. I delivered the news swiftly – “no-go.” We quickly moved on to logistics – do we go again? Take a break? What’s the account balance?

When I got off the phone with Jared, I just sat there. It was quiet and I was totally alone. I let myself sob for a brief period, maybe a minute or 2, and then I stopped. It was done. Crying, to me, has become a futile exercise. I mean, I still cry sometimes when I am talking about something or relaying information – it’s almost involuntary. But just sitting and crying has become stupid…it doesn’t change anything or help the situation and it usually makes me feel worse. So I let myself have a moment and then it was done. I removed my estrogen patch, took the picture of our embryo off the fridge, and shoved my calendar and all my meds that had been sitting out in the kitchen in my med basket on the floor. It was over and I didn’t want any evidence in my sight that it had ever happened.

After the negative test, I was able to stop the progesterone shots. (I actually had planned to switch over to progesterone cream anyway.) But after I stopped, not only did I still have numbness (now even a little on the left side as well as the right), I got a terrible rash on both sides at the injection sites. It was as if each injection spot had turned into a mosquito bite! The itching was so bad it was keeping my awake at night. Weeks have passed now and my butt/legs are still feeling the effects. I am not sure I could go through the shots again.

I was amazed at how quickly I started to feel “normal” again. “Normal” being “there is no way I am pregnant right now.” It just felt like it was back to life as we know it. The next step was deciding where we go next. Initially I thought about taking a month off but after giving it some thought I realized I just wanted to power through.  If my eggs really are poor quality, another cycle would tell us for sure. I just want to get that answer so we can know if there really is any hope or not. I am also ready to be done with fertility treatments. Of course, if the next round is not successful, we will always continue to “try” naturally. But I feel that this will probably be it, at least for a long while. I am ready to have my life back and to start beginning the execution of the “no kids” life if that’s what it’s going to be.

Looking back 2013 was awful…1 failed round of Clomid, 1 cancelled round of Femara, 1 failed round of Follistim, 4 rounds of Menopur  (2 failed, 2 cancelled),  4 IUIs, and 1 failed round of IVF. So much hoping and praying and so much heartache. Maybe in 2014 everything will turn around for us. Maybe we will finally be blessed with a child. Or maybe we will finally start to move on. I just keep praying.

Preparing to transfer our one miracle embryo...

Following the epic failure of our IVF cycle that resulted in having only one embryo to freeze, we had a sit-down with Dr. N. She said she and everyone in the office was so upset about what had happened. She also agreed that it made the most sense to move on to the transfer of the embryo next month, especially since the plan was to only transfer one embryo anyway. (In some cases, 2 embryos are transferred to increase the likelihood of success – in which case it would have made sense to go right into another IVF cycle to try to get more.)

Another thing we of course had to come to terms with is that the embryo could possibly not survive the thawing process. She informed us that the success rate for thawing is 95%. So there is a 5% chance that we will go through all of the prep work for the transfer and our embryo won’t make it. Hard to swallow.

The doc reassured us that the requirements for freezing at RMA are very stringent (even more so than where she worked before) and that our embryo had to be super quality. (As an aside, although this was meant to be comforting, and it was, I can’t help but wonder if we would have had more embryos if we had gone forward with a fresh transfer and the quality requirements hadn’t needed to be so tough. But I try not to dwell on this now since there is really no point in looking back.)

I also asked more about why the cycle had gone so poorly and what the scoop was on the egg quality issue. At this point, it could be one of two things: (1) It was just a bad group of eggs; or (2) My eggs are all of poor quality, which hurts our overall odds of success. If we go on to another round of IVF, we will likely get our answer. She also commented that next time she would probably reduce my meds, even if the cycle takes longer, in hopes of perhaps getting better quality eggs even if there are fewer of them.

She reassured us that the preparation for a frozen embryo transfer was much easier than a fresh IVF – just pills and patches to build up the lining of my uterus. I felt very relieved. However, upon scheduling my baseline scan and going through the discussion about getting my meds ordered, of course another bomb was dropped on us. Three terrifying words: Intramuscular progesterone injections. Yep – the doc had failed to mention that I would have to do these for 2 weeks. I have read horror stories about these shots – that they leave your behind sore and bruised and lumpy. Needless to say, I was pretty pissed. Plus, the nurse seemed to think it was pretty funny to joke with me about how long and huge the needle is. And to top it off, because they are done in the butt muscle, Jared would have to do them!

When my box of meds arrived and I saw the size of the needle, I freaked. I emailed Dr. N right away to see if there were any other options. I was already completely overwhelmed and frustrated. In my head, I was thinking that if I had known about the IM progesterone shots I might not have chosen to allow them to freeze the embryo! She replied that I could certainly opt to just use the Crinone (progesterone) cream instead and that she would just have to get it okayed by the rest of the docs. I felt instantly like a weight had been lifted.

When I arrived at the office for my scan, the nurse was on me right away. She said she saw the docs email and that the rest of the practice wanted to make sure I was aware that studies show better pregnancy rates when the injections are used instead of the cream. UGG. I was so upset and didn’t know what to do. I allowed the nurse to go through the injection teaching with us but had still not made up my mind. I wanted to talk to Dr. N to get her opinion (she was out of the office that day).

Also, at this appointment, we got the official calendar for our cycle. It was 2 weeks of estrogen pills, with a scan and blood work once a week (patches were no longer being used). In the third week, progesterone gets added (thankfully I had some time to make my decision on the shots). Our transfer was to be December 8 and our pregnancy test on the 17^th. I was so happy that everything would be done and we would know by Christmas, and even before the slew of Christmas gatherings began.

Later than day, Dr. N called. She confirmed that the success rates are better with the shots. She suggested that I at least try them and if it’s too awful, we can switch. So, in the end, I decided to buck up and deal. When I told Jared, he was less than enthusiastic. I think he was really liking the idea of not having to give me these shots. But once he realized like I did how much regret we would feel if it didn’t work and we hadn’t done everything we could possible do, he got on board. That night when I got all my meds out on the counter with the calendar and dosages (I have to check off every time I take a dose – I am too afraid I won’t remember if I took something or not!), I got one of the progesterone needles out, unwrapped it, and let it lay there on the counter. I felt that if I could stare it down – look at it every day – that I would be less fearful.

All looked good at my first scan after starting the estrogen – lining was thickening and levels were good. I got the okay to up my dose for the next week. My next appointment was supposed to be when my shots would begin.

An issue that I have been dealing with throughout this whole process, that I felt was getting worse, was my weight. I HATE putting on weight. At this point, I can probably wear about half, if that, of the pants I own and most of the other half is uncomfortably tight. I just felt like a big blob every day and it was wearing on me. Once my ovaries were shrinking back to normal size after the IVF cycle, I began to run again. And as time passed, I began to work on getting back my endurance, gradually increasing the length and speed of my runs. And I hate to say it, but the worse I felt about the extra pounds, the harder I was pushing myself on the treadmill. During my 2^nd week on estrogen, I was finally almost back to my normal running routine. I felt that it wouldn’t matter if I was running harder since my ovaries weren’t being stimulated this time.

At my week 3 appointment, Jared and I were geared up to start the injections and to hopefully (if the embryo survived the thaw) have the transfer that weekend. Why can’t I learn that nothing is a guarantee? My scan showed no growth in my uterine lining – in fact, I lost a little bit of it. Blood showed that my estrogen had actually DROPPED, despite the fact that I had been taking an increased dose for a week.  Due to this setback, we wouldn’t be starting the progesterone and the transfer would be delayed. I was instructed to stay on my current level of estrogen and I also had to start wearing an estrogen patch. These little boogers are pretty annoying – they go on the lower abdomen and get changed every 3 days. I spent the first few days worried the thing was going to fall off (although after I experienced the pain of removing the first one, I realized that sucker wasn’t going anywhere!). Plus, by the end of the 3^rd day, the edges are pretty nasty. I was to come back for another scan at the beginning of the next week.

Even though it doesn’t seem like a big deal, I was completely devastated by this turn of events.  Why doesn’t my body ever work like it’s supposed to?!  And, again, I felt like it was an obstacle at every turn – like we were being warned that we were doing the wrong thing or going in the wrong direction. I also felt completely fed up with putting my life on hold for these treatments.  This delay pushed us further and further into the Christmas season, which I just didn’t want to be ruined by being in the middle of treatment.

The next day, (as I always do) I did some internet research on exercise while trying to conceive. The consensus seemed to be that light to moderate exercise is deemed beneficial for conception but strenuous or excessive exercise is detrimental. What I was having a hard time pinpointing was what exactly is “moderate” exercise or “strenuous” exercise? If I weighed 250 pounds, walking might be strenuous, whereas if I ran marathons, a 4 mile run might be moderate. I found it all to be rather ambiguous. In the end, I decided that it was better to just err on the side of caution and cut back my running (speed and distance).

Finally, it was back to the office to see if my lining/estrogen levels were any better. At this point, I was less and less stressed about the progesterone shots – I just wanted to get moving forward! The doc said my lining was a really good type – “sticky” was the term she used. I could tell she was less than overjoyed by the thickness (just shy of 8 mm – I believe the goal is 7-9) but it was better than the previous week so she gave us the go-ahead to move forward (pending lab results). We had our nurse draw 2 big circles on my hiney with a sharpie so Jared wouldn’t have to worry about finding the right spot for the injections, which would begin that night. She also reviewed the whole process with us and I feel that we left the office feeling okay about it. I would also start Medrol that night, a steroid that suppresses the immune system so my body doesn’t fight against the embryo.

We were both nervous about the first progesterone injection. I just kept telling myself that thousands of couples go through this and are fine – we could do it too.  Jared did an amazing job – it didn’t hurt at all. He even knew just what to do to comfort me – counting to 3 before starting, singing while the liquid is going in, telling me when it’s almost over.  My butt did feel a little sore that evening and the next day but it was not anywhere near what I thought it would be. Since then, we have settled into an evening routine of the shots, and even though I still get a little nervous every time, I am thankful that it’s not so bad and that I have such an amazing husband who turned out to be a stellar shot-giver!

So where are we now? We are in a state of prayer. Praying that our little miracle embryo survives the thaw on Saturday morning. Praying that she hatches out of her shell and attaches to my uterine lining. Praying that she grows and grows and that in 9 months we are blessed with a beautiful, healthy Baby Graybill!

I think over the past year or more, because of all the treatments we have been through, I have allowed the science of baby making to take over my brain. It’s been all about medicine and scans and timing and numbers. I need to allow faith to take over and to refocus on the miracle of God that a child is. I have to just pray and believe that God will answer my prayers. Last evening, the pastor from my family’s church visited us and spoke to us about what we’ve been going through. He prayed with us and anointed me. I felt overwhelmed – and for once it wasn’t with anxiety or sadness, it was with peace. I feel at peace knowing that it’s all in God’s hands.

 

Will this be our last Christmas as a family of 3?

The Graybills 2013

Jared, Kristen, & Peanut Butter

 

A heartbreaking week...

Egg retrieval

Friday night before my egg retrieval surgery Jared and I headed down to King of Prussia…we had an amazing meal at The Cheesecake Factory and then headed back to our hotel to veg out (and eat cheesecake and try not to freak out about what was happening tomorrow!).

Yummy!

 

Bright and early on Saturday we were up and we headed over to the office (literally almost across the street) at 7:00. Almost immediately I was whisked away by a nurse. In retrospect, I wish I would have kissed or hugged Jared goodbye at this point – I didn’t know I wasn’t going to be seeing him again until after! The nurse had me change into a hospital gown, silly grippy standard issue blue socks, and the glamorous surgery hair net thing. I was so nervous - I peed twice even though I hadn’t had anything to eat or drink since about 10:00 the night before! She asked me some questions and checked my vitals. Then the doc stopped in to say hello, presumably having just finished the procedure before me. I had met him before – he had done a scan or 2 for me before Dr. Nguyen came to Mechanicsburg and he was actually the doc that did my last IUI. He asked if I was nervous…I told him yes but that I was trying not to think about it and so far I was just doing what each person was telling me to do! The best thing about this wait is that they cover you with a blanket that has been kept in this amazing blanket hot box device (note to self: must research getting one of these for the house). If I was going to be scared out of my mind, at least I was warm and cozy!

I was then moved to the next room where I met with the anesthesiologist. He asked me a litany of questions and checked my vitals again. As he was trying to jam a needle into my hand, he was trying to “distract” me by asking me about where I was from and all that. I had no interest, haha…I was trying so hard to be sociably but IT HURT! Apparently things did not go as expected because soon he was after the vein in my arm. That one hurt, but not nearly as bad as the hand. At this point, I started to panic. As I sat there, in pain, with a needle in my arm, with surgical garb on, surrounded by strangers in a fluorescent lit room at 7:15 in the morning, I just had a flash of a friend who had announced on Facebook the previous day that she was pregnant…AGAIN. In one overwhelming moment, I was just angry and sad and scared. Of course, the anesthesiologist thought I was having a panic attack and just tried to get me to breathe. Soon he was pumping me with fluids and I sat there…just trying to breathe in and out.

Before I knew it, it was time to go and they walked me into the operating room – it was huge and in the center was a chair-like thing with padded stirrups that held almost your whole leg. As I sat down I looked up and saw one of those big round surgical lights with the handle in the middle and I remember thinking that it was just like on Grey’s Anatomy. I literally said to the nurse and anesthesiologist, “wow, this just got real.” In a flutter of activity, they were moving me and strapping me, and hooking me up to stuff – terrifying. One of the last things I remember is getting an oxygen tube stuck up my nose and telling them I could feel something in the back of my throat…then I felt the meds kick in and it was lights out.

Of course, the first thing I said when I woke up was, “Is it over?” I was so happy with that fact alone. The first few minutes are fuzzy but I remember them wheeling me into recovery and hearing the most amazing words – “33 eggs”. Let me clarify that the average IVF egg retrieval results in 8-15 eggs. We knew there were going to be a lot but WOW. I immediately asked for Jared and was so relieved when I saw him. I cried when I told him the egg number. At this point, I was definitely in some pain but it was really not bad at all considered that they had just poked holes in my ovaries. It felt like period cramps but not even like the worst period cramps I’ve ever had. We sat there and hung out for about an hour. Jared was texting friends and family that all went well and they were periodically checking my vitals and going over what meds I was to start taking and other post-op instructions. When I was ready they gave me some orange juice and graham crackers – yum! When I was cleared to go, I just changed and it was off to Mifflintown for a day of R&R!

Hanging out in recovery - so happy it's over!

 The remainder of the day I was pretty narcoleptic and just laid around. The pain was a little persistent but manageable with Tylenol. I was thankful to not be feeling worse and also fearful that hyperstimulation symptoms were going to show up. I was definitely bloated but felt it wasn’t anything out of the norm. I started to feel worse in the evening so by 8:30 I decided to hang it up and went up to bed – I slept for almost 12 hours!

Embryos week

The next morning I felt much better – a little pain/tenderness and a little bloating. As we were eating breakfast in the kitchen, the embryologist called – 26 of the 33 eggs had fertilized! I cried. I think at each step I had been prepared for something crazy and rare to come along…the follicles would be empty…the eggs would reject the sperm and not fertilize... The average fertilization rate is 50-70% so we were officially above average. Jared and I just didn’t know what to do with all this good news. Looking back on those 2 days – it was like everything was going perfect. Too perfect.

Monday morning the embryologist called again. Right away I panicked because I could sense a tone in her voice – like someone preparing to deliver bad news. She said that 10 of the embryos failed to “cleave” (i.e. cells didn’t divide) which she thought was odd. She commented that this might even be the cause of my infertility. (I am thinking – “oh great, just add it to the list!) Of the 16 remaining, she said she was happy with the morphology (or quality) of about half. Then she said she would call early Tuesday in the event they decided I need to come in for a day 3 transfer. (Day 3 transfers occur when the embryos are not doing well vs. a transfer on day 5 which is the goal.) I was shocked! Plus, there was the idea of having to stop everything and drive to KOP the next day (the embryologist was quite shocked when I told her we were 3 hours away…I was thinking  ”guess what, lady – we don’t all live in Philadelphia!”) Everything seemed so hasty and uncertain. I felt upset and confused after the call. I waited all day hoping my doc or nurse would call to talk about the potential for a day 3 transfer. Finally after Jared called them, I got a call from my nurse. She said according to the notes, there were 16 ongoing embryos and even from as many eggs as we had, this was normal. (I really felt that if the same info had been delivered in a more positive way, I would not have been so upset.) She was very surprised to hear they mentioned a day 3 transfer and she didn’t know anything about it. She told me Dr. N was going to call to touch base with me.

Another question that was raised by all this was whether we were going to be doing a transfer at all. Last we knew, it was very probable that we would be freezing everything due to my hyperstim risk. However, except for a pretty severe case of constipation, I had been feeling pretty good. I was consistently the same weight every morning and my bloating and soreness seemed reasonable to me. I began to hope that we would be able to do a day 5 transfer after all.

Tuesday morning, Dr. N called. She started the report with “ok, are you ready?” I really felt she was going to tell us there was nothing left or that what was left was not good enough quality to be transferred. What she did say was that of the 16 embryos remaining, 7 had stopped developing or were not healthy. That left us with 9 embryos. In terms of quality, unfortunately, we had no A+s, a few As, and mostly Bs. UGG. However, the embryologist feels that there are a few that are healthy enough to make it to day 5. YES. But, because of my soaring estrogen levels and risk for hyperstimulating, they wanted to freeze everything that’s left at day 5 and delay the transfer until next month. UGG.

What a roller coaster of emotions. In 2 days, how did we go from 26 embryos to 9?! She said we might end up with only 2! The thought of this seriously concerned me because there is not a 100% survival rate when it comes to thawing embryos. Our fear was that if we freeze 2, we could end up with nothing. However, she made sure to make it known that if we would do the fresh transfer and I would get pregnant (and hyperstimulate), I would be very sick for a long time. We left it that she would discuss our concerns with the other doctors and go from there. However, the more I thought about it, the more I realized that fighting the doctors was one of the things that was making us stressed – it was feeling that we had to make decisions. Jared and I talked about it and later I emailed the doc and told her that we would concede to do whatever the team thought was best.

We spoke to her briefly on Wednesday and all the embryos were still growing but they aren’t graded on day 4 so we really got no new information. Although we did get the official decision to freeze and I got the go-ahead to stop my progesterone (used to prep my uterus for implantation and pregnancy) and Medrol (a steroid given to suppress the immune system so it doesn’t attack the embryo at transfer) since there would be no transfer this month. I should expect my period in a week or 2 and then they would start prepping me for next month. From my understanding it will just be oral meds and estrogen patches (no injections, I was assured!).

Thursday morning Dr. N called with what I thought was going to be the final pre-freezing report. She informed me that 4 embryos were continuing to grow. Somehow I was not surprised by this number and was even a little relieved –  I felt like so scared that none of them would make it. All 4 were in the very early “blastocyst” stage – the blastocyst is the developmental goal for a day 5 transfer embryo. She stated that because they were so early in this stage, the lab will wait to make the final decision on what to freeze and do the actual freeze on Friday. I didn’t ask any questions about the grading of the 4 – I think, at least for the moment, I preferred ignorant bliss to the risk of getting more negative news.

In addition to all this bad news, my body was suffering from what I believe to be the effects of mild ovarian hyperstimulation and/or the excessive hormones. My belly was still bloated and my ovaries were very sore. I was nauseous every day and had terrible heartburn. I had aversions to foods I normally love and became obsessed with certain foods (I think the week was officially dubbed “Tuna melt Week”!!). I was just a mess.

Friday was all about waiting…waiting waiting waiting…for the final call. In my head, I think I was allowing myself to hope that since the 4 embryos were all early blastocysts that they would all make it to freezing. I missed the call while Jared and I were at his grandfather’s viewing. We stepped out quickly before the service to return the call. After being on hold for what seemed like forever, Dr. N got on the line and delivered the blow. Only 1 embryo had been frozen. It felt like someone stabbed me in the gut. I didn’t even know what to say. 33 eggs and we got ONE embryo.  14 injection days, all the running to Harrisburg, a trip to KOP, anesthesia, surgery, plus the exhausting effect the hyperstimulation had on my body and not to mention thousands of dollars stripped from our insurance funding – and we got ONE embryo. I was sick.

She then proceeded to tell me that we have 2 options from here – proceed with the transfer of the single embryo next month or do a whole new round of IVF to try to get more embryos. I managed to ask her if she knew why things had gone so poorly. Her answer still rings in my ears: “It’s an egg quality issue.” She went on to tell me other things about the eggs and how they develop but it was all gobbledeegook at that point. All could hear in my head was – not only can you not ovulate, your eggs are defective.

To say that the events of this week sent me into a tailspin is definitely an understatement. Walking away from our first IVF cycle with only one embryo is heartbreaking – in addition to learning about my egg quality issue. I think that after we got so many eggs and so many fertilized, I allowed a little hope to creep in. But as I have learned over and over and over again, nothing is a guarantee. And now, I think more than ever before, I feel the need to mentally prepare for the distinct possibility that Jared and I will never have children.

We have a sit-down scheduled with Dr. N tomorrow to go over everything. I am hoping to get some more detailed answers about the egg quality problem and how severely this impacts our overall chances of ever having a baby.  At this point, unless she has some amazing pitch prepared for going right into another round of IVF, we are probably going to transfer our one embryo next month and pray for a miracle.

I feel very torn in this moment in time between "beating this horse til it's dead" - i.e. doing everything in our physical and financial power to have a child, OR taking to heart "If God shuts a door, stop banging on it. Trust that what's behind it is not for you." I've said it a thousand times - should it be this hard? We just seem to be met with obstacles at every turn. Every time we begin to have an ounce of hope, our hearts get shattered all over again. I met with a counselor for the first time yesterday. It really hit me hard when she said that, other than the loss of an infant or a small child, what we are going through is as bad as it gets. We are grieving the loss of the children we will never have.

IVF Days...

I was journaling most days while I was doing injections - I really wanted to keep track of everything that was happening...

IVF Days 1-3

On Friday (10/18), I got the official okay to start “stimming” (aka ovulation stimulation, aka doing my injections to make my follicles/eggs grow). As a bonus, Dr. N explained to me how to mix the Follistim with the Menopur so I only have to do one shot! I just have to push the Follistim (from the pen) into one of the vials of Menopur and mix it and then add a little bit of saline to get enough liquid…love her!

The starting dosage is 150iu of Follistim and 2 vials (150iu) of Menopur. I do this for 3 days and go back Monday for another scan and blood work. I was a little nervous doing my first one on Friday (it’s been a month since my last injection plus the first one for IVF felt like a lot of pressure) but it was so easy – once I got through the Follistim part (I haven’t used Follistim since April so I had to get reacclimated with putting in the cartridge and putting on the needle) it was just like mixing Menopur which I have done so many times. I am so happy to finally be starting!

As I am beginning this process, I am also mentally preparing for physical changes that will come along with it. I am cutting my running WAY back and will probably stop altogether at some point next week when my ovaries really start to get enlarged. I plan to just walk for exercise. I also need to focus on, particularly during the week, eating more (and eating healthy). I know that this combination will lead to me gaining weight. I just keep telling myself that I have to make a safe and happy home for my baby. I know most people wouldn’t care about gaining weight since I will if I get pregnant but, since we have been at this for such a long time, I have always tried not to pack on the pounds.  I am also anticipating feeling bloating and uncomfortable as my ovaries fill up with follicles in the coming days. But I am totally ready - flowing shirts and yoga pants will be my wardrobe staples!

IVF Days 4-6

Monday morning I had my first scan since starting my meds – not much to see but that’s pretty much what I expected. She said I have a good number of follicles on both sides. After my blood work came back, Dr. N upped my Follistim to 225 iu and kept the Menopur at 2 vials. It was back for another scan Wednesday morning – I could start to see the follicles on the screen but they still weren’t measurable in size. She reassured me that things were going great so far and that they are just going “slow and steady” – too much medicine at once and I could get overstimulated. Wednesday my estradiol level increased from 59 (Monday’s) to 233. She decided to keep me on the 225 Follistim/2 Menopur. So we just keep putting along.

I haven’t really noticed feeling any different this week – I’m not bloating yet, which is nice. I actually think I feel better being off the birth control pills! For now, it’s back for another scan and blood work on Friday. The NP gave me a heads up that I may be starting a new drug - Cetrotide - this weekend to keep me from ovulating prematurely. I am hoping they can give me instructions on how to mix it with my other meds so I still only have to do one shot.

IVF Days 7-9

At Friday’s scan, things seemed to be moving along. I had 16 follicles on the right side and 18 on the left, although she said some of them are really small and probably won’t develop.  Most of them were about 8 or 9 mm (17-21 is the goal for mature follicles). My estradiol rose to 560 so I had to add the Cetrotide to the drug regimen.  She also had me increase the Menopur to 3 vials (225 iu) and keep the Follistim at 225iu.

I was able to mix all the meds together and keep it at one injection, which is great. Adding the Cetrotide to the routine took some getting used to but I was able to get a new rhythm down. Saturday night I started to feel some abdominal bloating and maybe even some slight cramping/twinges – it definitely feels like something is happening in there!

 

My nightly drug regimen!

 

IVF Days 10-12

Sunday morning it was off to Harrisburg Hospital for a scan and blood work (we have to go to the hospital for monitoring on the weekends). The tech told us she measured 10 follicles on each side measuring 9 or higher! The biggest one,  I believe, was about 12. That afternoon I got the call from the office that my estradiol was up to 1,207! The instructions were to keep the Menopur at 3 vials but to reduce Follistim to 150iu. I was also to continue with the Cetrotide. They wanted to see me again Monday morning. I was beginning to feel like we were getting close J

Monday’s scan was great – the docs seem really happy with the progress and it was great seeing all my big follicles on the screen! She measured and measured and measured – 12 on the left and 19 on the right! Most of them seem to be in the 11-13 range. There were a few bigger ones – 15 and 16 – but I think she said she was going to “let them go” (meaning wait to trigger) in order to get the other group at the right size. Her best guess was that my egg retrieval procedure would be Friday. They will likely want to see me every day now. This is a bummer for my time and my veins (they are so sore already!) but it’s all about 100% effort this cycle. This one’s for all the marbles!

On a sad note, I found out after my appointment that my grandfather had passed away. It makes me sad that I never got to have a child while he was around. But I am happy that he at least got to be at my wedding and that I got to see him one last time last week before he died.

Monday afternoon I was informed that my estradiol was up over 2,200 and I was to keep the same drug regimen that night. Nothing really new at Tuesday’s scan. Jared came along and got to see all my crazy follicles on the screen. There didn’t seem to be a whole lot of growth – she said she was thinking more like a trigger Thursday and retrieval Saturday now. Of course, as Penn State season ticket holders, we were bummed at the thought of missing a home game…yet another sacrifice…Instructions were to keep Menopur at 3 as well as the Cetrotide but to up the Follistim to 200. Estradiol at 3,018! Closer! Closer!

At this point, I am feeling nervous about several things.

1 – That the follicles will poop out. I think after being used to scans every other day and seeing consistent growth, the piddly pace of every day scans makes me anxious, especially since she pushed back her estimate on the trigger/egg retrieval date.  Also, the fact that my follicles have pooped out before makes that a real thought in the back of my mind.

2- Hyperstimulation (Ovarian Hyperstimulation Syndrome – when, as a result of fertility meds, the ovaries become swollen and painful and the abdomen gets bloated and fills with fluid). The doc seemed very nervous about this and they are explicitly asking me how I am feeling each day.

3- Egg retrieval – as the possible day approaches, my nervousness grows. I even broke down and googled about it (as I always do – I am so weak!) and read some pretty scary things, especially about pain. Jared tried to calm me by telling me that only those with bad experiences write about it on the internet. He even ratted my googling out to the docs, haha – they were both, “Don’t do that! No internet!” They knew it would get me worked up.

IVF Days 13-15

Wednesday was an early, early scan -7 am! - so we could head out to Johnstown for my Grandpa’s funeral. Things really didn’t look much different but she insisted we were progressing. It was looking like Saturday would be the day, or maybe even Sunday. I got the call that afternoon that my estradiol was 4,200 and that things were coming along. Meds were to remain the same.

As an aside, I am almost completely bloated out of every pair of pants I own (I could probably get them buttoned but it would not be comfortable!) I have been doing my best to wear stretchy pants, skirts, and some of the larger items in my wardrobe. My belly looks like I just ate Thanksgiving dinner...twice...for about 3 days in a row, haha. Deep down I know that this is part of the process and I just have to deal with it. Maybe I will get pregnant and I can roll right into maternity pants!

Thursday I had my scan with a nurse from the Philly offices – she was there covering for my docs. She was great and really helpful in explaining things. I felt like I could really see a lot of growth in the follicles, particularly on the right side. I had a lot that were above 17 – it was looking good! She said she felt pretty certain I would be triggering that night for retrieval on Saturday. She reviewed with me all my pre-op procedures and meds. I think it was really starting to sink in that this was really a “real surgery” which made me a bit increasingly nervous. She was to call me in the afternoon (as always) for the official word and, if it was time, the dosage for my HCG trigger shot (which is the last step – it’s done 36 hours EXACTLY before the procedure and gets the eggs ready to be harvested).

The call was a rough one. My estrogen had skyrocketed above 8,000 which is not good. This puts me at an even greater risk of hyperstimulation.  I was definitely going to trigger that night but the doc wanted me to use “Ovidrel” (a name brand and lesser dose) instead of the generic HCG. HCG is one of the things that triggers hyperstim so the idea is to cut that to reduce the risk – however, less HCG can result in fewer mature eggs. The doc also wanted to me to start medicine – Dostinex – to reduce my chances of hyperstimulating. (Of course, trying to find a pharmacy that carried it in the middle of nowhere like Juniata County proved to be a drama in and of itself – thankfully Walmart had it!) And then the news that felt like a real blow – there is a decent likelihood that if I do hyperstim, the doc will want to freeze ALL the embryos and not do a fresh cycle at all. We would delay the embryo transfer until next month.  I was so upset and scared. Not to mention my hormones – I am really not a person of sound mind at this point! I just remember feeling defeated and overwhelmed…again. The words that have haunted me over and over – should it really be this hard?

In retrospect, freezing everything is not the worst thing in the world. The reality is if I would hyperstim, do the transfer, and then get pregnant, the HCG produced by the pregnancy would make the OHSS way worse and it would last longer. I have a friend who went through this and it put her in the hospital with severe OHSS. I am still VERY scared about hyperstimulating. From what I have read (yes, I was at it again), I could just be uncomfortable for a while (painful, swollen ovaries) or, if the fluid builds up in my abdomen, I might have to go into the hospital to have it drained out – uck! I am following orders – eating protein and fresh fruit and veggies, staying hydrated, making sure I am peeing enough, and , as of this morning, weighing myself every morning. But if I do get OHSS it probably won’t rear its ugly head until after the retrieval.

So last night (Thursday) I did my Ovidrel trigger. It is a pre-filled syringe so there was no mixing. It was so quick and easy it almost felt anticlimactic – there was so much anticipation about the “trigger” and in 2 seconds it was done! I had a final appointment for blood work this morning (Friday) – they want to ensure that the HCG is in my system. My mom came along, which was nice – to be able to show her where I’ve been going. She also got to meet Dr. N. I didn’t have an appointment to see her but I really wanted to talk to her because I knew she’d calm me down and she totally did. She still feels that everything is going to go great although the other doctors are a bit concerned about my estrogen level. But she said we will just wait to see how I feel to determine whether we will do a fresh transfer.

Jared and I are headed to King of Prussia later today for my egg retrieval tomorrow. We decided to stay over since my surgery is at 7:45 a.m. I am hoping to relax, have a good meal, and get a good night’s sleep. In reality, I am completely scared about the egg retrieval. I am trying not to think about it so that I don’t get worked up. I just have to focus on the fact that by this time tomorrow we might have fertilized embryos!

 

 

Beginning our IVF journey...

The consult

So the IVF consult with Dr. N went mostly as I had expected. My primary concerns going in were (1) having to do multiple injections a day…which she stated would not be the case, and (2) having to do progesterone shots after the embryo transfer (I had read about these bad boys on the internet – long needle, in the butt, and painful!)…she said they only use the Crinone (vaginal cream) for progesterone – no shots! Whew! (Progesterone is produced naturally by the body but they like you to have any extra boost to help with implantation.)

We also found out that they had FINALLY received my records from Danville. Based on what she saw there and everything that’s happened so far with RMA, the diagnosis is “Hypothalamic amenorrhea”. Here is the best description that I found on the web, thanks to shadygrovefertility.com:

The hypothalamus in the center of the brain controls reproduction. It produces the hormone, gonadotropin releasing hormone (GnRH). GnRH signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle stimulating hormone (FSH) and after ovulation, progesterone luteinizing hormone (LH). In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and, along with progesterone, prepares the uterus for a fertilized egg. Sometimes the hypothalamus stops producing GnRH, which in turn, will reduce the amount of other hormones produced (FSH, LH, and estrogen). Ovulation and menstruation stop, resulting in infertility.

So after 2 years, it sounds like I don’t ovulate because my brain in damaged. OUCH. But we are happy to at least have some answers at last.

After doing some research on HA, it’s looking more like this could have been caused by my diet and exercise habits as well as anxiety/stress.  As one website put it, Hypothalamic Amenorrhea is the fancy way of saying “stress-induced loss of menstruation.” Other interesting points – “The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children. “Safe” means both physiologically and psychologically. Mental stress can hurt your fertility just as much as physical stress. Unfortunately, these two stressors commonly occur in women today.  Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating. Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating. It’s no wonder that so many women struggle with this.” (http://www.paleoforwomen.com/overcoming-hypothalamic-amenorrhea/)

Five years ago, I started counting calories and took up running. I lost about 20 pounds and my eating and exercising has never been the same. I also tend to get stressed out really easily. (Not to mention over the past 5 years I had a job in politics – hated it…went back to school – hated it…and then started a whole new career!)  I think all of these factors have been enough stress on my body that it may have caused my infertility. In the end, I am trying not to dwell too much on the cause and rather focus on solving the problem.

The other problem with me, we learned, is I have a super duper storage of eggs.  The doc said there is a hormone called AMH (antimullerian hormone) that is measured to estimateAMH, or antimullerian hormoneAMH, or antimullerian hormone how many eggs you have – typically for someone my age, a 2 or 3 would be normal. I am a 5. This makes sense for the problems we’ve been having…my body will do next to nothing as far as making follicles/eggs on its own but then once the docs added the meds everything would explode (ie. lots of follicles that all wanted to grow together). This is actually perfect for IVF because the goal is to grow as many eggs as possible.

After explaining more about what is happening with me, she reviewed the whole IVF process.  Most of it was not new – I had already read A LOT. But basically it’s approximately 10-12 days of injections (she said I can expect to get pretty uncomfortable and bloated-feeling toward the end due to my ovaries being so enlarged).  Then, if all goes well, it’s off to King of Prussia for the egg retrieval (where I will be asleep).  The eggs go to the lab where they are fertilized with Jared’s sperm and they wait in the lab to see how many fertilize and how they grow and depending on that I come back to KOP in 3-5 days for the embryos to be transferred into my uterus.  As a bonus, the wait to find out if it worked in IVF is only 10 days instead of a full 2 weeks like with IUIs! The doc said if we do a 3 day transfer (meaning 3 days after the fertilization - less than ideal, they do this if the embryos aren’t thriving, they might do better in me) we will put 2 in, if we make it to day 5, she only wants to put 1 in. (As an aside, I am not sure how I feel about this. I feel like 2 should go in regardless…but twins are still a big health risk and I read that it is possible for an embryo to split, which could lead to more than twins. I am still holding off on this decision until we get to that point.)

The other awesome thing we found out is that we can freeze any embryos that are good but that we don’t end up using. Then if this cycle doesn’t work, I don’t have to go through all the injections and egg retrieval again – they just thaw 1 or 2 of them out and do the transfer. And if it does work, we can even store the frozen ones and come back in a few years to try for #2! Pretty crazy!

At the end of the meeting, we just had to talk to the financial office to get squared away and then we could get started. Oddly enough, I have to be on birth control pills for at least 2 weeks before I start injections in order to regulate my hormones. Seems counterintuitive I know. But we definitely left the office that day feeling good – not overwhelmed at all, just ready to start this new chance at a Graybill baby!

Beginning the IVF process…

The next week Jared spoke to the financial office and, as we expected, almost everything is covered. (Can you say “AMAZING”!) The only thing we have to pay for is to freeze any remaining embryos and a yearly fee to store them. Overall, we couldn’t ask for anything better.

I scheduled my “baseline scan” (to make sure everything looks good for me to start the birth control pills) and nursing consult (where the NP goes over all the consent forms and meds instructions). Luckily, I have already done injectable medication so there wasn’t really too much for me to learn. I can’t imagine women that have to learn all that in one sitting – that would be totally overwhelming!

We got paperwork to look over before that appointment because they require you to decide in writing what you want done with your frozen embryos in certain situations (ie. if one or both of us would die or if we would get divorced). It was kind of stressful because you start to think about whether or not you would consider these embryos as “babies”.  One of the options is disposal in accordance with proper procedures. You can also donate to an infertile couple. It was a lot of discussion about these embryos that we don’t even have yet!

Everything with the baseline scan looked fine and I got my script for BCPs. Two bombs did get dropped on us at the nursing consult. First, I would definitely being doing at least 2 shots per day during the egg stimulation. The 2 meds I will be taking – Follistim and Menopur – I have already done by themselves. However, Follistim is delivered in a reusable injection pen that takes a cartridge of meds whereas the Menopur is a powder that has to be reconstituted and delivered via a syringe. Thus, they can’t be mixed and taken together. Bummer! Plus, there is another medicine – Cetrotide – that I may have to take toward the end to keep me from ovulating prematurely, which will make 3 shots a day. In the end, though, it’s definitely one of those “Crap! Oh well…” situations.

SIS and mock transfer

The other bomb was that I needed to come in for 2 procedures before I can start stimulation meds. The first is a “mock transfer”, which is exactly what it sounds like – a “practice round” of the embryo transfer so they can figure out how best to navigate their way in. The other is a “Saline Infusion Sonohystogram” (SIS) where they fill my uterus with saline and look at it in a scan to ensure it looks healthy and that there are no polyps.  I was told these would be easy-peasy….

Doing what I always do, I googled about these procedures before the day of my appointment. As soon as read that someone thought the SIS was similar to the HSG, I began to worry. (The HSG was a procedure I had done in our early months at Danville – they inflate a balloon in the uterus and then shoot dye into it to see if the fallopian tubes are blocked at all. If the dye comes out the other end, the tubes are open. My HSG was easily the worst pain I have ever felt. I screamed and screamed. In the end, my tubes were totally fine. But I knew I couldn’t go through that kind of pain again (unless I got a baby out of it, of course!))

For the mock transfer (and the actual embryo transfer as well), you are told to arrive with an uncomfortably full bladder. Not fun. (The full bladder is needed to help them see things better.) By the time they took us back to the room, I was very miserable – I just wanted to get it over with so I could pee! They use a belly scan to look at the catheter as it’s going into the uterus, which was actually pretty cool. This procedure was uncomfortable, but certainly not terrible – pretty much like an IUI while having to pee.

After they let me use the restroom, it was time for the SIS. It was not as bad as the HSG but it was a close second. I moaned and bawled but did not out rightly scream (thankfully). I felt kind of bad for the doc and NP – they looked terrified, haha. The doc questioned me about the results of my HSG – she said that normally an HSG or an SIS will only cause that much pain if there is tube blockage. My opinion is I am just a sissy!

Here we go!

So that pretty much brings things up to date…I had a scan and bloodwork yesterday and got the okay to stop taking the BCPs. If all looks okay at my scan on Friday, I will start stim meds that night!

All the supplies/medication I will need for my first cycle of IVF 

Right now, I am feeling excited and nervous. Excited about starting something new – a new chance. Nervous about the injections and changes in my body.  But I know I just have to focus on how badly we want a child and how it will all be worth it if it works!

Here is a prayer that I have been praying:

The Fertility Blessing

You know my deep desire for a child - a little one to love and to hold, to care for, to cherish. Grant that my body may conceive and give birth to a beautiful, healthy baby in Your Holy image. Guide me in all my choices so that this conception, my pregnancy, and my baby’s birth are in line with Your will. Heavenly Father and Holy Mother, hear this prayer of my heart, mind, and spirit. Amen.