Meet The Kids!

Today we transferred three day-3 embryos. I was really hoping for a day-5 transfer, but our little cellular bundles had other ideas. In order for my doctor to OK a day-5 transfer, I needed to have at least four 8-cell, grade-A embryos on day three. As of this morning we had two grade-A embryos, two grade-B embryos, and four others that were pretty fragmented or lagging behind.

I was semi-upset when I got the news that we’d be transferring today. In my head, getting to a day-5 transfer meant that my embryos were good quality. I felt misled by Dr. Braverman — after all, he promised me my embryos would be better quality this time around. What a cad! However, I just looked back at my day-3 report from IVF #1, and I had fewer decent embryos at that point than I did this morning, and we did a day-5 transfer anyway. So it seems that my new clinic is just more conservative with day 5 transfers. And you know what? I’m ok with that. I did not want to end up with nothing to transfer. No thanks.

The morning did not go smoothly. Tim wasn’t allowed into the OR area. The acupuncturist accidentally needled my left calf so hard that the entire muscle cramped up. The embryologist felt the need to tell me, multiple times, that just because two of my embryos were grade A did not mean that this cycle was going to work. Um, WTF? I finally said to her, “Look, I know that grade-A embryos guarantee nothing. This is my 3rd cycle. I’m just looking for some hope here.” Then the doctor was an hour late to my procedure. I had to pee so bad that my whole body was sweating. And when it was all over, the doc did not bother saying “goodbye” or “good luck” before he left the procedure room. Again, WTF?

Needless to say, I was on the edge of tears all morning. I tried listening to my meditations and all that biz, but none of it was really helping. The clinic is just awful, and unfortunately we have to use them because they are the only one in our area who works with outside doctors. The one bright spot was the nurse in the transfer room. She was awesome and totally kept the morning from careening off into The Bad Place Of No Return.

The actual transfer itself went off without a hitch — super fast, no weird catheter malfunctions, no embryos stuck in the tube, etc.. And now I have three embryos  back where they belong, which is really all that matters in the end — not what day they arrived there.

So without further ado, meet our three beautiful babes. We transferred both grade-As and 1 grade-B. The rest will continue to grow, and we’ll find out their fate on Wednesday. Say “Hi,” kids!

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When we picked Lettie up from the babysitter I showed her this picture.

“These are embryos,” I told her.

She looked mildly interested, so I asked, “Which one is your favorite?”

She immediately pointed to the chap on the bottom right.

Ooooh, I thought, maybe that one is The One.

Then she said, “Do we eat embryos?”

Aw, my little cannibal. Sprinkling embryos on her cereal.

Anyway, I’m feeling pretty good right now. Maybe not the zen-master self I was in my last post (ok, not at all), but still pretty decent. I carried the picture of our three babes with me everywhere today. I propped it on the couch and the embryos watched some football. They saw Pope Francis perform his historic mass on the Ben Franklin Parkway. I leaned them up against a trivet and there they stayed as we ate our dinner.

And really, I can’t help but think today is a fortuitous day. There’s a supermoon lunar eclipse tonight. The pope was cruising around my city, kissing babies and spreading his holiness everywhere. And, perhaps most unbelievable of all, the Eagles won.

Boom.

Signs, people, signs.

All That’s Left To Do Is Let Go

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For the past two weeks, I’ve been preparing my body with blood thinners, steroids and intralipids. There is a constellation of hematomas on my abdomen, like a map of our progress, a connect-the-dots path to our baby. Right before each shot, Tim and I hug. Then we send up a silent prayer to that spirit we know we are meant to meet. I don’t know what Tim says, but mine goes a little something like this: I love you. I’m open to receive you. Please come home.

In three days, all nine of our embryos will be defrosted. They will grow and divide in their mysterious way, and if all goes well, we’ll transfer two blastocysts on Tuesday.

Five months of preparation have come down to this one day. The trips to New York, the surgery, the immune testing, the supplements, the new doctors, the shots, the procedures, the blood work, the renewed hope—all lead to Tuesday.

Am I ready for it?

Yes.

If it works, I feel prepared to navigate the challenges of pregnancy after infertility and loss. I’m not saying it will be easy, but I believe I can do it without losing my sanity. If it doesn’t work, well, of course I’ll be crushed, but I will be ok. This is one thing I now know without a doubt: I will always be ok. I will hurt, sometimes so much that I won’t want to open my eyes in the morning, but I will keep going. I will heal.

And so, one way or another, this epic quest is finally coming to a head. I’ve searched far and wide to find the answers I needed. I’ve prepped my body. I’ve prepped my mind. I truly believe I’m giving this baby the best possible chance to make its way to us.

All that’s left to do is let go. To let what is meant to be, be. There is so much sweetness in that, and so much peace.

I am ready.

A Long Overdue Update: IVF # 3, Part 1

Hey, dudes. It’s been busy ’round these parts. Since my Dr. Braverman update, I went on vacation, work turned into Crazytown and I lost my friend to cancer. And, oh yeah, I did a stim cycle. Retrieval was almost two weeks ago at this point.

I’ve been meaning to update you guys on the cycle for ages, so here’s the breakdown.

What we did differently this time vs. last time

I was on a much lower dose of stims. You might recall that for my last IVF I was on the atomic bomb dosage of meds, so I was initially very worried about this decrease.

The doctor added Clomid to the Menopur and Follistim cocktail.

He also threw human growth hormone into the mix. (Yep, just like A-Rod.)

I did a double trigger. So instead of just HCG, I also injected myself with Lupron as well at trigger time.

I took my Dr. Braverman supplements throughout the cycle.

I worked with a fertility coach and she helped me change my entire headspace. Although I had a few relapses, I made it through the cycle with minimal anxiety. I’ll try to write more about the work we’re doing together soon. She’s awesome.

Instead of doing a fresh transfer, we froze everything on day 1. The embryos will later be thawed and grow to day 3 or 5 before being transferred.

How it turned out

I stimmed relatively fast — only 8.5 days

They retrieved 11 eggs. My first cycle they retrieved 10, and my second cycle they retrieved 8.

9 out of the 11 fertilized with traditional IVF! My first cycle 6 fertilized via traditional IVF, and my second cycle only 3 fertilized using ICSI (insert sad face here). So, HOT DAMN, 9 is pretty amazing for my bod. Dr. Braverman promised me that my embryos would be better quality now that my endometriosis is no longer hanging around, and I’m hoping the high fertilization rate means he’s right.

I believe

Since the embryos were frozen so early, we’ll have to wait until they thaw and grow to really know if they’re good quality. I believe in them, though. And I wasn’t sure I’d ever be able to say this, but: I’m beginning to believe in my body again, too.

 

Immune Testing Results & Consult With Dr. Braverman

You guys, have I told you lately that I love you? For real. Your comments on my last post were just beyond. Not to mention my friends in real life that reached out to me as well. Thank you everyone. A million times over.

Last Tuesday I had my Skype consult with Dr. Braverman and found out the results of my immune testing. Basically, all the findings were consistent with endometriosis. This is pretty good news overall – there’s nothing else more sinister lurking on the sidelines.

Warning: I’m about to get very long-winded and detailed. I want to share as much as possible in case I can help anyone on the interwebs searching for information.

What the testing found:

I am genetically predisposed to endometriosis (duh at this point), Grave’s disease, Hashimoto’s thyroiditis, Antiphospholipid Syndrome (this one is no surprise either), Celiac, psoriasis and psoriatic arthritis

This does not mean I have any of these things–it just means I have the genes that would allow them to develop. Or something. I’m disclaimering right now that I barely understand all of this immune biz, so most of the explanations in this post will likely be at least semi-bogus.

Other things that are awry in my immune system:

My white blood cell counts are a little low. This is consistent with endometriosis, but I forget why.

My anti-cardiolipins are still testing as highly positive.

My natural killer cells and CD8+ T-cell levels are through the roof. Both are in the 98th percentile. Meaning, of all of Dr. Braverman’s patients, 2% of them have higher natural killer cells and CD8+T-cells than me. Whoa.

So why is this significant? Basically, both of these types of cells are totally normal. Everyone has them in their bodies. They fight off cancer, viruses and the like. But if they are too active, they see an embryo as a foreign body and kick it out.

To sum it up: I have endometriosis. This negatively impacts egg quality for a variety of reasons, two of the main ones being that it creates inflammation in the reproductive organs and also messes up the mitochondria in my eggs. This makes it really hard to produce eggs that actually turn into babies. Then, on the off chance that I do make a healthy embryo, the anticardiolipins, natural killer cells and CD8+T-cells kill it. On many levels, my reproductive system is – no, was – screwed! Was. It’s a whole new world now.

What Dr. Braverman suggests:

Luckily, everything that he found is straightforward to treat! Huzzah.

The first step is to remove the endometriosis, which I have already done.

Next, we wait two cycles in order for the inflammation to die down. I’m a little less than halfway through this.

Then he recommends another IVF cycle. As some of you know, I have an embryo still frozen at my old clinic. He said it’s not impossible, but very unlikely given what we know, that this embryo is genetically normal. So he recommended holding off on transferring that one for now.

After the IVF cycle we’ll freeze all embryos, ideally on day five. Apparently, the drugs from the IVF will make my immune response worse, so no fresh transfers for me. He then wants to do something called mitochondrial testing on the embryos. This is apparently a brand-new test. Instead of genetically screening the embryos, it tests only the mitochondria, which is apparently the most important factor for endometriosis patients. I’m not sure if we’ll do this yet. I need to look into it. He does not recommend traditional genetic screening.

Finally, we’ll do a frozen transfer, using Dr. Braverman’s immune protocol.

The immune protocol will include:

Lovenox (a blood thinner)

Steroids (reduces inflammation)

Intralipid IV infusions (this is, like, straight-up fat, I think. I don’t even remember what it does, but it sounds like some mad scientist hootenanny. Sign me up!)

All of this will be done at our new clinic, with Dr. Braverman consulting on the frozen transfer. The new clinic is about an hour away from us, which is a major downer, but our old clinic won’t work with outside doctors, and this one does.

Other recommendations from Braverman for patients with endometriosis:

Cut out gluten (I’ve been gluten free for a year or two now, so we’re good there.)

Cut out dairy (I’ve also been dairy free for a while. Dr. B. says a little dairy every so often is fine. It’s not as much of an issue as gluten.)

Eat organic

Take a crapload of supplements.

Here’s the supplement list, if you’re interested:

Pycnogenol and Resveratrol (antioxidants that reduce oxidative stress and lower reactive oxygen species in the follicle, improving egg quality)

Melatonin (an antioxidant — it has been shown in the literature to increase the number of FSH receptors on the follicles in patients with endometriosis. I may not be able to stick with this one, btw, as it appears to be exacerbating my asthma)

VSL#3 probiotics (to lower the level of inflammation by increasing the production of IL10 in the blood. If anyone knows what IL10 is, let me know.)

Fish oil with Omega 3 (didn’t get an explanation for this)

Mitochondrial optimizer (helps to improve mitochondrial function in the egg, which increases the competence of the nucleus. This leads to higher euploid rates and better embryo performance)

Vitamin D3 (to help decrease natural killer cell activity)

Greens formula (didn’t get an explanation for this)

General notes:

He said that, after surgery, I have about a one-year window until the endometriosis comes back.

His official word is that one cup of coffee a day and drinking socially is fine. He’s firmly in the everything-in-moderation camp. So, guess what guys? If I want a friggen glass of wine, I’m having a friggen glass of wine. No more guilt!

He called me young! Well, kinda. When I asked him if I should be taking DHEA, he was all, “That only works for older women, not women who have diminished ovarian reserve for other reasons.” Consider my life made. It’s not often that 38 is classified as a younger woman in the fertility world. I’m taking that and running with it.

Whew! Are you still awake? I am, but only barely. If you’ve read this far, you are a rock star.

And with that, I’m signing off. Must go to bed. Tomorrow we meet the doctor at our new clinic for the first time. I hope we like him (and the clinic) because we really don’t have much choice in the matter.

‘Night, dudes. Sleep tight.

The View From Down Here

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A quick peek inside my head.

Well, here I am. A little less than two weeks post surgery. I’m feeling much better physically.

But mentally, yikes. If you could see my thoughts right now, you’d be like, whoa. They’d be all black clouds and evil robots and scary vintage dolls with those flip-lid eyes and I don’t even know what else.

Things were ok for a while. Initially after the surgery I felt relief. It’s over, hooray! I have endometriosis, hooray! It may seem strange to feel relieved upon finding out you have an incurable disease, but I was just glad that we finally had some answers. So many things were explained: the spotting before my period (endometriosis on my cervix), frequent urination (endometriosis on my bladder), the pain in my lower right side that doctors had been dismissing for years (endometriosis on my ovary) and my crap-quality eggs (endometriosis everywhere). And even better, all of it was removed! (P.S. the surgeon did remove the endo on my ovary – in my anesthesia-addled state I misheard the him.) For the moment at least, I am endometriosis free!

I was also feeling happy with myself. Happy that I kept searching and digging until I finally got some answers. That I didn’t give up. That I trusted my gut and listened to Dr. Braverman when he told me to get surgery after a ten minute phone consult. I was like, well, this is totally crazy, but I think he’s right so I’m going for it.

And he was right. We both were.

So yeah, I was feeling pretty good for a few days, despite the pain.

But then, I don’t even know what happened.

Maybe it was the fact that recovery was worse than I’d expected.

Maybe it’s because, as relieved as I was, it started sinking in that I have an incurable disease. Yes, the endometriosis is gone, but it usually comes back at some point.

Maybe it’s because, despite my very best efforts, I can’t seem to get my stupid teeth situation under control. Like, I can’t remember a time when my teeth didn’t hurt. One gets fixed and another one gets jacked up. It’s never ending.

Maybe it’s because we’ve been going at this babymaking crap for over two years.

Maybe it’s because I’m staring down the barrel of our last IVF. One final chance and that’s it.

Maybe it’s because after all of our talk of adoption, I don’t know if that’s truly going to end up being a valid option for us. We don’t have the cash up front right now to make it happen, so we’d have to either borrow money, clear out our dire-emergency-only funds, save for years or a combination of the three. Not to mention the fact that this fertility journey has already taken a toll on my relationship with Tim. We’re not headed to Divorce City or anything like that, but I think we both agree that we’ve seen happier days. What would another two or so years going through the adoption process do to us? Yes, I want another child more than almost anything, but not at the cost of my marriage. I’m not saying adoption is off the table, but it’s certainly going to require further discussion and exploration.

So when all is said and done, we may end up without another child. Which means we would have spent years on this journey with nothing to show for it — nothing good anyway. Two dead babies. A sharps container full of needles. A strained marriage.  Not to mention that I’m now the kind of person who rolls my eyes when I see a pregnancy announcement — so essentially I’ve become someone who begrudges others their happiness. And I’m sure I’m a worse parent to Lettie than I would have been if I didn’t go through any of this stuff. How many times have I been obsessing about my fertility, or lack thereof, instead of being in the present moment with the amazing child that I already have? How many times? Just thinking about it makes me want to cry my eyes out. She deserves better than that. Tim deserves better than a wife who’s anxious, upset and preoccupied all the time.

And there it is, the root of why I’ve been feeling so low lately: maybe I’ve fought valiantly for the last two years, but I’m not sure I like the person I’ve become.

Extensive Endometriosis

Hi everyone, this is Tim. Tanya wanted me to let you know that she finally had her surgery yesterday, and to give you an update.

The doctor found endometriosis on her cervix, bladder, back side of uterus, and right ovary. He classified it as stage 3. Everything was removed, except for the endo on the right ovary – he didn’t want to risk damaging it. He said endometriosis isn’t usually seen on the cervix, so he sent that off to pathology.

Tanya is fine, but recovery is rougher than we anticipated. There’s lots of pain from the gas injected into her abdomen, plus abdominal pain from the surgery and some nausea. She’ll post more once she’s feeling better.

Thanks so much for all your support!

Sometimes Waiting Makes Me Want To Punch A Wall

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Ok, fiiiiiine. I’ll wait then. Whatever. [image]
You think I’d be good at waiting by now. Like, I should have my masters degree in waiting. Eff that, I should have my full-on doctorate. Right? Nope, I suck at it. Admittedly, I think I am getting overall a little more patient. These last two years have taught me that I have control over nothing. But the waiting curveballs still get me. I can deal with the expected waits, but I’m no good with the sneaky ones.

When I was talking to the doctor yesterday, he said we could reschedule my surgery for next week. His exact words were, “I can do it any day you want. I can even do it on a weekend if you want.” He told me he’d call me tomorrow.

He didn’t call, but someone from scheduling emailed me and was like, “The next available appointment I have is June 25th.”

So I immediately called her and said, “Dr. Vidali told me he could get me in next week.”

And she was like, “Oh, he did? Ok, let me call him. I’ll call you back today after I work everything out.”

I didn’t hear from her. Tim called her at the end of the day to check in. He left a message. She never called back.

So who knows. Maybe next week will still work out. But we need to make childcare arrangements and hotel arrangements and work arrangements, so we kind of need to know soon.

And even if we have to wait three more weeks, it’s not like it’s the end of the world. It’s three weeks, not three years — or even three months. I need to chill. But I thought I was having surgery yesterday. And then I thought I was having it next week. And now, who knows. Not to mention part of me is wondering why I’m even rescheduling this at all after the whole disappearing power act yesterday. That sh*t was freaky. But I digress.

I still need to update you guys on the appointment I had with Dr. Vidali on Wednesday. Dr. Vidali is the surgeon who works with Dr. Braverman. He’s also a reproductive endocrinologist. Oh, and in addition to those things, he’s very charming. We had a great visit with him. I’ll post about that soon.

But for now I just want to say &@#^#*&$*&, and give a big middle finger to the waiting that surrounds every single step of this babymaking process.

Every.

Single.

Step.