As The Ovaries Turn: IVF #2 On The Horizon

Things are moving along here in baby-making land. I had my hysteroscopy a couple of weeks ago and that went well. My doctor said that she did see a slight curve in my uterus, but neither she nor the other doctor she discussed it with felt that it was an issue. So no additional surgery needed, hooray!

I’m currently estrogen priming, which entails taking estrogen pills twice a day. This is to ensure that the follicles grow at the same rate during the stimulation phase of IVF–a greedy, over-acheiving follicle is a very bad thing indeed. Once my next cycle starts, I’ll have a day two ultrasound, and if that looks good (fingers crossed no cysts!), I’ll start injections that night. Of course, the pharmacy is being dumb (long and boring story), so I’m not altogether sure that we’ll get our medications in time, but hopefully we can borrow from our clinic if needed.

I haven’t decided yet if I’m going to blog during this next IVF. I really want to keep my head on straight, and I wonder if the blogging play-by-play last time increased my anxiety. Or maybe I would’ve been an Anxious Annie no matter what (let’s be honest). I might even take a full-on blogging break for a bit to make sure I’m feeling centered. Who knows, dudes. I’m saying all of this, but I might be back posting again tomorrow, all like “Did you guys miss me?!” I guess I just want to let you know that if I do drop off a bit, it’s not because something is wrong.

One of my teachers on this baby-making endeavor, Julia Indichova, often talks about how this journey does not need to feel like a prison sentence. It is only our perspective, she says, that makes it feel like a punishment. I think this is very wise. Some days I do feel trapped in a jail of my own making–like either I’m stuck waiting indefinitely or I have to give up completely. Some days are really, really hard. But other days, I am able to shift my thinking and see this all for what I, deep down, truly believe it to be: a great adventure. An opportunity to become more compassionate towards others, and also towards myself. A chance to get well acquainted with hope and faith.

Thankfully, today is one of those days. I’m feeling pretty good. I don’t know what will happen with the next IVF, and right this minute I don’t really care. Because right this minute I am feeling grateful. I’m thinking about the two pairs of blue eyes–one big and one little–that I get to look into each day. I’m thinking about the cold rain on my face as I left work this evening. Normally, that rain would have pissed me off, but today I was like, yes!

Because, really: how lucky I am to feel that rain. How lucky I am to hear and see. To have good, plentiful food to eat. To know deep love. How lucky I am to feel each breath–a constant rhythm, a reassurance that I am here, right now, exactly where I’m meant to be.

What’s Next: Doctor’s Appointment Update

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Disclaimer: This is fairly boring post that you may want to skip if you’re not interested in the details of IVF or miscarriage.

We had our what-the-f*ck-happened appointment with our doctor on Monday. I had a two-page list of questions prepared, starting with the IVF cycle and ending with the miscarriage. Here’s what we learned:

I did not respond to the IVF meds as well as my doctor thought I would. She initially started me out with what  was a higher-than-normal dose because she was worried there might be some after-effects of the cyst. She said she was prepared to lower the dose, but instead ended up having to up the dose. She said this could indicate that I had lower ovarian reserve, despite the fact that my FSH and AMH (two tests they use to predict ovarian reserve) were good. I guess ovarian reserve is a big predictor of IVF success. The more you have, the more likely you’ll be successful. And the opposite holds true for low ovarian reserve — less chance of success. So, yeah, great, possible secret low ovarian reserve. That’s definitely what I wanted to hear. I’m not even sure what to do with that one. I feel a little blindsided by it. I don’t understand why my tests would be normal, yet my ovarian reserve is still possibly jacked.

If we do a fresh cycle going forward, she would continue with the same protocol as the first time (estrogen priming with no birth control pills), but start out with the higher dose of meds than I ended up with last time.

As far as the recurrent miscarriage tests go, the ones that came back so far were normal, save for one of the blood clotting ones, which was slightly elevated. She said that could just be attributed to still being pregnant, though, so they will retest me once my hcg drops to zero. The genetic karyotyping that Tim and I had done is not back yet. There are also several other tests that she wants to do, but she again wants to wait until my hcg is at zero.

Apparently my last hysteroscopy showed a slight heart-shaped uterus and a slight septum. Either of these things could have contributed to the eccentric embryo implantation, which could have contributed to the miscarriage. She said that the hysteroscopy findings previously did not worry her because I’ve had a successful pregnancy in the past. But now, based on the fact that I’ve had the wacky implantation, she may recommend surgery to get the septum removed. Sweet, another possible procedure. She’s going to see what the results are of my next hysteroscopy are before she makes that decision.

I had a D & C on Thursday (more on that in another post) and they are going to genetic test the “products of conception.” Lovely term, right? Apparently, it isn’t a sure thing on whether they can get reliable test results or not (I’m not clear on why), but hopefully we’ll get some more information.

Because I’ve had two losses, my doctor suggested that we pursue genetic testing if we do another fresh cycle. Apparently, if there are no other underlying issues, blastocysts that are genetically normal have a 70% chance of resulting in pregnancy.

We basically have a few options going forward:

1) Use the frozen embryo we have and don’t genetic test it.

2) Use the frozen embryo we have an attempt to genetic test it. If it’s already hatched when it thaws, then it can’t be tested.

2) Do a fresh cycle and genetic test the embryos we get during that. We can also defrost the frozen one at that time and test it with the others, if it can be tested.

Right now we are leaning towards option three, a fresh cycle. I’m not sure what we’ll do with the frozen one yet — that’s what we can’t figure out. I don’t want to end up doing something that will waste it somehow. I would hate to thaw it, find out it can’t be tested and then have to re-freeze it and risk damaging it. It very well could be totally normal. It could be our take-home baby, but I’d like to have some backup in case it isn’t. There are just so many unknowns here, it’s hard to know what to do.

I think the results of our recurrent miscarriage panel and whatever we learn genetically about the baby that I miscarried will help guide our decision as well. It could be well over a month until all of that comes back, so for now it’s all speculation.

Regardless of what we decide, I’m benched from starting another cycle, be it frozen or fresh, until at least mid March. I have to wait for my first period so my lining can repair itself after the D & C  and then I have to get another hysteroscopy. So I won’t be able to start another cycle until my second period after the D & C. Plus, who knows how long this potential uterine septum surgery could delay things

And that, my friends, is what’s getting to me the most about this whole experience: waiting, waiting and more effing waiting. I just want to be moving forward. I feel like time is one thing that I don’t have the luxury of right now.

At least two more months for another chance at getting pregnant. That’s just for another chance! And if that chance doesn’t work, more waiting. And even if it does work, it doesn’t mean I’ll have a healthy baby in nine months. I know that, in the end, this period of infertility will just be a few years out of my entire lifetime, but right now I’m struggling to see anything beyond the waiting, uncertainty and heartache.