IVF #2: #GoEmbryos #HopeStreet

You guys, thank you so much to everyone who commented on my post or sent me a message yesterday. I even had one friend drop off some marigolds. It was a rough day, one of the roughest I’ve had in a long time, but you all managed to make me feel so loved. It’s pretty easy to feel isolated and alone on this journey, but you have proven time and again that you walk beside me.

After Lettie went to bed yesterday, Tim and I talked for a long time about what to do. I did end up connecting with my doctor, but she didn’t give us a strong opinion one way or another on whether to go for the day three transfer or hope that the embryo grew to blastocyst. We hashed out every single possibility six times over. We even called a real-life friend who has gone through IVF to bounce ideas off of her. We worried about miscarriages and chemical pregnancies and the possibility of a genetically abnormal embryo implanting. We worried and what-ifed until we were about to pass out from exhaustion.

And then we both just kind of stopped. We simultaneously came to the conclusion that we did not want to make a decision out of fear. Neither one of us wants to live our lives like that. And we certainly don’t want to teach our children to be ruled by fear either. For us, all the reasons to avoid a day three transfer came from a place of fear, not hope. So we decided that if the next day our embryo or embryos looked the same or worse, we would go ahead with the day three transfer. We called the acupuncturist and told her to meet us at the clinic in the morning. Then we went to bed, feeling happy with the decision that we made together. I think we both felt lighter. And dare I say it? Hopeful.

But you know how it is. The best laid plans and all that. This morning the embryologist called bright and early and told us that the decent-looking two-cell guy from yesterday was now a bad-ass, grade-1, 8-cell embryo (these are all good things). And guess what else? One of the two poor-quality embryos from yesterday also looked pretty good! The last one was disintegrating (sorry, buddy. I still love you, though).

Well, eff me. This was not the news we were expecting at all. All of you that told me yesterday not to give up were absolutely right. Your prayers and thoughts and good vibes must have worked because those punks are fighting!

So Tim and I reassessed, and again made a decision from a place of hope. We decided that since the embryos were clearly fighters, we were going to let them fight it out another couple of days. On day five the embryologist will check them again–if any are still going and can be biopsied for testing, they’ll do so at that time. I know there are wildly different theories on this in the infertility world, but both my doctor and the embryologist said that if the embryos were going to make it to day five, they would do so whether in the lab or in my body. I trust them on this one. My clinic has really good labs and that is one of the reasons I chose them. And not only do I trust the professionals, but I have faith in our embryos. I believe they can do it. I’m proud of our scrappy little cells.

And yeah, this means that we might not have a damn thing to transfer in the end, but I think I will ultimately be ok if that happens–very sad, yes, but ok.

Because today, one more time, I choose hope.

IVF #2: I Choose Hope

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It’s been a rough week. Since my last post I’ve pretty much descended into madness. I’ve been obsessing about follicle growth and root canals and estrogen numbers. My anxiety level has been out of control.

I’m pretty sure it reached its peak this afternoon. My clinic called to say that I would be triggering this evening. A few minutes later I emailed them to find out what my estrogen was at this point during my last cycle so I could compare. For real-life friends: your estrogen number can be indicative of how many mature follicles you have. The higher your number, usually the more mature eggs you’ll produce. You don’t want the number to get too high because then your ovaries can freak out and fill with fluid, earning you a one-way ticket to the hospital. But you don’t want it too low either. For reference, my estrogen today was around 1500.

So this one nurse writes back. I think she’s kind of new, but I’m not sure. She’s young and super sweet, but she just doesn’t seem as with it as the other nurses.

She writes, “Your estrogen at this time last cycle was 258.”

And I’m like, huh? That seems crazy low. So I write he back saying, “Wait, 258? Is there a missing number somewhere? That seems really low.”

And she writes, “Oh, I’m sorry, 258 was your first beta from your last pregnancy. Your estrogen last time was 2578.”

Cue multiple freakouts. Freakout number one: Who wants to be reminded of an unsuccessful pregnancy right before trying to get pregnant again? WTF? Freakout number two: Why is my estrogen so much lower this time? Does that mean I’ll get half the number of eggs? AAAAAAACCCCCKKKK!

So then I wrote, “Whoa, that’s a lot lower than last time. Does the mean I’ll get a lot less eggs at retrieval?”

After that, another nurse wrote me saying sorry for the miscommunication and that I had been given the wrong number ah-gain. The 2587 number was from the day after trigger shot. My number the day of trigger shot was like 1800-ish.

That’s really not that much of a difference than last time. Plus, I had 16 follicles last time and now I have 12, so it makes sense that the estrogen would be a little less. But by the time time I got that last email my anxiety was in super-freak mode, and continued on that way until about an hour ago.

Until I decided enough of this.

I can choose to keep going down this path of fear that I seem so hell bent on walking, or I can choose hope. That’s what has been absent from this cycle so far: hope. I completely lost sight of it. I got so mired in the teeth pain and the baggage from my last IVF that I let the anxiety completely overtake me. I lost sight of what I long for this experience to be: a chance to connect with the soul who will join our family.

Yes, I’m having major teeth pain and root canals. Yes, I’ve been doped up on Tylenol 3. Yes, I’ve been stressed to the max for days on end. Yes, I’m still sad about the loss of my last pregnancy. Ok, fine, these are not 100% perfect circumstances for an IVF cycle. But what in life is ever perfect? Just because it’s not perfect, doesn’t mean it won’t work.

So today, right now, I choose hope. I’m packing my bags and moving my whole family to Hope Street — and that’s where we’ll stay, for as long as we need to. Fear Street is derelict, you guys. And the neighbors are all paranoid assholes.

IVF #2: My Motley Follicle Crew

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I saw my second favorite doctor at the practice this morning.  He looked over my chart when he came in and said, “Ok, so you’re on antagonist protocol, estrogen priming and then atomic bomb. I like it.” Atomic bomb is of course referring to the ridic amount of meds that I’m throwing at my ovaries right now.

He did an ultrasound and said he was pleased with the follicle growth between Thursday and today. There were still a dozen follicles hanging out, so at least I didn’t lose any more. Score! According to him they were “all different sizes,” so they’re definitely not all growing at the same rate. I hope, hope, hope that the tiny ones catch up to the big guys.

I left there feeling pretty good. I was imagining my dozen follicles sitting pretty in a cardboard egg carton. Sure, I’m not going to win the award for the World’s Largest Follicle Collection, but 12 is still pretty damn solid. And besides, quality over quantity and all that business that you wise women always tell me.

But then. Here’s that but again. The nurse called back this afternoon and said that I was to take my regular dose of meds tonight, and tomorrow night I should up my Menopur dose. Whaaaaat? You guys, I’m already taking the Atomic Bomb amount of stims. I thought I was at the max dosage. And now she’s UPPING IT? This can’t be a good sign, right? Something must be wrong for her to do this. I read back through my old posts, and my doctor did up my Menopur around this time last cycle as well. But this cycle I started out on a higher dose of meds than last time, so I assumed that I would be staying at the same dose the whole time. After I increase my dose I’ll be on 450 units of follistim and 225 units of Menopur. So that’s 675 total units of stimulation meds. Gah! Does that seem crazy to any of you IVF vets out there? .

Again, there’s nothing I can do about it, even if it’s a bad sign. All I can do is breathe, take my Atomic Bomb med cocktail, and wait. I have to find a way to get back to my happy place, though. This gloom and doom crap that I’ve been feeling the last couple of days is for the birds.

IVF #2: Why Can’t I Be A Zen Master?

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Ok, I tried to stay away from the blog. Tried it. I thought it would help me tone down the crazy. I can’t do it, though.

I CAN’T DO THIS ALONE.

I need you guys like the desert needs the rain. I need you like leaves need the sun. I need you like ____________ (insert cliché of choice).

The truth is, there is likely no way for me to not be crazy. Let’s face facts here. To be fair, I was feeling cool as a cucumber until this morning. I was taking my injections like a champ, listening to my hypnosis MP3 every night and not obsessing about anything (I swear). But then. There’s always a but, right?

This morning I had my first scan since starting stims. At my baseline scan a few days ago, I had 28 follicles. This is a record number of resting follicles for me. I was pumped. I was feeling pretty bad-ass—yeah, don’t mind me, that’s just my ovaries, with like a million follicles. Now, I know that baseline follicle count doesn’t really mean jack, but I was excited just the same. Surely that meant I might end up with more than two blastocysts at the end of this, right? Meh.

So anyway, I go to my appointment this morning after three days of stims and my doctor counts 12 follicles total. Wait, what? Where did the other 16 follicles go? You mean they just turned into dust and disappeared? WTF.

I asked my doctor where they all went and she said that some just don’t respond to the medication at all. So yeah, 12. I’m pretty sure that’s less than I had last time at this point. I asked her if that meant that only 12 would make it through to the end and she said it’s not a definite number, but that’s around what we’re looking at. Well, eff me. Has this ever happened to you guys—after three days of stims you had way less follicles than you started with?

I mean, don’t get me wrong, I’d be psyched to get 12 eggs at retrieval. But last time I had 16 follicles at the end and only got 10 eggs. So this is making me nervous. At my age, a little over half of my embryos will be genetically abnormal. So if I don’t end up with at least two day-five embryos, it’s not looking good for normalcy in these parts.

Another thing that’s upping my crazy factor is that I found out yesterday that I need three more root canals. They’ll have to happen in the next two weeks because I don’t want to put them off until I (please God) get pregnant. You guys, all I do is get root canals. It’s like a part time job. And who wants to get root canals while also injecting yourself every night?

Plus, hormones. HORMONES. This cycle I’m on the highest possible dose of stimulation meds that my clinic will allow. So yeah, I’m like, whoa.

But guess what? I have zero control over any of this crap. It is what it is. So really, what is my crazy accomplishing?

Nada.

But yet. I’M STILL CRAZY.

I need my center back. If you find it, can you send it along to me?

Thanks.

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.