FET #1 – Results

Today I feel like I can write about these things and I’m stalwart enough to do it. Anyway, let’s rip off the band-aid from the outset: the embryo transfer was a bust. I am not pregnant. It’s time for me to woman up and admit that and start moving on, which I am in the process of doing. Writing it out again makes it real and I was really hoping it wasn’t real.

As for the rest of it, people have been very good. My initial response was very strongly one of isolation. I just wanted to be left alone, I stayed away from social media because I knew there would be many good people telling me they were sorry but at that moment contemplating a flood of sympathy felt like too much. I felt broken wide open and vulnerable. We retreated together, V and I. We took the dog for a nice long walk in a park we don’t usually go to on Saturday. We cried (okay, I cried) we yelled, we hugged, we tried to make sense of this in the face of how hopeful we’d felt.

On Friday, I sobbed until my eyes hurt. Saturday, I cried intermittently throughout the day with a few major sobfests. Sunday, I had some trickling tears, and on Monday I didn’t cry at all. Yesterday I had a relapse and cried a bit and I’ve cried today, but I guess that’s all part of this stupid process of hope, dashed hope, grief, hope again. I will say this, I haven’t given up. On the first day I felt hopeless, I felt like “how could I possibly deal with this pain again?” I’ve asked myself that many times over the past four years. Yet somehow today my answer is “Come at me, I’m not finished yet.”

If there’s one thing I believe that infertility has brought me it’s my indefatigable strength in the face of this, honestly a strength I didn’t know I had before. It’s not that I don’t cry or have weakness, but at the end of the day I pick myself up and dust myself off and keep going. I’m proud of that. (I want to make it clear though that it can take just as much or more strength to realize that it’s time to change course or even stop going, so that’s not a knock on anybody’s personal decisions. Just for me, right now, I need to keep moving forward and I’ve been proud of my coping).

Dr. M called us on Friday after the huge mixup with the clinic – I don’t even want to write about it at length because it’ll make me angry again, but suffice to say they didn’t call us with the beta test results. We finally got ahold of them by calling them repeatedly and they claimed to have been trying to call us and left messages, but we didn’t receive the messages and we were waiting by the phone all day, obviously. Dr. M called us to say how sorry he was, but we missed the call because we’d gone out. HE had no problem leaving a message… He tried to call us back again yesterday and we missed those calls, too – it’s been frustrating for that. But finally he was able to reach V today and they talked.

One of the most important things he wanted to say was: Please tell Stacey that she didn’t do anything wrong. He really wanted me to know that it wasn’t my fault. Even if I hadn’t followed their aftercare rules regarding heavy lifting, etc. (I did). He said that even a good looking day 5 blastocyst like this one only has a 50% chance to implant and it’s entirely up to the embryo, not up to the person or anybody else. He’d mostly wanted to talk about what our plan going forward was, and had intended to have an embryologist call us. V asked him about the chances of the day 6 and day 7 embryos that are frozen. He said that day 6 embryos have a lesser chance of implanting – like 30%, maybe. The day 7 embryo is an unknown quantity. Some people get pregnant from them. But there are no statistics about it. V asked if that meant they’d put two (day 6) instead of one and he said yes, exactly. Not more than two. But then V said but wouldn’t it be better to thaw the remaining 5 day 1s and grow them out? And he said yes, that would be his recommendation, and since we are all on the same page there’s no need for the embryologist to call us and he would just give the order that this is what we’ll be doing.

I think he doesn’t know that when I talked to the embryologist he’d said to consider the day 6-7 embryos as “insurance” but know that the next transfer the best course of action would still be to thaw and grow the little ones. So we’ve been on board for that all along, really. Since I called the hotline thing when I got my period we’re on the record for that, but the FET waiting list is a few months long I suppose so I don’t expect we’ll be offered treatment this time. We’re looking at probably starting the process again in April/May depending on how things shake out.

Now that I can write this dry-eyed I’m feeling okay today. I’m still going to take the next few months to try and focus on other things because obsessing about this isn’t healthy and for now all I can do is wait. My current thing is tracking my food and walking again because I’d really like to lose some weight. Four years of hormones and emotional eating combined with disappointment have really taken their toll and I feel it’s something important and good that I can do for myself. V and I are planning a vacation in the summer now that we know what’s going on – our planned trip to Montreal may be delayed until the fall, we’re not sure about that one for right now, but we want to make sure we have some time to ourselves. Now that I know how the whole process goes I think I can approach the next transfer cycle with open eyes. If we can get another good day five blastocyst from the bunch, it’s got a 50% chance just like this one had. Maybe next time we will get lucky. I’m not really a big gambler, though!

Planning ahead for a FET

I just want to write this all down before I forget! I don’t want to take notes during our meetings with the RE because I’d rather focus on what he’s saying. So forgive me if this is a little jumbly and all over the place, my brain isn’t always really linear. p.s. – I have included a photo of our Christmas tree not because it’s relevant but it makes me happy. You don’t want to see a photo of the clinic, it’s boring!

We were meeting with our RE today as a kind of “post IVF” consult, to discuss the results of the IVF and what is going to happen next. The first thing he did was pull up my file on the computer to take a look at the sheet that he said is “how we look at a patient’s IVF overview.” It’s basically where they wrote down how many follicles, the size of the follicles, and my estrogen levels each day. He said that the 150 Gonal F I had been on is “quite a conservative dose,” but that dosing me higher would’ve been risky, and went on to show us where they’d lowered my dosage, which I know about. I was there! Hah. He said basically that my results overall – the super high estrogen levels (it capped out at 24,000, by the way) and even the way I felt after retrieval are all in keeping with someone that has PCOS like me.

Next we got to the part where we looked at the embryo report in greater detail. I told him that the embryologist had been pretty vague about the quality of the embryos and he admitted that it’s because at this stage they don’t know THAT much about the quality of them. But he showed us an itemized list of each embryo and explained how they can really only guess at the maturity of the eggs at retrieval because the egg itself is inside the egg mass. He said that’s the part that the sperm go through in order to get to the egg and then once fertilization has happened they know a bit more. So of the nineteen eggs that we had, eight of them were actually immature. It’s just that of the eight, some of those were even more immature than the others. Those were all of the ones that did not fertilize. They had some grading/designation for the two types of immature eggs, but I don’t remember it. Of the eggs that were mature, 100% of them fertilized, that’s all eleven. I asked him whether that was a good sign and he said that it should be, and that our main fertility problem is that the eggs and sperm haven’t had a chance to meet yet. But that V’s sperm had done their job and there was no problem with them (good work, sperm).

He admitted that the number of eggs we have does mean we may need to be more conservative about our thawing strategy, and that much of that deciding is done in contact with the embryologists. He said many clinics don’t have their embryologists interact with patients at all, but theirs asked to be in contact with patients so that they could devise the most optimal strategies because they are the ones who see the embryos every day. I’m fine with that, the embryologists seem nice! So one option would be to just thaw ALL the embryos and then culture them out and see how they grow. He said this would be a more automatic choice to do, if we had say – 20 eggs. But we don’t, so the more conservative option might be to only thaw some as-needed. We’re not sure on this point what will be best to do – we’ll obviously have to talk to the embryologists and see what they recommend. If they were to thaw and culture all the eggs, they’d see how many could become day 5 blastocysts, transfer the best one and then just re-freeze the rest. To me, the risk here is what if some of the blastocysts then die when they are thawed later? He said that the reason they freeze day one embryos is because that stage has the best survival rate and the least amount of cell loss. (All eggs frozen/thawed will have some amount of cell loss, but can usually keep growing regardless. Ones that don’t, it’s because they lost too many cells, apparently).

Anyway, I was left with a feeling of wishing I’d managed to have more mature eggs that could be fertilized. I KNOW we could have had more eggs, and he admitted we could’ve had as many as 30(!) but that it would have been too risky for my health in all likelihood. He explained that even the fact that I’m feeling okay now, one month later – was not a guarantee. Even in cycles where an antagonist protocol and antagonist trigger are used, women can still go on to develop severe OHSS and be hospitalized, etc. I told him I am truthfully glad we weren’t going to do a fresh transfer because of how I’d felt after. He said, “Imagine if you had gotten pregnant and then you would’ve felt MUCH worse, honestly!

We asked him to talk about how many embryos they would put back in and I was happy with the explanation. Basically, it breaks down like this. If we had a really good looking blastocyst at day 5, they will put one. At that point, he said, the chances of a successful pregnancy for me are really high – 55% or possibly even higher, depending on the quality of the embryo. Putting in two blastocysts in that scenario does not increase the pregnancy rate, only the twin rate. He said “We want you to have as many babies as you want, but ideally one at a time.” I told him we are not looking to have twins if we have a choice but obviously if we did we would be okay with and deal with it! I said I am not actively seeking twins and he said that many of their patients are. Which I get, honestly. Especially with these treatments being out of pocket, maybe having twins is their only chance to have the kids they want and more power to them. I definitely don’t judge. But the risks of having twins are higher to both the mom and the babies and he told us he’s also had patients who have lost twins that he knew would’ve probably been fine if they’d only had one, and that shit is scary. Nobody should have to deal with that at this point, after having gone through everything else already.

The second situation is if the embryos are not looking as good, if they may not make it to day 5 and need to be transferred earlier, on day 3. In that circumstance, transferring two embryos significantly increases the chances of pregnancy, even if it’s just with a single one of the two embryos. The odds of having twins are still 30% though and obviously pretty high when you’re putting two in, but you take that chance since you have increased chances of a pregnancy which is the ULTIMATE GOAL. (My caps, sorry, I got excited). I was picturing it in big ass Star Wars lettering.

One other thing that’s relevant, we asked him about the success rate of frozen embryo transfers vs fresh because the documentation they sent suggests that frozen is automatically worse than fresh. He explained that this is partly based on availability of the best quality embryos. Basically, a person getting a fresh embryo transfer gets the best embryo(s) from the entire cohort of developed and fertilized embryos. Then, if they do not get pregnant, subsequent FETs use embryos that are not as high quality as that first transfer, so naturally the success rates do go down. But in cases like ours, where all of the embryos have just been frozen, our success chance is as high as a fresh embryo transfer because we still have access to the entirety of the fertilized eggs, including whichever ones will turn out to be the best of those. Subsequent FETs might have lower odds if our best embryos are used, I suppose, about equal with anyone else’s subsequent FETs.

I am going to start birth control pills tomorrow in order to start regulating stuff there. Then I’ll take Suprefact starting on January 2nd, although he didn’t write the Rx for that and I’ll have to wait I suppose until the nurse calls me to confirm starting my FET cycle. Based on the math I have done, I’m looking at a transfer in very early February and I guess I’ll know by the end of February whether I’ll be pregnant before I’m 33 or not. I wish he’d sounded happier about the number of eggs. I mean, it’s a good number but I got the feeling it could be better. Now I’m just generally anxious thinking about all of this. Being back at the clinic doesn’t help, I think. Seeing people being called in who are going to their retrievals – even the way the cautious, slow way that the lady got up from her chair reminded me of how I felt before and after. I know that feeling intimately. Some other people brought their super cute kid and were right up in my face with her and I almost cried. I’ve been doing a lot better lately but just feeling sensitive today, I guess.

I was telling V that honestly that place is just…it brings me down. I hope that everyone who is going there will be able to have the babies that they want. I hope that we will be able to have them, too. There’s just so much anxiety and stress wrapped up in that room. The people having retrievals, getting medications, there for other procedures like IUIs, the invasive exams, the nail biting results as you’re trying to grow your embryos and all. Overall, the interminable waiting. It’s just a roller coaster of stress from start to finish and I’m happy that at this point I mostly feel I’ve come out okay but I’m also aware of the toll it takes. It’s just a slow erosion of your tolerance and emotional and physical health and well-being.

I did feel that our RE was especially sensitive this time about asking how I had been doing and expressing concern for my health and recovery. He said it was understandable that recovery had taken me longer because “You had two cantaloupes in there!” I can laugh at that now but yes, that is basically what I had and also how I felt. All I can do is keep quietly hoping for the future. I said “I just really hope that these eleven embryos have all the potential we need, because I’m not sure I could do all of that again,” and he said “I don’t blame you, and I really hope so, too.”

IVF Survival Kit

I recently joined an IVF Sock Buddies group on Facebook. It’s a closed/private group but everyone dealing with infertility is welcome to join. The idea is that you join up, find a buddy (or buddies) to exchange messages and packages with. The idea started from women who would send each other fun socks for all of the appointments we have. For those of you who may not already know, you’ve got to take off everything from the waist down for a transvaginal ultrasound – but you’re allowed to keep your socks on. For the egg retrieval they put little surgical booties over top of my socks, but you know – I wish I’d thought to get some fun socks beforehand.

So a sock buddy is perfect. They’re someone who gets what you are going through. You send each other small presents in the mail, including but not limited to fun socks. I managed to find another Canadian buddy just yesterday and we haven’t exchanged anything yet, but I’ve been really thinking about what I would put in a comprehensive IVF survival kit for someone. This is a bit beyond the scope of small gifts to mail to someone, but it should provide a nice list to prepare for if you’re going to be going through IVF. I could also see preparing it and giving or mailing it to a friend you know who will be going through IVF as a care package, or preparing it for your spouse. V and I made up our own. Here’s what I think an IVF Survival Kit needs. I’m going to divide it into phases.

Pre-Retrieval

When your IVF has started and is only just ramping up! This is when you’ll be going for the bulk of your appointments and giving yourself injections. You may be sore, tired and hormonal. You’ll want things to help take care of yourself at this time.

• Frozen meals or a meal subscription service. Whatever is in your budget, before you even start IVF it’s a good idea to stock some food away. You’re not going to feel like cooking and you want to be nourished during this time. You don’t want to be ordering take out every night, because it gets expensive and isn’t that healthy. For a few weeks beforehand, we’d double a recipe and just freeze the other half so we had chili, a lasagna, etc.
• 1-2 good books, magazines, or gift certificate for your e-reader of choice. This obviously depends on what you like to read, but I personally opted for more uplifting books, things that were funny or cheerful. Nothing with pregnancy or babies.
• Nice smelling hand soap. You’ll be washing your hands a lot, much like a doctor or nurse! You need clean towels too, but there’s no point buying a special one because you’ll need a clean one every day.
• An ice pack. The one I chose didn’t work really well, but one that you actually put ice cubes in should be perfect. This can be very helpful especially if the injections scare you. I found that icing the area for a few minutes beforehand made a huge difference in how painful it was.
• Fun band-aids. Often, the injection sites won’t bleed but sometimes they do. If you have a reaction to band-aid adhesive like I do, you might want (boring) hypoallergenic band-aids on hand.
• Small chocolates or candy. Remember when you were a kid and you got a lollipop after going to the doctor? Some days after your injections you might feel like that. This doesn’t have to be food. It could be any small thing that might cheer you up – temporary tattoos, stickers that you stick on your day planner, etc.
• Patterned socks for wearing to your many ultrasound appointments. These are as personal as the individual wearing them, but they could feature your favourite animal, shamrocks, or a hobby. Anything that will make you smile. If you’re stumped for ideas, I learned the other day that penguins are the unofficial mascot of infertility. Do with this knowledge what you will!
• Bath salts, bubble bath, scented candles. You’ll be spending a lot of time at the clinic during this phase. It’s tiring and stressful. Also, your body is busy growing more follicles than it usually would. Take some time to relax and pamper yourself. You deserve it!

Retrieval Day

Your clinic may have specific requirements for this day, so please take that into consideration. Nothing here is medical advice and you’ll have to adhere to your own clinic’s guidelines.

• Unscented soap and unscented deodorant/antiperspirant. Many clinics have a “no scent” policy especially for retrieval day. It turns out that strongly scented lotions and perfume can be damaging to embryos! I also wasn’t allowed to wear any make-up or nail polish. If you have these things ahead of time you won’t have to be stressed out.
• Ginger ale, Gatorade, tea. Before the surgery I was only allowed to drink clear liquids. My blood sugar wasn’t a fan of this, so I had a bit of ginger ale before we left home.
• Fun socks (again). Especially important to brighten your day when you may be nervous or anxious.
• A small snack for your purse so that you can eat as soon as you’re able. My clinic brought me some digestive biscuits and ginger ale so I didn’t need the snack until later, but it’s still good to have.
• Support person. Not everyone is doing IVF with a partner, but you should still bring a friend or loved one you trust with you. You’ll need to be driven home after the surgery and they can stay with you to keep you calm beforehand.
• Playlist on your phone or MP3 player with soothing music. Clinic policies here may vary, as well. My clinic does conscious sedation and allows patients to listen to music during the retrieval. I put an earbud in one ear playing jazz music. You should play whatever you enjoy. There are studies that show listening to music before, during and after a surgery can help with pain and recovery. Even if a general anaesthetic is used for your retrieval, you can still listen to music to calm down or relax before or afterwards.

Post-Retrieval

This is still technically on retrieval day, but once you’ve come home from the clinic. Many people sleep the day away. I wasn’t one of them, and I needed many of these things right away. You should stock up your supplies beforehand, of course. The person staying with you that day after surgery may not be able to leave you to go and get anything else. Some of the items here are aimed at preventing OHSS (ovarian hyperstimulation syndrome). Please note that my experience with recovery was not the usual. Because I had so many follicles and my retrieval was very painful, it took me about two weeks to start feeling normal again. Many women I know felt better after just a few days! I hope your retrieval will be that way, but if it isn’t you will be prepared.

• Electrical heating pad. Far superior to the bean bags that you heat up in the microwave, this will really help with cramping and pain as the IV meds you were given start to wear off.
• Cozy blanket. I have a quilt that my Mom made me, but whatever you’re comfortable cuddling up with, really.
• Gatorade/electrolyte drinks. The brand name doesn’t matter, the electrolytes are the key. Don’t ask me why, I’m not a doctor, but IVF friends of mine swore by this and it really helped me. When I was getting severely bloated I actually stopped drinking any water and only drank Gatorade for a day and it helped a lot.
• Salty snacks. Similar principal, the salt helps draw out excess fluid. I chose roasted peanuts because they are my favourite. Also, tiny goldfish crackers, ramen and other salty soups. I know these aren’t exactly health foods and you’re getting a ton of sugar and salt but it’s only for a short time. You won’t be eating like this forever.
• Fibre supplement, fibre bars, prunes. This is an “any of the above” situation. Post-surgery painkillers can cause constipation. You don’t need any additional bloating, and you really don’t want to have to struggle in this area because you’ll already be in pain. Preventative measures are best. Any high fibre food can also help – think fibre cereals, beans in pretty much anything – but don’t start eating a bunch of things you aren’t used to eating because you can get gas and that hurts, too. I like Benefibre, you can mix it into a warm drink and it’s tasteless.
• Suppository or other laxative. Ask at your clinic’s pharmacy about this. It’s cheap and you want it on hand just in case none of the other stuff mentioned above works.
• Tylenol. Use it once you run out of prescription Tylenol. I still had to take a lot of Tylenol on an ongoing basis.
• Entertainment. Pick a series on Netflix you’d like to watch or whatever movie is comforting to you. Read the book you picked out, or its sequel. Play a video game or any game on your phone or tablet. This is actually the hardest part of recovery, at least it was for me. I felt so cooped up and was unable to do much of anything for myself, including getting up/sitting down in chairs. My husband had to help me by having me grab onto his arms.
• Friends. Arrange to have a friend stop by to chat with you and cheer you up. A friend of mine brought me a cupcake and it was really nice just to see another person for a bit when I was feeling bored and lonely. If that’s not possible, call one on the phone! (I know, I don’t usually do this either, but desperate times…)
• Tissues. Hormones are rough, and you just went through an emotional process. Don’t be surprised if you are weepy at unexpected times.
• Change of scenery. Once you’re starting to feel better, try to get out of the house. Don’t overdo it, but going for coffee, or a little bit of shopping (I overdid it) can help a lot.
• Acupuncture. This can help with the bloating and overall sense of well being. My acupuncturist also told me that they can do just one side (instead of making you roll over) so if it’s tough for you, you can just lie on your back.

Transfer Day

I haven’t had a transfer yet, because we had to do a freeze all! All of the same advice and items apply to this procedure as well, though. It’s similar to an IUI except it includes ultrasound and a full bladder. If you’re having a fresh transfer, not much time will have passed since your retrieval. The transfer is much less invasive and time consuming than the retrieval. You’ve already survived that, you’ve got this! Wear another pair of lucky socks and remember to take good care of yourself and rest afterwards. Whatever the outcome might be, be kind and continue taking time to do things that make you happy or relaxed. You are more than your ability to get pregnant and you deserve happiness.

Egg Retrieval Day

Yesterday and today have been pretty painful, but I don’t want to get ahead of myself. I wanted to record this so that I remember it and in case people are interested in the specifics of how everything went. Warning, I suppose, some of this is a bit graphic sort of? Although I don’t think it gets gory or anything.

My egg retrieval ended up being scheduled for Monday at 11:00 AM. I did my final injections on Saturday night at midnight, and then noon on Sunday. Those were the trigger shots (Suprefact, in my case). All those 5:30 AM mornings waking up to go to the clinic have done a number on me because staying up until midnight on Saturday felt SO LATE, haha. We watched two movies and I looked at the clock just – really, it’s only 10 pm? The downside of this was that I had to go and have bloodwork done on Sunday morning, and that’s a whole story by itself.

Basically, the fertility clinic gave me a requisition with a “STAT” sticker on it and said just go to this specific lab at 7:30 AM on Sunday morning, and they will see you right away because it’s a STAT situation. They needed to test my LH levels so that they could know what to do about the retrieval. I’m a little unclear on the details of that because our doctor explained it while I was still a bit high from IV pain meds. Anyway, I asked the nurses several times if they were sure about just going at 7:30. That particular lab is a zoo, and other times I’ve needed bloodwork there and can’t get an appointment, we’d go right when it opens to get a decent number. They said it would be fine.

So on Sunday, running in little sleep (after being up until midnight Saturday to give myself the trigger shot) we get to the lab and the guy at the desk is completely unmoved by the STAT sticker. He just goes, “Take a number.” I have number 34, they’re serving 17. I don’t know what my estrogen levels were at this point – higher than 17,700 – but to super hormonal, bloated and uncomfortable me it felt like the last straw. I ended up handing my requisition sheet to V and ducking out in the hallway to burst into tears. It just felt like The Worst Thing in the world, even though I know it wasn’t. When I came back, obviously having been crying, V managed to talk the guy at the desk into letting him speak to the team lead there. He explained to him how the test needed to be done at a specific time, and how if we’d known we would have come at opening but they’d told us that STAT meant both for collection and processing. He said the STAT was only for how quickly they’d get the results, not for the actual line-up. Long story short, he agreed to have them take me sooner, but the whole thing was just stressful and not what I needed at that point. V resolved it because he has superpowers when it comes to medical professionals, I guess, but I still hated it. I’m not really a “can I speak to the manager” or a line-jumping sort of person. I’m sure everybody in that waiting room thought I was a huge jerk. I hope they gave me the benefit of the doubt though. One thing I’ve really learned over the last few years is that you don’t know what anybody else is going through and so you shouldn’t assume or judge. I was relieved to go home, in any case. That was Sunday.

I spent the rest of Sunday getting increasingly more anxious as I thought about the egg retrieval the next day. The waiting was driving me bananas. I just wanted to get it over with. The best part of Sunday was the valium they’d given me to take at bedtime. I popped that sucker at around 10 PM and was sleeping in twenty minutes. We slept about nine hours which was nice after the previous night. Getting ready in the morning was easy because I wasn’t allowed to eat anything before the surgery, or to wear any makeup, so I just had a bit of ginger ale to settle my stomach and packed everything up for the retrieval.

We left the house at 10:00 and arrived at the clinic around 10:15, a little bit early (they’d told us to be there at 10:30) but the nurse came and took us in right away. We went to the section of the clinic I’d never been to, where the OR and recovery places are (it’s completely on the opposite side of the consultation and ultrasound/exam rooms). The first nurse we met was Donna and she was really nice, she took us over to the place that would be “mine,” which was basically an armchair with a locker for my clothes and purse. I got changed into a gown that mercifully had a back and side tie so that there was no butt flashing action happening.

The next part was all pretty routine, she took my height and weight and I sat in the chair waiting for the other nurse to start my IV. Her name was Amy and she was also really nice, she managed to get the IV in my hand on the first try and I was grateful for that. At this point we also got to meet Debbie, our embryologist. I’d been planning to ask the embryologist what video games they played to keep their reflexes sharp, but when Debbie came in she looked like a tough grandma and I don’t think she played any video games, haha. She explained what she’d be doing and that she’d discuss with us after the retrieval, too. After we’d been waiting awhile, it was already 11:15 and no sign of Dr. W who was doing my retrieval – he’d been held up at the big meeting all the doctors have every morning to decide the course of action for each patient. Amy decided to move me into the OR so that we’d be ready to go as soon as he arrived. I brought my phone and headphones with me – I’d had jazz music playing in just one earbud to try to chill out and to help distract me during the actual procedure.

The OR was…I’m not sure what to say about the OR, to me it was horrifying, but just because I was freaked out and scared of everything that was happening. The table design was smart, really, rather than having stirrups there’s these kind of padded sleeves that you put your legs into. Amy had me get on the table but not yet in the sleeves until the doctor arrived. To my left was a TV screen that she said would show what Debbie was doing as she looked for eggs from what Dr W retrieved. After a few minutes of chatting to Amy, Dr W came in quickly. Amy asked if he’d been paged and he said no, but he kept looking at the time and finally told them he would have to go because he was late for my egg retrieval. At this point Amy put the medication into my IV that would help with pain and also keep me calm. She said it might make me dizzy but I didn’t feel that way immediately at all.

This initial part was the scariest. You see, the way they reach your ovaries to get the eggs is to jab a needle through the wall of your vagina. I’d been told it was just a pinch on each side, and it actually wasn’t bad. Dr W told me to take a deep breath and hold it and then just that quickly it was done. I could feel him start stabbing and aspirating follicles from my left ovary. It wasn’t too bad initially, there were a few cramps and pinpricks of pain. The way the room is built I could see behind him a window where Debbie was sitting. She was going through the tubes finding eggs and she’d yell out when she found one. In what seemed like no time, to me, the doctor was saying he was finished with the left ovary. I was worried at this point because so far, they’d only found four eggs. I couldn’t imagine that 30 follicles on one ovary would only yield that many!

Dr W went to start on the right ovary and do the whole needle thing again, which was okay except that at this point things really started hurting more. I asked Amy if I could have more medication. She gave me some, and then Dr W said that he’d have to come at this ovary from another angle because the initial one wasn’t working. So a third stab, and this ovary was REALLY hurting. He apologized that he was having to press so hard on it to try and get the follicles out. They both asked me to try and relax my body, I wasn’t aware but every muscle I had was tense, even my fists were clenched. At some point the ear bud had fallen out of my ear, too, so I didn’t have my music anymore. Amy gave me another dose of the medication and then told Dr W she was going to get some Gravol to inject as well since I’d had a double dose of pain meds and would probably feel nauseous. Dr W said that she was being proactive, which I appreciated.

I asked him how things were going with this ovary because I just wanted this whole thing to be over with and at that point he said he was about halfway finished with it. I heard him say something about a “baker’s dozen” and in my drug-induced haze I said in dismay, “Only twelve?” and he says, “No, a baker’s dozen is thirteen,” haha. Amy hastened to assure me that Debbie still had six tubes to go through, though. Finally, mercifully, he was finished. The two of them helped me down and into a wheelchair, I was pretty dizzy and woozy. They wheeled me out to the recovery room where V was waiting for me. I was so glad to see him. The timing of everything that needed doing meant he only got back two minutes before we were finished anyway. He was bummed out that he didn’t get to see the screen with the eggs on it or anything.

This next part is pretty boring. I just sat with a blanket and heating pad while they monitored my blood pressure and gave me a bit of ginger ale and some digestive biscuits to nibble at. After awhile, Debbie came to see us and tell us about the eggs she had found. The final count at this point was 19 eggs from the 60 follicles. Of these, Debbie said 14 looked mature to her and the others were a bit small. She explained that it could be difficult to assess maturity at this stage but that based on size that’s what she figured. They’d keep the eggs safe overnight and see how many would fertilize.

After Debbie left, my friend Tara from Andrology (she’d been taking my blood all week) came to find us and see how I was doing, which was really nice. I liked her and I’m sorry I won’t be seeing her again, although I’m not sorry I won’t have to be at the clinic every morning anymore! We told her how it went and also talked about the debacle at the lab. She said the STAT sticker (she used to work at lab services) is SUPPOSED to mean STAT for both collection and processing, but that the people who work there aren’t often good at knowing things. Anyway, it was nice to see her. V went over to the pharmacy and filled my prescription for Tylenol 3. Dr W went by and came to talk to us, he said that based on the pain I’d had that I should take two Tylenol 3s every four hours and don’t wait until I feel pain. I guess when they have to remove 60 follicles they know you’re going to be hurting later! The last thing I had to do before we left was go and pee – if you aren’t able to pee they can’t let you go because the needle might have nicked your bladder. I didn’t have any trouble with that and so we were free to leave, me a little unsteadily but leaning on V.

It’s hard to believe that all happened just yesterday. We got home and I went upstairs and went to sleep immediately. They’d given me regular Tylenol at the clinic so I had to wait to take any more. When I woke up I could feel immediately that all the medication had worn off. I couldn’t get out of bed by myself, it hurt so badly, and I ended up messaging V so that he could help me stumble and wince my way to the bathroom. I remembered that they’d had a heating pad on my stomach at the clinic that seemed to help a lot but we don’t own an electric heating pad. We made do with a hot water bottle and V called my parents to see if my stepdad could bring a heating pad on his way home. He stopped at the drugstore and brought one. I was really struggling trying to sit up in bed, and lying down hurt worse, so at that point I moved into the big reclining chair in the living room. The heating pad was such a huge relief when he dropped it off, it really helped a lot with that initial pain. I can’t even imagine how much pain I would’ve been in without the Tylenol 3. I kept taking them every four hours and mainlining Gatorade which is supposed to help with preventing OHSS symptoms. Still, when the Tylenol wore off last night I woke up and knew right away, and had trouble getting out of bed again.

I’m really bloated and still can’t move around without a lot of pain, I can sort of gingerly move across the house but I feel best if I stay in a reclining chair with the heating pad. I look like I’m pregnant but that’s just Angry Ovaries (talk about adding insult to injury). Needless to say, I don’t know if I’m just a wuss or this is worse because of my many follicles, but I was unprepared for just how rough the recovery would be. I thought I’d be able to get some work done today – definitely NOT happening. I’ve been mostly reading and watching some TV. My appetite is fine. I can’t tell if Gatorade is helping with the bloat, I guess these are mild OHSS symptoms but I don’t seem to have any of the really major ones and hopefully it’ll stay that way. I’m actually glad at this point that the plan was a freeze all. I feel certain that if I’d tried to insist on a fresh transfer that I’d get severe OHSS for sure. I also can’t even imagine potentially being pregnant right after all this. I’m glad I will have a few months to recover properly before we attempt any frozen embryo transfers (FET).

Finally, the last important news is that the embryologist called us this morning (not Debbie, a different one) and told us that of the fourteen mature looking eggs, eleven had fertilized and they had frozen all of those. He said this was good, and it’s a fertilization rate of about 80% which is higher than expected, the average being 70%. I hope that bodes well for the quality of the embryos when they are eventually thawed. I have to admit that thinking some of them might not keep developing properly, or be damaged when thawed is doing my head in a bit. I know I should just be happy that we have them, these potential eleven chances, but I also know that some loss happens at each stage. I just hope there are enough for us to use and hopefully get pregnant. Now that we’ve been through this entire process, I’m not entirely sure I could do it all to my body again. It’s been, for lack of a better world, grueling – and the recovery isn’t over yet. I hope I’ll bounce back quickly but right now that’s not looking like it will be the case! But it’s just early days, so maybe tomorrow I’ll feel better. Wednesday is a day off (Remembrance Day) so V will be with me and he’s prepared to take Thursday off as well but I hope he won’t have to. I already feel bad about him having to work from home the end of last week because I was feeling so rotten, and now he’s missing work again at this end, too.

V has been a star, really – I’m so grateful that he is my partner in all of this. He’s been uncomplaining about having to fetch everything for me, asking if I need anything, coming over to help me up out of my chair and holding my arms to help me sit down again. He’s been doing everything and never said a peep. I’m just glad for him. I think any lady should be so lucky to have a husband like him throughout a process like this! I’ve also had lovely friends offering to help with food, dropping off chocolates for us, asking how I’m doing. My parents have also been great, they brought us some stuff some Costco and then the heating pad. My Mom has been giving me muffins all week. Everything seemed to happen so quickly once the stims started, it’s hard to believe that it wasn’t even two weeks ago.

I am grateful that my retrieval happened when it did. I heard the nurses talking while I was recovering, and they said there are TEN retrievals happening on Wednesday. They’ll have to start in the early morning and some ladies won’t have their retrieval until late afternoon. They are going to be running flat out to deal with all of those retrievals. But when the eggs are ready, they’re ready and there’s nothing you can do about it! Now I just have to spend a few months letting my body recover (I’m probably going to be bloated for a few weeks, the nurse says) and prepare for the eventuality of a FET and hopefully subsequent pregnancy. It’s going to be nice to have the holidays without any fertility treatment stuff, just taking it easy and knowing that 2016 right now contains eleven tiny pieces of hard-won hope.

IVF: Day 8

This is me right now.

I am back from another day of monitoring! I don’t have the results of my bloodwork yet, but in all likelihood I’ll be staying at the same dosage today as yesterday – a slightly reduced Gonal F, with regular amounts of Luveris and Cetrotide.

Today V was able to come with me and stay at the appointment and he’s going to do the same tomorrow. He didn’t like getting information second-hand and also having seen me yesterday he was concerned about me being on my own so he’s working from home today and tomorrow. I’m happy about this. It’s funny how quickly something can become routine to you. I’m getting used to being at the clinic at the crack of dawn, I’ve never seen so many sunrises in a single week (not a morning person, usually). But because we’ve adjusted our bedtime accordingly, I’m not that tired. It makes me feel like a grandma to go to sleep at 9:00 PM but hey, whatever is best and healthiest for us both.

Today I had a new doctor doing my ultrasound and actually I liked him. He wasn’t 100% new as I met him during one of my IUI cycles and *didn’t* like him but I promised myself that when we met again I’d give him the benefit of the doubt that he’d just had an off day that one day. He was really gentle. My follicles have grown at an appropriate rate, today there are some that are 1.8, and some stragglers at 1.6. Because it seems as though communication isn’t always clear there, I told him that they’d lowered my dosage yesterday. He said, “I know!” and I said of course, you have your meetings with all the doctors. I’ll bet I’m a hot topic at those right now. He replied gravely, “It’s quite a dilemma.” Anyway, we talked a bit, he asked where I lived and I told him [Suburb] and he was surprised because he’d assumed I was from out of town. He said that 50% of the patients there are from out of town! I consider myself lucky that we live in a city with a clinic that so many have to travel to access.

He told me I’d have today again at the same dosages as yesterday probably (based on my estrogen test results again today) and then took himself off to the next patient while we met with the nurse. It was really crowded in the waiting room this morning – they were calling number 24 as I went in for my bloodwork! Thankfully I was number seven so we didn’t have too long to wait. Everyone still keeps asking me if I know about the freeze all – I think they expect that I’ll be upset or disappointed, but I’m really glad we were prepared for this going in. The doctor this morning said women with PCOS are two ways – either over responders, or under responders. Guess which one I am? We were able to get some clarification from the nurse about the follicles. Here’s the scoop.

Fifty of the follicles are still responding. They will be retrieving everything they can. Fifty is NOT the clinic’s record – apparently another lady had a HUNDRED eggs retrieved and I am very sorry for her because she must have felt at least twice as crummy as I feel right now. As I was writing this I sneezed and it hurt, haha. She said the number of eggs doesn’t necessarily mean the procedure will be longer, because the eggs are close together and they should just be able to get a bunch at once. So basically, they’re going to be playing Space Invaders in there.

Now, caveat: Many of those eggs are probably going to be garbage. There are varying sizes, some small, and those aren’t expected to fertilize. The IVF game is one of attrition – so at every stage there’s some expected loss. Some won’t fertilize, some won’t make it to freezing, and some may not thaw properly at that point. So I’m not counting my eggs before they hatch, if you will, but I hope, really hope what this means is that we get enough that we can do however many frozen embryo transfers it will take to get pregnant. They freeze the eggs on day two.

At this rate, it’s very likely that tomorrow will be the day we trigger and the retrieval will be on Sunday. It will be an antagonist trigger, and I don’t really know how that’s different from a regular trigger. I’m going to go and google it, though. The nurse also had some reassuring things to tell us about the retrieval. She said if I’m in pain I can and should ask for more medication. She said that if V isn’t allowed inside, that there will be a nurse with me. She explained that they don’t do a general anaesthetic because they don’t have an anaesthesiologist on staff so it’s more dangerous and they can’t do it. I guess that’s fair. She said I won’t feel better right after the retrieval but the time after the retrieval will allow my body to recover so that when it’s time to do a transfer (in the new year) I won’t develop OHSS.

That’s all the news that’s fit to share. I am still sore (I have to sort of crabwalk myself out of bed) but I’m hanging in there. It’s all happening!

IVF First Steps

I want to write this stuff down before I forget it! Completely due to an accident of fate, my sonohysterogram was scheduled for today – the same day that we were meeting with our RE later on. V came home and picked me up, we went to the SHG and then out for late lunch after (he didn’t have time to eat lunch before we had to go since my appointment was at 1:15).

First things first, the SHG. I don’t know what combination of factors made this test so awful for me. Maybe I just have an angry uterus, or maybe the doctor who did the test wasn’t great at it – I’m not sure, but it was a LOT worse than the hysterosalpingogram was. For those of you who aren’t well-versed in all of this – an HSG involves a contrast dye and a monitor and checks for tubal patency/uterine issues. The dye is injected until it spills out the end of your fallopian tubes so that they know the tubes are clear. An SHG is just a small amount of saline injected through a catheter at the same time as an ultrasound probe. It’s supposed to be (generally) the less painful and invasive of the two tests.

I’d never met the doctor who was doing it before. He seemed nice enough, he tried to shake my hand but I was holding the back of my gown closed with one hand and carrying my clothes in the other, so that didn’t work out. The speculum/catheter part of the procedure was okay. It was once they started putting the saline in it that it hurt A LOT. I don’t think I’m a wuss but this was some serious pain, I half doubled over and I definitely cried out. The doctor begged me to try and stay still so that they could see and so I fought it back and just deep-breathed until I heard him say “It looks good, it looks good!” Haha. I think he was almost as relieved as I was that they could finish up. The next ten minutes were just regular ultrasound stuff and that was fine, but I’d broken out into a cold sweat and was shaking a bit. It was really not good times. Although, unlike the HSG I do feel much better now and maybe that is the big difference. After the HSG I was sore for days. It’s only six hours after the SHG and I don’t have much pain or anything.

It’s my understanding that this test can really vary for different people and maybe the doctor makes a difference, too. Later when we met with our regular RE I told him I’d “traumatized poor Dr. W” and he laughed and said “HOW?” so I told him about the procedure and he said sotto voce, “He probably got flustered.” Yep, he sure did. So that happened. The good news is that my uterus looks fine, so the results of the test itself were good.

Now as to the meeting with our RE, we didn’t take long to get to the point. He started with a “You two are at a crossroads,” speech and I told him “Yeah, we’ve definitely decided on IVF,” and briefly explained our reasons. I don’t think he was surprised. He did say “What, you don’t want me to drill your ovaries!?” That’d be a capital N-O-P-E, thank you. So we got down to the nitty gritty of him explaining the protocol that he’d favour and us getting a chance to ask our questions (many of which were answered by what he was telling us in the first place. He explained some of the different types of PCOS ovaries and responses to medication and said that I have what he’d call “true PCOS.” (Just what I always wanted). He said that since they’d last looked at my ovaries, I have MORE follicles than I did before. Previous ultrasounds just reported >25 follicles per ovary. He said that in actual fact, one ovary has 50(!) and one has 35. This could also be due to the fact that the previous ultrasounds were mostly interested in the largest follicles. So rather than counting each one they’d just go “Definitely > 25” and move on. This ultrasound took longer and seemed more thorough so perhaps I had these all along.

Because of these ridiculous ovaries, If we were to do a regular IVF protocol, my chances of getting ovarian hyperstimulation syndrome would be something like 30% and in the group of people who get OHSS the risk of a stroke are 1 in 77, with no way to predict who’ll have one. No, thanks. I told him that honestly, whatever we have to do that’s safest – my own health is paramount and if my choices were “possible death” versus “not having children,” I sure wouldn’t choose death. He laughed, and agreed.

So here’s what we’re going to do. The protocol is an antagonist IVF protocol. Without getting super technical, it uses different medication and while it’s still a balancing act, the chances of OHSS are greatly reduced. In addition (and this is the major thing) we will be aiming for an entirely frozen cycle. This reduces the odds of OHSS still further and is much safer for someone like me. What this means is that the whole process will take a lot longer. I’ll do a month of birth control pills once they offer me treatment (you call when you get your period and they either offer you treatment or not depending on the waitlist). So it might not even be my next one, but the one after. After the pills are finished I’ll do the stimulation part of the cycle (12-14 days) and then the retrieval. They’ll fertilize all of the retrieved eggs. Currently ICSI is not part of the plan, but could be implemented last minute if things don’t look good on V’s side. Then all of the fertilized embryos will be frozen the next day.

After that, I have to wait 11 weeks before the next part of the cycle, which would be a frozen embryo transfer. I’d never have a fresh cycle. Our RE explained that pregnancy rates at my age/with this protocol are actually equivalent to a fresh cycle so it’s not actually a major detriment to our chances. My reasoning is that it also gives my body a bit of time to recover and get ready for the pregnancy stage. So it’s a long process and I don’t know when we’d even be getting to do a transfer. Just with a bit of napkin math, if they offer treatment to me the first time I call in, we’d be looking at a retrieval in early November. Then after that, assuming everything goes well and we have some good embryos, eleven weeks after that would be February. That’s a long wait and I’m trying not to feel deflated about it, but really what’s another few months in the grand scheme of things? We have waited this long, and if this is the best way to have a baby and not get sick doing it, that’s what we’ll do!

He did also say that if we got to that point and things were looking good/okay and I didn’t have OHSS that we could still do a fresh transfer. He just didn’t want me to be disappointed and have it in my head that we WOULD do the fresh transfer when it’s very likely we’ll be doing a freeze-all. So that’s what is happening with me. I’m glad we have an RE that we trust, although he did say as he was leaving (and I’ve heard from others) to remember that it’s a shared clinic. Once you start the IVF procedure, you’ll meet any or all of the REs there, and he says sometimes he doesn’t even see people again. Then he thinks, “What ever happened to so-and-so?” and looks them up and goes “Oh, they got pregnant and left, okay then!” I told him if we didn’t see him again I’d send him a note in the mail so he’d know we got pregnant and left, haha. Here’s hoping!

What’s next?

We had our appointment with the reproductive endocrinologist yesterday, a follow-up to our last failed IUI cycle in which my endometrial lining was too thin.

V and I both agree that we’ve come to like our RE more and more, every time we see him. I think he’s more caring than he initially seemed, but he also is very forthright. He doesn’t mess around. He started the meeting with basically, “So. Your lining. Pretty thin, huh?” and I was just, “YEP it sure was!” He explained how with a lining so thin (0.3 mm) that someone can occasionally get lucky/pregnant but it’s really unlikely. Which we pretty much already knew. He said Clomid is not my friend. We talked about Letrozole and he said that doctors used to think that it had less of an effect on the lining than Clomid, but they’ve since come to find that it does still thin the lining. Especially in women who had problems with the thinned lining on Clomid, he said it is very likely to happen on Letrozole as well. And since I had such a bad reaction to the Letrozole initially, I told him I’m in no hurry to try it again anyway. I’m over oral medications, I told him, and he pretty much agreed.

He started enumerating our options.

Option 1) More IUI cycle(s) with injectable medication rather than the oral medication. He described this process and said that especially for women with PCOS like me, it’s a very fine balance to stimulate the ovaries sufficiently to produce 1-3 eggs but no more than that. The triplet risk goes up to 7%, and twins is pretty high as well. I knew this was a concern with PCOS/injectable medications because we have so many follicles just hanging out there, that it can get out of hand if too many of them are stimulated.

The process involves a series of injections followed by an ultrasound. So a sample cycle might look like: Three days injections, one u/s. If follicles aren’t developing, three more days injections, one u/s. If still not developing, slight dosage increase. Three days injections, etc. He said it’s long, tedious, and 50% of the time what happens (especially in women with PCOS) is that too many follicles are produced when the medication finally tips those scales. What happens at that point is that you either have to cancel the cycle (if you proceed with the IUI you’d have a major risk of high order multiples which is highly undesirable) OR you can convert it to an IVF cycle. The problem with doing that is that it would be kind of a weak IVF cycle – you’d have many fewer follicles than you’d want if doing an ordinary IVF, but still too many for an IUI.

The combined cost of this type of cycle and the medications for it would be 3000 dollars. The chances of a successful live birth are about 22%. He said that his major concern would be multiples, because in our case “sperm and egg” haven’t had much chance to meet yet. I guess the fear being that if they do – in multiple amounts, things could get bad.

Option 2) IVF. The medications used for IVF are similar – and may now be covered partially by our health insurance but we need to look into that. We talked some more about the process. He said it’s unfortunate, that if we opted to do IVF it might be “people who don’t really need IVF” doing it, he said he’s pretty sure that if I ovulated (without the thinned lining) that I’d be pregnant already but… I feel like, at that point, you kind of DO need it, don’t you?

The process to initiate an IVF is a long one. I need to have my uterus checked again, which could be done with an HsG (another one, ulp) or a sonohistogram, I think that’s what it’s called, where they use saline solution to visualize the inside of your uterus. He said among women he’s talked to, that the sonohistogram is much better/less painful. I opted for that (duh). He said he doesn’t need to see my tubes again and they haven’t magically gotten blocked or something. So I will need to do that test, as well as more bloodwork for infectious diseases, a day 3 blood test (I think it’s estradiol levels). Basically regardless of which option we were to choose, they are going to proceed with us as if we were doing IVF because if we tried an injectable cycle and had to convert it IVF, we’d need to be ready to go at that point. There’s a mandatory information session that you have to attend to learn about IVF. And we have a follow-up with him after we’ve gone to that so we can talk about what we’d like to do.

I’m going to digress for a second to say that, when we finished the meeting we came out. I really had to go to the bathroom so I asked V to make the follow-up appointment and book us in for the IVF info session – we agreed to go in August, it’s August 6th and our appointment with the RE after is on August 14th. So he went to do that, I took myself off to the bathroom. Afterwards when we were in the car driving home, I joked about him charming the receptionists (we’d been joking around with them) and he said, “You know what they said to me?” No, I didn’t know. “They said, they needed to make sure I understood that the IVF information session is mandatory for BOTH partners. Both. I told them that with all that you’d be going through, what kind of husband would I be if I didn’t even do THAT much to support you?” The receptionist said, “You’d be surprised.” I went on a five minute rant about how if I was married to someone who cared so little about this process/me that he wouldn’t want to go to the info session that I’d damned well find a sperm donor because that would be a better bet and I wouldn’t be saddled with an asshole to boot. HONESTLY. Anyway. I got a little off-track there, there you go.

So, IVF. Kind of scary, lots of needles. The doctor said that at my age, and if my eggs are good quality, I’d have a 50-60% chance of success. With a woman that has PCOS like I do, he said he’d expect in the ‘teens for number of follicles. He gave us a rough estimate on the medication (it varies, because it depends how much of it you need). The advantage of injectable meds is also that they do not affect the lining. The total cost of an IVF would be in the neighbourhood of $13,000. To recap: That’s $13,000 for a 50/50 chance of taking home a baby. Or $3000 for a 22% chance that has a 50/50 chance to end up needing to be converted to an IVF (e.g. spending $10,000) anyway. Those are the first two options. Option three is a non-option in my mind, and the doctor himself introduced it as a “really barbaric” option – ovarian drilling. Basically it’s a laparascopic surgery where they go in and drill holes into your ovaries, it does what it says on the tin. Many women resume ovulating after this procedure is done. But he told us that many women also still need medication to ovulate after just a few months. Not really an attractive option in my mind, I’ve read about it before in my PCOS books and it seems outdated and not that helpful. I’m not interested.

So that leaves us with the preceding two choices. And we’ve pretty much made our choice. We had both more or less made our choice by the time we were in the car heading to a restaurant (we usually go to a restaurant after RE appointments to sort of de-stress). We both think an injectables cycle doesn’t make sense for us. If I’m going to very likely end up having to turn it into an IVF anyway, I’d rather set up the IVF from the outset for the greatest chance of success. Do the stimulation the way it’s meant to be done, and prepare myself physically and mentally for what is undoubtedly a grueling process but that gives me a 50% chance of having a baby at the end of it. According to the SART calculator thing my odds are lower than that but I’m going to ignore it. My chances *are* 50% if we put in two embryos instead of one… I’m not sure what we’ll do there. We’ll see at the info session what they say, and what the doctor says. There’s a 38% chance of twins if you do that.

Anyway. So that’s our decision. Although I’ve thought about it extensively, I’m not ready to walk away from this, I’m not ready to give up the hope of having children. I know I’d seemed to waffle a bit but I was just so tired. The prospect of a break from this before we proceed is a very good one, and honestly I’m relieved that we have a plan going forward. All along in this process, since November 2011 when we started trying, I’ve hoped that something would work – anything. I hoped it wouldn’t come to this but I also knew that it could. I hoped I’d be one of the lucky ones who never had to do anything super invasive but I also knew that it was an outcome that was out of my hands. We have reached Ultimate Science Level. I’ve been saving up money for the last few years and now I’m glad that I did. I mean we’re not rolling in it but we can do at least one cycle without debt. I don’t know how much frozen embryo transfers cost but I think a lot less than a cycle with stim. So that’s also a possibility after the fact.

I don’t think anyone could say that I didn’t give other procedures a fair shake. We did twelve cycles of oral medications. TWELVE. Two of those with a trigger shot and IUIs. We can’t really count that first, cancelled IUI. I’ve had hot flashes for literally years and felt hormonal and like garbage. Doing an IVF is likely to make me feel like garbage also and it costs a lot more but it also is much more likely to be successful. More than anything, I want a resolution to this. If we do IVF (or a few IVF transfers) and they don’t work, at some point we will be done. We can say, we did everything we could to try and have a biological child and it just is not going to happen. At that point we can stop with a clear conscience and decide whether we want to pursue adoption or if we will live child free instead. But I won’t have regrets, I’ll know I did everything I could do.

I’ve also decided that I’ll probably post about this on Facebook when the time comes so that everyone knows what’s going on. I read so many stories of women who don’t tell many people (and I understand their reasons so it’s not at all a criticism) but they struggle so much on their own and I don’t want that. I am going to, honestly, be unashamed about asking for help. This is a huge, expensive undertaking and I will need support. If local people want to bring me a casserole I will take that casserole. If people want to text or message or just check in with me to see if I am okay I want them to be able to do that and I want them to know what’s going on. I want to feel like people are rooting for me and in my corner. I may even link them to this blog if they want more detailed information, I don’t know. But I’m not going to hide this or be ashamed. I have a disease that unfortunately affects my ability to have a child. It isn’t my fault that I have this condition. I’m doing everything I can (trying to lose weight, mostly) to make this a success. I think just being open about it and not hiding it will be best for me. I know it will make it harder if it’s unsuccessful but I will need my people then too, more than ever.

Slow Start to IUI #1

So we started the month doing all the stuff to proceed with an IUI cycle. They make you pay a $150 non-refundable deposit for getting it set up, (that gets paid towards the total cycle cost, which is $500) when the IUI nurse calls you. The big benefit of this is that the IUI nurses, more than the “general infertility nurses” seem more competent and aware of what’s going on and I’m glad about that. It isn’t a nice feeling to wonder if your clinic even has it together. We paid the fee and I had my Clomid all ready to take (Clomid compound because apparently Clomid is out of stock everywhere in the world right now and there are many conspiracy theories about why, I don’t know). I took the Clomid, did all my acupuncture appointments, etc.

It’s around this time that things seemed to start piling up. My acupuncturist e-mailed me to tell me she was leaving the clinic. I e-mailed her back to tell her that I’d be going wherever she was going, I don’t care about that clinic itself. It turns out she does mobile appointments. She came to my house with her portable massage table thing. It was awesome. Except for the fact that I had to clean our bedroom in about twenty minutes – and try to vacuum up the dog hair. This was fine except for Rufus’ “helpful” nature when people are visiting. I’m lying on this acupuncture table on my back and he’s in the hallway. I just KNOW what’s going to happen, so I said to him, “Don’t you dare lick my feet.” Two minutes later, guess what happens. Euuugh.

Because of my irregular/weird cycles, our RE wanted me to do monitoring ultrasounds. It’s a bit of a hassle but it’s okay, my mom agreed to go with me which was good because honestly it was nice having someone else to wait with me – I don’t like the dildo cam at all. I joke about it (even by calling it that) but it’s not a pleasant exam. Depending on who is doing it, it hurts. So I went on Tuesday (the 10th) and my follicles were pretty small. 0.73 was the largest one. I don’t know what sizes they are talking, by the way. Millimeters, maybe? Smaller? But anyway that’s pretty small. We went again on Thursday and they’d grown a little bit – one on each side that was 0.9. I thought that was good and was glad they were making progress. Mom and I went for lunch both days, which probably doesn’t help the overall costs but definitely was a nice distraction. They needed at least one follicle to be 1.8-2.0 in order to proceed with the cycle. I asked the nurse what rate they expect them to grow at, and she said mine were growing at around half the rate that they’d hope for. I hoped this just meant that they were slow and it’d happen a little later but not too late. It was only CD 15 at that point, and my cycles are usually longer, so we still had time, I felt. She said they’d cancel the cycle if they hadn’t gotten large enough by day 22.

Then V and I went on Saturday morning (Valentine’s Day) for a third ultrasound. This time we had to do it at the fertility clinic itself because it was a kind of last minute “you’ll need at least another appointment” thing. The appointment was an hour late, which is sort of the usual at this place. When they did finally call my name, I was already not thrilled about the little room (and had been waiting an hour and a half). This room had a table with stirrups instead of the ones at the downstairs lab. It just has a squishy table, which is far preferable to me. Then another RE from the practice breezes in, we’ll call him “Dr. Guy,” and instead of letting me put the scanner in myself he does it, and I don’t like that – and he hurt me a lot more than any of the previous techs that week, and he just casually goes “I’m just not seeing a dominant follicle.” He’s not even bothering to measure them. I press him for details about the sizes because they HAD been growing. He says they’re 0.7, 0.8, 0.9, around there. Not big. Not bigger. “You just need a higher dosage,” he tells me.

I’m understandably a bit upset – who is this guy, even? You know, a fucking “Sorry” is all I might’ve needed to change my perception. “I’m sorry, they haven’t grown and you probably need a higher dosage” feels different than what happened. Coming from a man who just jammed an uncomfortable scanner up my business, a little compassion wouldn’t have killed him. I asked them if we could have another appointment on Monday just to check again and he agreed but in a sort of pitying “This is a waste of time” tone. I went out to the waiting room to confer with V and set up the appointment with the nurse. He had to go to the washroom and I just told him I’d meet him at the car. I pretty much fled down the stairs (didn’t want to be in an elevator with anybody else) and held it together until I was in the lobby of the building where I could cry in relative privacy.

I know it’s minor – in the grand scheme of things. We knew that trying the 100 mg dosage was a crap shoot and might not work, even with the help of acupuncture. I really hoped it would, though. I hate the way these medications make me feel. I hate feeling unstable and angry. I hate the fertility clinic and how hostile it feels. This was the first time actually that I saw two women there talking/making friends. Everyone is usually silent, nobody makes eye contact. Nobody wants to be there and it feels like everyone is always sizing each other up. Instead of a feeling of “We’re all dealing with this shitty thing” there’s more of a feeling of “I’m going to get mine,” as if we’re in competition with each other. Which is actually ridiculous. I’d say it’s all in my head but I don’t think so, I’m usually pretty good at picking up on subtle emotional stuff like that. That’s just how it feels there, to me. I hope it’s not me projecting onto anybody.

But anyway, back to me, crying. I was upset for awhile, mostly just that day – we went for pho and then at supper V made a cheese plate and got out the tablecloth and made things pretty – it was really sweet. By the end of the day I was feeling better and not so watery and wibbly wobbly. I think I was so upset in large part because of the doctor. We talked it over during the day and decided to cancel the Monday appointment (Monday was a holiday here). Rather than wait another three hours in this miserable place to receive news that is very unlikely to have changed and waste the last day of our weekend, we stayed home instead. The IUI nurse called me on Sunday to talk about what was going on/the plan etc.

Again, IUI nurses are v. heartening as they must have a list of active IUI cycles or whatever. We’d spoken to the reception to cancel. What’s funny is that the nurse had to ask ME what Dr. Guy had said to me because “I went to ask him but he couldn’t quite remember what he’d said,” yeah, to the surprise of nobody, because he barely gave me a moment of his time and was an asshat throughout. I told her what he’d said, and that actually I didn’t like him much. She was all apologies for him, “Oh no, he’s usually quite lovely, Saturday was so busy,” etc. I told her perhaps that was it (but I don’t actually think that was it). I think MY doctor would’ve delivered the news a bit differently, but anyway. She told me that looking at my chart (apparently he HAD bothered to measure a few of them when I asked him to) she said the follicles had actually gotten smaller since Thursday’s appointment. At that point I was feeling even better about our decision to cancel the Monday appointment.

The way things stand now is that I have to wait until I either get a period or don’t. I might not, since I probably won’t ovulate, or I may – we don’t really know. If I don’t, I have to do another Prometrium withdrawal to start the next one. Then I’ll start another batch of Clomid, this time at a higher (150 mg) dose. I’ve taken the dose before, it’ll be fine. We wasted some money ($85 for the Clomid, $150 for the cycle plus ultrasounds, I think) and I paid $100 for the trigger shot but since it wasn’t mixed or used, that’s fine and can be used for the next cycle. I’m really hoping I just ovulate really late and even though I’m VERY unlikely to get pregnant and wouldn’t even hope to, at least I won’t have to take Prometrium. That’s pretty much the “best case” scenario for this, I feel.

The Plan

I haven’t written here in ages or talked about any of this stuff either, so bear with me. I had to go back and read my last post to see where I had even left off. We basically spent most of 2014 with little to no western medicine fertility interventions. I wanted to see what the acupuncture/dirt tea etc. could do and honestly I just needed a break from that other stuff. All told, since starting the acupuncture I had four cycles that I assume were probably ovulatory, although I don’t have actual confirmation of that. One of those cycles was also, I strongly suspect, a chemical pregnancy. Which is neither here nor there, though it was the closest I’ve come to any success on this so far!

I started acupuncture and the TCM stuff at the end of March. It’s now December. Owing to my long cycles and an unfortunate hiccup at the end, I guess that’s the best we can expect from acupuncture alone, so far. In September I missed three acupuncture sessions in a row (I go weekly) because my acupuncturist was on vacation and apparently that threw a wrench into everything because I stopped having cycles. September went by – nothing. October went by – ditto. I realized just how I’d come to depend on the somewhat reliability of feeling like my body was “working” and then when it didn’t I was miserable and cranky. Finally, by late October my acupuncturist suggested I might want to take Prometrium to induce a period and start things over again. (I joked that my body apparently needed a hard reset).

She was right, and I realized that after I did it. I felt more at ease, and at least had peace of mind. The few months prior hadn’t been easy ones and I was coming to terms with the fact that I would need to go back to the fertility clinic. My acupuncturist (K) agreed. At this point I have tried medication (Clomid/awful Letrozole) and I have tried acupuncture/herbals but I have not tried the two together and we feel they could work well in tandem. I think I was always pretty adamant that I hadn’t turned my back on science or anything, but that if alternate methods had something to offer me, I would take them. We made an appointment to see our RE again, which is a precious thing – he books about 5-6 weeks in advance.

Yesterday was that appointment. I went armed with the knowledge that I had been/could have cycles on my own and that whatever acupuncture and dirt tea does, it isn’t nothing. I wasn’t sure how the reception was going to be or whether our RE would scoff at any of it, etc.

First of all, I think the waiting room there is my least favourite place in the entire world. Not just because it’s a clinical waiting room, it’s just not a happy place. Unfortunately our RE was running late (15 min late, they told us when we arrived) which turned out actually to be an hour late. So we weren’t thrilled by the time we got to see him, but like I told V, I already waited 6 weeks, what’s one more hour? He’s a doctor and a specialist, it happens. As it turns out he apologized straight away, said he’d had some emergencies that came up that day and it snowballed on him. That’s a good enough apology for me, and I think everyone relaxed at that point.

So then he said basically, long time no see, and asked me to tell him what had been going on with me in the interim since he’d seen me last. I got the impression that he did not know about the side-effects I’d had from Letrozole, because when I described them and explained why I’d refused to take a higher dosage, he was basically “Yikes, yeah, no.” This feeds my suspicion that the nurse who told me “the doctor” wants you to take a higher dosage either made that call herself or didn’t bother telling him about the side-effects. Because it wasn’t in my file. But anyway, he won’t make me take it again, so that’s good.

He asked me more about the acupuncture – whether I’d made any other lifestyle changes during that time, diet, exercise, etc. and I know I had intended to but honestly I didn’t that much. Maybe some more walking with the dog, but not enough to explain such a radical shift in the way my body was working or not working. If anything we ate worse this summer than we had been. The only change really is that because I’ve been taking seeds per my acupuncturist’s suggestion, I tend to have more fruit/veg at breakfast in my smoothie. I take pumpkin/flax seed from days 1-14 and then sesame/sunflower from 15-28. I think he was skeptical about that one but figured it couldn’t hurt.

We told him that we are ready to/want to move forward with IUI at this point, so we talked a bit about the protocol for that. I told him that I had recently (Sunday) had a positive result on an OPK for the first time, but also that it had been positive on Monday, and Tuesday. He said that’s not really normal, although it could be possible depending on the timing, but said he wouldn’t use OPKs for me for the IUI anyway and would prefer to do ultrasounds, probably three per cycle because of the irregularity of my cycles. That’ll be a bit of a hassle (getting around isn’t always easy and transit is a pain to get there but I’ll manage).

We talked about a natural/no drugs IUI cycle versus using Clomid. We also talked about my cycles, even the ones I’d had, and he said that the thing is when a cycle is that long (e.g. 40 days) even if you’ve ovulated you may not get pregnant because of egg quality at that point. So he said he would prefer if we used a medication to help things along, but he was really receptive to the suggestion that we try Clomid at a lower dosage than before (100 mg instead of 150 mg). He agreed that it was worth a try, saying that it makes sense that we treat things differently now because “You are different,” and “Maybe your body is self-correcting.” We all agreed that’d be great if it was. He got really excited when I said it was currently CD20 and that I think I just ovulated. “That’s perfect!” he exclaimed. “Go for a blood test! On Monday!” So we’re going to do that, to see whether I ovulated this cycle just on my own.

So that’s what we’ve decided on for the IUI. It may not be the next cycle IF this cycle is “normal,” because then it’d be happening at Christmas/New Year and who needs that hassle, really? Plus I think the office closes for parts of it and our RE agreed it would be best to wait until January. So if need be, I’ll take Prometrium then if things haven’t “progressed” on their own, to get things started for the IUI.

As for the IUI itself, I have a lot of documentation that lays out exactly how they do it, they schedule your ultrasounds based on your cycle length etc. There’s a nonrefundable $125 fee or something at the start of the cycle, and if it has to be cancelled because you didn’t ovulate, you’re out that much. Which is not too bad I guess, and still worth the lower dosage experiment to me. I’m going to continue with acupuncture and my herbals throughout. Basically he agreed to everything we’d already more or less planned, and I’m happy he’s willing to try a lower dose of the Clomid. Unfortunately apparently there’s an issue with Clomid’s supplier right now and it’s not obtainable, so he said their pharmacy has made a compound and we can only get it there. Which sucks because their pharmacy is closed at 3:15 in the afternoon? I mean. Come on, now, try and work with us. Anyway, we’ll get it all figured out. We will do three IUI cycles before we meet with him again to discuss. For the time being I am going to just go for the blood test and not worry about this stuff until January and just have a nice holiday!

Break

After getting the news from the fertility clinic yesterday that I did not ovulate on the Letrozole, I was feeling pretty downtrodden. After the side-effects I’d had (abdominal pain severe enough that I went to the emergency room, mostly) I had wrongly assumed the medication was doing something in there.

I was a bit annoyed with the clinic as they tried to reach us on Friday and V missed the call on his cell so they just left a message. We were out of town for a much needed birthday weekend getaway, and of course they didn’t return my call all weekend so I worried about it when I would’ve rather forgotten about it. It was enough that I had to do bloodwork right before we went out of town resulting in a spectacular bruise on my arm. I didn’t want to think about any of this while we were gone.

So the nurse who finally returns my call on Tuesday just starts in, “So as the other nurse told you, since you didn’t ovulate on the Letrozole at that dosage…” Excuse me, wait, what? No, the other nurse didn’t tell me, this is the first I am hearing of it. She blithely goes on to tell me how my RE wants me to take 10 mg instead of 7.5 mg at the next dose. That’s the maximum dosage, and where can she send my prescription please.

I basically told her that since we’d bought three rounds (45 pills) I’d have enough to do another cycle at a higher dosage (20 pills). The nurse failed at math, which wasn’t reassuring. I mean, I’M not super at math but… Anyway, we hung up and I didn’t talk to anyone for awhile, just sorting through it all in my head. We’ve talked about going to this holistic fertility centre here in town for awhile – just hadn’t really followed through on it.

Honestly, to be truthful, I’m skeptical about some of the stuff they do there. More in the chiropractor/reiki/craniosacral range. Also, they have “nutritionists,” which is not the same thing as a “dietician” and I’m not sure about those either. I guess I am skeptical about many things. But they also have mostly traditional Chinese medicine, which I don’t have experience with and could be fantastic for all I know, as well as fertility yoga, acupuncture and fertility massage. I have read studies suggesting that acupuncture was helpful for fertility as well as a complementary therapy for people doing IUI and IVF and that many of these things could help alleviate side-effects from fertility medications.

At this point, I feel a bit like – what do I have to lose? Even if we do three months of this other stuff and it does NOTHING AT ALL, nothing at all is still better than actively hurting me like the other stuff is doing. I’m not abandoning the western medicine/fertility clinic approach either. But what I am going to do is spend the next three months just completely focused on me. We booked the initial consultation AND an acupuncture session the same night because acupuncture freaks me out a bit and I figure if I get it done I will see that it’s not so scary and then after that it’s all gravy. So we’re doing that on the 21st, just a little over a week away.

At the same time, I am going to get active again (that has definitely dropped off) and stop making excuses for eating like crap. I know I have been doing this – side effects from the meds and probably depression from dealing with all of this means that many nights it’s just easier to order take-out. Many nights became “almost every night,” which is not only expensive, it’s bad for us.

I’ve gained probably 15 lbs since we started all this and I started at overweight to begin with. I can no longer ignore how all of these medications and this entire process have affected my life (spoilers: 100% in a negative way, not a single aspect of this has been positive or enjoyable or made me happier.) So I think that taking three months (then we have our vacation scheduled in June) can only be a good idea. Yes, I was feeling melancholy because I just turned 31, but it’s not 3-4 months that will make or break our efforts to do this and if I can possibly ovulate on my own by losing weight and getting healthier and acupuncture/yoga etc then maybe that is what I should be doing.

Apparently other people agree with me because my Mom kept saying, “I’m so glad to hear you’re doing this, I think you’re being so smart about this and this is a great idea,” etc. etc. as well as “We’ve all been really worried about you. You don’t look healthy.” I guess, really at the end of the day, what is more important to me: having a child or ME? I mean if I had to choose. It’s a pretty obvious choice to me. If having a child leaves me absolutely wrecked and even takes years off my life to do, is it actually worth going through all of that for? Not saying we’re stopping. But we are going to pause and take stock. I might also contact and make an appointment with a dietician. There is a single dietician here in town who mentions PCOS in her description, but her website seems to be more focused on pregnant or just-gave-birth or with-young-kids people. So I will have to e-mail her first to know more. And yeah – I would opt to go to the dietician over the nutritionist at the fertility place.

So that’s where we are at right now. I’m also going to keep my workload pretty light to give me lots of time to exercise and cook healthy. I know I’m fortunate that I can afford to do that, and also afford things like a psychologist and these other therapies. I hope they pay off, and when I say that I don’t mean “put yoga in, get baby out,” I mean more that if they help me to feel healthier in even a small, tangible way, then they will be worth it as far as I’m concerned.