FET #2

I haven’t written here much because the long wait between FET #1 and #2 left me with not much to say! After our FET finished with a negative result in February, we weren’t offered treatment again until sometime in May. Well, technically we were offered it sooner but by the time they called it was too late to start birth control pills that month and so we had to wait another month. I was really frustrated, but adopted a “grit your teeth and deal with what you can’t change” attitude.

So I started taking Suprefact again on June 3rd. The actual FET itself was a rollercoaster. Again, there were concerns about my lining. We ended up having to supplement my Estrace dosage (8 mg/day) with additional estrogen in the form of estrogen patches. The clinic wanted me to do estrogen pessaries and I refused after my last experience. The pharmacist explained to me that because estrogen is absorbed differently this way, some people don’t tolerate it well because it causes major spikes. That’s exactly what happened with the last FET. I took it and then when I woke up the next morning (it had been absorbed) I was so dizzy that I ended up losing my breakfast. No, thank you!

The estrogen patches are much better. You change them every three days and can otherwise mostly forget about them. Tip: baby oil works really well to remove the adhesive residue when you change the patches! I should also mention here that overall I felt much better throughout this cycle physically. Prior to the start of the FET, I had been working out 4-5 days a week and had swapped my normal breakfast out for a green smoothie every morning. Regardless of any impact on the outcome of the FET itself, the working out gave me a place to channel my emotions and kept me on an even keel. V even said that I seemed emotionally much tougher and less volatile this time around. The smoothies helped keep up my energy. Let me know if you want some green smoothie recipes, I’ve made dozens of them over the past few months!

Anyway, the date of our embryo transfer kept being pushed back because they wanted my lining to be thicker. At the first ultrasound, it was 0.7 which is the bare minimum, they prefer it to be at least 0.8. The next time we went back, it was 0.76 which was really frustrating. I thought for sure it’d be 0.8 by then, but it still wasn’t. We talked it over with the RE doing the ultrasound. I asked him if it was a bad idea to do the transfer, and if we’d be wasting precious embryos doing it. He has this gentle Irish accent and he assured me, “No, you know what they say about spreading seed on rocky soil – the soil isn’t rocky.” I had to laugh later, I know he meant to be reassuring but it was so funny. Sir, you are talking about my uterus. He said I did have the option to stop the cycle and try again, but there was no guarantee that I’d respond any differently to the medications in a subsequent cycle.

I’d already been snorting Suprefact for a full month at this point. The lining still had the “trilaminar” appearance that is very important. We decided to proceed as planned. The thaw date was still pushed back some because of dates and holidays (Canada Day, I think) so I’d still have some more time to respond to the medication. They’d thaw the remaining five zygotes in about a week or so and then they’d see how they grew.

Thaw day came and I was actually pretty calm. I knew the clinic would report back to me each day to tell us how the embryos were doing. All five of them survived the thaw, which was better than last time, when 1/6 didn’t make it. Unfortunately, they were growing “slowly,” or at least more slowly than they’d wanted them to. I thought it’d probably be okay. We had a very good day 5 blastocyst last time, and three more embryos from that batch of six had gone on to become blastocysts on day 6 (and one lone day 7). This time, all 5 were growing but just slower than you’d expect.

The day before the scheduled transfer day, I was a wreck. The embryologist called again to say that the embryos were still behind. I was so afraid that none would be worth transferring and that we’d lose them all and have nothing. I wondered if we should’ve transferred on day 3 so at least we’d have had a chance. It was a pretty rough day.

The next day was the actual transfer. V took the call about the embryos. The embryologists had one “early blastocyst” that hadn’t expanded quite as much as they might have liked and another that was a little behind that one. They were recommending that we transfer two instead of one. This really ran counter to everything they’d said up until that point about single embryo transfer, risk of multiples, etc. It was really hard to be optimistic. I thought how dismal it was that this cycle seemed to have less chance of success than the previous cycle with a great day 5 blastocyst. It was really demoralizing.

We showed up early again along with my acupuncturist. I let V choose my “lucky socks” that morning, because I chose them for the last FET and obviously they weren’t very lucky. I made some rookie mistakes – the first one was drinking too much water. The clinic tells you to drink 2-3 glasses of water about an hour prior to the procedure. Well – we’re past TMI here, right? I don’t have a big bladder. I drank the water I was supposed to drink and within twenty minutes I was hopping and trying not to writhe in my chair. They still hadn’t called us back into the procedure area. At V’s urging I finally went back on my own and told the nurse at the desk that I had kiiiiind of overdone it with the water. She gave me a cup to pee in and told me how much I could pee. This happened two more times before the embryo transfer, haha. Right before we went in for the transfer the nurse asked if I was doing okay and did I have to pee very badly, asked to feel my bladder and said yes, you can go again. I could have hugged her.

When we were actually in the OR, she showed V my bladder on the screen and said “It’s still so full! It’s like a black hole!” Yep, that’s me. The embryologist brought out the photo of our two little embryos, and contrary to what I was expecting given their “slowness” she said “Actually they look really nice!” It’s always good to get compliments. They showed us the embryos in the petri dish along with our last name to confirm that they were ours, and even zoomed in so that we could see them – two teeny specks. They made me think of Horton Hears A Who.

We had a different doctor for this transfer, and she was really nice. I’d met her before during my IVF cycle but only briefly. She got everything ready and then when they were about to do the transfer the nurse said “Okay now, try not to move.” I was SO COMPLETELY still. After a little while I piped up, “Can I breathe now?” and the nurse and doctor both laughed. I was dead serious about not jostling the catheter or interfering with the transfer in any way! The nurse said “Yes, breathe! We don’t want you to die!” Haha. Some things are worth holding your breath for, I guess.

After the transfer was done the doctor wished us luck and left. The nurse got me positioned comfortably on the bed and left us alone for 10-15 minutes to rest quietly. It’s a weird feeling post-transfer – there are no drugs involved but both times I have felt really dopey and relaxed. I think it’s a post-adrenaline reaction. As much as you try to stay calm and channel your inner zen, after the procedure you can really relax because it’s over and everything is out of your hands.

We went out to the changing rooms and had some more acupuncture done, and then went out for lunch and back home. My post transfer instructions were a mix from my acupuncturist and the clinic. From the clinic: No sex, no sunbathing/hot tubs, no lifting anything heavier than 10 lbs, no swimming, no strenuous activity including vacuuming. From the acupuncturist it was: keep your feet warm, have fresh pineapple core until five days after the transfer, watch funny movies/try to laugh a lot, and go for gentle walks to keep blood flowing.

I’ll admit to you, truthfully, the following two weeks were the hardest part of this whole process. Being unable to do much including the working out I had been doing really affected my mental state. I couldn’t even walk the dog because he’s a 90 lb Labrador Retriever and he has a tendency to pull, sometimes suddenly. I could only go for walks by myself (which breaks his heart) or with V there to hold the leash. I chafed at the restrictions. We’d planned it out really carefully so that V had three days off at the beginning of the week when we’d get our results. We even asked the nurses to change the bloodwork requisition to allow for it to be drawn on July 31st instead of August 1st because the labs were closed for the holiday. They told us they’d call on August 2nd because of our clinic being closed as well. So we’d get the news on Tuesday, V would answer the phone, and have Wednesday to mourn together if it was negative. We’d both decided after the last FET fiasco that we did not want to do a home pregnancy test. No early testing, no false positives or negatives, we would wait for the verdict from the bloodwork.

Well, Monday rolls around and we’re just puttering around. We’d been for my bloodwork the day before. I was really down in the dumps, if I’m being honest. This felt like slow torture, and I hadn’t had any symptoms besides some intermittent cramping. I was so sure it had failed, just like the FET before. I was talking with V about other tests we could have done, possibly considering a different clinic, anything that might change things. We talked like that for awhile and then V decided he wanted to fix some things around the house, and he’d gone upstairs with a pair of dimmer switches to install in the bathrooms. I was downstairs at my computer because I had to help him by turning off the appropriate electrical breaker. The phone rang. We have call display so I saw that it was the clinic and my heart sank. Although we’d planned for V to take this call, I knew he was in the bathroom with no phone. I had to answer it.

I picked up the phone and answered tentatively, my voice shaky. The nurse asked how I was, I said fine, asked how she was automatically. She said she was fine. Then she said, “So, your numbers are slightly low but that’s probably because we had you test a day early…” My brain stuttered to a halt. WHAT? I cut her off. “I’m sorry. Are you saying that my numbers are anything at all?”

“Oh,” she says with a little laugh. “Yes, you’re pregnant. Your beta is 206, which is slightly lower than we like to see usually – we like it to be 270, but since it was a day early it’s probably just that. Anyway, we’d like you to go for more bloodwork tomorrow just to make sure it’s high enough.” By this point I was crying but I managed to hold it together on autopilot mostly through the rest of the call, making sure that the requisition would be faxed to our preferred lab. I thanked the nurse and hung up the phone and stared at it, still crying, before my brain slowly remembered that V was upstairs and he still had no idea that any of this had happened. This was the only thought I had – “He doesn’t know. I have to tell him!” I ran up the basement stairs, sobbing and panting, then the upstairs. I came around the corner of our bedroom (still sobbing, haha) and V looked at me from the bathroom, alarmed.

“What’s wrong?!” he said, coming towards me. “They called,” I choked out. “It was positive. I’M PREGNANT.” I wish I could bottle the look of stark disbelief on his face followed by elation. “YOU ARE?” he said. “COME HERE!” and we were hugging and I was crying and I still couldn’t believe this was happening. A minute or so later we heard our neighbours (who are also our good friends) coming home and I went to the window and yelled “HI I JUST FOUND OUT I AM PREGNANT,” because I’m the queen of chill and am super good at secrets. They came over to hug and congratulate us and we talked awhile and it was perfect.

I’ve told more people since then, my small Twitter account and also my parents. After the bloodwork came back good on Wednesday, I felt okay sharing it. The beta was 365, which is in their range between 270 and 1100, apparently. I’d have liked it to be higher but it’s going up enough that I’m trying not to worry. I know it’s early to be telling people but it’s a choice we’ve made that we would like the support and happiness of this moment, whatever the next moments might bring. I am holding out hope that this really is our time and that the baby will be okay and everything will go smoothly. I am only 5 weeks pregnant today. We have an early ultrasound on August 19th and that will be the most important part in these early days. So whatever you believe in – good thoughts, various deities, crossing your fingers, please do it and hope with me. It’s so surreal. After five years of this I didn’t even think this was possible.

Believe it!

 

What’s funny is that some odd/coincidental/superstitious stuff happened beforehand, let me tell you about it. As the FET was beginning, I found $75 on the ground while walking the dog. It was a conundrum for me, ethically. There was nobody nearby who could have dropped it, and it was too small an amount for the police to take. I didn’t feel right keeping it because it wasn’t mine. We decided to donate the money, so I donated it (along with another $25 to make it an even $100) to the Generations of Hope fund. They help couples who can’t afford IVF treatment.

Next, the day before the transfer we went out for Chinese food and we both got fortunes that seemed prophetic. Mine said “Tomorrow is a good day for trying something new.” I can’t remember what his said and he can’t find it, but it was in a similar vein. V chose these retro gamer socks to wear on the FET transfer day, saying that being a gamer has been the luckiest thing for us both after all (we met playing Ultima Online about a billion years ago). Come to think of it, gaming socks are also relevant to our WoW guild, Business Time. “When I’m down to just my socks, you know what time it is!” Haha.

We went out Pokemon hunting during the long two week wait, which I thought was appropriate. My gentle walking was also video gaming! At one point we went to a new park we’d never been to before, and I said “I want to go down this path, here.” We rounded the corner and there was a big sign – “BP Birthplace Forest,” established in 2007 to celebrate the city’s newborns. We exchanged a look – I didn’t even know that we HAD a “birthplace forest.” It turns out there are a number of them for different years around the city, but still…It was weird that we ended up there.

Finally, the due date is April 7th. This is V’s late father’s birthday, so it’s a day of particular significance for him and it seems awfully coincidental to me that it would be the due day. Just some funny stuff, is all. Anyway, one footnote – since we put two embryos in, we don’t actually know how many stuck around. I thought surely there could only be one based on my beta numbers (assuming twins would make them a lot higher) but my friend who had twins pointed out that she thought she’d only have one, too. Gulp. So we’ll find that out at the ultrasound for sure. Of course I’ll be happy with whatever I can get, whatever ensures we have any healthy baby at the end of this is what I most want, and what we’ve been struggling for all these years. I’m so happy! Nauseous, anxious, but still happy.

 

 

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!

Sniffing in the new year

I’m a little behind with my blogging, mostly because nothing really exciting to read about has happened. We had a pretty quiet holiday season. I was due to start my Suprefact medication on December 30th. I’d been taking birth control pills all month as the “first” part of the FET cycle but it was the Suprefact that, in my mind, would really mark the beginning of things.

Suprefact is a nasal spray, and I didn’t know how that was going to be. There are two things about it that are annoying. One, you have to take it five times a day, which works out to every four hours plus an 8 hour stretch for sleeping. We decided on a schedule of 6:30 AM, 10:30 AM, 2:30 PM, 6:30 PM, and 10:30 PM. What this unfortunately meant was that we were having to wake up at 6:30 AM on our vacation. The first couple of nights I hardly slept, waking up every hour because I was afraid I’d miss the alarm we had set. Especially the first night, this was true! Now if I don’t have to get up right away, I can pretty much wake up, spray this stuff into my nose and then go back to sleep. Most of the time.

That’s because the second thing that’s annoying about the Suprefact is that has an awful taste. Just – ugh. Super bitter and putrid. If you inhale too strongly, it goes down your throat immediately. I’ve found that keeping some Mentos nearby helps with this (the fruit ones) but I don’t really want to have candy right before bed! But currently, I’ve got no choice.

These are minor things in the grand scheme – it’s mildly annoying to be on this strict schedule, ducking into the bathroom at a restaurant to snort drugs (haha but it’s TRUE) but hey, at least it’s not injections! As far as side effects, the Suprefact is intended to shut down your body’s own production of hormones. So it’s a sort of false menopause, with all the side effects you’d expect. Hot flashes, night sweats, mood swings/depression, all that fun stuff. I’ve definitely been feeling it, my temper is shorter than usual and I have less patience. I’m grateful that we’re doing this while it’s still winter so that I can go stand at the back door if I have a hot flash, though!

The next step, now that I’ve finished my birth control pills, is waiting for a period. When I get it, I let the clinic know. Then they’ll tell me when to start Estrace (estrogen). The point of this is to build up a healthy, welcoming endometrial lining for an embryo. After awhile of taking that, I’ll go in for a single ultrasound to make sure the lining is greater than 7 mm. If it is, then we do the transfer and I’ll start taking progesterone to support (hopefully) a pregnancy that might result.

Now, as far as the embryos go, we had to decide how many to thaw. This is a little different for us because we had a freeze all cycle, when the embryos were frozen at such a young development stage. There’s no way to know which of those embryos has the potential to develop into a day 5 blastocyst, which is the ideal. The nurse, when she called, asked if I wanted to just let the embryologists decide how many to thaw and I said I’d prefer to talk about it with them.

It was funny; this whole process is such a hurry up and wait thing. For weeks I was just doing my thing, taking the birth control pill, etc. but then the day that they called me to say I was approved for the FET I spoke to a nurse, and then later a pharmacist, and then later the embryologist, all in one day. Needless to say I wasn’t getting much work done!

So the embryologist explained that usually what they like to do for the number of embryos that we have is to thaw about half of them. We have 11, so we had to choose whether to thaw 5 or 6. We decided to thaw six because of some math reason that V was confident about, I don’t really care. We want to maximize our chances as much as possible with this first FET which is really our first true chance with IVF at all. The embryologist said that if a bunch of the six are able to develop into blastocysts, they can refreeze them but they don’t have good statistics regarding success rates using refrozen blastocysts. All embryos will suffer a certain amount of cell loss when they are frozen/thawed and it’s ideal to minimize the number of times that happens, if possible. She said the only thing that they can really guarantee is that I won’t have 11 embryos at the end, which is fair, and I knew that. I’m going to go ahead and say right now that I’ll be really thrilled if three of the six embryos are able to make it to 5 days. If more than that can, I’ll be over the moon, but if 50% are able to that’ll be fantastic as far as I’m concerned.

Both V and I will have to take another round of antibiotics starting at the time I start Estrace (I think). I’ve been on low-dose aspirin and will continue that. If the embryos need assisted embryo hatching, I’ll need to take another drug called Medrol, just for a day or two. I guess it has to do with my immune system. Most embryos that are frozen need assisted hatching because the freezing process hardens the shell. They shoot them with a laser(!) to make a hole and help them hatch better, which let’s be honest, is pretty cool.

If everything goes according to plan, we’ll be transferring in the first week of February. I’m not sure what I’m going to do about handling the results. One downside of being so public and open about this process is, I mean…you guys are going to KNOW when we did the transfer. And you know that I will know whether it worked two weeks later. Many people often wait until after the first trimester to “announce” anything but it’s going to be hard to keep it a secret because of the infertility stuff.

I’ve been having some ambiguous feelings. This is all such a mindfuck. A month from now, I could possibly be pregnant, with the highest chance I’ve ever had. A part of me is so hopeful, and another part is afraid of feeling hopeful and then having those hopes stomped on (again). What if the embryos don’t grow well? (What if NONE of them grow well?) I’m trying to just take it easy instead of driving myself in doubt spirals. I bought this frozen embryo transfer guided meditation/visualization program and I’ve been doing it not daily but every few days. I figure at the very least it can’t hurt. I should also schedule some acupuncture for soon. There’s nothing I can do about how this will play out so I may as well just do my best to relax and even hope, a little. I was looking at some baby clothes but I feel silly admitting that, and I didn’t buy any. It seems like too much of a jinx at this point, and also what would I do with them if I never ended up needing them? It’s better to wait.

Right now it feels like January is going to be a long month, 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.”

Looking back on 2015

I was reading back through this blog chronologically last night. It didn’t take very long, because it’s not a very long blog. There were large gaps during which I didn’t write because nothing was happening on the treatment front. It’s a little sad to read my optimism at the start of each new phase of treatment. I know reading my own words that I was so hopeful that acupuncture would be the answer to solving this problem. Then I had really high hopes for a successful IUI cycle.

It’s easy to look back with hindsight and think, “Why did you waste an entire year doing acupuncture?” but the honest truth is, I don’t think that it was a waste. I have a different perspective on many things. I remember when I first started going to therapy for all of this, three years ago, I described how I felt like I was in a race and people were streaming by all around me while I just stood still. I was very focused on the feeling of being left behind.

I can honestly say now that this simile is no longer true for me. I do mark the passage of time, of course – I can’t help that. People who had babies while we struggled with infertility have gone on to have second, and in some cases even third babies. Some of those babies are having birthdays. Three years ago me would have considered each of those reminders a thorn in my side, just another jab to remind me how nothing has changed and we were still standing in one place. But current me doesn’t feel that way.

I notice the births, pregnancies, and birthdays with a sense of rueful amusement, but I’m not in a race with anyone. I’m trying to deliberately cultivate a conviction that we will be parents however that happens – that we will have our children precisely when we’re meant to, because it can’t happen any other way. Please note this is different, to me, than believing that any higher power will provide children IF we are meant to have them. I don’t believe that and I don’t find comfort in it. If I had to find another comparison, if life is a stream, we’re moving along with it just like everyone else, and everyone’s life is different. It’s not a race to the finish line. Honestly, if the finish line is the end of life, I’m not in a hurry to get there, anyway!

The shape of our life together is completely unique to us, just like everyone else’s. I’m going to be ridiculously happy if/when we’re able to get pregnant and have a kiddo. That’s what all this has been about, after all. But I know that it isn’t going to magically solve all of our problems. Infertility is a big part of what we are dealing with, but its far from the entirety of who we are. When we can have a baby we’ll have to learn how to be parents and face all the new challenges that come with that.

I suppose you could say that this whole experience has made me into a much more patient person in some ways. I wouldn’t say I am fundamentally a PATIENT person, but I’m more patient. This year in particular has been pretty intense on the infertility front, but I also feel like we made some significant steps forward. We realized that IUI wasn’t going to work for us and that I am not a great candidate for injectable IUI. We made the decision to have IVF and take that leap of faith, although we won’t know the results of that until 2016. But as V keeps pointing out to me, it’s progress. Even if the end result of all of this is that we decide to stop all fertility treatments and are never successful there, it’s still progress towards whatever the eventual outcome will be, whatever path we will choose.

My infertility has changed me. At one point, I was worried because I felt that infertility had hardened me. Not just in the sense of being tougher, but also less sympathetic to people, even less considerate of others, maybe very focused on myself or very “poor me.” At the end of 2015, I can look back and say that I am proud of everything we’ve accomplished this year.

One of those things was a deliberate and conscious attempt to connect with people rather than disconnect. I’m not saying I’ve been perfect, far from it. But I’ve tried to be kinder. If I find myself thinking something mean or unnecessary, I often won’t say it, or I’ll try to reframe it to be empathic to someone else’s situation. I know that infertility can feel very isolating, and it’s easy to feel that you’re completely alone with this huge thing that you’re carrying. But everyone is carrying things, some are bigger and heavier, some are smaller, but no one has a perfect life free of any struggle.

I guess you could say this has been my year of reaching out, and I’m mostly glad that I did. I want to be the best version of myself, the one who is a good friend, partner, who cares about people and shows it. Infertility had made me lose sight of that person. I was becoming very pessimistic and negative. I think I’ve managed to turn it around, or at least I am on the right track, and while I may not finish this year with a pregnancy or a baby, I’ve still created something really important for myself.

 

 

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: Day 7

Oof, what a day. So here’s the scoop with me. First of all, I am so sore. Everywhere. Specifically my abdomen, my ovaries are ANGRY and they are still making many eggs. Too many eggs. A plethora of eggs. Since my monitoring ultrasound on Monday, my leading follicles have grown from 0.9 to 1.5. The expected rate of growth is usually 0.2 mm per day. Also, all of the follicles are growing. They aren’t all at 1.5 but they’ve all grown. Everyone I meet at the clinic is currently asking me if I am aware of the “freeze all” plan. I sure am! I’m beyond “high risk” for OHSS at this point and freezing everything they can retrieve is the only way to ensure my health and avoid that. I always knew the odds of us having a fresh transfer were pretty slim to none and I’m okay with this.

They sent me home with only another dose of Cetrotide (the “antagonist” medication, this prevents you from ovulating). I had to wait and hear back about the dosage of my Gonal F. They lowered it from 150 iu to 125 iu because my estrogen levels have just about doubled since Monday. They went from 5500 something to over 12,000. That’s a lot, I’m given to understand. So now it’s a fine balance between maturing the eggs enough to trigger them but without driving my estrogen levels much higher. The nurse said “You’re ahead of the game here,” which seems to me not necessarily a great thing to be, but it does mean that I’ll have fewer days with as many medications and the retrieval will happen sooner. That part is scary because it’s the retrieval that I’ve been worried about, honestly.

I had a conversation with some ladies while we waited in the lobby this morning and they said that the retrieval IS painful. One said she felt everything as if the medication had never kicked in at all. Another one said that it had hurt, but that the medications they give you kind of make you not care that it hurts. Honestly, I’m glad it will be over soon. Even if I’m really sore after, there’s pain medication for that and I think it’ll be a tremendous relief just to not have this hanging over my head. I try not to worry about it too much but it’s tough. It will be over soon!

So what happens from here is that I’m going in for another ultrasound and bloodwork tomorrow morning. They’ll see how the follicles have progressed. This morning’s nurse said she didn’t think they would have me trigger as early as tomorrow, but the nurse who called later in the day said that they might, because of my estrogen levels. The rough timeline is that the retrieval will probably be this weekend. V has planned to take Monday and Tuesday off to be here with me depending on how I’m recovering.

I really hope that the doctor doing our retrieval (I don’t yet know who that will be) is willing to let V come into the room with us. I know that having him there will help me be more calm and feel better. Especially with how many eggs we’re looking at, the procedure may take longer than usual. I don’t actually know how many of all of those will be useful, good or retrieved. I can’t seem to get a straight answer out of anyone – I guess they don’t know themselves at this point because some will mature more than others. Also PCOS can mean plenty of eggs but not necessarily high quality ones. There are some unknown quantities right now, but the current focus is keeping a close eye on these follicles and doing the retrieval.

I’m so tired right now. Making 50+ follicles is a lot of work, I guess, and I am also bloated and uncomfortable. It’s hard to find a position to sleep in at night because laying on either side hurts and even on my back there’s pressure. I just keep telling myself that in the end this will all be worth it (hopefully?!) Now you can cross your fingers, toes, or whatever you do to ensure luck that the retrieval goes well and we get some GOOD, quality grade A embryos. All I want is enough to give me some chances at this in a few months when my body has calmed down. I don’t honestly know if I’d be willing or able to put my body through this again, so it’s my sincere hope that we’ll have something we can work with. Think good thoughts for me! I’ll keep you posted as things develop.

(So many opportunities for egg jokes. V said, “But you don’t even need more medication, you’re very economical!” and I told him, “Right? I have so much EGG for your buck I’m like a chicken coop!”) I’d laugh at this but laughing hurts right now. I think I may go and lie down for a bit.

IVF: Day 6

Today is the sixth day I have been taking the IVF medication and I am beat. When I first started doing it (the first 3-4 days) I’d feel really good in the morning and be able to be productive and get things done. Then as soon as I’d take the medications (maybe about twenty minutes later) I’d start to feel dizzy and exhausted and sometimes a bit nauseous. I threw up a bit on Sunday, completely out of the blue. The clinic keeps trying to say this is the antibiotics that I’m taking, but I remain unconvinced because I took a round of the exact same medication in August without those effects. I also took them before my HsG in 2014 so I really don’t think it’s that.

Yesterday I was up bright and early to wait at the clinic for my bloodwork and ultrasound. This time I had the ultrasound first, and the doctor and nurse were having some technical difficulties there. I can tell you that there are less opportune times to hear someone say “Maybe we need to reboot it.” I said, “What’s going on down there?” and the doctor says, “Oh, it’s just – your ovary looks like it’s standing on its own. I mean it isn’t – it’s fine, it’s just the picture!” A few seconds later: “I’ve never seen this before.” I think it took longer than usual because of this but the doctor started counting and measuring. I heard her say “0.9,” which is millimetres. For comparison’s sake, at my suppression check the largest follicles I had were 0.6 on one side and 0.7 on another. So 0.9 is a reasonable increase. Mature size is 1.8-2.0. But they are growing.

However. When the doctor was finished I asked her (because I like to keep track of these things) just how many follicles are currently at 0.9. Please keep in mind that I have PCOS – by definition, I have many follicles on both ovaries. 75 follicles that they counted, back in August. So the question “How many of these are 0.9?” The doctor goes, “Oh. Well, fifty of them.” Fifty? Five zero? No wonder I feel like hot garbage all of the time. My body has been pretty busy. The doctor notes that I’ve already talked with them about the high likelihood of a freeze all for the eggs that they retrieve. This can help them prevent OHSS. I’m quietly freaking out a little bit at this point but the doctor doesn’t seem concerned so I’m not going to be, either.

I go and wait for my bloodwork and then head out. The way it works is that once they have the results of the bloodwork and ultrasounds, all of the doctors have a meeting where they decide how to proceed with each of the patients. I like that, because all the doctors will be familiar with all of the currently active IVFs and the decision is a group one rather than it depending on what any individual doctor might think. The nurses then call you to follow up and let you know what to do next, based on what the doctors have decided.

My mom picked me up from the clinic and we went for second breakfast at Cora’s, which was nice. Later she came in and helped me clean up a bit – the house wasn’t messy but some things just needed cleaning. She hung out while I did my shots (she also had brought me muffins, which aren’t really muffins but cupcakes without icing and I don’t even care). It was nice to have company for the afternoon.

When the nurse called me I asked her for some more info about the fifty follicles and she said that at this stage it’s really common (especially in women with PCOS) to have lots of small follicles that have responded but that doesn’t mean they will all continue to get bigger and that I absolutely shouldn’t worry. I hope she’s right and that they can control this. Worst case scenario for me would be if they had to cancel the cycle because I over-responded and it wouldn’t be safe to get the eggs out. Then we would’ve gone through all of this for nothing and we’d be out thousands of dollars for medication alone (I think they refund some of the cost for the IVF procedure if you don’t make it to retrieval, but even so).

So my current hope is that MANY of those follicles realize that this month is not their turn to shine, and they stay the size that they are. A friend on Twitter remarked that the follicles just need to stop playing nice with each other, and I like that. My follicles are too Canadian. They’re all no, after you, no no, please, after you, and they have to get ruthless and have a FOLLICLE DEATH MATCH to determine who is worthy.

Meantime, everything hurts and it hurts to move around (walking hurts, sitting hurts, accidentally bumping my tummy hurts). The most comfortable spot is on the couch downstairs because I can recline in it and there’s no pressure on anything. I’m also bloated and pretty much resemble a wildebeest. I’m happy to report though that the shots have been going fine and I feel like I have them all down, now. I don’t love doing them, but I’m able to just be very businesslike, get them done and then be happy that I don’t have any more to do until the next day.

So that’s all the news I have right now. I’m hoping when I go in for another ultrasound and bloodwork tomorrow that the ultrasound shows some of the follicles have pulled ahead of the others in size, and that many of the others have not grown. I know our RE said that we could expect “in the teens” for eggs retrieved but I don’t want to be an overachiever in this case, where having too many follicles could make me sick or cancel the cycle altogether.