I wish I could tell you that the emotional turmoil linked with years of infertility just magically disappears with a positive pregnancy test. I wish more, that I could tell you my mind is free of negative thoughts, fear, hesitation. Instead, we’re going to talk about something ugly. Pregnancy after infertility. We’re going to talk about the impact of infertility – after the positive pregnancy test.
Progesterone in Oil, PIO. Hate is a mild word for how I feel about PIO. Jabbing myself with needles is horrible in general, but PIO is a special kind of hell, so I’m going to bitch about it. A lot.
Don’t get too excited by the word pregnant. The embryo transfer involved the doc putting those lovely embryos of mine back into me. There was still a long wait (9 days) before the pregnancy test, but after the embryo transfer it is pregnant until proven otherwise. I am to act and think pregnant.
When I first went over the basics of IVF fertilization and embryo growth wasn’t included as a step. While it’s technically not a stage of IVF it was definitely separate from the egg retrieval and not included as part of the transfer. From here on out, I’m calling it a step. It was definitely on it’s own level in the middle of this process.
As you know, my egg retrieval yielded an outstanding 35 eggs. After retrieval there are three separate reports. The first report is day one after retrieval (so the next day), and involves the number of mature eggs and the number of fertilized eggs. The second report is on day 3 after retrieval. The third and final report is on day 5, usually the day of the embryo transfer.
Prior to my egg retrieval it was suggested that we try ICSI on half of our eggs. ICSI stands for intra-cytoplasmic sperm injection. Basically, ICSI involves injecting a single sperm into a single egg. This differs from conventional fertilization where they pretty much dump a bunch of sperm on each egg and let them fight it out. Generally ICSI is used for couples with male factor infertility – aka sperm issues. My nurse explained that it was recommended to us, despite Casey’s super sperm, because we have unexplained infertility. According to her ICSI can improve fertilization rates in couples with unexplained infertility. This could potentially point to an issue with the fertilization process, or my eggs, but it’s mostly just more effective over all. It was to be treated like a safety net, so we bit the bullet, forked out the extra cash, and decided to use ICSI on half of the eggs retrieved.
Day One: On day on I received a call from my nurse tell me that I had 14 eggs left fertilized and growing. Fuck. Logically, I knew that there would be a drop off between retrieval and fertilization. I knew because I have done buckets of research, and because they told me at least 12 times. Logic did not prepare me for that number. Not even a little. It is heart wrenching.
Out of my 35 eggs 25 of them were mature. This means that 10 were out of the game right away. Immature eggs are to be expected, not all follicles grow at the same rate, so there are going to be some that are too small to produce a mature egg ready for fertilization. The 25 eggs were split for the fertilization process, with 13 eggs being fertilized with ICSI and 12 eggs being fertilized with conventional fertilization. Out of the 12 eggs conventionally fertilized only 4 properly fertilized. Out of the 13 ICSI eggs 10 fertilized. I never really got an answer as to what this means, if it indicates a potential problem for us or not. To me, that is a VERY significant difference in the percentage of eggs fertilized. That’s 33% vs 77% for anyone who doesn’t want to do the math.
I’m happy we did ICSI on at least half of the eggs. If we end up needing a second round of IVF I will definitely choose to fertilize all of my eggs with ICSI.
Prior to the retrieval I was told about 70% of the eggs retrieved will be mature and about 70% of the mature eggs will fertilize. If we apply this to my eggs I would have ended up with 17 eggs fertilized, so I came in a bit below average. It was disappointing to say the least, especially after my awesome response to my stimulation medication and large number of follicles retrieved.
Day 3: The second report involves how many embryos are still growing/dividing properly. One day 3 we were left with 9 embryos, and were told that they were looking and growing right on track. My nurse said we would lose about 60% by day 5, and that we wanted 6 embryos left on Day 5. (60% of 9 is 5.4 for anyone wondering).
Day 5: Waiting for Day 5 was the most difficult wait. I was terrified that none of my embryos would make it, and that I would have nothing to transfer. Early morning on Day 5 I got a call from not my nurse giving me some basic instructions and telling me that we do have embryos to transfer and to show up at 11am. No report on my remaining embryos by phone, I had to wait until I arrived at the office to hear about them. When I arrived we had three embryos ready for transfer, all grade A. Yes, A is the best in embryo grading too. We also had 5 embryos remaining that they were going to watch into day 6 to see if any progressed to blastocyst (the stage that they want to freeze at). My doctor was hopeful that some of those 5 embryos would be ready to freeze by the next day.
I’m saving the embryo transfer story and final embryo report for my next post, it deserves it.
I could have included all of my fertilization and embryo growth reports with my retrieval, or my transfer. But it was very much it’s own thing. Waiting to hear how many made it was excruciating. Making embryos was a lot more emotional than expected. I get grossly sappy just thinking about it. For the first time, I knew for sure that we made something together. I’m not going to argue about when life begins, but dammit – Casey and I made these tiny little starter humans and I am fucking proud of every one!
This process is going so much faster than I ever thought it could. Let’s talk about my egg retrieval. The retrieval process started off well because Casey was in town! Being away from home and alone is not a whole lot of fun, and being able to spend time with him took my nerves down more than a few notches. He arrived Tuesday evening for our appointments Wednesday morning. We had a delicious dinner at Olive Garden, which I miss a lot living in Montana. It was a nice last meal before the whole no eating and drinking protocol prior to anesthesia. Casey had to be there for his sample at 7:15 am, and I had to check in at 9am for a 10am retrieval. The drive from where I’m staying to the clinic is about 45 minutes, so we were up bright and early and on our way. It wasn’t really time effective to leave Spokane between Casey’s sample and my check-in, so “we” went to breakfast. We meaning Casey devoured his breakfast in front of me, and I didn’t even get a sip of water. After checking in I had the privilege of getting all dressed up in my surgical garb. Including backless gown and blue hair cap. Then one of the lovely nurses came in to start my IV. It’s no secret that I’m not a fan of needles. While I am terrible with needles in general IVs are the worst. I hate them. I hate having them started. I hate having them in. I hate taking them out. hate. They usually do IVs in the hand after a few shows of Lidocaine to numb the area. Well, I’m allergic to Novocaine, so they refused to let me have any Lidocaine. Apparently an allergic reaction would throw the whole process off. Party poopers. The IV went in my arm instead of my hand. Apparently the hand can be a lot more painful to start than the arm without the Lidocaine, I took the nurses word for it. After my IV was started I had a chat with the anesthesiologist, who was wonderful. He did a great job explaining everything without talking down to us, and gave ample opportunity for questions. Once he had the information he needed it was go time. My nurse took my IV bag and led me to the bathroom (I couldn’t help thinking of it like a leash). I emptied my bladder and off we went to the surgery room. The anesthesiologist did not delay in starting some feel good drugs in my IV. Probably Valium. He told me what it was at the time. While hooking up my heart monitors on my chest he moved my gown and accidentally exposed a wee bit of boob. Like, barely even the top. Ladies show more tit in church. He immediately started apologizing profusely. In my Valium induced warm-fuzziness I thought it was hilarious. “Hey man, it’s alright. Everyone here is about to spend the next 30 minutes looking at my vagina, I’m not worried about a little boob.” That, along with my very favorite nurse holding my hand and giggling in my ear, is the last thing I remember before retreating into anesthesia dream-land. The next minute (about a half hour later) I was waking up to someone saying my name and asking if I wanted Casey. Of course I wanted Casey. Anesthesia does some funny things to people. It makes me happy and all lovey-dovey. I was quite ecstatic to see Casey and have him hold my hand. After a few minutes in bed they moved me over to a recliner with a heating pad for the pain and handed me a capri sun and one of those awesome cheese and cracker packs. You know, the ones with that little red plastic stick. Yum. After the ten minute eternity a nurse came to tell us how many eggs they retrieved. THIRTY-FIVE. I asked her to repeat the number twice. And then high-fived her. My last ultrasound before retrieval showed about 14 follicles that were the right size, so I was astounded by the 35 eggs they managed to corral off my ovaries. No wonder I looked 4 months pregnant and felt like my ovaries were going to explode. We spent the rest of the day watching Netflix and just hanging out. The pain was definitely there, but wasn’t excruciating. I was thankful for my pain killers, but would have survived without them. Casey had to leave super early the next morning, but thanks to said pain killers I slept like a rock. The bloating and pain slowly subsided, and I was left with the task of not going crazy while waiting for my fertilization report, finding out how many of those 35 eggs fertilized. More next time on my fertilization report and the grueling nerves that took over while our embryos grew (or didn’t).
It’s been over a month since I’ve posted. Crap. At first I was using the busy excuse, but the last week I’ve been doing a lot of sitting on my ass and watching Netflix, so I think that whole busy thing doesn’t quite cut it anymore. The only thing busy about me right now is my ovaries.
I am finishing up the stimulation phase of IVF. It’s been awhile, so I’m going to back things up a bit. On June 10th I received a gigantic box of medication.
That, ladies and gentleman, is what a couple thousand dollars of medication looks like. I just about peed my pants when I saw all of those needles. Almost 150 needles in that box. Not so great for someone who is terrified of needles.
Fast forward to the 14th when I actually had to start my injections. Casey was out of town visiting his dad for fathers day, so I had to do my first round of injections alone. The first night consisted of two shots, and they sucked. I’m still not sure how I was able to get through them both, I had a bit of a breakdown and spent half of the night crying.
The needle part wasn’t so bad. For subcutaneous (stomach) injections I was using a small 1/2 inch needle, and could barely feel the poke. The injecting part on the other hand, I could feel. I was not at all prepared for the burning that accompanied my second medication. It felt like I was injecting acid into my stomach. I generally don’t react well to needles, and this was no exception. My body immediately went into panic mode with an instant headache, dizziness, increased heart rate, nausea, etc. I felt like shit for the rest of the night.
For the second night I adjusted my strategy. I iced the area before hand, made sure my medication was room temperature, and injected as slowly as possible. Luckily, the burning and pain went down a couple notches. Still no where near the realm of pleasant, but mostly tolerable. The last few days I’ve added a new med, Ganirelix, to the daily regimen. While the Follistim and low dose HCG make my follicles fat, Ganirelix prevents me from ovulating too early. No way I went through all of this working growing these little bastards to have them float away into the Fallopian tube abyss. Ganirelix is hands down the worst injection, I’m actually glad I didn’t have to start until after I was a pro with the other ones. It burns. It itches. It stings. For hours. At least with the low does hcg the burning dissipates ten minutes or so after. Ganirelix makes the low dose hcg burning feel like a tingle.
Now, eleven days into stimulation I am almost 30 injections in. I still hate them. It hurts. I am always rewarded with a killer headache, but I am so fucking proud of myself for being able to make these injections my bitch. If you would have told me a year ago I would be laying on the couch every night watching Dexter and giving myself multiple injections I would have laughed at you. But, here I am.
So, what good are all of these horrendous injections doing? Follicles, my friends. I might go into the details of each monitoring appointment later, but for now I’ll stick to the summary. At my last monitoring appointment (that’s where they do a trans-vaginal ultrasound to check my uterine lining and follicles) my lovely ovaries were the proud owners of 14 follicles, all in the wonderful size range of 18mm to 20mm. I’m not expecting all of you to know how big follicles are supposed to be at this stage, so just trust me when I say they are right on track.
My monitoring appointments also required blood draws. I have had nine blood draws so far this month. (I swear I had a nightmare like that once). I used to faint after I had my blood drawn. Now, I (mostly) don’t even get dizzy. I still have to lay down, but there are worse things than getting a private room in the back of the clinic with a recliner.
I’m proud of my ovaries. Not so proud of the ridiculous level of bloating that I’m experiencing. Some lady at a department store asked when I was due. I can’t so much blame her, I do look about four months pregnant. The baby-less baby bump. Oh Joy. I’m so bloated and tender that spandex leggings are uncomfortable. Probably doesn’t help that I’ve jabbed about 30 needles into my stomach in the past week and a half. Good thing I’m not much of a pants fan.
The next step is getting all of these eggs out of me, the egg retrieval (someone clever came up with that term), which is happening tomorrow. Last night and today I do my trigger shots. These are the shots that force me to ovulate. Some trigger shots are one large intramuscular injection. Mine are two subcutaneous injections twelve hours apart. Apparently this is so we don’t shock my ovaries and cause ovarian hyper-stimulation (a very very bad thing). Ovarian hyper-stimulation syndrome could potentially cancel the rest of the cycle, meaning that I would have to wait a month or two before transferring any embryos. As long as we keep my ovaries in check I should have one, or two, embryos floating around my uterus a week from now.
Hopefully I can manage to post an update with how many eggs we retrieved and how many fertilize before I go in for the transfer. There is a considerable drop off rate during this process. They say that out of all of the eggs retrieved about 70% will be mature. Out of all of the mature eggs, about 70% will fertilize. About 50% of the fertilized eggs will make it five days old for transfer. For anyone too lazy to do the math, that means about 25% of the follicles end up as viable embryos. Please don’t hold me to that, it’s very rough math, and everyone responds differently to this process.
If I get around to I might write another post about the craziness of morning labs at the clinic, the stress of monitoring follicles, and the joyous side effects of IVF medications. In the meantime, wish me luck. Keep those fingers crossed, and if you have some to spare send good thoughts my way. I have never been more nervous or more excited in my life.
I have officially started the IVF process.
I finally got the ball rolling with blood work at the beginning of my cycle, which should have been a lot sooner, but my period was eight fucking days late. Casey and I went in together on CD3 (CD stands for cycle day, because apparently I’m motivated enough to write and entire post, but too lazy to spell out all of my words. Also, for anyone who doesn’t know cycle day 1 is the first day of my period). Infertility has created some interesting situations for us as a couple, but this was the first time getting our blood drawn together. I think I need to come up with some clever term related to these “dates” related to infertility. Suggestions are welcome. Back to the blood work – I handled it better than expected with no dizziness or fainting, which was quite surprising to me because I’m fairly certain that they took about half of my blood. I may be exaggerating slightly, it was really only four of the big vials – which would have been about 13 of the regular size vials. THIRTEEN vials of blood. Some of which I had to ship, overnight, to the clinic in Spokane for them to process at their lab. I still find it hilarious that I had to ask for my blood back after they did the draw and let it clot/centrifuged that shit.
After the blood work I officially got to start the first step for IVF: suppression. Just in case you need a refresher on this step: I’m taking birth control to quiet my ovaries and get in sync with the schedule at the clinic. I assumed that this step would be a simple one, because there are a ton of women that take birth control on a regular basis, so it can’t be that bad, right? Wrong. I now remember why I was never able to stay on the pill. I’m a little over a week in and side effects include: headaches, heartburn, fatigue, fucked up appetite, and crying. Moodiness may have been a better word, but I’m not cranky, just crying about everything. Happy things, sad things, frustrating things, things that should hold no emotional merit whatsoever, everything.
Starting this process also included some other big steps: making payment and setting up my appointment calendar. I’m not sure that I’m ready to advertise exactly how much we’re paying here, but I’m not shy about it either – if you’re truly curious feel free to ask. The money is far less exciting than the calendar any way. My first IVF monitoring appointment is June 9, and I’m scheduled to start my stimulation (step 2) medication on June 14. My late period made me miss the May round at the clinic, so I was pushed to June. Most days (so far) I’m doing alright with the waiting. In the coming weeks I will be scheduling my medication education class, receiving my medication orders and lab orders, signing what I’m assuming will be a thousand consent forms, and trying not to drive myself crazy (which may be easier said than done on this birth control).
My feelings are slowly morphing during this process. I started out with fear and disappointment. Our consult appointment mixed in a little bit of hope, and the feeling of being completely overwhelmed. As I continue this process I’m still scared (and honestly, still disappointed that I have to go through all of this), but fear is no longer predominant. More than anything else I am excited.
Lets talk about baby making! No, not the fun kind. Most people have heard something about In Vitro Fertilization, IVF. The magical medical creation of test tube babies (although it’s actually a petri dish, not a test tube). While the specific procedures and protocol can vary there are some basic components to every IVF cycle. Now, keep in mind that I am not a medical professional, just sharing my general knowledge about this crazy process I’m about to dive into. Here we go: the basics of IVF.
Step 1: Suppression, getting those ovaries ready. Ironically enough, this generally involves taking birth control. Part of this is to control the timing of when the IVF cycle starts, but the main point of suppression is to quiet the ovaries so they are ready for the next step – stimulation!
Step 2: Stimulation. For anyone who might not remember every detail about the reproductive system from health class – generally the ovaries produce one follicle each month which releases an egg that can then be fertilized. Stimulation essentially kicks the ovaries into high gear to create multiple follicles. (By multiple I mean A LOT, the nurse coordinator told me to expect 10-20). More later on why so many follicles are necessary when it only takes one egg to get pregnant. This step involves a lot of medication, mostly by injection. Also, most of the appointments for IVF are during the stimulation process – blood work and trans-vaginal ultrasounds every other day and then daily until the follicles are nice and fat. And when the shit ton of follicles are all fat and ready?
Step 3: Egg Retrieval. This step starts with – you guessed it – another injection. This trigger shot lets the ovaries know it’s time to release all those eggs. But how do we get embryos in petri dishes? the actual egg retrieval involves sedation, and then the doctor aspirates all of the eggs by sticking a needle through the vaginal wall the reach the ovaries. I am not a big fan of anesthesia, but I’m pretty happy I get to sleep though that particular needle. This is also the day that sperm is collected, I’m going to assume you can figure out how that happens (yes, he masturbates into a cup). Once we’ve passed all of our goodies to the doctors they throw them together in a petri dish for fertilization.
Step 4: Embryo Transfer, putting those babies back where they belong. Than pretty much sums it up. The fertilized embryos, which are usually 3-5 day old blastocysts on transfer day, are deposited into the uterus though a cervical catheter. The embryo transfer is usually one or two embryos, because no one wants to octo-mom, and the remaining embryos are frozen (these can be used down the line for a frozen embryo transfer).
Step 5: Waiting. Alright, so this isn’t an actual step, but I think it counts. After the transfer you wait, almost two weeks, to go in for a pregnancy test.
I guess after the pregnancy test it’s either start designing a nursery or planning for a frozen embryo transfer (assuming there are embryos left, which isn’t always the case). So there you have it, my rundown of the IVF process.
So it’s been awhile since I’ve written posted anything. Part of that is being crazy busy with the house like always. I have some seriously awesome updates coming soon, I love it when the construction zone starts looking like a house, even if it’s only one room at a time. But, I’m not writing today to talk about the house. Today is about In Vitro Fertilization (IVF).
Last time I updated about infertility it was the end of our break, and I was about to start Clomid for our last IUI. Well, that happened and was a complete failure. Not to mention the month was pretty much hell, with killer Clomid side-effects, questionable test results, and idiotic doctors. More on that month later, for now I want to look forward.
We had our consult appointment at a fertility clinic in Spokane (6 hour drive away) on April 4th. It was an appointment that I had made six weeks prior, hoping that the IUI would be successful and that I could cancel the appointment. Didn’t exactly work out that way.
The appointment was almost three hours long and involved a doctor, nurse coordinator, and financial advisor. The appointment was almost two weeks ago and I am still processing everything.
Trying to make a long story short:
So now I’m playing the waiting game, again. I will do blood work and then start the IVF process when I get my period at the end of this month. The big stuff, like the egg retrieval and embryo transfer, will happen early May or mid June depending on when I get my period. I start the process with birth control (which I find a little funny, taking birth control to start a process to get me pregnant) and have to be on said birth control for at least 10 days before I begin the stimulation process. I’m hoping to make it in time for May, but we’ll see. I’ll try and post a run down of the IVF process soon, for now I just needed to get it out there that we’re doing it. The next step. The big guns.
Fuck. I’m equally excited and terrified.
This is the post I’ve been both excited and terrified to write, and it will probably be a long one. I don’t know how much you know about infertility. I’ll try to explain things the best I can, but if you have a questions – ask it!
There are millions of women in the U.S. that struggle with infertility, and each one of us goes through something different. This is my story. I’ll try not be vulgar, but I will not beat around the bush. We are talking about making babies here, which means that you’re going to hear read words about anatomy and sex. Yes, it’s personal. And yes, some of it is gross. But I think it’s important, and don’t feel the need to leave out details that might make people uncomfortable. I’ve had to stop being uncomfortable. It’s come to the point where I can no longer count on my hands the number of doctors, nurses, etc that have seen/felt/poked/prodded me. If you add it all up, I’ve spent days in stirrups in front of these people. But I’m not going into detail about stirrup time, at least not today. Today, I’m going to try to explain the road so far, a basic outline of where we’re at and where we’ve been. Here it goes.
We’ve now been trying for over two years (27 months to be exact) to get pregnant with absolutely no success. It didn’t begin with a life changing conversation on being ready to have kids, it just happened. We had talked about wanting a bunch of kids, and randomly decided to go for it. After a year of no birth control, a ton of sex, and not a single positive pregnancy test we decided it was time for some testing. The one year mark is where the term infertility kicks in, unless you’re over 35, and then it’s 6 months. At that point I had already been charting my temperatures and using ovulation prediction kits to see if and when I was ovulating, and to make sure we were having sex at the right time of the month. All signs indicated I was ovulating, and our timing was impeccable. Testing started with my OB, and all of my tests looked good except one – my Progesterone was a little low. My levels showed that I was definitely ovulating, but may not be high enough to sustain a pregnancy. The sperm analysis came back as above average, my crazy OB decided to use the term “Super Sperm”, and I still haven’t heard the end of it. We assumed that Progesterone was the issue, and I decided to try Progesterone supplements for 3 months before moving onto a specialist in infertility.
Turns out, Progesterone alone didn’t work, and we moved onto a fertility clinic. Our new doctor confirmed that all tests looked good, and decided that I should start Clomid (Clomiphene), a drug that helps with ovulation. Essentially, they were trying to create more, bigger, better eggs. We spent three months with that doctor/clinic, and then life happened, and we were moving to Montana with two weeks notice.
So, I found a new doctor in Montana. After another unsuccessful attempt with Clomid and Progesterone, our new doctor decided it was time to move onto IUI (intrauterine insemination). For the IUI, I stayed on the same medications, but instead of having sex when I was ovulating, we showed up at the doctors office with a sperm sample. The sperm sample was “washed”, basically meaning they remove all the extra gunk and add some very swimmer friendly liquid. I’ll give you three guesses as to where they put the washed sample. That’s right, directly into my uterus through a cervical catheter (which is about a pleasant as it sounds).
We did IUIs three months in a row, with absolutely no success. Each time the doctors/nurses said that everything was perfect: timing, follicles, sperm, my uterine lining, etc. I guess perfect doesn’t always cut it. I found out IUI number three failed about a week before I was scheduled to go home to Seattle for Christmas. My trip home was one of the many reasons we decided to take a break for a month. Other reasons including my strong desire to drink copious amounts of caffeine and alcohol (which I had been avoiding almost completely for the last year), and to get some mental and physical relief. There will be plenty about all of emotions and the terrible side effects of the medications later. One month off turned into two, I just wasn’t ready to through myself back into the turmoil.
I guess I’ve decided I’m as ready as I’ll ever be to get started again, tomorrow I go in to get checked and get a new prescription for Clomid that I’ll start when I get my period next week.
That pretty much covers the basics, and maybe a little extra, in the medical journey so far and where we’re at in the treatment process. I have plenty more to say about specifics in the process, the emotional hell, and the next possible steps in treatment; but, I think I’ll save that for another day.