waiting in IVF | Laughter Through Tears

Hello, Goodbye- Part 2

Image: John Via Flickr

Phew. Glad I got Part One out of my system. Now that its done, that goodbye has been said, let’s talk about the FUTURE.

Well really, let’s talk about NOW because our next step is already well under way.

Hello Future.

We don’t stay down for long in this family. Before the sun set on us Sunday night I had already emailed the new/old clinic to explain our situation and set up a consultation. It often takes time to switch clinics. Time for diagnostic testing, Time to get on the calendar. I was expecting it to take time this time too. Nope… we are in full swing.

Before we left our new/old clinic we already had a consultation with our Reproductive Endocrinologist (RE) to hear his recommendations for what we should try next after our miscarriage. Those of us in the fertility world call this the “WTH” (What The Heck?) appointment. Some more colorful ladies use another letter besides “H.”

I am more comfortable just calling it a consultation myself. If you think about it, with the odds of IVF being less than 50% the WTH appointment should be reserved for when a patient actually gets pregnant. At least that is how it feels for this unlucky girl.

In preparation for this discussion my new/old RE created a plan. All our lab work and other testing is recent enough that there is no need to repeat. So when I opened my email Monday morning and one of my favorite nurses had already responded, I was pleasantly surprised to find we could pass go and go straight to cycling. All we had to do was call the business office and pay a deposit.

By close of business on Monday, the deposit was paid and we were on the calendar for a May retrieval. We set up consultation appointment on April 10th to review the plan and also make necessary adjustments based on what we learned from Celebrity Miracle Clinic. I was told to call with my “pre-month” menses which I took to mean April. However when my monthly friend arrived Wednesday I called to be sure and they told me it was close enough that we could get going. Yes!

Drugs have been ordered and are scheduled to arrive. I am back on birth control again and we are taking supplements to improve egg and sperm quality. At the consultation we will pick a date in May and count backwards to select a date when I will go off the pill to begin another antagonist cycle (I will explain what that means in a later post). We will retrieve my eggs in May and create our embryos which will all be frozen.

In June we will thaw several of them for transfer. We are doing this because I have never been pregnant on a fresh cycle. Some women just do better with frozen cycles and I appear to be one of those Ice Queens. More importantly, we know that my embryos are slow starters and a frozen cycle will allow us to better match the time when the lining is receptive to the development of the embryo.

Over the last few days I have already talked to three of my favorite nurses. I am excited. I am nervous. But mostly I am just glad to be ready to go and to be working with my old friends.

Now I just need to give new/old clinic, new/old nurses, and new/old RE a more creative and acceptable name. Something as fitting for them as “Celebrity Miracle Clinic” was for the other one.

I’m thinking about it…

Any ideas?

Knocked Up

It’s done!

And yet it begins.

“Blob” as we are calling him (or her) is now resting peacefully at home, preparing to burrow into my lining and take root for the next nine months. It was a harrowing, exciting, and ultimately pleasant experience which began with our wondering whether we would be transferring Blob at all.

Blob’s First Baby Photo

Yesterday at the top of Breck’s Peak Six, I picked up a call from the clinic asking if I could come in right away for a cautionary ultrasound. It seemed the doctor was concerned about my cyst and the pain from the night before. Rather than blow our day of boarding we opted to arrive very early this morning to check on the status of my temperamental reproductive system. Until about 7:30 this morning we feared we would be coming home empty handed (or in this case empty “uterused”). Luckily the lining, ovaries, and vitals all checked out fine and we continued with the embryo transfer.

Our first hurdle overcome.

Next up was the transfer.

Because our ultrasound and lab appointments were at the break of day, we had time to kill before the 11:45 transfer. We spent it at Target where I picked up these groovy lucky socks. These socks were so perfect they jumped into my shopping cart and I was wearing them before we left the parking lot.

Fertility green and orange with the luck of the Irish thrown in for good measure.

So far the knee highs worked their magic.

Ease of transfer is one of the many critical factors that lead to enhanced odds of success. A fundus (top of the uterus) touched by the catheter used to transport the embryo is a lousy precursor for implantation. Much effort goes into making sure the depth and shape of the uterus is understood before the procedure so the doctor can avoid the edges. It’s like that game of Operation we played as kids, except on a fuzzy black and white ultrasound screen with no buzzers to tell you when you screw up.

Image by Mykly Roeventine via Flickr

The doctor gracefully guided our little bundle of cells to the exact right spot without a single hiccup. Dr. S navigated Blob to the sweet spot with the precision of a fighter pilot landing on a aircraft carrier. What makes this feat more impressive is the embryo can barely be seen by the naked eye. Try landing that in a tiny little spot on a computer screen with only a bit of guidance from an ultrasound tech.

Way to go Dr. S.

Catheter releasing Blob in the perfect spot

Another hurdle overcome.

Blob was a busy little fellow this morning and hatched completely out of his shell prior to transfer, earning a final grade of 6BB. When the lab flash froze him after genetic testing back in January the embryologist graded him a 5BB. He’s overachieving already.

You can see the incubator holding Blob who is waiting in the background while we prepare for transfer

Blob’s incubator in the background

You may be wondering, what the heck do those letters and numbers mean?

Embryo grading is a complicated process, but essentially this means Blob was at stage 5 when he was frozen. This is the final blastocyst stage right before he hatches and burrows into the lining. The letters are grades for the inner cell mass (ICM) and the Trophectoderm Epithelium (TE). The ICM is a clump of cells that will eventually become a baby. The TE will grow into the placenta which will replace all the hormones I am taking between 7 and 10 weeks.

6BB is a good quality embryo. 6AA would be perfect. Both are fully capable of becoming future Rhodes Scholars.

Blob as a Rhodes Scholar

Typically an embryo reaches stage 6 on the fifth day after fertilization. Blob started slowly and took six days to get there. This is the main reason Dr. S gave Blob slightly lower odds than other genetically normal embryos. However, Day 6 blastocycsts like Blob fair much better with a frozen cycle like ours. This is due to the surprisingly short window in which the lining is receptive. Unlike in a fresh cycle, in a frozen cycle the doctor can control the timing of the lining receptivity and match it to Blob’s developmental stage, increasing the odds he will stick.

While our overachiever was quick to break out of his shell, he was slow to expand. If you have ever taken a balloon from a warm place out into really cold weather you know it shrivels up and loses its fullness until warmed again. Embryos are the same. They compact when frozen and then begin to expand when warmed. We are slightly concerned that Blob didn’t expand more prior to transfer, but encouraged that he is still developing. Most important, every last one of Blob’s cells survived the warming process.

A final hurdle overcome.

Post transfer I remained on bed rest for an hour before being wheeled to our car. We are now at the hotel where I will spend today and tomorrow at a 45 degree angle, able to rise only to powder my nose. Butler Bill enjoys this part of the process because it is the time he is most involved in IVF. I enjoy abusing my personal butler and make the most of being cared for by the love of my life at this sensitive stage.

If you look hard enough you may be able to see all the way to Blob through those nostrils.

If you look close enough you may be able to see Blob through those nostrils.

Butler Bill will bring me food, water, and medicine for two solid days. I will read, watch stand-up comedy, blog, goof off on the internet, meditate, and try not to obsess about possibilities. I am allowing myself only a half hour with Dr. Google to see what I can learn about slowly expanding embryos. After that half hour I am firing that negative jerk in order to relish being pregnant.

Pregnant.

In the IVF community we describe this part of the cycle as being PUPO (Pregnant Until Proven Otherwise). I am so done with the uncertainty implied by “until proven otherwise.” This mama has decided she is straight up knocked up. I plan to prove it on March 22nd.

Our countdown begins anew…

The End of the Internet

Totally exhausted from three days of travel for work and estrogen overload, I created something a little different for my IVF friends today. Years ago I ran across an “End of the Internet” cartoon and have often thought about it when I go on one of my IVF information binges. These binges are especially common during the two week wait when I scour the Internet to see if I can divine what will happen based on statistics, anecdotes, and real life stories. We have all been there…to the end of our sanity and near the end of the Internet itself.

Enjoy and good luck to you. May you find what you are searching for in life if not on the web.

Waiting- Part 2

Image: Victoria Pickering via Flickr

Ahhhh…. waiting. If you battle infertility you know a thing or two about waiting. Waiting- Part One detailed the many milestones a couple must pass in the quest to become parents through IVF. The type of waiting discussed in Part One is a tactical type of waiting. One procedure, medication, or result leads to another, then time passes and its time for another, then yet another. Tick Tock. Tick Tock. You wish you could sleep through all the steps and just wake up blissfully pregnant. This type of waiting is torturous, but worse exists.

This worse type of waiting is on a higher level, its more big picture. Let’s call it a strategic sort of waiting, even though that word feels too business like to describe it. For the couple that does not have a child of their own and desperately wants one it can feel like they are waiting for the life they were meant to live to begin. At least that is how we felt.

During the years we were trying to conceive Spork, I distinctly remember feeling like life was on hold. I could see what our life could be like, what kind of parents we would be, how much fun we would have. But we didn’t have our child and weren’t sure that we ever would. We were reasonably happy, but something crucial was missing in our lives. There was a giant void sitting between us as we drank wine and watched movies together, threatening to suck us in forever.

I know we did more than drink wine and watch movies back then, in fact for a large chunk of time I didn’t drink at all. We were extremely active and on the surface must have seemed to be completely content. We trained for and ran a marathon together. We travelled. We sailed and motor boated all over Northern Michigan. We entertained. We developed successful careers.

However when I think about that time, I remember it as a few years of sitting around, barely talking, drinking wine and waiting. I felt as though our lives, our marriage, lacked purpose and that if we could just have a baby our life could be vibrant and full in a way I felt it may never be without a child.

We are lucky, we came out of the holding pattern and our life is exactly what I had envisioned. I am confident that many couples who don’t succeed in having a baby also find purpose and happiness. Perhaps not all couples, but many. Likewise, not all couples that do have children find what they are seeking. Ultimately it is all about moving beyond infertility and its hold on you either through having a baby through some means or through accepting a life that is childless and discovering fulfillment and purpose within that life. For healing to begin, with or without a child, it is important for this waiting to end.

Interestingly, my experience in the quest for baby number two has taught me about a new kind of waiting. Please understand, I want so much to once again be pregnant. Other than the health and wellness of Bill and Spork, there is nothing in this world I want more than another baby. However there is a growing part of me that also just wants to get beyond all this. More and more I find myself eagerly waiting to start my life again. Not just our life. My life.

I thought about this while running my three measly little miles on Sunday morning. I am itching to go long, to train for distance again. But logging double digit miles is not particularly good for building life sustaining fat stores. Oh how I miss my running and exercise. As much as I tease Bill about being a member of the cult of CrossFit, I long to join in the fun and get tone again. Not female body builder ripped, I just want to see my abs and have a little definition in my arms and legs.

My desires go beyond exercise and vanity. I fantasize about having a cup of coffee, some chocolate, or a glass of wine when I want without having to worry about how it will affect my uterus or ovaries. I dream about waking up in the morning on a weekend whenever I feel like it, not to an alarm set for a shot that has to be taken at just the right time.

My most profound and clear vision of the future involves me being free from infertility and able to be fully available to my family. I want to feel good again, not always affected by some hormone or another. I need to have energy again so I can completely enjoy the daughter and husband I have. Hopefully I will need even more of that energy to take care of a fourth member of the family when all this is behind us.

Sometimes I worry that allowing this longing for the future me is sending a message to the universe that I don’t really want to be pregnant and that maybe the universe is listening and giving me what I want. I have to believe, however, that is the universe is indeed paying attention, it understands and it hears my cries to experience motherhood just one more time. It is possible to want a baby and a life after babies at the same time. I do.

All of this waiting has taught me the importance of enjoying the moment and being fully present in the now. I have been doing a lot of work with being mindful and it has been rewarding. When I eat lunch, I eat lunch and pay attention to the flavors and colors of my food. I put my phone away and take a moment to breathe. When I am driving I take in the scenery around me and experience the trip, rather than multitasking. When I am with someone I focus on them, not what I have to say or do next. I only check email twice a day so I can interact with people at work on the phone or in person and have real experiences. When I am home, I engage in activities with my daughter and husband. Or at least I try to do all these things and its helping me get more out of all areas of my life.

If life had a fast forward button before we were blessed with Spork, I probably would have used it, even if it meant losing precious time and life experiences. While its tempting now to wish my life away so I can make it to that next step, I can’t do that. My little girl is already growing up too fast and I don’t want to miss a moment of her precious childhood.

So I will be patient and I will suck every bit of goodness out of this time that I am in right now. Its something I wish I would have understood back when I was waiting for Spork. I can only hope that this story may help one person try to find the joy in life, marriage, friendships, and work that exists even before you have a baby. It was always there for me, I just couldn’t see it through the blinding light of my burning desire.

Waiting- Part 1

Image: Denise Curran via Flickr

For many, waiting is a as much a part of trying to conceive as sex. When sex is removed from the equation for the couple trying to conceive through IVF, waiting becomes the single most frequent conception act. Waiting, just like its more provocative cousin, can come in many flavors and is done throughout the IVF odyssey.

The big waits are obvious. The most mammoth is the wait between the time the embryo is transferred and the results of the Beta HCG pregnancy test. In our case, this wait spans nine intolerably long days. Time moves very slowly over the course of what is commonly called the two week wait. I’ve often heard women say it would be just fine to be unconscious during this time and awoken only after the results are received.

March 13th is the date of our transfer which means on March 22nd we will have the eagerly anticipated results. The date is circled on the calendar. The hope and anxiety are already building.

The torture of the two week wait is followed in magnitude only by the wait a couple experiences between the egg retrieval and the final fertilization report. Money, hope, health, and mental well being are all riding on discovering whether the eggs fertilize and grow to a stage and quality acceptable to transfer and make a baby. Being sadistic people by nature, we chose to extend this period at our new clinic by throwing a little genetic testing into the mix. The time it took from retrieval to receiving the call that we had genetically normal embryos to transfer extended over 3 weeks.

Waiting for the genetic results is further broken down into waits that are much smaller. We experienced almost immediate gratification after retrieval and waited only two hours to learn that 22 eggs were retrieved successfully. The clinic then called 24 hours later to tell us that 12 of those eggs were mature and 11 fertilized. These were minuscule intervals in comparison to what came next. For the next six days we patiently but eagerly waited to be told that 5 of those embryos made it to the blastocyst stage and were good enough quality to be genetically tested. Next we waited two and a half weeks to learn we had two genetically normal embryos and two that needed to be retested, therefore requiring yet another two week wait. Our embryos were on my mind every spare moment during this time. Ultimately we ended up with three genetically normal embryos. Our last is the one we will transfer in March.

The longest wait of all was this summer and fall while we waited to work through a long process at our clinic that would culminate in our embryo transfer just last month. We first called in June and were able to meet with our new doctor in July. This was followed by another month long wait to get on the calendar to visit the clinic for our work-up to make sure we had a green light to begin our cycle. By November my ovaries were finally percolating and we flew back to our clinic again for egg retrieval surgery. After retrieval the wait was another two months as we completed testing on the embryos. In the months preceding retrieval we used the time to get our eggs and sperm ready to do their life’s work. We each took different supplements, limited alcohol, exercised moderately and ate healthy. At my peak I was taking 19 different supplements a day and Bill took 11. At least it helped us pass the time.

Tiny little waiting periods pepper the whole IVF process. Since our failed cycle back in January I have waited three days to get my period, three more days to start birth control, another 13 days to start lupron, and five more days to once again stop the pill. Each step takes us a little bit closer to our fate, whatever it may be. Though small in terms of actual time, these steps feel gigantic. When they come early, it can be unequivocally thrilling. And that is what happened today.

If you read a Deeply Disturbing Fascination with Toilet Paper you know a little bit about the waiting for that happens for a woman who is getting ready to start a frozen embryo transfer or other cycle. Since Saturday I have been a devoted student of TP. Today I hit pay dirt and was able to call my clinic to check off a critical step that will take us to transfer. Two days from now I will begin estrogen patches that will prime my uterine lining. I continue administering lupron daily but cut the dosage which should help with the headaches and other symptoms. Sadly the bitchiness caused by lupron will only be replaced by the emotionality of estrogen. The end result for me is about the same. Say a little prayer for Bill who catches the worst of the mood swings.

My call to the clinic today was a full day earlier than we all expected. However, no changes will be made to the transfer date. The lupron I am injecting keeps my reproductive system suppressed and on schedule. The extra day may only serve to give my lining just a tad bit of extra thickness to welcome our embryo home. A nice, thick, cozy lining should help that embryo want to stay for the long haul. With a little luck we will then be waiting for doubling HCG levels, morning sickness to pass, a myriad of ultrasounds, and ultimately a scheduled C-section date.

Even though meeting today’s milestone early will have no impact on when we actually get pregnant, it is a rare event to have something, anything come early. I’ll take it.