Holding Faith & Trust in the 2 Week Wait

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The waiting has begun. Well, more waiting I suppose. The hard, second guessing everything and over-analyzing every twinge kind of waiting. We had our embryo transfer last Thursday. Everything went well during the thaw. I mostly knew it would, but there’s always that small chance of something going wrong. I didn’t focus on that. I did acupuncture right before (and after) the transfer and was feeling pretty at ease at that point. After we got called back to the transfer room, it was just a short wait until my RE brought me a picture of my precious little girl. There were two pictures actually. One was right after the thaw and the other was 4 hours later. I was relieved when I saw that in that short time she had already started hatching. To me, that meant that she hadn’t been harmed during the biopsy or thaw and was right back to growing strong again. My RE said, “Let’s give her something to attach to,” and just like that, my perfect baby was placed into my womb.

I’ve been following a post I came across about what happens after a 5-day transfer. It’s interesting to read about if you haven’t, and you can find it here.  Yesterday I was at Day 4 after transfer, and on that day my little embaby is finding her way deeply into my uterus and attaching to the endometrial blood supply. Early in the morning I felt a sharp jab to my uterus that actually woke me up from sleep. It was over in an instant. I can’t help but think maybe this was my baby making that final journey deep into her nest.

Or it could have been unrelated. This is that time during IVF/FET when you really over-analyze absolutely every little thing your body does. The two week wait is a trickster. Every “symptom” could easily be explained away by all that progesterone, a pending period, or anything else really. Feeling so unsure about myself is something I’m not accustomed to, and it’s rather unsettling. More than ever I have to rely on trust and faith. Trust in the science that brought us to this point. Trust that this  little embryo and my body know what to do and can do it. Trust and faith in the Divine that my prayers will be answered. Faith that this will really work. To hold space for that I must find my courage. I can do this.

Yesterday I went for a walk in the local arboretum. It’s a place of beauty, serene nature, and fond memories. It’s also home to a lovely labyrinth. Labyrinths are magical places and I feel lucky to have one so close by (although you could certainly make a simple one in your backyard or home with nothing but a long piece of yarn). Labyrinths are different from mazes. Mazes have multiple pathways, dead ends, and the correct path is hidden for you to deduce. Labyrinths have once path; it goes in then back out. There is no guessing or figuring. Walking the curving path creates a rhythm and lets the mind disconnect from everyday tasks and stressors. It’s a meditative practice. There are many different ways to mindfully walk a labyrinth.

In the spirit of connecting with my trust and faith, I began my path at the labyrinth opening by calling to the Divine and all of my spiritual and angelic helpers. As I walked the curving path toward the center I focused on my prayer – that my embryo transfer succeeds in blessing me with a healthy pregnancy and baby. I focused on this as I slowly walked with intention all the way to the center. Once there, I gave thanks. I am truly grateful for all the help and blessings I have received along this journey. I know that the Divine and my helpers have been watching over me all along, and have had a hand in all the amazing things that have miraculously gone right. As I wound in the reverse direction out of the labyrinth, I filled my heart with gratitude – including gratitude for the blessing that is growing inside my womb. Labirynth

Approaching Transfer in Sync with the Full Moon

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Two days until transfer day, or maybe that’s one day if you don’t count the actual transfer day. It’s finally (almost) here. The wait has been long and I’m ready to get my little embaby in my womb. It’s obvious, isn’t it? I’ve managed to find myself in a calm and hopeful place, which was my goal for this process. I attribute this state to a number of things including, but probably not limited to, emotional exploration through reflective blogging, Circle and Bloom FET meditation practice, prayer and ritual, honest conversations with my few supportive people, mindfulness practices, acupuncture, craniosacral therapy, nature walks, date night with my husband, some fun outings, and getting accurate information from my RE. These things have been invaluable. I didn’t have all of this the first time around, and it’s made a huge difference.

 

Yesterday was the full moon, and as I approach my transfer on Thursday, I wanted to harness the energy of the moon. I’m entranced by the moon. The August full moon is often called the Corn Moon, and calls us to focus on harvesting that which we have already planted. The synchronicity with this and my embryo in waiting and  (hopefully) pending pregnancy is magical. It was suggested to me by another magical woman that I set out a special stone to charge with the fertile energy of the full moon and keep it on my person until I get a positive pregnancy result. I liked the idea and thought the best way for me to do this is to use a piece of stone jewelry. After considering my options, I decided on two pieces that are made with stones that aid in fertility, and have a special meaning for me. These particular pieces include rainbow moonstone, rose quartz, carnelian, rhodochrosite, amber, and quartz. I also decided to set out a rose quartz heart palm stone that I plan to have handy after the transfer as a reminder of love, acceptance, and welcoming.

 

I set these items out on my wood stump on my balcony, which gets a great show of moonlight, and spent some time in prayer. This morning I mindfully put on my bracelet and necklace, and offered thanks. Thursday can’t come soon enough.

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Jewelry by MacRae Naturals, Goddess statues and spiral baby by Brigid’s Grove, candle by me.

Understanding the ERA: A Field of Flowers

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StockSnap_P52TO8UCYSI find that it’s so easy to over-analyze in this process, inevitable leading to anxiety. I’m also tempted to consult Dr. Google and we all know how that turns out. So I’ve been trying to not over think it, but the one aspect of my upcoming FET that has really got me in knots is the timing of the transfer and my Endometrial Receptivity Assay (ERA) results. Learning just enough about the ERA test and implantation to make me dangerous, I’m struck by just how small the window is for implantation. Since I only have one embryo, I know we have to get the timing right for success. When the timing is off, that’s when perfectly normal, healthy embryos don’t make it. Sure there are other reasons FETs can fail, but this is a big one. And so, I’ve been worried.

Let’s talk ERA testing and implantation. Here are the basics. Estrogen help us grow a nice plush lining. Some women do a natural cycle for this and others do a medically controlled one. If you’re going the medical route, there are many different protocols to help you get there. Mine included 2 shots of estradiol weekly for about 6 shots total prior to transfer. My nurse explained that while estrogen helps build the lining, progesterone helps the lining stay put, so days before the transfer I’ll start progesterone in oil (PIO) shots. But it’s a lot more than that, really. Progesterone actually changes the make up of the lining and helps the receptors there activate.  Now here’s where it gets scary. Those receptors are only active for a short amount of time and then they close off. An embryo can only implant during that small receptive window. So the timing of the transfer is key, and that’s really based on how long progesterone has been in your system.

The ERA test is a relatively new one to hit the infertility treatment scene. To do the ERA, you do a mock cycle – including medications and all – but instead of doing the embryo transfer, they biopsy your lining. My RE did 2 biopsies in one mock cycle – a biopsy on day 5 and another on day 7 – to ensure that we covered the most likely receptive time frame. If the first biopsy comes back receptive then they don’t bother testing the second. But if the first is non-receptive then they can test the second sample to see what’s going on. I was glad they did 2 biopsies in the same mock cycle because it saves time  (and money) from having to do another whole mock cycle for a second biopsy if the first one fails to find the right day.

In my case, the first biopsy came back pre-receptive – meaning my lining wasn’t quite ready yet – and the second biopsy came back post-receptive. The laboratory that did the testing recommended a certain number of hours of progesterone that would get me right into the middle, which should be my peak receptive time. Based on this, I’m supposed to start my PIO shots at a very specific time and have my transfer at a specific time on day 6. Those results have literally been haunting me.

There were 2 things that worried me:

  1. I’m worried about doing a transfer on day 6 since for my first IVF we did a fresh 5-day transfer, which obviously worked because I have a daughter. So is changing the day really a good idea?
  2. I was really hoping one of the biopsies would come back “receptive” rather than pre- and post-receptive because,  to me, that seems like guess work. Having a biopsy be clearly receptive would seem like more of a sure thing. Maybe my thinking was wrong here, but I was worried.

Now I haven’t seen my RE since my biopsy, and won’t see him until the big day, and the nurse gave me my ERA results. She assured me they were accurate and I tried to accept that. But here we are one week before my FET, and I couldn’t stop thinking about it. Today I went in for my last blood draw before the transfer, so this was really my last chance to ask questions in person before the big day. I went in to get my blood drawn, and to my surprise there was my RE standing there looking at some files. He’s rarely ever out of his office or the exam rooms, so this was a rare opportunity. I asked him if he had time for a quick question even though he was clearly busy. He said yes and not only took the time to fully answer my questions, but he even drew me a graph. I love this guy. And I feel so relieved having my questions answered and getting a better understanding of this complex process. So I wanted to share.

ERAHe drew a normal bell curve and explained that it represents how many receptors are active in the lining. The more receptors that are active (represented by the highest peak of the bell curve), the better chance an embryo has of implanting. The ERA results focus specifically on finding the peak window of receptivity – the optimal receptivity. This could be day 5 for some women, or other days like day 4, 6, or 7. My results gave a peak window on day 6, but there are still receptors active on day 5 (which for me would be on the right side of the bell curve where the line is lower), which is why my last IVF transfer worked. ERA doesn’t test for the whole bell curve – it’s aiming for the peak window. So he said, that this time I’ll have even more receptors active than last time so we will be giving my embryo an even better chance of implanting than we did the first time.  That cleared up question #1 for me and made a lot of sense. Then he explained that the test is able to accurately calculate my receptive window even with the pre- and post-receptive findings, so they purposely space out the biopsies by 2 days (rather than doing days 5 and 6) to capture the best window. He said he is very confident in the results and that made me feel good too because he is great at what he does and I trust him. I’ve also read about the high accuracy of the ERA in research studies. That gave me peace of mind on question #2 also.

My RE also gave me a nice analogy. He said that the receptors in the lining are like a field of flowers. The more flowers you have open, the more likely your baby is to implant. At first, only a few early flowers begin to open. Implantation can occur but it’s less likely. Shortly thereafter, the whole field bursts with life and all the flowers are in bloom. This is when there is the greatest chance for implantation. Then most of the flowers begin to fade, while a few hold on for a bit longer, and implantation success dwindles. The ERA test tells you when your whole field is in bloom. A pretty thought, isn’t it? I think I’ll use that visualization on transfer day, and the days after as my embryo continues to nuzzle in, Goddess willing. I can’t help but think that someone was looking out for me today and helped time things perfectly so that I could ask my RE these questions. Now I’m going into the last stretch with a renewed sense of calm and confidence. I finally feel excited!

Meditation for FET

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sunflower.jpgEight days until our frozen embryo transfer (FET). We’re almost there. I wrote in my last post about my unexpected influx in anxiety and worry about this FET. I’ve been able to significantly reduce that, thankfully, and one of the major contributors to that reduction has been a meditation and visualization program that I’ve been doing daily. This program is specifically designed for the FET process by a company called Circle and Bloom. You can find it here. I’m not affiliated with the company in any way, and I’m not getting anything for this review, but it has been so helpful for me that I wanted to share. What I like best about this program is that it’s designed specifically for FETs so there are different meditations in the series for the various stages of the process. So it really “fits” with what my body is doing at the time. The guided instructions for focusing my attention, progressively relaxing my body, and fertility related visualizations help keep my wandering mind on target and allow me to fully melt into the experience. It’s really been a life saver. They also have a series specifically for IVF, which I did 3 years ago when I did my first IVF. I found both programs to be well worth the money, and I like that they have digital versions so I can listen to them on my phone or other device, wherever I am.

 

One thing that I really like about using meditation is that it helps to reset my mind so that I can leave the panic and “what if’s” behind and find a place of calm. And that is no easy task when you’re going through infertility treatments. In those moments of calm I’m better able to focus on what I’m grateful for and connect with the Divine. I can also more easily take solstice in my mantra: trust, faith, courage. Every day I’ve been reminding myself that worry and lamenting over the worst possible outcome will not change anything. It won’t prevent anything. Meditation has helped my calm my fears just enough so that I can say, “What if this does work…” rather than “what if it doesn’t”.

 

But meditation doesn’t have to be something formal. I think that anytime you find yourself completely immersed in the moment, that is a form of mediation too. I feel the same sense of calm when I’m talking a walk in nature, sitting in the sun, or engulfed in an art project. My husband took me to one of those painting and wine places, where you get a blank canvas and are instructed by a teacher on creating some picture. And there’s wine (which I drank, moderately, without guilt or worry). Aside from when we had to stop and sneak into the bathroom together so that my husband could give me a shot, gotta love this process, I literally didn’t think about anything other than the painting I was creating. It was a great break and so wonderful to connect with my husband for a fun date night. We laughed and teased each other. IVF is so all consuming that we often loose that joy, or at least misplace it for a while. So I’m going to continue my meditations, both the structured FET meditation series and the more fluid “in the moment” pleasures. I think this will help me come to my FET on the 10th holding a sacred space of readiness and welcome for my baby.

FET: Unexpected Apprehensions

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I have an apprehensive feeling setting in. I have my baseline ultrasound and initial blood work for my frozen embryo transfer (FET) scheduled for Friday. This is the real deal. We have one embryo. One shot. And that’s making me nervous.

It’s so different from the first time we did IVF three years ago. Then we did a fresh 5-day transfer. When I showed up that day, 5 days after my egg retrieval, I didn’t even know how many embryos had made it. I knew that at least some did because the transfer wasn’t canceled. But I didn’t know anything about the embryos. That day I found out that 3 of 7 made it to early blasts, and 1 was lagging even more behind so they were going to watch it to see if it continued to grow. The RE recommended transferring 3 due to my age, 35 years, and quality of the embryos. We didn’t do PGS testing back then so it was based on visual grading. I was shocked when he suggested transferring all 3, but it gave us the best chance of success per his statistics and the risk of triplets was so small. I had been through so much by that point that I was willing to do anything to get pregnant, so we transferred all 3 and I was thrilled. That fourth one arrested so we didn’t have any left to freeze.

When I look back on that I realize there are some similarities between then and now. In both situations no embryos will be left over after the transfer. So really they are both one shot deals. If either failed, we would have to start IVF all over again. But I didn’t feel apprehensive that first time. I felt excited. I felt like for the first time EVER I had a real chance of becoming a mother. Why did I feel that way then, but feel so sacred now?

Well, I think there may be a few things going on now that are impacting my emotions.

First, let’s face it – my biological clock is screaming. We’re past ticking. I’ll be turning 40 in the middle of this FET. Happy birthday to me. The thing that scares me most about that is how poor my egg quality was despite supplements. At age 35 I still had some time for multiple retrievals if I needed them. We didn’t do banking, though I now wish we had. At that time we were paying out of pocket and doing multiple rounds for banking would have been a challenge. Plus my RE didn’t even mention it, and I was so focused on just trying to get pregnant that banking never even occurred to me. Truthfully, I thought one child would be enough if I was ever lucky enough to have one. And I am so blessed to have my daughter, but that doesn’t mean that I can’t still feel a deep desire to grow our family like so many other people do.  If this FET doesn’t work and I am faced with doing another egg retrieval, my egg quality could be even worse than it was this round. It might not work at all. So time isn’t my friend and that makes me nervous.

This time I was given the option of doing another egg retrieval after the first for banking, but I decided to move forward with the FET. It’s a gamble really. At this point we are only trying for one more child. We decided to go for it with our PGS normal embryo because my RE gave us a high chance for success. So we are betting on this little one.

Another thing that makes this time different from the first is the expectations. Mine, my husbands, my family and friends, even our daughter’s expectations.  I was so fortunate that our first IVF worked for us. But I knew what a miracle that was. I read all the statistics about how most couples need multiple rounds of IVF to bring home that baby. I even participated in the Attain Financial program where you pay up front for three IVF cycles at a discounted rate and they reimburse you a large percentage of the cost if they all fail, so you don’t go completely in debt for nothing and can afford additional treatments or other options if necessary. There’s no reimbursement if it works on the first try, so really I ended up paying more than I would have if I had only paid for one round of IVF. But I don’t regret that decision because having that safety net was so reassuring during the process. I made that choice initially because I knew it would most likely take multiple attempts. But my loved ones hadn’t read the research I had. They pretty much expected IVF to work. And it did. So now my family and friends are already planning for my second baby. And, truth be told, so am I. PGS testing seems to make that expectation even higher. A normal embryo should stick, right? I know it’s no guarantee, but it raises the bar.

All in all, I suppose it’s kind of like expecting the worst and getting the worst. It’s harsh, no doubt. But when you expect it to work and it doesn’t – well that’s even more devastating. I want to be optimistic, and up until now I have been – but as I start this FET I feel more shaken than I had in the past. My expectations are so high. I don’t want to fall that far.

We’ve also been very open with our daughter about this whole process. It’s something I have mixed feeling about. I can completely understand why many parents would keep this a secret from their child until the pregnancy is well established. But I can’t even poop without my 2.5 year old all up in my business. Do you think I could administer 4 shots daily without her noticing? No, I couldn’t. So we decided to be honest with her. We told her that we are trying to make a baby and this is how mommy makes a baby. Of course she wanted to participate in the process. So I gave her a job that she proudly did every morning and evening. She was in charge of the alcohol wipes and wiped my belly before each shot. She talked about wanting to take the shots herself because she wanted a sister in her belly. We explained to her that if we are lucky to get a baby it could be a boy or a girl and we’d be grateful for either, but either way it will be in mommy’s belly. It was sweet. I have no idea where she got the idea of having a sister from but she was adamant. When we found out that we actually had one normal embryo – and it was a girl – we caved in our excitement and told her. She was so excited. I know telling her may not have been the smartest decision, but we couldn’t hide our elation. It’s done. And I’m terrified of letting her down. I want to give her that sister.

And the last thing that I think is weighing on me this time around is that I’m already picturing our lives with this second little girl. Somehow, knowing up front the gender of this little embryo that isn’t even in my womb yet has made her all the more real to me. I’m not sure if that even makes sense. With my first IVF baby, we didn’t even find out the gender until she was born. It was one of the best moments of her birth, at least in part because it was a pretty traumatic birth and seeing the look on my husband’s face as he told me our baby’s gender was a precious bright spot. I loved not knowing the gender during pregnancy, but honestly it did make me feel a tiny bit disconnected. It’s not that gender is so important, in fact I think it’s a bit overemphasized. But there is something more personal, to me, about naming the baby and connecting in that concrete way. Knowing that this little embryo is a girl has made her seem more concrete – more real. We’ve even started calling her by name. I can envision my two daughters growing up together.

Going though the lengthier mock transfer process has allowed me so much more time to create this attachment to this little embryo than I had when I did my fresh transfer 5 short days after my first egg retrieval. How can I be attached to an embryo that isn’t even in my womb yet? I’m not even pregnant yet. Still I sit here having these real feelings. And that make me more afraid of loosing her before we ever even had a chance.

As I write all of this out, it makes more sense to me why I’m feeling all these scary feeling as I begin my FET, rather than the excitement I expected to feel. While I really don’t want to go through this whole FET fearful, I do want to acknowledge these feelings and give them the respect they deserve. I do have good reasons for feeling the way I do, and I feel less confused having explored them. So now that I’ve acknowledged these feeling and have a better understanding of them, I’m going to look for ways to move past them. Ultimately, I want to go through this FET with hope, joy, and cautious optimism. With the help of the Divine and a small circle of support people, I think I’ll get there.

Soaking Up The Sun

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natalie-collins-177075I’m lucky to live in a place that usually has clear beautiful blue skies most of the year. It’s what gets me through the colder months. In July the sun is radiant and, well, a little hot. I’m one of those people who spends a lot of time indoors. I have a desk job. But I do love the sun. The feel of the sun’s warm kiss on my skin. It reminds me of my childhood days spent playing in my parents’ pool, and my teen years listening to the waves crash on the beach. Getting out in the sun is good for my soul.

As a psychologist I also know it’s good for my mental well being. Studies have shown that exposure to sunlight, or lack thereof, is related to mood changes. Without enough sunlight we may feel sluggish, down, or even depressed. There’s even a disorder all about this called Seasonal Affective Disorder. What is it about the sun that affects our emotions this way? Well, there are several contributing factors, but the one that I want to call out here is vitamin D. The sun is hands down the best source of vitamin D for our bodies, and Vitamin D boosts our mood. It also does a myriad of other positive things in our bodies and plays a role in several illnesses from diabetes to cancer to infertility (which you can read more about here). So sunshine is good for my mind, body, and spirit, and my fertility.

I had my Vitamin D levels checked prior to beginning IVF. It was low-normal. At my doctor’s recommendation I began taking a vitamin D3 supplement to boost this up a bit. Then my RE suggested I up it even more to help with egg quality, as Vitamin D is also a great antioxidant. Even though I’m now past egg retrieval, I’m continuing to take Vitamin D as I prepare for my frozen embryo transfer and hopefully become pregnant. So now I’m currently taking the recommended prenatal dosage, although the dose varies based on which resource you read. I’m sticking with what the American Pregnancy Association says, which is 4,000 IU daily of the bio-avalible cholecalciferol form of D3.

But the truth is that our bodies are designed to make vitamin D from sun exposure. This is optimal. Now I know there are a lot of sun-related fears out there. Yes I’ve heard that sun tanning causes skin cancer and we should slather ourselves daily in sunscreen. But on a side note, have you ever read the ingredients in most sun screens? Lots of them are filled with carcinogens (caner causing) and endocrine disruptors (wreaks havoc on hormones which is not good for fertility), so that seems a bit counterproductive to me. I won’t go too far down that rabbit hole in this post. I’m not a sunscreen hater. It has it’s place. Burning isn’t good for anyone and there are some more natural, non-toxic ones out there. But sun exposure has gotten a bad rap. And I’ll admit it: I am a sun lover, in moderation of course.

So I have been making an effort to engage in short, intimate rendezvous with the sun.  I found this article helpful for knowing when and how much sun exposure to aim for safely. But as much as I love the vitamin D, it’s more than that to me. The sun represents energy, power, will, and endurance – and these characteristics are woven into my journey with infertility. So when I bare my skin for a glorious 15 minutes up on my balcony under the sun, that’s what I’m taking in. I’m filling every cell in my body with this energy, this power. I ask the Diving power of the sun to recharge me and give me strength on this journey. I visualize my body filling with this energy and beginning to glow. And then I offer a quiet word of thanks for this wonderful gift.

I was inspired by a recent post in a group that I’m in that referenced an older blog post about a meditation called “Eating the Sun”. It’s a simple meditation that you can do anytime, anywhere. You can find the blog post here and try it out if you’d like. It’s really beautiful.

We could all use a little more sunshine on this journey, couldn’t we?

A Nice Plush Lining

Last week I had my first, and only, ultrasound since starting the medications for the mock frozen embryo transfer (FET). At this stage the goal is to grow a warm cushy lining so that when they put in my little embaby, she’ll be able to nuzzle in comfortably for a long 9 months. My RE said they like to see the lining at least at a 8mm for implantation success. Mine was 12mm and I was thrilled. Funny how excited one can get over endometrial tissue. So how does one grow a plush uterine lining? If you ask an RE you will get a much more technical answer, but from what I can tell it’s heavily influenced by how well your body responds to the hormones and how much blood flow you’ve got going to the uterus. When it comes to the fist part of that, well I think I’m just lucky. At least growing a lining isn’t one of the problems I have. And that feels good since my body apparently has so many other issues when it comes to conception. But there are things that I do to support my body by giving my uterus some of the nutrients it needs and increasing blood flow so it can do it’s job.

First, I attend acupuncture for fertility. My RE actually recommends it and there are some studies showing that acupuncture right before and immediately after embryo transfer increase the rates of IVF success. Many acupuncturists and doctors of Eastern medicine recommend much lengthier protocols than that to regulate hormones, improve egg quality, and increase both fertility and IVF success. There is less and some conflicting research on the totality of the effects of acupuncture on fertility, which I have to say is likely in part due to the fact that the Western approach to research is not often applied to Eastern medicine. Given that, you have to interpret some of the research findings, or lack there of, cautiously. But, you know, something must be said for hundreds, sometimes thousands, of years of experience. And it can’t hurt, plus it can help with some of the medication side effects and ease stress and anxiety.

I began doing acupuncture this time just about a week or two before beginning my stimulation medications for egg retrieval. I often hear that women do acupuncture for months, 3 months seems to be frequently cited, before beginning IVF, but to my surprise my acupuncturist didn’t seem to be in any rush for me to begin. Honestly I think it might have helped more with my egg quality had I started earlier, but by the time we got to the mock FET cycle that I’m currently in, I’ve had several sessions that are likely helping with the blood flow to my uterus. So I’ll count that as a win.

The other thing that I have been doing to help build a healthy lining is drinking red raspberry leaf (RRL) tea daily. RRL tea has an long history of use by women and midwives for supporting healthy fertility, pregnancy, and labor.  It’s a great uterine tonic and delivers several nutrients that support uterine health, such as carotenoids, citric acid, tannins, vitamin A, B complex, C, E, iron, calcium, phosphorus, potassium, and silica. You can read more about the benefits and uses of RRL tea here and here. A variation on tea that packs a much stronger punch is an infusion. Infusions are steeped longer than teas, which allows for significantly more of the plant’s constituents to be extracted. So basically you get more bang out of the herbs.

Here’s how I make a RRL infusion:

First you will need a lot of RRL. I buy mine in the bulk herbs section from either Mountain Rose Herbs or Starwest Botanicals. These are both trusted sources for great quality organic products. No I’m not getting anything for saying that, I just like their stuff. I purchase a pound, which is a lot of herb, but it takes a lot to make daily infusions, and it’s actually reasonably priced at as low as $11 per pound.

RRL

The jar will be about half way full. RRL is light and fluffy so 1 oz is a lot.

Second,  measure out 1 ounce of RRL, I use a kitchen scale, and put this into a quart size mason jar.

Third, fill the jar with boiling water. You’ll want to use a spoon to push down the herbs and saturate them. This will make room for more water so you can top it off. Then cap it with a lid and let it set for about 6 or more hours. I usually make mine in the evening and let it sit overnight.

Easy peasy. You can drink 1-3 cups of this daily. Sometimes I drink the whole jar’s worth in a day and sometimes I split it between two days. I strain out the herbs using a fine mesh metal colander and heat up the infusion on the stove. I avoid using the microwave because some say it can kill off some of the good things in food, and well, I’m not taking any chances when it comes to my fertility. Be prepared though, this makes a dark, strong infusion. RRL tastes noting like raspberry. Nothing. You can find recipes online for mixing additional herbs in to make it more flavorful (just make sure the herbs are safe for fertility and IVF), or you can add some honey. I just drink it straight because I know it’s good for me and it’s not that bad. Of course, I’d do just about anything to get pregnant so enduring the somewhat bitter taste of RRL infusion is the least of my challenges.

Happy drinking. And now I’m off to my second and final biopsy for ERA testing, which, by the way, doesn’t hurt nearly as much as I anticipated.

RRL2

PGS Results Are In!

I spent last week anxiously awaiting the news about whether my one tiny embryo passed preimplantation genetic screening (PGS). All of my hopes are riding on this one embryo. This one shot. I’ve been preparing myself for what I would do if the results are abnormal. I’ve found information about different protocols that are better for egg quality and low ovarian reserve. A lot of the recommendations are different from the protocol that my RE had me on. I prepared a list of questions to ask him about to explore these options. I saved research articles to back up my points in case I have to argue, or should I say advocate for myself. I also spent a lot of time praying. I pray to Goddess and God, I call to my spirit guides and angels, and basically give a shout out to any benevolent energy that will lend a hand. I figure I need all the help I can get.  I do these things to feel empowered. To gain some sense of control in this process that feels so out of control. Because at this point I’ve really done all I can do to make this round a success. My embryo has been biopsied and frozen in time. I can’t do anything to alter the quality of that life or the outcome of that test. I just have to wait.

After calling the genetics lab to see if they sent my results to my RE yet, which they had on Thursday morning, I left a message with a nurse at my RE’s office asking about my results. I was feeling pressured and I didn’t have time to wait for their normal procedure of scheduling an appointment with the RE to discuss results and make a plan. I didn’t have time because my period had started a couple days before and if the PGS test came back normal, then I would need to start injections for a mock transfer the following day so I didn’t miss a whole cycle and waste more time. Really, I had no more time to be patient.

And then the call came. The nurse called me back. She started with the polite, “how are you doing?” I resisted the urge to give the curt reply that I was thinking. I mean, really, lets get on with this. Am I about to get my heart broken or filled? Then she said it: “Do you want to know the gender?” And at that moment I knew… the results were normal. My psychologist brain quickly processed her statement before I could even blink. She would never ask if I wanted to know the gender unless the results were normal, so I knew what she was going to say before she even said it. I just couldn’t believe it. My breath caught in my throat. My one lone embryo is healthy! This is really going to work!

While I know that getting a PGS normal embryo is not a guarantee for pregnancy and live birth, it does significantly improve the chances of that success. I  vividly remember at my IVF consultation when my RE told me that getting a normal embryo (at my age, humph) would be my biggest hurdle, and that if I got one then my chance for success is 80%. That’s an astonishing rate. I’ve seen other women get lower quotes on that one, but I’m going with my RE’s predictions because he does know me and my specific medical history. I’ve also seen countless women in online groups talk about their failed frozen embryo transfers (FET) with PGS normal embryos, as well as early miscarriages. But a PGS normal embryo significantly reduces the risk of failures and losses. I have to remind myself, repeatedly, that the stories I read online are not really representative samples of everyone that goes through this. Sure we hear a lot of successes online, but we really hear a disproportionately large number of failures. After all, many women who have success move on to pregnancy support groups, or even spend more time in real life preparing for their baby and less time online, and don’t spend much more time in infertility groups.

I remind myself of this because a part of me is still scared. Scared of falling into that dark 20%. I’m also scared because I’m feeling very optimistic. It’s a peculiar place really – to feel so confident and happy on the one hand, yet a tiny bit scared on the other. I asked a trusted someone if I should temper my excitement , you know, to try to reduce my heartbreak should my FET not work and prepare for the worst. She simply said, “No!” She told me to enjoy this and focus my thoughts and energy on my healthy baby. On this healthy baby that will join me soon. But she also said to find a place in my heart to be neutral and accepting of whatever happens.

How do you hold such different energies at once? To be optimistic and confident that I will have this baby, yet also accept a negative outcome. They seem like such different mindsets. Yet I know that humans are capable of such complex emotions. For me, I think it comes down to not feeding that one little part of me that is scared with excessive fear. That means not obsessively reading about FET failures with PGS normal embryos. And there are so many posts about that online. I simply pass those by. Sometimes it’s a matter of engaging my rational thinking to remind myself that there are many reasons PGS normal embryos fail, and many of those reasons do not apply to me based on my medical history. I remind myself that worrying won’t help. Sometimes it is a matter of simply noticing the fear creeping up, observing it without judgment, and letting it pass by me. I picture these fears on a sailboat and watch them sail away. I don’t attach myself to them or feed them. Observing without judgment can take some practice, but this mindfulness strategy really helps me. And then I focus back on my embryo and the excitement my husband and I share about our future with two amazing children. I think I can hold onto this mindset – being optimistic and also accepting of whatever happens. I know we have a back up plan if we need it. We would do IVF again if we had to. I’ve come to peace with that, but I’m not going to focus on that now. I’ve done all the research I needed to when that was helpful for me, but now I’m not going to focus any more energy there. I’m not going to feed that path or the emotions that go with it. And that helps me with the acceptance part.

Now I’ve started the medications for the mock transfer and endometrial receptivity assay (ERA) to determine the optimal time for a transfer. We want to get the timing right since we only have one chance. But it’s more than that, isn’t it? This little healthy embryo is mine. My baby. I already feel the connection. And I want her home where she belongs.

Finding the Energy of Summer Solstice

leonard-von-bibra-182682As the Summer Solstice quickly approaches, I’m struggling to connect with the energy of the season. This solstice marks the height of the Sun’s energy, gardens are in full bloom, and magic is afoot. Fertility is a major theme of Midsummer. Yet here I sit, struggling with mine.

I recently found out that 1 of my 4 embryos made it to day 5 for biopsy for PGS testing. The nurse attempted to cushion this news with reassurance that my tiny embryo is of “the highest of quality”. She rattled off technical details of the embryo’s cell structure, but honestly, my brain turned off at that point as I simply tried to take in the news that all of my hopes are riding on this one bundle of cells. And I know that embryo grading is not a good predictor of PGS results. Since then, I’ve been waiting as patiently as I can on the results from the genetics lab. If the results come back normal, then we will proceed with a mock transfer to determine the optimal day for a frozen embryo transfer. If not, then I’m back to square one, facing another simulation cycle. To be honest, all of this stress, having just one embryo after what I had though was a successful egg retrieval, and waiting for what seems like forever, is simply wearing on me. I’m not feeling the energy and magic of the Summer Solstice. And that’s okay. But I do want to find a simple way to honor the turning of the wheel and rekindle a connection that I’m struggling to feel as I tread in the depths of IVF stress. This is what I need to stay connected with myself, the Divine, maintain my hope, and prepare for what may come – good or bad.

So I’m going to take a relaxed, fun approach to try to both pull myself out of my head and to focus on the life and energy that is around me, even if I’m not quite feeling the spirit myself. It’s time to pull out the flying wish paper and sparklers and just play with my husband and toddler. I’ll watch my little girl, so full of Midsummer energy, run and laugh and spin, and I will be reminded of the blessings that I have. That is the true spirit of the Summer Solstice – fullness, strength, creation, love, magic. And at the close of the evening, I’ll sit in front of a small fire on my deck, gather up some of that buzzing energy and send it to my one little embryo.

The Stages of Grief – IVF Style

There’s always good news and bad news, isn’t there? First the good news: egg retrieval went excellent. They retrieved 12 eggs! I was shocked and happy. Really I was riding cloud 9 for the rest of the day, feeling confident and excited. Then I waited for my fertilization report the next day. Last time I had a great fertilization rate so it didn’t occur to me to expect anything less. But then the call came and I was hit with the bad news. Of my 12 eggs, 8 were mature (not bad) but only 4 fertilized and are still alive. I literally lost my breath. How could this have happened? My nurse explained that 3 of the other eggs died immediately after being fertilized and the other one is barely hanging on so they don’t expect it to make it. Given these outcomes, she said they believe it’s due to egg quality. And there it is again – my age.

After I got this news I started to go through some familiar reactions. I remember feeling these ways at various points the last time I did IVF too. I’m going to call this the Stages of Grief – IVF Style. These are not based on research, just my personal experience as a mindful psychologist. But I venture to say that if you have ever been through infertility treatment, you will no doubt recognize some, if not all, of these stages.

Stage 1: Emotional Tidal Wave.  As soon as I heard the bad news I was hit with a wave of intense emotions. I could literally feel them hit my body. Sadness, fear, disappointment, shock. I went from confident that IVF will work to the stark realization that I may not get a baby from this. In fact, it felt like I had already failed. My heart pounded, heat flooded my body, my stomach and throat tightened. It was like the floor fell out from under me. These are uncomfortable feeling. Really uncomfortable. Because it’s so uncomfortable it’s easy to slip past this and move on to the Second Stage: Anger. Anger is a secondary emotion that often masks primary emotions that are felt in Stage 1 because anger, although far from pleasant, is easier to deal with.

Coping in Stage 1: First I want to note, that these stages may not always be linear. I found that I actually circled back to Stage 1 after I moved into Stage 2. And that’s a good thing. It’s healthy to feel and work through the tidal wave of emotions. So even when I moved on to anger, eventually I circled back to deal with what was actually underneath my anger. And I had a good cry. The release felt good. It’s important to acknowledge and sit with these hard emotions. We need to feel to heal. That doesn’t mean that we want to get sucked in despair for long periods of time. When these feeling become overwhelming for too long, there is an increased risk for depression and anxiety, which is understandably common with infertility. Some other things that can help in this stage are talking to a supportive person, creative expression of grief (e.g., writing), mindfulness practices, and meditation , to name a few. These are all practices that help you experience emotions without hiding, denial, or escape and can help process the emotions to lessen their power.

Stage 2: Anger.  I switched gears to focus on anger. This change happened automatically as I pushed past my sadness. Anger that my supplements didn’t work better. Anger at my age. Anger at my reproductive endocrinologist (RE). Anger at the embryologist. Anger is a fiery emotion. It’s easier to deal with because the other emotions can be really dark, scary, and isolating. Both feeling and expressing anger is highly influenced by culture, gender, and religion. For me, in my culture, anger is acceptable. Due to the intense energy of anger, people are often motivated to action. Anger made me second guess my doctor’s protocol for me. Why didn’t he include HGH during my stim cycle since he knew egg quality was an issue? Would my eggs have fertilized better if we used natural fertilization like we did during out last IVF rather than ICSI? Did the embryologist damage my eggs during ICSI?

Coping in Stage 2: When anger is front and center, it’s important to funnel that in a healthy rather than destructive manner. Don’t lash out at your partner. This isn’t their fault. Similarly, don’t take it out on yourself. You really didn’t do anything wrong and you don’t deserve this. For me, getting out in nature helps me diffuse my anger enough to help me focus it productively and move into stage 3. I find going for nature walks, taking some calming breaths under the moon, walking a labyrinth or using my hand labyrinth, or talking a bath can help calm my anger. Any healthy distraction will do.

Stage 3: Research and Planning. Fueled by anger and armed with 100 questions, like every determined IVF patient, I rushed to the internet. Google and Facebook groups are both a blessing and a curse for IVF patients. I found support and comfort from women who had experienced just what I had. I read stories of women who similarly had just a few embryos and those embryos made it to biopsy and were found to be normal. These stories were comforting, reassuring. I also saw so many women that had canceled cycles due to poor response or ended up with no embryos after retrieval. These stories made me feel grateful for the chance that I still have. I learned that a 50% fertilization rate for a practically 40 year old is actually really good. Why didn’t my RE tell me that ahead of time? But not all of the things that I found on the internet were helpful. I discovered that, contrary to what my RE had told me, ICSI isn’t necessary for PGS testing. In fact, the newest biopsy technologies allow for either type of fertilization. I was irritated that my RE hadn’t informed me about that option. One women even suggested that my RE’s motives were questionable for recommending ICSI without a sperm quality issues (suggesting he did the procedure for the money) and recommended I find a new clinic. Wow. I had to step back. Literally back away from the computer. I had to stop jumping to conclusions and acknowledge that there are several reasons why my clinic prefers ICSI, and that the internet did not know all of the factors in my infertility. But I did learn some new and good information, so I wanted to be productive with that. I turned all of my second guessing and research into reasonable questions that I tucked aside to discuss with my RE if we end up needing to do another round of IVF. I turned my anger into something productive, and I set the product aside for later. For later. Because there is nothing that I can do about it now.

Coping in Stage 3: I think the trick to this stage is finding that balancing point between constructive and destructive, and staying on the constructive side. I can use the support I find from others in online infertility communities to help me manage my reactions in stage 1 and 2, and use the information I learn from them to help me compose a list of questions for my RE. Armed with a list of questions and ideas for things to try differently next time (should we need a next time), I feel empowered. The trick, however, is knowing when the internet becomes your enemy. And it does eventually happen. People give “advise” and don’t have all of your medical history and may be making recommendations that are beyond their training and qualifications. It’s easy to catastrophize and self-diagnose with infertility problems that you don’t actually have. At some point, I think it’s important to make a decision about whether you trust your RE or not. Certainly some clinics are pretty questionable and it’s important to be your own best advocate. But at some point, if you decide your RE is qualified and good, you have to put your trust in them, and remind yourself of that when times get tough. Asking questions and being educated is important, but you also have to be able to be honest with and trust the person that you are working with.

Stage 4: Acceptance. That brings me to acceptance. The realization that what’s done is done. I cannot go back in time and change anything. I’m not even sure if changing anything would have led to a better outcome. So I had to let it go. The fact is, I have 4 embryos growing. I know they might not all make it to day 5 or 6 for the biopsy. I know that drop off is normal from day 1 to day 5. I certainly experienced that before. If we are lucky enough to have some continue to grow and be biopsied for PGS testing, I don’t know what the results will be. I do know the statistic that 60% of embryos at my age are abnormal, but that is an average that does not tell me what my results will be. So there is nothing I can do but accept what has been done, and wait for what will be.

Coping in Stage 4: Once you have your list, it’s important to set it aside and focus on the present. There is nothing you can do to change the past. Regrets and worries won’t change the future. All the worry in the world won’t change the outcome, it will just drive me crazy. I remind myself of that to find acceptance.

Stage 5: Hope.  At some point during IVF we find ourselves in complete despair. Hope is absent and no glimmer of it can be seen. We don’t know how we will ever find hope again. Yet we do. It’s what keeps us going. Somehow, after I accepted where I was in this, stopped trying to change it or fight against it, I’ve found a way to regain my hope. I’m focusing on my 4 little possibilities. Hoping that one of those 4 embryos will be strong and healthy to become my baby. I remind myself that it only takes one.

Coping in Stage 5: How do you find hope? How do you hold on to it once you’ve found it? I’ve heard many women in this simply say that eventually it comes back. They just found hope again. It might be that mysterious. Some people find hope in their believes – spiritual, religious, or simply their unyielding desire to have children. Personally, I find a lot of my hope through my spiritual beliefs and connections. It’s something I hold on to or come back to when I’ve veered away. It’s familiar and comforting.

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So now I sit here, the day before I will find out how many of my embryos grew into blastocyst stage and were successfully biopsied for PGS testing, and somehow I managed to make it all the way to stage 5. I’m hopeful that I will get good news tomorrow. I’m hopeful that one of those tiny 4 embryos will eventually become my baby. And I wait.