#flipthescript

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This week (April 22 – 28, 2018) is National Infertility Awareness Week (NIAW) sponsored by RESOLVE The National Infertility Association. This year’s theme is #flipthescript, which you can read about here. I’m flipping the script in a way that people often don’t want to talk about, but it’s a perspective that should also have a voice.

They tell you to never give up. Always have hope. Keep trying.

And so we do.

We try everything. We pay tens of thousands of dollars out of pocket on treatments that have no guarantee of working. We sacrifice our time to make appointments and drive to clinics. We get poked and prodded. We change our lifestyle – what we eat and drink, how we exercise, what products we use, when we have sex. We spend countless hours researching and advocating for ourselves. We try every strategy from yoga to supplements to meditation to embryo glue. We hope. We pray.

It begins to take on a life of it’s own. Finding our fertility becomes a full time job. And then, it becomes consuming.

We begin to separate from family and friends who don’t quite understand or know what to say. We see pregnancy announcements and go to baby showers, then cry secretly in our bathrooms. Eventually we start avoiding them completely. Our world begins to get smaller as our one focus grows. We become desperate to have a baby. And we do everything.

For many there is the big pay off at the end – we get the miracle baby, healthy and sweet smelling. All of our efforts are rewarded. We say it was all worth it. And we mean it. That’s the happy ending that everyone tells you about.

But what happens when that happy ending is nowhere in sight? When your life has become something you no longer recognize? When your fluctuating emotions seem to control you? When your desire has morphed into an obsession? When your debt has risen and you’re simply exhausted? How long are you supposed to keep going?

Is it ever okay to stop treatments or should you really never give up?

In the early days of my infertility, I held onto the “never give up” mantra with an iron fist. And after 3 years of infertility and multiple treatments, my first IVF was a success. My beautiful daughter was born healthy and strong. At that moment I thought my journey was over and I had won. While I always wanted at least two children, I never wanted to go through infertility treatment again. It took so much out of me. It changed me. But as the years passed and the pain faded, my desire for one more child resurfaced.

Dealing with secondary infertility now, I’ve done five more IVF cycles and two frozen embryo transfers, and I’m realizing my ending may look quite different this time around. While my journey is not completely over yet, the outlook is not bright. For the first time, the “never give up ” mantra may be doing more harm than good.

Then I had an epiphany.  When a want becomes a need, then morphs into an obsession, sometimes it is healthier to let it go. It’s not giving up. It’s making a healthy choice. It’s not saying “no” to a dream, rather, it’s saying “yes” to the life I have.

I’ve spent so long holding onto a picture of my future, that I’ve lost focus of the present. I can change the picture of my future. I can take back my life. There will, of course, be sadness and loss for a dream that was never realized, but in time I will heal and I can find me again. I’m right here surrounded by blessings.

There will be life after IVF, and it will be good.

 

An Unlikely FET

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Well this should be an interesting cycle.

Yesterday I began the preparations for another frozen embryo transfer (FET). My baseline ultrasound went well – my lining is thin as it should be at the start and my ovaries are “quiet”. Glad there’s no party going on in there. My blood work came back normal and so I was given the green light for estradiol valerate injections. Somehow I managed to forget that this medication is an intramuscular (IM) injection. Who wouldn’t want to block that out?  Also I’ll be doing progesterone in oil  – the dreaded butt shot – later in the cycle. So with these two, I’m anticipating a sore back end. However, I recently realized that my husband had previously been doing my IM shots way too low, which probably accounts for much of the pain and bruising. Mind you, I used PIO for 10 weeks during my IVF pregnancy so you’d think we would have known better. In any event, I think (or hope) things will go smoother now that we know to aim higher.

What makes this cycle so interesting, though, is that we are using 2 embryos that have the odds highly stacked against them – my PGS “abnormal” embryo and my bonus embryo left over from last cycle. I wrote more about these embryos here. If this works I’ll be shocked.

This cycle feels pretty different from the rest. I feel calmer. I’m not stressing about every little thing, analyzing every option, and second guessing every choice. And you know, all of that mental effort is exhausting and time consuming! I’m taking a cue from my beloved ocean – going with the flow and riding the waves. I’m not fighting the current. There is strength in that. Of course I hope this goes well, but honestly I’m not expecting it. I’m not clinging onto the outcome. I’m just riding the wave and waiting to observe where I end up. This is my visualization, my mantra.

That’s not to say this will be easy, or that another negative outcome won’t hurt. But I know I can weather that pain. I know the storm will calm and there will be sunshine again. So let’s see what happens…

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My happy place

 

Next Up: FET (again)

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My follow-up consultation with my RE yesterday was packed full of good information and even a surprise. So first the surprise: we have one frozen blast left over from my last cycle! Sure I’m ignoring the fact that it’s been a month since my egg retrieval and fresh transfer and no one mentioned to me until yesterday that I have a frostie. Seriously, why did the nurse not call me with that update?! Anyway, I’m going to ignore that slip up and focus on the fact that I have a surprise bonus embryo that I wasn’t counting on. Of course it’s not tested and it’s an early blast graded “BC,” which isn’t the prettiest embryo but still has a 90% chance of surviving the thaw. I asked if BC embryos still make babies and my RE said, “yes”. In fact, just for fun, he looked back to my cycle 4 years ago – the one that resulted in the birth of my daughter – and we discovered that she was also an early blast graded BC. Maybe my crappy looking embryos fair better than my high quality ones. Okay, I’m grasping at straws here. I was 36 back then and I’m 40 now, so the chance that this little BC is healthy is lower. But still – it’s a chance.

My RE recommended using what we have and doing a frozen embryo transfer (FET). Using what we have includes a little frozen PGS “abnormal” girl too. Yes, you heard that right. My RE is recommending that I transfer a PGS abnormal embryo. But first a few points to clarify. We did not do Next Generation Sequencing (NGS) so the results are either normal or abnormal – all mosaics are labeled as abnormal. Knowing what I know now, I would have tested using NGS so that the results would have specified whether the embryo was mosaic and the percentage of mosaicism. But I digress. In any event, I have a lot of respect for my RE (and his knowledge base) because he isn’t quick to dismiss all abnormal embryos. He took a close look at the details of the results and saw that this particular “abnormal” embryo only has a tiny segment of duplication on the short arm of chromosome 17. He said that a small percentage of the population may be walking around with similar minor abnormalities  and no one knows it because we never tested for that sort of thing before. This particular partial duplication will not lead to the birth of a child with an abnormality. Maybe my embryo will even have a superpower. Okay, that’s probably not true but I’d like to think so. The embryo may not implant or might be an early miscarriage (no different than what happens with so many pregnancies both IVF and unassisted) or the embryo could develop into a healthy baby. Both of these embryos are long shots simply due to my age-related quality issues, but it’s a chance. So the plan is to transfer both for my upcoming FET.

Going into this consultation I was prepared for the FET recommendation. I was also prepared to call it quits afterward if the FET fails. Over these last several weeks I’ve come to a place where I’m at peace with not having another child. I never thought I’d say that. And I’ll write specifically about how I shifted to that mindset in a later post. For now though, my RE convinced me to try one more egg retrieval and fresh transfer if this FET ends in another negative beta. My husband and daughter are both strongly rooting for another child, and my husband was also hoping to do one more fresh transfer.

My RE told me about some studies that followed women over the course of up to 12 (gasp) complete IVF egg retrieval and transfer cycles. The studies found that the chance for success increased over the course of 3 cycles, but plateaued after that. Meaning that after 3 complete cycles, the results don’t often change much. It should be noted that multiple FETs with eggs collected during the same retrieval only count once – that is, you can do several FETs and that doesn’t count against the 3 cycle benchmark. Of course there are exceptions to this rule, but when weighing the pros and cons of when I want to stop, I’m not going to keep doing this forever in the hopes of breaking the odds. Taking all of my cycles together and the particulars of my results, my RE said that if it were he and his wife, he would do one more IVF and fresh transfer after the FET. He said if we do that and still it fails, then I can feel confident that I didn’t leave anything on the table. No looking back and wondering. No regrets.

I like the sound of that. It makes sense. I think with the “break” of doing a FET first – since there’s so much less prep work for a FET – I can muster up the strength for one more IVF cycle. I don’t want to look back one day and wonder, “what if”. This plan seems like it will satisfactorily exhaust our options with my eggs. And if the journey ends there, I’m okay with that.

On a side note, I want to mention that I mustered up the courage to ask the scary question I had been avoiding. The “does repeated rounds of IVF cause cancer” question. My RE gave me a confident “no” and explained that the hormones used for this are naturally occurring in the body so the body knows how to process them. It doesn’t cause cancer. When I asked specifically about estrogen-sensitive cancers, he explained that again the answer is that IVF will not cause them. Prolonged estrogen can cause estrogen-sensitive cancers to grow (get bigger) but will not cause them. But he specified that it really does have to be prolonged exposure – the short bursts we use for IVF isn’t considered prolonged even when we do it multiple times. So I’m putting that fear to bed and thankfully moving on.

The Moments That Give Us Pause

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StockSnap_COT4YSOLEHThere I was, sitting at my desk having a perfectly good day. It had been a while since I was on Facebook and so I decided to see what my friends had been up to. And as a scrolled there it was – my dream. A woman holding hands with her husband and toddler, a beautiful pregnant belly growing obviously under her dress. Everyone in the picture was smiling with what could only be described as bliss.

I’ve seen this picture a million times in my mind’s eye. Only in my picture, I’m the woman. This was supposed to be my future. But today this picture was of a friend who is not much younger than I am. I was happy for her, yet also sad for the loss of my dream. I know I am not quite done with infertility treatments yet, but the end is very near and our last efforts are a long shot at best. So I am preparing for, and on most days accepting, this loss.

It did make me wonder, though, how some older women get pregnant so easily and others are fighting an uphill egg quality problem due to age. I began to get irritated. Maybe even angry. On the one had you see all these stories of women getting pregnant well into their 40’s, many even seem to be natural conceptions. Everyone knows a mom, friend, or friend of a friend who had a healthy baby after they passed age 40. On the other hand, any fertility expert will warn you that egg quality dips after 35 and plummets after 40. That doesn’t mean that there is nothing that can be done to help improve egg quality. But I feel like I’ve done all the recommended strategies – supplements, healthy clean eating, removing toxins and endocrine disruptors from home care and beauty products, weekly acupuncture, etc. – and still my egg quality has been dismal. I’m not sure why these strategies seem to work for some women and not others. I’m not sure what the norm is.

To many women, stories of others conceiving in their 40’s gives them hope. And in the beginning of this journey they gave me hope too. In fact I delayed seeking infertility treatment for about 5 months because I had so much hope. But at this point those stories don’t give me hope. Call me a pessimist, but I prefer the term realist. I think it really comes down to perspective. While we see these great stories of pregnancy success in older women, what we don’t see posted are all the stories of the women who didn’t become pregnant. Now I know we do see many negative outcomes in IVF support groups for women over 40, but still, what about all of the women who are silent? Can you imagine what it would look like if we knew how many women tried and were unable to conceive in their 40’s? How much would those stories outweigh the successes? Would that give us a more realistic picture of our chances?

When I thought that age was just a number and it didn’t really impact fertility, I felt hurt, confused, and depressed when my IVF’s failed. I simply couldn’t understand what was going wrong. When I take a more balanced perspective and realize the positive stories of conception in older women are exceptions not the rule, then I don’t get so down and hard on myself when things fail. I know that now, I’m the norm – unfortunately. It’s still sad and part of me wishes I would have been able to try when I was younger. But I also know that life circumstances simply didn’t work out that way for me, and I wouldn’t necessarily change them.

I may never get my dream picture, but I will adjust and heal. I will enjoy life and all my blessings. But I think there may always be days when I see my dream manifest in other people, and I will take pause and hold loving space for that loss.

Thoughts on Approaching the End of the Road

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How do you decide when to stop infertility treatments?

I got an email from my IVF nurse coordinator saying that it is good that I’ll be talking about my options with my RE on the 9th, but she also indicated that my RE is leaning toward recommending we do a frozen embryo transfer (FET) with my PGS “abnormal” embryo that we still have on ice. Since we didn’t do Next Generation Sequencing, we have no way to know whether this embryo is mosaic or not. It has one small issue that would either result in a failure to implant, early miscarriage, or self-correct and turn into a healthy baby. There’s just no way to know. It won’t result in a live birth of a baby with a chromosome-related disorder. In my mind, I’ve been saving this option in my back pocket for our last ditch effort before discontinuing treatment. It is a long shot after all, but still a possibility. So I don’t want to leave this one embryo behind, but I’m not expecting it to work. Honestly, I really thought my RE would recommend one last egg retrieval and fresh transfer before going with this long shot FET.

I know it’s my choice. My body, my money, my choice. So I think I could talk my RE into one more IVF try. That’s what my husband wants to do, but he is open to hearing what the RE’s rationale is. But if my RE ends up recommending transferring the PGS “abnormal” embryo rather than another IVF fresh transfer, then he is basically saying that  I’m at the end of my road with my own eggs. He’s saying that the chances for success with my eggs is so low that it’s not worth going through another cycle.

But it’s still my choice. So how does one make that choice?

It’s a heart heavy equation. You weigh your dream against your finances, the physical impact of the medications and procedures, the emotional toll this takes on you, the effect on your relationships, and you try to figure out just how much more you can take. Or how much you want to take. I think I can take much more, but honestly, I don’t know that I want to. Many women won’t have to make this decision because IVF will work before they reach their limit. But some of us do have to make the decision.

People tell you, “don’t give up.” Never give up. But I think that is naive advice at best, and potentially harmful advice as it can make you feel like a failure or guilty if you stop. Not everyone can afford endless rounds of IVF. I’m lucky to have insurance coverage or I would have had to stop due to finances long ago. But that still doesn’t mean I should never give up. I’m fighting an uphill battle against age. I could do this 10 more times and have less chance of success each time as I get older and my egg quality decreases. But honestly, the factor that is weighing heavily on my heart is quality of life. I’m tired of my life revolving around IVF cycles. I’ve missed conferences and trips. I’ve missed time with my family. Often, I feel like I’m missing life. Every decision I make revolves around my fertility – what I drink and eat, when and how I can exercise, when I can go out of town, what I read, the appointments I fit into my schedule, how emotionally connected and present I feel with those around me. Some days, many days, during IVF I don’t even feel like myself anymore. The hormonal fluctuations are real and they change how I feel and perceive things. It changes how happy I am in life.

At the end of all of this, whether it works or not, I will still have my life to live. And my life is filled with so many blessings. Not the least of which is my daughter from my first IVF years ago. And I want to enjoy all of the blessings in my life, and sometimes that’s hard to do when I’m so deep in IVF hell.

So I have to weigh out all the factors in my equation and decide when it’s time to stop. After this last cycle failed I found myself feeling really good about the idea of doing one more egg retrieval and fresh transfer, then the last FET with the PGS “abnormal” embryo. If I did those 2 cycles, I felt that I would be satisfied knowing that I didn’t “leave anything on the table”. I would have given it my best shot without sacrificing myself.  Doing more cycles beyond that tipped the scales too much and didn’t feel worth it. But am I ready to go straight to the FET with the PGS “abnormal” embryo? Can I forgo one more retrieval and fresh transfer and still feel okay about my decision if I end up not pregnant? I’m not sure. That ending almost feels too abrupt. But I won’t lie – there is a part of me that feels relieved at the thought of not having to go through another whole IVF cycle. I want to be realistic about my chances.

I’ve done 6 IVF cycles in total. I know some women do many more than that. If I didn’t already have my daughter then I know I would be willing to do more. But part of me feels like I’m missing out on fully enjoying my daughter’s life because I’m so caught up in infertility treatments and the hormonal emotional roller coaster that goes along with this. But I want to give her a sibling so much, and we want to expand our family. However, the truth is she may very well be my only child – how much do I want to miss out on? I could say that I’m not really missing out on anything with her, and maybe that’s true for some women. But it’s not true for me. The medications and the emotional ups and downs do impact me, and negatively affect my relationships and my ability to really enjoy life. IVF is hard. It gets depressing. It becomes all consuming. If can even feel addictive.  And I’m tired of paying that price.

It is okay to stop. That doesn’t mean that you are giving up or are a quitter. It means you are carefully weighing all the factors, which are unique to you, and making a smart, healthy decision. That stop point is going to look very different for different women. And that’s okay.

I suppose I’ll wait to hear what my RE ultimately ends up recommending and what his rationale is before I make my decision. I feel like I’ll have to make a quick decision after our meeting since I’m already on birth control pills to get ready for my next cycle – whether that be another IVF or the FET – and I don’t want to drag out being on those pills. Will I feel like I’m done if I do only the FET? Will I regret not doing one more IVF? Do I want to do another IVF even if the chances for success are so low? Those are the questions I have to weigh.

Beta Day

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There’s never an easy way to do this. Yesterday was beta day. Simply the thought of waiting all day for the nurse to call with the results made my stomach turn. In the past, I’ve done it different ways – testing early at home, waiting for the call. But this time I decided to try a new method. I waited until after my beta – because I wouldn’t want to go get the blood draw if I already knew it was negative – and then used a home pregnancy test (hpt) after the beta rather than waiting for the call. Of course, I saved first morning urine for this to be sure I did it “right”. But the key to this method was having my friend come over to take the test with me. My husband was already at work, and although he is wonderfully supportive, I really wanted my girlfriend there. My poor husband is understandably emotional about this and I needed someone who could just be there for me.

So that’s how I did it. When the 3 minutes were up, I sat on my bed and my friend hurried into the bathroom to look at my test. I could see her from where I was sitting. I pictured this a million times – she was supposed to start screaming and jumping up and down. Instead she bent over to look closer. And I knew – it was negative. She turned with concern in her eyes and said, “I’m sorry”.

Afterwards, we hugged, cried, vented, got angry, and even laughed. As much as it hurt, it was the gentlest experience of bad news I’ve ever had. After hours of talking, we went out to lunch where we enjoyed strawberry martinis and cheesecake. Oh and there was actual food in there somewhere too, but who really cares about that when you have strawberry martinis and cheesecake?

At 3 o’clock in the afternoon, the nurse finally called to deliver my beta results. The first thing she said, in a nervous tone, was “are you sitting down?” And I rolled my eyes with irritation. I don’t know why – she is a nice nurse – but I can’t tell you how glad I am that I got the news on my own terms and didn’t wait for this call.

I’ve been instructed to start birth control pills again on the second day of my cycle, which will be tomorrow. I will meet with my RE on April 9th to discuss options. The nurse said, “we have many options – even a good donor embryo program.” I informed her that we are only interested in using my eggs, so when that option is exhausted we will be done. It’s such a personal decision – when to stop, whether to use donor eggs or embryos, etc. Somehow, having our daughter already has made us not interested in donors. Although I completely understand why others would take that option for their first and/or additional babies. It’s just not the right fit for us.

The wait to the 9th is going to be long, as all the waits are. I want to find out if my RE thinks it is worth it to try another IVF with a 3-day transfer – if there is still hope. But I do want to be realistic. I’m also concerned about the potential long term affects doing 7 rounds of IVF could have on my health. Is there an increased risk of cancer? I don’t know. The few studies I’ve come across have found either no increased risk or a teeny tiny increased risk. But I don’t know if the results would be different for multiple rounds of IVF. So I need to find out more about this. If the risks are low and there is still a reasonable chance for  success then I will do one more round. If not, then we will pull out our last ditch effort – transferring our pgs “abnormal” embryo that only has one partial deletion on one chromosome. The lab that did our PGS didn’t use next generation sequencing, so we have no way of knowing if this “abnormal” is really a mosaic – or the degree of mosaicism. Since many mosaic embryos do self-correct, that is an important distinction. And we just don’t know with this one. My RE said that based on the results for this embryo, it would either fail to implant, be an early miscarriage, or correct and be a healthy baby. He said it would not result in a child with a health problem or disability. So that will be our very last option. I won’t leave that embryo behind – wouldn’t it be crazy if, after all of this, that “abnormal” embryo was the one that made a baby! I do realize that is a very long shot though.

So that’s my plan for now, and we’ll make the final decision after my consultation. It’s hard to think about having no baby after all of this. I am ever grateful that my first IVF brought us a healthy daughter. I hold onto that. It will still be hard to let go of the dream of expanding our family.

I’m dreading starting birth control pills tomorrow. They make me irritable and negatively impact how I see my life. All these hormones lead to nasty mood swings. I discussed this fear with my friend yesterday and it was good to get it off my chest. It really impacts my ability to enjoy my time with my husband and daughter – and that scares me. I don’t want to waste any of the treasured time I have with my little miracle, and sometimes when these hormones rage, I feel like I’m not fully present or happy. That’s a major reason why I don’t want to keep doing cycles for too much longer. But my friend and I made a pact. I’m going to text or call her and say all the dark, angry things I might be feeling – and she is going to remind me that it’s just the hormones. It’s not how I really feel when I’m my real self. And I need to hear that to help me push past it – because it can feel so dark and real at times. Having a good friend to help you through this roller coaster is so precious.

Mindful Strategies for Coping During the Two Week Wait

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How does one make it through the two week wait (TWW) without loosing one’s mind?

It’s a good question. It’s a rough time, often filled with anxiety, hope, fear, joy, anticipation, daydreaming, crying, excitement, etc. It’s all the intensity and contradictions of this roller coaster ride packed into two short weeks. Or less. It’s hard to maintain calm for the duration of what may seem like to others as a little blip on the calendar, but to us seems like dog years. Take me, for example. I’m trying to maintain hope and optimism. Yep I’m trying my best, but sometimes that little bit of fear or anxiety creeps in. Or sometimes it’s just neutrality.

Daily someone who loves me is asking me how I’m feeling. I know this is code for: “do you feel pregnant?” I smile and say, “I’m fine.” But I feel like the pressure is on. Not that they mean to make me feel pressured. Maybe I put that on myself. Everyone wants this to work. Of course we do.

Having gone through more TTW’s than I can remember, I’ve come to the conclusion that the most dangerous thing you can do during the TTW is symptom spotting, which that “how are you feeling?” question feeds into. Symptom spotting is basically the enemy of every women in their TWW. We tend to obsess over every little twinge or difference in our bodies. “My breasts feel more tender,” I think to myself.  Although that could be due to how much I’m squeezing them to check for breast tenderness.

But the reality is that all those “early pregnancy symptoms” can also be explained by the high levels of hormones pumping through our bodies. And to complicate matters even worse, many early pregnancy symptoms look an awful lot like what happens as Aunt Flow approaches. During my TWW during IVF #1, I was absolutely certain it had failed. I started getting a hint of a nagging heading slowing building up steam – exactly what always happens just days before my period starts. I thought I was out. I was so sure it was a negative that I typed out a list of questions to ask my RE at our follow-up “WTF appointment” (you know, the appointment you have after a failed cycle to discuss what went wrong). Literally 30 minutes after clicking save, my nurse called with my positive Beta results. Compare this to IVF/FET #2 where I was certain it worked – I felt tired, queasy, I felt what I thought was implantation cramping, sore breasts – and the Beta was negative. That was when I learned the hard way just how much progesterone can play with your mind, body, and heart.

In an effort to get through this TWW without symptoms spotting and maintain as much hope and receptivity as I can, I’m trying a different strategy. I’ve been using 2 tools daily to help keep my spirits up.

First, I’m doing a combination of deep breathing, affirmations, and meditation with the aid of a counting ritual tool. This tool can be a Witches Ladder, Prayer Beads, or simply a bowl of stones or other small items. The Witches Ladder I use is a beautiful string of crystal beads in 3 sets of 9 beads. Each set is a different type of stone, which represents certain characteristics. I created an affirmation for each set of stones. I start at the beginning and hold each bead between my fingers, take a deep breath and state my affirmation, then repeat for each bead in that section. As I proceed mindfully, slowly through each individual bead, my mind is calmed and my focus strengthened. I find this really calming when I start to feel that bit of doubt or anxiety creep into my mind. Also, doing it before I even begin to feel worried helps me prevent it and maintain a more positive sense of being.

Photo and Witches Ladder by Etsy shop Esmeralda Holly

Above is a photo of what I used, and here is a description of the stones and my affirmations. Starting at the antler (both the antler and acorns are also fertility symbols):

  • Aventurine  = luck, creativity, heart chakra, confidence
    • “The odds are in my favor”
  • Tree agate = stability and nurturing protection, weathering the storm, putting down spiritual roots
    • “I am rooted in the earth, nurtured, I can do this” 
  • Moss agate = creating abundance, fertility, new beginnings, the spirit of nature
    • “Abundance flows through me and fills me, I am fertile” 

The second strategy I’m using is drawing a daily “mantra,” or focus, using a Mini Moon Oracle set; but you could use any oracle or affirmation deck that resonates with you. I love the simplicity of the Mini Moon Oracle set, which I downloaded for free from Spirit de la Lune, because it’s just one word that doesn’t need any other interpretive guidebook to understand. Each morning, I take a few deep breaths, ask the Universe for a focus that will benefit me that day, and draw a mini moon from my bag. Throughout that day I mentally come back to the word and see how I can fit it in to support my well-being. As an example, I recently picked “Flow”. As my day progressed and at times got chaotic, I reminded myself to just flow with it, not fight with it. Things that would usually get under my skin were let go as I reminded myself of the bigger picture. The following day I ironically picked “Ebb,” so I carved out time that day to withdrawal into myself in healthy ways to engage in self care.  Each day, these guiding words have been helpful in different ways.

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These strategies may not change the outcome of my cycle, but at least I’m finding this TWW a bit more tolerable than ones in the past.

Finally An Embryo Transfer

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Embryo transfer day was March 10th. My husband and I got to the office for our 9AM procedure and were so ready to get our embryos back where they belong. It felt a bit empty in there without them. We waited in the transfer room wondering how many we’d have to transfer. My RE popped his head through the doorway to say that the embryologist was just finishing up our embryos’ first pictures. Awwwww. Still we didn’t know how many we had.

 

After what seemed like f-o-r-e-v-e-r, but was realistically about 5 minutes, my RE entered the room with a photo page. Before he turned the page around to me, I could see through the back that there were 4 embryos on it, and I let out a little sigh of relief. He turned the page around to show me our 4 embryos (none of the others had made it). He explained the growth and quality. He didn’t use the terms that you often hear for embryo grading, like 4 AB and such, and I’m guessing that is because they are 3-day embryos and not blastocysts. They simply used a 1, 2, 3, etc. system which was based on the number of cells present and how well those cells were dividing, the presence of fragmentation, and relative cell size. Please note that the grading system can vary from one lab to the next. I’ve seen other labs that use an opposite scale than my clinic, making higher numbers equal a higher grade. So it’s always important to find out your clinic’s grading system and not assume it’s the same as others you read about.

 

My embryos were as follows:

One 9-cell, one 8-cell – both were considered “grade 1” which is the highest grade on my clinic’s scale

One 6-cell – “grade 2” which is pretty darn good

One 4-cell – I don’t recall the grade but it was lower

Later I Googled cell division on day 3, because there’s always something to Google, and found a few varying answers (as always on the internet). Some resources said that by day 3 embryos are typically 4-8 cells, others said 6-10 cells, another said they prefer 7-10 cells. In any event, mine were in the ballpark, albeit one growing slower. At first my RE suggested transferring the top 3 embryos. I quickly responded, “why not transfer all 4?” You know, leave no embryo behind, because let’s be real – I doubted that 4-cell would catch up in the Petri dish. He looked at me and said, “that’s what I would do to, I just didn’t want you to feel pressured to transfer 4.” He told me that the 4-cell had about a 1-2% chance of sticking, but at least we were giving it a chance. Wouldn’t that be crazy if that was the one that made it – not that we’d ever know which one made it (if one actually does). Still he made both my husband and I initial a paper for the embryologist, because he though she might try to object, stating that we were making an informed decision to transfer all 4 – I guess my clinic usually only transfers 3 at the most.

 

My Re returned to the room, after I had been given a lovely little Valium to relax my uterus, and reported that the embryologist actually thought our decision to transfer 4 was the best choice. It was only the nurse who exclaimed, “but what if they all took!?”. We all had a nice chuckle at her expense. I mean seriously, we’ll be lucky if one implants. If all 4 implanted then we should probably start playing the Lottery because we’d have hit some unlikely odds – plus we’d need the extra money for all those kids. In all seriousness though, I know there are risks involved in having multiples and I don’t mean to make light of that reality. But after so many IVF failures, my personal risk of multiples looks pretty darn low so we felt very comfortable transferring all 4 and so did my RE.

 

And there we have it. I’m sitting here typing with 4 little embryos in my uterus. I feel like I’ve gone through so much to get here. It’s going to be a long wait until my pregnancy test on the 21st. I’ll actually have my first beta on the 19th, and the second test on the 21st, but my clinic doesn’t call with the results until after the second beta. I know this is an uncommon practice, as most get the news after the first beta, but I suppose my clinic wants to make sure that the HCG is doubling on time before getting your hopes too far up. I could request a call after the first one, but I decided I’ll just wait like I’ve done before. I’d rather wait the extra 2 days and know if things are starting out well rather than obsessing for the following 48 hours, which is completely what I’d do.

 

And so the wait begins. I’m not going to symptom spot, I’m not going to symptom spot, I’m not going to symptom spot…

Another Egg Retrieval, Another Fertilization Report

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natalie-rhea-riggs-359448-unsplashEgg retrieval was yesterday and full of surprises. It started off great because I saw that my favorite anesthesiologist was there for my procedure. Yes, I have a favorite anesthesiologist since I’ve done this, and had other fertility related surgeries, so many times. It’s always a relief to see him because I know I’m in good, capable hands. But then my RE came into the room as I was laying there getting hooked up for monitoring. He asked if everything went okay with my trigger shot. Odd question, I thought.

I told him that it had gone well. To my surprise, and horror, he said that my HCG test that I took that morning  was negative – since the trigger shot I take is HCG it should be positive which tells them it’s in my system correctly. The trigger is a vital step in the process because it signals to the eggs to begin making their final maturation preparations, and it begins to loosen the eggs inside the follicles so that they can be retrieved just in time before they are ovulated. If this doesn’t happen, then eggs are stuck and they cannot retrieve them. My RE was concerned. He said that he’s had this happen before – sometimes it turned out fine and other times it didn’t. I was shocked. I’d had such a great response to meds this round, I had about 12 perfectly sized follicles, and I really though this would be my last round – and now this. Was my perfect cycle about to be ruined?

My RE exited the room. I was left with the anesthesiologist and my husband, who was nervously rubbing my feet. The anesthesiologist turned to me and told me not to worry. He said that everything would be okay and that he has a good feeling about this. He said that in his line of work it’s very important to trust your intuition because sometimes it lets you know things that the monitors do not. And intuition was telling him that everything was okay. His kind words and comments on intuition helped me. I believed him without logical reason. Shortly thereafter, my RE poked his head in the door again and happily announced, “the test turned positive – it was just slow.”

And so I drifted off to sleep with a smile on my face. Upon awakening the anesthesiologist and a nurse were the only ones in the room. He asked me if I’d heard how many eggs they’d gotten. With one eye open I said, “no.” He said, “18! But don’t tell the doc I told you – act surprised because he’s going to want to be the one to give you the good news.” I couldn’t believe it.

After I had woken up a bit more, my RE came in to tell me the great news. I seriously don’t know how he manages to get more eggs than we expect. He’s amazing. Of the 18 eggs, 13 were completely mature, 3 were almost mature and they were going to try to mature them in the lab, and only 2 were not yet ripe. This is by far my best response and I feel grateful.

Today I waited for the fertilization report, unsure of what to expect. Last cycle we had an astonishing 100% fertilization rate (the same as my first IVF 4 years ago), but in the 3 cycles before that we had a 50% rate at best. Finally the call came. Of the 13 mature eggs, 6 fertilized normally with ICSI. Another 3 fertilized but were showing significant cleavage, indicating they were not growing well. Nevertheless, the embryologist wanted to give them some more time to see if they corrected. The other 4 arrested after fertilization. The 3 eggs that they tried to mature in the lab did not make it. So there it is – in just one day I went from 18 eggs retrieved to 6 embryos growing with a hope of 3 more. Not the fertilization rate I was hoping for, but still glad to have these.

In my last cycle I had 7 fertilize normally but by day 3 there were only 3 still growing well. The others had significant cleavage and eventually arrested. So that’s why I’m a bit thrown off. With so many eggs retrieved, I actually started thinking that I may have some left over after my transfer to freeze. While it’s still possible, I’m adjusting my expectations. I’m going to continue to meditate, pray, and send reiki energy to these 9 embryos. I hope they grow well and I have a healthy looking bunch on Saturday for my 3-day transfer. And if I have any left over, and if they make it to day 5, I’ll be happy to have a bonus embryo or two to freeze.

I desperately hope that my baby is in this batch. It’s crazy how fast numbers can change, and how moods can shift during this journey. They don’t call infertility treatment a roller coaster ride for nothing.

Trigger day and Neupogen Wash

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Tonight is trigger night. It’s been a great stimulation cycle so far. I have 12 large follicles and some smaller ones, which may not catch up. Even my left ovary has decided to play ball this round, producing a whopping 5 large follicles – the most I’ve ever gotten on that side was 3. This is the most follicles I’ve gone into retrieval with so I’m pretty excited.  Somehow I’m excited despite the repeated failures and disappointments. Every time I think I’m not going to find hope again, and then somehow I do. I’m not sure if that’s a good thing or not, as I would prefer to stay cautiously optimistic. But here I am, thinking this will be the one.

I had a neupogen wash for the first time today after my ultrasound check. Neupogen is a drug that stimulates the growth of white blood cells and is typically used during cancer treatments. A neupogen wash during IVF is an off label use where they insert the liquid into the uterus through a catheter. The procedure felt like getting an intrauterine insemination (IUI). Quick, easy, and pretty much painless for me. My RE, who loves his analogies, explained that the embryo is like a fuzzy tennis ball and the receptors that cover the uterus are like little strips of Velcro. The tennis ball has to hit a Velcro strip to implant. A neupogen wash basically makes the Velcro strips stickier with a longer reach – fuzzier Velcro. So the idea is that neupogen can help the embryo attach better to a receptor site to implant. He calls it “embryo Velcro” – not to be confused with “embryo glue” which is something different.

last menopurMy egg retrieval will be Wednesday at 8:30 AM. I’m ready to get this show on the road!

Last night while taking my meds I though, “This may be my last menopur shot.” It was a strange thought. On the one hand comforting, as I envisioned this cycle finally bringing me my baby. But on the other hand it was sobering. If this cycle fails, I’m not sure that I will do another round of IVF. It may be the end of my road. Two very different thoughts. Two very different feelings. One thing is for certain – I won’t miss the menopur burn.