Category Archives: IVF #6 with Fresh 3-day Transfer

Thoughts on Approaching the End of the Road

27 Tuesday Mar 2018

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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

22 Thursday Mar 2018

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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

15 Thursday Mar 2018

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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

12 Monday Mar 2018

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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

08 Thursday Mar 2018

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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

05 Monday Mar 2018

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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.

 

To women going through infertility…

22 Thursday Feb 2018

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I feel the need to send some support out there to all the women struggling with infertility. To those women who have ever felt that they were drowning in infertility treatments, like their life was one never ending IVF cycle. Those who think about getting pregnant all the time, stare at home pregnancy tests squinting to see lines, and consume so many supplements they can’t even fit into one of those weekly pill containers.  I want you to know, you are not alone. You are not crazy. And you are not broken.

I was recently telling someone about what it’s like going through infertility treatments. In my defense he caught me on a rough day, but nevertheless I ended up sounding like a crazy person. When you spend years battling infertility, having multiple surgeries, treatments galore, and are in the middle of your 6th round of IVF, you look back and realize you’ve done a lot of crazy shit in the name of procreation. It becomes all consuming.

On that particular day, I confessed that while I would prefer a coffee, I was sitting there drinking tea that tasted like dirt because it was high in antioxidants, which is good for my eggs, and the other herbs in it are uterine tonics. Since it was my day off, I was planning on going for a long walk on my favorite trail to help improve blood flow to my uterus. Then I planned on taking a bubble bath, which I find soothing, but it also helps increase circulation which is good for my ovaries and uterus. Later that weekend, I’d be going to my friend’s house for her birthday and celebrating with one glass of wine. While I’d love to have more, I won’t because, you know, egg quality. But having just that one is okay, according to my RE, because it dilates blood vessels thus increasing blood flow to my uterus. The man I was talking with looked at me like I was an alien.

I’ll confess, this man is my therapist. I decided to go see someone after my last IVF cycle ended in 2 PGS abnormal embryos and no transfer. I was devastated, my husband was devastated, and I felt like I was exhausting my coping skills. I wanted someone to talk to that wasn’t my husband or one of my fertile friends. Someone I could say all of the dark things to who wouldn’t judge me. So yes, I’m a psychologist seeing a psychologist, and that feels a bit weird to me. I know it is the healthy choice and many therapist need therapy from time to time, but I’m like one of those doctors who avoids going to the doctor. I knew I needed to go though, after I started snapping at my loved ones. That’s not who I am or who I want to be. Infertility is HARD and we need support.

So there I was, sitting with a man who is really being kind and supportive, but I can tell he thinks I’m being excessively obsessive. And I completely am. But that is also completely normal when you are going through infertility. It happens to most of us, maybe even all of us who are at this long enough. It’s normal to want to do every little thing you can to try to improve your chances when the stakes are this high. When you are putting your body, heart, finances, and soul through so much. If medicine advanced to the point where our RE’s could tell us that “x, y, and z” will give you that positive pregnancy test, so don’t bother doing all the other silly things you read about – well, we’d all jump on board and do those things and get our babies. But that’s not the way it works. Even when we have every piece lined up, we still end up with failed transfers and negative tests. Science simply cannot control human reproduction – it’s too complex, too fragile, and possibly too magical.

So as long as our doctors can’t guarantee that treatments will work, as long as multiple women do the same thing but have different results, as long as things remain “unexplained,” we will always do our best to shift the odds in our favor. Whether that be this supplement or that, yoga, meditation, affirmations, tapping, castor oil packs, one more diagnostic test, exploratory surgery, the keto diet, the paleo diet, cutting out sugar, coffee, and alcohol, juicing, prayer, intentions,  pleading and bargaining, or standing on your right foot for five hours every full moon (okay I’m making up that last one) – we will try it.

And we will not be alone. We are not crazy. We are not broken. 

The Green Light

21 Wednesday Feb 2018

Posted by in IVF #6 with Fresh 3-day Transfer

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I had my suppression check today. Everything was perfect – my uterine lining was thin and my ovaries were quiet. Just as it should be to begin IVF number 6, and so I got the green light to begin. I’m on a microdose lupron protocol again, which I seem to respond well to. Being a “regular” at my IVF clinic, I won’t have to return for my next appointment for 7 days. By this point, we pretty much know how fast I will respond to the stimulation medications, and we can make reasonable predictions about how long I will be on them. So for the next 7 days I will dutifully inject myself twice a day and hope to have a good number of follicles growing at the next appointment. I never get a lot by some standards, but I’m hoping for at least 7. Less than that would make me nervous. But I will try my best to not worry about that. I expect my whole protocol will last about 12 to 13 days.

We will be doing a fresh 3-day transfer. I’m excited to finally know I will have a transfer again, which gives me at least some chance of becoming pregnant. At the same time, that also means I’m going to get one of those calls. You know, the call that determines your future; in other words, “the beta call”.  I stopped taking home pregnancy tests a long time ago because they were always negative. I became paranoid – like somehow I was “jinxing it” by taking the test. So I stopped. But lately it seems like I’ve accumulated quite a history of getting calls with negative news from my IVF clinic. Whether it be a negative beta, abnormal PGS results, or news that none of my embryos made it to blast – these experiences have now made me dread, or should I say fear, those calls from my nurse. Simply thinking about it makes my heart race.

I’ve asked my close friend to take the day off when I’m expecting the beta call. My husband will be at work. She will come over in the morning and I will have a test waiting. I’m considering testing on the morning of my beta to avoid spending the whole day sick to my stomach with anxiety, and to get the news on my own terms. We’ll have a plan – to go for a walk on my favorite trail and then go out to lunch. We’ll do these things no matter the news. Having a plan, and reserving the right to change it later, is comforting to me. It eases some of my anxiety about beta day and lets me focus on the now.

Another way I’m trying to stay present focused is by indulging my creativity.  I made a fertility crystal grid, and I plan to use it as a focal point for meditation. I concentrated all of my intention for this IVF cycle – having a healthy pregnancy and baby – into the creation of this grid. Every time I look at it, I’m reminded of my intention. It contains some stones that were given to me when I started this fertility journey, other crystals that hold special meaning for me, and a pregnancy support bracelet that I intend to wear after my eggs are fertilized and my little embryos begin to grow.

And so, here I go again…

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A New Plan for IVF #6

31 Wednesday Jan 2018

Posted by in IVF #6 with Fresh 3-day Transfer

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After completing yet another round of IVF without having any embryo to transfer, I knew one thing for sure. I could not do the same thing again. I read something once that said, “Doing the same thing over and over again and expecting different results is the definition of insanity.” And I felt like I was going insane.

Yet I was not ready to end my pursuit for a second child either. That led me down a rabbit hole of PGS articles, hypotheses, anecdotes, and unknowns as I searched for an alternative plan that I felt comfortable with. After much thought and careful consideration of the alternatives, I decided on a plan. I decided to go back to the basics of IVF with a 3-part plan. Here’s what I decided and why:

  1. Forgo PGS testing. I decided to write a separate post about why I came to this decision. It’s not an easy one to make and I don’t think there’s a “one size fits all” approach. But if you’d like to ready about why I decided against PGS testing for my next round, you can read about it here. There are also links to some good articles and research studies there. One thing I will say is that had we done PGS testing 4 years ago when I did my very first IVF that resulted in my daughter, she might not be with us today. It’s one of those unknowns. The fact is that on day 5 the embryos that we transferred were all still early blasts (we transferred 3 5-day embryos). That means they would not have been ready for biopsying and they would have had to try to grow them out to day 6 to see if they developed enough for PGS testing. I’ve never had an embryo make it to day 6 in the lab. I didn’t back then and I haven’t in our last 4 rounds. Maybe my embryos just don’t do well for that long outside of my body. I don’t know. And I just can’t shake that thought. I might not have my daughter if we did PGS testing back then.  When I told my RE that I want to do another cycle and not do PGS testing, he said, “Whew! Before I came in here I was trying to think of what to say to convince you to not do PGS.” He has a lot of reservations about PGS testing too. He believes it has it’s place, but isn’t the panacea that it’s made out to be.
  2.  Fresh transfer. Next I decided that since we don’t need to freeze for PGS, why even bother with a FET at all? Why not do a fresh transfer? Many people say that FET success rates are higher than fresh transfers. But when you really look into why that may be, you see that it’s not always the right approach in every situation. One reason FET may be preferred is because some women experience ovarian hyperstimulation syndrome (OHSS) after egg retrieval. That’s serious and painful, and doing an embryo transfer in that situation would not be a good idea. But that’s never going to be me. I simply don’t produce enough eggs. Another reason FETs can be better is because the focus of the medications during egg retrieval is really focusing on egg production – not promoting a plush lining. Women who struggle with lining issues may find better success when they can concentrate just on growing a good lining during a FET. But that has never been my problem (fingers crossed it stays that way). At my last egg retrieval my RE commented on how perfect my lining was. My lining is always ready during my stim cycle. My daughter was a fresh transfer too. So why wait and put my embryos through the stress of freezing and defrosting?
  3. Do a 3-day transfer of however many embryos I have instead of a 5-day transfer. So if we are already doing a fresh transfer, why grow them out to 5-days instead of putting them back on day 3? Well, if you have several embryos then allowing them to develop to day 5 and selecting the best looking blasts can be a good technique. It will narrow down the pool. But I already know I’m not going to have a large pool of embryos to select from. And at age 40, I’ll be fortunate if one of them is normal. So why wait? My RE, as well as many others, thinks that maybe the uterus – the embryo’s natural environment – is a better place than the lab to grow embryos. And I believe that too, even if it’s just opinion. Can a petri dish really match mother nature? I doubt it. The lab can be a hard place to be, especially for embryos from older women that may be more fragile. Typically the medium that the embryo is floating in is changed on day 3 and that can be stressful. Many women loose a lot of embryos from day 3 to day 5. Why not give the embryos the best fighting chance at development in their natural environment where they can get what they need?

When I proposed this 3-part plan to my RE, I prefaced it by saying, “I want you to try a hail mary with me.” (Yes, that’s a football reference.) I thought I was proposing a long shot. But to my surprise he laughed and said that that was the exact same plan he was going to propose to me. He thought that it is actually a smart plan given my history.

So we are doing IVF like they did years ago, back before the science may have gotten in the way, at least to some extent. I know this may not bring me my miracle baby. I know that if I get pregnant, and that’s a big if, I will be at higher risk for miscarriage and chromosome issues due to my age. And that will be stressful, scary, and heartbreaking if something goes wrong. But that is the same risk that fertile women have during any natural pregnancy. It happens all the time. And at least this will give me a chance at pregnancy – something I haven’t had during these last 3 rounds of IVF.   

And on a side note, we are saving one of our “abnormal” embryos because the issue that it has is one deletion and my RE said there is simply no way of knowing if it might self-correct. He said it will either miscarry or correct and be fine. The lab we used doesn’t say if it’s mosaic or not – they call all mosaic embryos “abnormal”. So there is some chance this one could make it. I’m keeping this embryo just in case I need one more “hail mary”. My RE will transfer her if I want.

To PGS or Not To PGS – That is the question!

31 Wednesday Jan 2018

Posted by in IVF #6 with Fresh 3-day Transfer, Uncategorized

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When I started out on my journey for baby 2.0, I was pro-PGS testing. Completely on the PGS bandwagon. It sounded like a dream technology – something that will eliminate the concern for having a baby with a serious health problem, drastically reduce the risk of miscarriage or still birth, and increase my chance of pregnancy. And at age 40, that sounded too good to be true. But what if it is too good to be true?

After having a PGS normal embryo fail to implant at my first FET, I was shocked and devastated. After 3 subsequent rounds of IVF, 2 that resulted in no embryos even making it to blast for testing and the other ending in 2 PGS abnormal embryos, I began to seriously question the approach. The more I read about PGS testing, the more I carefully climbed down off of the PGS bandwagon. I started to read that although PGS is often recommended for older women, these older women, as well as women with diminished ovarian reserve (DOR), are the very women that may benefit least from PGS. In fact, it may actually lower IVF success rates!

There are several factors involved here. First, if you struggle to make blasts you may not even have anything to test on day 5. That means no transfer, which equals a zero percent chance of pregnancy. You might as well have saved yourself a bunch of money, shots, and ultrasounds and just had sex instead. At least that would give you some chance of pregnancy.

Second, more and more studies are coming out that call into question the accuracy of PGS test results. At my RE consult today, my RE pulled out a medical journal to show me a research study that was published just a few days ago where they transferred mosaic embryos. A lot of them. This was done in Italy. I didn’t have time to read all the details but the study found that all the mosaic embryos transferred made healthy, normal babies. In conclusion, the authors suggested that we should be transferring mosaic embryos and warned of how many babies are essentially being “thrown out”. This gets complicated because mosaicism isn’t necessarily an all or nothing thing – it comes in percentages – and some labs don’t even differentiate and instead call all mosaic embryos “abnormal”. But it doesn’t stop with mosaic embryos. Last year my own RE told me about a study he did where they biopsied embryos at day 5, but also immediately transferred one of the biopsied embryos during the fresh IVF cycle. That means they got the PGS results after the embryo was already transferred. One of the results came back abnormal (not mosaic) – it was an abnormality that was supposed to be incompatible with life. My RE and the staff all waited for this poor women to miscarry, and to their complete shock she did not. That baby is now a healthy bundle of joy. And there are lots of stories like this.

Furthermore, when you biopsy for PGS you are taking cells from the trophectoderm (TE), which becomes the placenta. Studies are showing a) that the TE contains more abnormal cells than the inner cell mass (ICM) that becomes the baby, b) that abnormal cells may even be pushed out into the TE to keep them out of the ICM, and c) that they may self-correct down the line after the blast stage. So when you are only biopsying the TE are you really able to make an accurate assessment of the baby? Maybe not.

One point that I found interesting in the articles I read explained that mathematical models demonstrate that when you only have 5 or 6 TE cells (a typical PGS biopsy) the rates of false negatives (saying an embryo is normal when it’s not) and false positives (saying an embryo is abnormal when it’s not) is simply too high to accurately determine whether those cells accurately reflect the ICM. Let me say that again – math says you just don’t have enough data to make a reliable determination.

I could go on, but I’m just going to link to some articles so you can do your own reading, if you care to. That being said, I do think PGS has its place.  If I made lots of blasts it could be a useful tool for helping my RE select which embryo to transfer. After all, when you have lots of blasts and several PGS normal embryos, the error isn’t as harmful. I can also see why women who have had several miscarriages would opt for PGS testing in an effort to improve the odds. But that’s not me either and I don’t have many embryos to work with.

For more reading on PGS, check out this study, this one, here’s another, and one last one. I wish I had a link for the Italian study my RE showed me today, but I don’t have electronic access to that medical journal. Ultimately it’s a hard and personal decision. Given my history, I’m not going to do PGS testing next time.