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.

 

To women going through infertility…

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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

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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

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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!

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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.

PGS Results: Sad News

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Another blow. I got my PGS results today and both embryos are abnormal. My heart broke when I heard the tone of the nurse’s voice as she said, “I have your results…” It was easy to tell what she was going to say next. I don’t know the details yet about what is wrong with them, but I’ll have a consult with my RE next week to go over everything. For the first time I’m feeling truly hopeless in this process. I’m wondering if it is time to quit. I’m scared I’m damaging my body with all these medications. I’m worried about getting cancer. I’m worried about how much more I can take emotionally. I feel like I’m missing out on my daughter’s life, at least a bit, because I’m so wrapped up in infertility treatment and the emotional mood swings.

I’m wondering what my chances really are at age 40? I know it works for some women, but how many does it not work for?

There are so many emotions that go with this. Right now I’m vacillating between anger, numbness, and hopelessness. That’s not a good place to be in. I’m the type of person that likes to have a plan. A direction. I like to be in control, or at least have the illusion of control, yet this whole process feels so out of control. Waiting is maddening. And now I’m waiting a week for my consult with my RE to discuss my case and options for moving forward.

How do you know when it’s time to give up on a dream? When you read IVF support groups you see so many people saying, “don’t give up!” But is that really the best advice? Is that reality? I don’t think so. And that’s one of the hardest parts of infertility. You have to make hard decisions without the aid of a crystal ball. If I knew doing one more IVF would bring me a baby then absolutely I would do it. But I don’t know that. What if one more round brings me cancer or depression instead? These are the hard decisions.

I’m not sure where I am right now. Stopping and saying good-bye to my hopes of a second child, of making my daughter a sibling that she so very much wants to be – I’m not sure I’m ready for that. But I’m scared of doing another round of this.

I have a lot of questions for my RE. I keep questioning whether PGS testing is the best way to go. Some women, especially those who have a hard time getting blasts, do 3-day transfers under the idea that the body is a better environment for the developing embryo than the lab. Maybe that’s the way to go, or maybe I’m just fooling myself. Maybe at age 40 my eggs are simply not good enough. Yes, I have a lot to discuss with my RE and much to think about. I just don’t know that there’s any right answer. That scares me.

Waiting by the phone

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waiting 2It would be easy to think that the waiting periods would get easier after you’ve done this for a while. Like you’ve gotten good at it. But I’m finding that it seems to be getting worse as time goes on. In the beginning of this second IVF journey, I was optimistic and expected good results. After all, I had success with IVF in the past. But the longer this process goes on for, the more IVFs I’ve had, the more negative experiences I accumulate. After all, if I was getting lots of good news then we wouldn’t still be at this. So every time I have to wait for news – fertilization reports, 5-day progress reports, PGS results, beta results – my brain automatically pulls up all of the experiences and outcomes from my past waiting periods. It’s starting to feel overwhelming.

Yesterday it really hit me. I had been doing fine up until that point and feeling optimistic, but the day before my 5-day progress report (which my clinic doesn’t give until day 6, ugh), I started to recall my last 2 IVF cycles where none of my embryos made it to blast. Those conversations I had with the nurse when she told me rolled through my head on a loop. They even triggered other bad news conversations, like when my nurse called with my negative beta result. I dug into my bag of healthy coping skills and pulled out everything I could. I went for a walk, attended a yoga class, talked to supportive friends, made rational responses to the negative thoughts in my head, reminded myself of my inner strength, took deep breaths, prayed, cleaned the kitchen, drank a glass of wine (hey, red wine is kinda healthy).

And I made it. After waiting half the day today, my nurse finally called. Two of my 7 embryos made it to day 5 blastocysts and were of good enough quality to biopsy. They were hoping another would make it on day 6, but it ended up dying. The others didn’t last as long. So there it is. I have 2 going into PGS testing.

I’m grateful to have these 2 little embryos. Really. None of my embryos made it to blast in my last two rounds of IVF. So this is great. But I’m still really scared. I know that the rates of abnormal embryos are high for my age group. What are the chances that either of these 2 embryos are normal? Not good based on the statistics. But that’s the thing with statistics – they tell you the averages, the probabilities, but don’t actually tell you anything about you. I’m going to try my best to keep the faith and hold onto hope. We leave tomorrow to go on vacation and visit my family out of state, and I’m so thankful for that. It will be a good distraction to help me get through at least half of the waiting period for our PGS results. These are going to be a long 7 to 10 business days…

Another Egg Retrieval & Surprising Results

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Another egg retrieval down. My husband and I arrived bright and early at 7:30 am last Friday for the procedure. As per protocol, I had to give a urine sample. When they buzzed me into the back I saw my favorite anesthesiologist was there and shouted a welcome down the hall. The fact that I’ve been through enough infertility procedures to actually have a “favorite anesthesiologist” I find almost comical. Almost.  But it was great to know that I would be well taken care of, and as always, my RE and the nurses made me laugh and feel comfortable. The retrieval went well. We got 8 eggs, 6 of which were mature and they were going to try to mature the other 2 in the lab. Yep, that’s a thing. My RE was really pleased, and so was I.

That happy post-egg retrieval feeling typically only lasts one day until I get the fertilization report. Unfortunately, my fertilization rate has been really poor since beginning this process this time around. The best we’ve ever gotten was a 50% fertilization rate, which doesn’t leave you with many eggs when you begin with so few. This is a huge difference from my 100% fertilization rate at age 36. When the call came it was the embryologist on the phone. That was a huge surprise. He has never called me over the course of 5 egg retrievals. I paused and expected the worst. Was he calling because none had fertilized and he wanted to give me an explanation?

He told me that 7 ended up being mature…and all 7 fertilized! Wait, what?? I was shocked. I literally couldn’t believe it. He was very pleased and I cried. This means that this batch of eggs is of better quality than what we had been getting. In previous rounds, the eggs had a tendency of immediately dying when the sperm was injected, which is a sure sign of poor egg quality. Now I know we are far from being out of the woods. We still need to get some of these embryos to make it all the was to blastocyst. And since we are doing PGS testing, we will need to see if any come back normal, which is always a nerve wracking prospect since the results are based on a small sample of cells and there could be error. So there are many hurdles yet to pass. But this is a big win and sets us up for a fighting chance.

I am so beyond thankful for this chance. This is truly a synergy of science and miracles at its finest. Did we find the golden egg? We shall see, but I am hopeful. And now another wait begins.

The DHEA Debacle

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DHEA. It’s that supplement that’s often touted as a magical egg quality enhancer, and it seems there’s some good research to back that up. That doesn’t mean it’s good for everybody, and I’ve learned that the hard way.

I first read about DHEA in the book, “It Starts with the Egg,” which is a great book for women who are looking to improve egg quality and enhance fertility. Like every good student, I diligently read every word. Still, I was uncertain about DHEA as I knew it impacted hormones. My doubt was quickly set aside when my RE recommended I take it, along with a laundry list of other supplements, to help improve my egg quality when I first went back to him to begin the IVF process again at age 39 (and 8 months). I assumed that because my RE told me to take it that I should. Not really my smartest move. The problem is that my RE never tested my testosterone, which DHEA can increase.

I didn’t think much about it during my first IVF for baby #2. We got a PGS normal embryo and I thought all was well. After the FET failed we went right into another egg retrieval. When that one was a bust – resulting in zero blastocysts – I began wondering about my testosterone level. At the consultation to prepare for yet another egg retrieval I asked my RE about testing my level and he said we could. Then, unexpectedly, we changed protocols and started stimulation meds that same day. So there wasn’t any time for testing. During a monitoring appointment I asked the physician assistant who was doing my ultrasound if we could get that test done, and she said that it wouldn’t be good to do mid-stim cycle because my hormones would be all over the place. After that one failed too, I brought up the topic again with my RE. That time we had time to test as I waited for my period to start. I got the results on cycle day 1, which was also the day I began my meds for this current round of IVF.

When the results came back they were high. My intuition was correct. Honestly, I was irritated that they never bothered to test this before and I regret not testing it from the very beginning. The RE instructed me to stop DHEA cold turkey that day. I was told that high testosterone “could” suppress follicle growth and “possibly” negatively impact egg quality, though there aren’t definitive answers on this. He also said that my testosterone level would drop back to normal quickly, so that by the following week when my follicles are doing the majority of their growth, there won’t be a negative impact. What I didn’t ask was, “is the damage to my egg quality already done?” I’m thinking that since eggs take about 3 months to mature, it might not have been good that for the majority of those 3 months my testosterone was high. But I don’t know what, if any, impact testosterone could have at that early stage. I’ll hold that question for the next consultation if it comes to that.

I decided not to worry about this as I’m going forward with the cycle anyway, since the potential impact is really an unknown. There’s nothing I can do about it now. I’m hoping that I stopped in time to mitigate any significant harmful effect, and keeping my fingers crossed for finding that golden egg.

Tonight is my trigger shot for a retrieval on Friday morning. We are expecting about 7 eggs based on my follicle count and size. I feel like an old pro at this egg retrieval thing, but I hope this can be my last one.