Tag Archives: IVF

The Liminal Space After A BFP

11 Monday Jun 2018

Posted by in Pregnancy After Infertility

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It’s only been 3 weeks since finding out that my FET actually worked, but it feels like a lot longer. Since my initial HCG beta, I’ve had 2 more betas and each had doubled appropriately. Each beta brought temporary relief and renewed confidence. All in all, I’ve been maintaining a decent level of calm, right up until about 3 days ago. Since then I’ve been beating back that feeling that, I think, goes had in hand with pregnancy after infertility. It’s the feeling you get when you know just how fragile something is. When you know how easily it can be lost. And how frequently “bad things” happen. How I wish I could be blissfully naive.

When I see women posting pictures of positive pregnancy tests, as they announce to the world that they are having a baby, I cringe in silence and hope that they really do end up with that baby. Or I roll my eyes and spat out, “idiot!” You know, it depends on how my hormone cocktail is affecting my mood that day. The reality is that those of us who struggle with infertility have a deeper level of understanding about what all can go wrong. And that makes the early weeks, even months, of pregnancy after infertility a peculiar time.

I feel like I have to pause to state specifically how grateful I am to be pregnant at all after my FET. So let me be clear – I am grateful. I would rather be riding in this anxiety boat than preparing the ships for another turbulent round of IVF, no contest. We all work so hard to hopefully get here. But I do want to acknowledge the strange liminal space that comes after a big fat positive (BFP).

The psychological impact of infertility does not go away with a positive pregnancy test. Sometimes, it doesn’t even go away when you get the baby in your arms. Trauma, depression, sadness, anxiety, fear, anger, guilt – these emotions can be carried forward. Sometimes their faces changes, but in some ways they may go with you. At least for a while. This concept caught me completely off guard when I became pregnant after IVF 4 years ago. In fact, it wasn’t even until the second trimester that I even realized how numb and detached I felt. That’s never how I imagined I’d feel after trying so hard for so long to get pregnant. And I was too ashamed about that to tell anyone.

The problem was that no one talked about it. So that’s why I’m bringing it up, because I know my experience isn’t unique. The infertility community is a wonderful support resource. But it can be hard to share anxieties and fears with those who are still struggling to get their BFP. And rightly so – I get that. Assumptions of happiness also come from family and friends, sometimes from our partners too. But I think it’s important for women to know that it is normal to not feel ecstatic after a positive beta. You don’t have to feel guilty for that – we’ve felt guilty about enough crap, haven’t we?

So what can we do when we are standing at the threshold of pregnancy land but we still feel like an infertile imposter?

First and foremost, I think just knowing that these feeling can happen and are normal is a huge step. I was literally blindsided, and when I realized what was going on I wondered why no one talked about this. As a psychologist I’ve worked a lot with trauma survivors, and I realized that there’s an analogy there. When you take a person out of a traumatic situation, we all know that there is going to be carryover effects. For example, when a soldier comes home from war, we know that simply being home and no longer being shot at doesn’t make all of the symptoms of post-traumatic stress disorder (PTSD) go away. Not by a long shot. I’m not saying that all women who go through infertility have PTSD, although some may. But, we can’t simply remove a woman from infertility and expect that she is going to be all smiles and have no remnants of the pain that she went through. Yet, a lot of people kind of expect her to.

When women talk about the unique experience of pregnancy after infertility – and not just the side with rainbows and kittens – we create awareness, normalize the whole continuum of the experience of infertility, and foster honest support. I’ve found some Facebook groups specifically geared toward pregnancy after IVF, but honestly they were harder to find than the infertility groups. I think these groups can be valuable since it provides a space for opening up about these feelings to women who can likely relate, without being insensitive to those who are still in the IVF trenches.

Lastly, I just want to say that we need to be kind to ourselves. That is true no matter where we are in this process, and it doesn’t end with a BFP. And this is particularly relevant to me today as I sit here anxiously awaiting my first ultrasound tomorrow. I’ve reluctantly analyzed every symptom in a futile effort to determine whether this pregnancy is still progressing – whether we’ll find a baby with a heart beat in there tomorrow. It doesn’t feel real. I don’t feel connected to this baby. I’m scared to, because what if… But I know that right now this is out of my hands. My body will do what it intuitively knows to do, and if this embryo is healthy then it will still be growing. If not, I will find a way to cope. I hope I don’t have to, but I will. If infertility has taught me anything, it’s how strong I am.

An Unlikely Outcome to an Unlikely FET

22 Tuesday May 2018

Posted by in FET #2 (after IVF #6)

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Yesterday was beta day. I didn’t even bother taking the day off of work because I was prepared for the outcome. I basically expected this to fail, again. After all, it was an unlikely FET. The fall seems a little less painful when you set your expectations so low. In fact, in the days leading up to beta day I really wasn’t even anxious. My husband was a nervous wreck, but he had high hopes. I’d just smile kindly at him and think to myself, “you poor, sweet fool.”

So I decided to go first thing in the morning for the blood draw, then do my PIO shot, and only after I got all of that out of the way, then I planned on taking a home pregnancy test (hpt). Women who take hpt’s and get negatives, but still have to go through all the motions until the confirmation beta must be made of steel.  I just can’t imagine going for a blood draw and taking meds if I already knew it was a bust. Still, by doing the hpt after all that, I at least save myself the dreaded all day wait for the nurse to call to deliver the results. Plus, as I learned from my last cycle, this method allows me to get the news on my own terms rather than from an awkward nurse who isn’t quite sure how to break it to me. I’ve had enough of those awkward nurse calls, thank you very much.  

It was a long 3 minutes waiting for that hpt. Seriously, how can 3 minutes take that long?! After waiting in another room for the seconds to crawl by like a dying snail in the sun, I went in to see the test. I couldn’t believe my eyes. For the first time ever, there were 2 lines. And they were nice dark lines. OMG!

My hands were shaking so bad as I picked up the test and tried to use my phone to tell my husband. I sent pictures of the miracle test to the people who are close to us that have been supporting us all along. These are the few people I would tell regardless of the outcome. I prefaced each text with, “don’t get to excited yet, but…”. Because I wanted people to stay calm and rational about this. No one did, of course, but I guess really I’m just trying to keep myself calm.

I waited 4.5 hours for the nurse to call with my beta results. It seemed like a whole day at least. And I finally got good news. My HCG was 365. A solid number. I had a moment of relief.

To my confusion, my clinic recently changed the way they do betas, so they weren’t planning on doing a second beta until a week from now. Honestly, I don’t get that since the doubling time is more important than one number. But I guess it’s because they are doing them later now, rather than earlier (mine was 12 days past a 5 day transfer, which is like 17 days past ovulation), so if you have a good HCG level at this point they are less worried about it, I guess. I’m not less worried though, so I asked the nurse for a sooner beta. She agreed and said I could do another on Friday, which is 4 days later. I’m sure I’ll hate myself for asking for this come Friday morning, but hopefully by the afternoon I’ll have a little more reassurance.

So here I sit, pregnant. I’m still in shock. The beautiful hpt is still sitting on my desk a day later. I don’t know what to do with it, but I can’t bring myself to throw it away. It was very hard won. It’s like gold. Maybe I’ll take it for a walk later or pet it. I never had one of these with my first IVF pregnancy because I was so traumatized by years of negative tests that I was simply too scared to take a hpt, even after my positive beta.

Despite the shock though, somewhere inside of me is a calm. It’s the same underlying calmness that I felt during my pregnancy with my first IVF baby 4 years ago. I had that calm despite 2 rather large bleeds that were reminiscent of crime scenes due to a nasty subchorionic hematoma early on in that pregnancy. It’s a calm that says, “everything is going to be okay,” despite the statistics that might suggest otherwise. If I let my analytical mind begin to stir, I start mulling over miscarriage statistics for my age, and panic starts to pound in my chest. So I’ve decided to simply be irrational and not think at all during these next weeks. Is that possible?

One thing I do know for a fact is that worrying will not change the outcome, it will only make me miserable in the process. So I’m making the conscious decision to trust that calm wave that’s flowing through me right now. Maybe it’s my intuition telling me that everything really will work out. Maybe it’s hope sneaking in. Maybe it’s completely irrational. Whatever it is, I’m going to go with it. Otherwise I’m not sure how I’d survive the next 4 days.

Of course, this may be easier said then done. Must. Stop. Thinking.

Do you trust your RE?

15 Tuesday May 2018

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When you become involved in the online infertility community, you learn a lot about what happens with other women during treatment cycles. You quickly find that different doctors subscribe to different beliefs, strategies, and practices. Not all doctors or clinics are created equally. And sometimes the differences seem to teeter on negligence.

Just recently, in fact, I heard from one woman that her RE is recommending that she cancel or convert her IVF cycle to an IUI because her lead follicle grew too much and is “overripe”. She has several other eggs that are prime size for retrieval, but her RE subscribes to the idea that the healthiest eggs (that is, the ones most likely to become a baby) are the ones that respond first to stimulation meds, so if you miss your lead follicle(s) you may blow your whole cycle. Compare this to RE’s who purposely “sacrifice” lead follicles to allow smaller ones to catch up in hope of gaining a bigger harvest. Their belief is that with more eggs retrieved, you have a better chance of getting the baby. Two very different approaches, with potentially very different outcomes. This woman is stressed and torn about whether to forfeit this cycle or proceed.

Another women is fuming because for the second cycle in a row, her RE wasn’t able to retrieve all of her eggs due to issues with the dose and timing of the trigger. So her mature eggs are stuck in her ovaries. The RE should have known better and made adjustments after the first cycle.

Then there are the tests that should have been done, but never were. Protocols that weren’t individualized for women, who were treated like numbers instead. The examples can go on and on.

Some of this discrepancy is no doubt due to limitations in the research. Some things just aren’t fully known yet when it comes to assisted reproduction (or reproduction in general for that matter – the birds and the bees was clearly too simplistic). But a big part of that discrepancy also falls on the shoulders of the RE. They simply are not all built the same. And the most disturbing part for me, as someone in the health profession, is that not all RE’s stay up on the current research or are even qualified to understand the research (it takes training in research methodology and statistics to really understand the studies that are published. Just because it’s published doesn’t mean that the research design and/or statistical analyses fully support the conclusions drawn in the study). So some RE’s unfortunately aren’t up on the current findings, and some really don’t understand the findings that they read. I don’t mean to pick on RE’s – it’s like this in any discipline that attempts to bridge the gap between research and practice.  And then there’s the RE’s personal experiences, which can influence how they practice.

I often joke that I should be awarded an honorary degree in reproductive medicine after everything I’ve been through and all the studying I’ve done. Seriously, I know more about reproduction than my OBGYN. But all joking aside, I’m not an RE. I rely on my RE to advise me, make the best decisions for my individual case, be knowledgeable about current research, and care about making this work for me. And I do. I trust and respect my RE. I actually think he’s awesome for so many reasons.

And that gives me a sense of peace. I know that if this doesn’t end in a baby, it’s not because my RE wasn’t skilled enough or should have done something differently. That isn’t to say that I wish we wouldn’t have done some things differently, but I do believe that we did the best we could at each step with the information we had. And when we got new information, we changed things up accordingly.

Going through IVF is easier when you trust and believe in your RE.

It really is. In life we often have to advocate for ourselves, and I want to encourage women to speak up during infertility treatment. Ask questions – as many as you need to until you feel satisfied with the answers. Don’t be shy. And if you don’t feel comfortable with your RE – if you don’t believe in their skill and trust them – consider finding a new one. I know that’s not always an option. You may be restricted by insurance, geography, or other factors. But if you have the option, exercise it. If you don’t have the option,  it makes this difficult process that much harder.

FET, Emotions, and Control

11 Friday May 2018

Posted by in FET #2 (after IVF #6)

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Another frozen embryo transfer is complete. We transferred my 2 remaining blastocysts on Wednesday the 9th. One is the surprise embryo left over from my last fresh transfer, and the other was PGS tested and labeled “abnormal”. I know how that sounds, but you can read more about how my RE and I came to the decision to transfer these two here.  The transfer went well. Both embryos were thawed about 5 hours before the transfer and immediately began showing great growth. One was almost completely hatched. The procedure was easy and lots of laughs were shared among the RE, nurse, my husband, and I, as usual because my clinic is awesome. I did pre- and post-acupuncture, then relaxed.

FET blasts

Hatching day-5 blast, early blast day-6

And so there it is, I have two tiny embryos doing their thing in my uterus. And by day 2 after transfer, I completely lost it. Typically, the panic and worry doesn’t set in until much closer to beta day. Normally, I’m in a happy “pregnant until proven otherwise” state, with my hand on my belly sending good energy to my embryos. I envision it working and the good news I’m soon to get. I put all my intention, prayer, and determination into a positive outcome.

But not this time. This time, I feel scared to touch my belly and think of these embryos. I feel scared of being hopeful. Maybe I’ve simply gotten bad news one too many times.

Here’s where it gets tricky though. My mind has started playing games with me. I know a big factor influencing this is the estrogen and progesterone I’m injecting, which makes me not feel quite like myself anymore. Despite rational thought to the contrary, I’m scared that if I don’t set my intentions and focus on these embryos that maybe it will fail because I didn’t want it bad enough – because I didn’t try hard enough. You see, I’m a person who believes in both rational science and the magic of the universe and power of the mind. Sometimes I feel conflicted because these two sides of me don’t seem to mesh, while other times I have no problem seeing how beautifully they dance together.

The truth is I want to protect my heart. I don’t want to get my hopes up. I don’t want to spend this next week connecting to a baby in my womb just to find out that the embryos were dead all along.  It’s a set up for a big fall. But I’m scared that in allowing myself that distance, I’m somehow sabotaging the outcome. Like a self-fulfilling prophecy. Logically I know that can’t be true. My very first IVF, the one that brought me my daughter, I was absolutely convinced by beta day that it failed. Earlier in the wait I was more positive though. Then, years later when I transferred my PGS normal girl, I was certain it worked. And it didn’t. Last cycle I spent the whole time sending energy to my embryos, connecting with them, and sending my intention out to the Universe to be heard, yet none implanted.

My logical mind tells me that it doesn’t really matter what I do. At this point, whether my embryo implants and grows or not only depends on the strength and make up of that embryo. Inside my uterus, where my lining is perfect, there is silence, safety, and opportunity. I’ve done my part, and now it’s up to the embryos. But my emotional mind, and possibly my spiritual self, struggle to surrender to that.

At the beginning of this cycle I told myself that I wasn’t going to try to control or influence the outcome, which may only be a perception of control anyway.  Of course, I follow protocol instructions, take good physical care of myself, and all that. But I decided not to stress, over think, over analyze. I decided not to pray every night, light candles, or visualize. The Divine knows my desire, I’ve not been shy about it. So I let this one go. I surrendered to the Universe. I’ve been able to maintain that less anxious attitude all the way up until yesterday, when all the fear crept back in. When I started to second guess myself and whether I’ve done or am doing enough to make it work.

As though I can control it.

Maybe that’s the lesson here. To learn to truly let go.

 

 

In Other Words: Day #3 of a 3-day quote challenge

02 Wednesday May 2018

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Rounding to a close, today is the last day of my 3-day quote challenge. It’s been fun to share my some of my favorites because, let’s face it, during this infertility journey we all need a little inspiration and perspective. So before moving on to my last quote, a reminder of the rules:

    1. Thank the person who nominated you. One last thanks to CW from Almost Pregnant for tagging me. Be sure to go check out her blog if you haven’t yet. You’ll find great stuff there.
    2. Post a quote for 3 consecutive days and explain why it appeals to you.
    3. Nominate bloggers to participate in the challenge each day. My final tags are Silently Screaming and Serenity. Be sure to check out their blogs.

Today’s quote is a reminder of just how badass we all are – especially us infertility warriors.

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Photo: Pinterest

It’s simple but packs a big punch. During infertility treatments it’s easy to forget how tough we are when we focus so much on what is going wrong – with our bodies, our plans, our relationships, our eggs. But think about all the things we do in the pursuit of our dreams. We sacrifice. We endure pain. We get poked and prodded. We fall, and then we rise and do it all over again. We really are badass. And we shouldn’t forget it.

In total I’ve gone through 6 IVF cycles. I’ve always given myself the subcutaneous belly injections during the stimulation phase. Those were easy. Well, as “easy” as any of this ever gets. But I’ve always had my husband give me the intramuscular shots (IM). You know, the ones with the giant needles that go in the rear. Now, I’ve got plenty of booty, but still I always feared that if I stuck myself with that tree-sized needle I just might go too far and hit bone. The needle looks that big to me. I’ve had to do both progesterone in oil (PIO) and estradiol valerate intramuscularly. These shots have to be given at certain times. I have literally driven to my husband’s work site to have him give me an injection. (Umm, awkward much?) I’ve panicked when I thought he wasn’t going to be home in time to give me the shot. He’s turned down overtime to be home at the right time to administer my shot. It’s ridiculous.

This cycle I said fuck that. I decided to do the IM shots myself. I’m tired of waiting and worrying. I’m tired of being afraid.

So last night, while my husband was driving home late from work, I prepped my gigantic needle and gave myself the shot in my ass like an IVF boss. And then I smiled. Because I’m tough like that.        

If you missed Day 1 or Day 2, please check them out.

An Unlikely FET

19 Thursday Apr 2018

Posted by in FET #2 (after IVF #6)

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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)

10 Tuesday Apr 2018

Posted by in FET #2 (after IVF #6), Uncategorized

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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

03 Tuesday Apr 2018

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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

27 Tuesday Mar 2018

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

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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

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

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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.