Tag Archives: Pregnant after IVF

Pregnant After Infertility: IVF reflections and the needle shot

17 Monday Sep 2018

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PicsArt_09-17-02.02.50I saved my IVF needles. All of them. That’s a total of 6 egg retrievals, 2 fresh transfers, 2 frozen transfers, and 2 mock cycles. Some people, including probably everyone who has never gone through IVF, would think I’m a bit nuts for holding on to all these needles. But it’s oddly hard to part with something that you’ve put so much of yourself into. Something that symbolizes an experience, or maybe a part of you.

I even have my needles from my very first IVF cycle over 4 years ago – the one that brought me my feisty daughter. At that time I think it was just feeling a bit overwhelmed that kept me from taking the time to bring them back to my RE’s office for disposal. I didn’t have any grand plans for them. But this second time around, I did. I kept the needles from each cycle in a separate sharps container. I envisioned making one of those IVF baby announcements one day when it finally worked. You know, the cute pictures where all the needles are arranged in the shape of a heart with care, surrounding baby’s first ultrasound picture. Maybe a onsie or booties, too. I was so hopeful back then, and it made me smile every time I saw one of those pictures.

But as my failed cycles piled up, so did my needles. The idea that once symbolized optimism and success, morphed into something quite different. Now I have a giant pile of needles. I’m actually missing about 80 percent of my Gonal F pens because my nurse would discard them when I’d bring them in for her to combine the tails to get me an extra dose or 2 of meds. My pile began to feel chaotic as one cycle blurred into the next. The FET that finally worked consisted of 2 embryos from 2 different egg retrievals; I lost track of which sharps containers led to which of these embryos.

I’m left with a big pile of needles and no desire to shape them into something pretty.

Why did I keep these needles? Because when I look at this pile on my table I see my pain and strength. I see determination and perseverance. Countless hours spent crying in the arms of my loved ones, and even more spent crying alone in the bathroom when no one knew. Friendships fading away, while unexpected ones blossomed when I needed them most. Miracles. I see isolation and connection. The highs and lows that no one really understands unless you’ve walked in my shoes. Failure and success. Baddassery (especially when I self administered my first PIO shot). Luck – sometimes good, sometimes bad. I see hours of research and hard decisions made. Coping skills executed and eventually exhausted. Asking for help, and helping myself. Enduring more than I thought I could, and then a little bit more. Making a healthy decision of when to stop and finding peace with that. The emotional, spiritual, and physical tolls. Pride in myself. Somewhere along the way, infertility became a part of who I am. It is not all of who I am, but it has challenged and changed me in ways I never anticipated. And I’m different now. Oddly, I wouldn’t change that.

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Me and my almost 4 year old IVF baby and 17 weeks pregnant with my second IVF girl.

If all goes well, I will be a mom to 2 daughters. Yet in my mind, I will always be infertile. Despite the failures, I got the outcome that we all hope for. I am so very blessed. And, well, really I think I’m just lucky.

Pregnant After Infertility: The anatomy scan

05 Wednesday Sep 2018

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close up of pink baby booties

I had my anatomy scan last week. As the day approached, I had my usual influx of paranoia that my baby had stopped growing. In other words, I was afraid my baby had died. There I said it – the “D” word. I’m always afraid to type that word. As though saying it out loud, or in this case typing it out loud, could make it come true. But that’s the fact of my feelings – oddly I’m not afraid that my baby has any disease or growth abnormality. I’m afraid of finding a silent heartbeat.

As soon as the scan began and the heartbeat was present, I was able to relax. Then my Maternal-Fetal Medicine (MFM) specialist proceeded through the lengthy process of measuring and calculating every detail of my growing baby. Reclined on a comfy table, I watched in awe and enjoyed every moment. I loved having my scan with a highly experienced MFM, who also happens to be a geneticist. He was able to explain everything we saw, not only the structures but also assumptions about functioning, with precision backed by extensive experience and knowledge. It really is amazing how much they can tell based on these pictures. For example, when they see fluid in the baby’s stomach, they can make assumptions about how the brain is functioning because apparently swallowing is a much more complicated series of behaviors than you would think, which relies on a well developed brain.

And every bit and part checked out perfectly. Could there by something wrong with my baby that they cannot see? Well sure, I suppose. But the chances of that are very unlikely. So unlikely that I’m not going to worry about it anymore. I know my baby is healthy.  I will, of course, continue to worry about my healthy baby dying before every appointment, even though that doesn’t make any logical sense. I mean, why would that even happen? It wouldn’t be due to some fetal disease or deficit, but sometimes things go wrong in pregnancy for other reasons. I guess my IVF stress has to go somewhere.

One slightly annoying thing we found out was that I have an anterior placenta. On the plus side, this means that my placenta did grow away from my cervix, as my OB thought it would. That’s great news and I’m thankful. But, seriously – how do you freak out an IVF mama-to-be? Give her an anterior placenta so she can’t feel the baby moving as often as she “thinks” she should. It’s a rabbit hole I’m trying to not go down. How am I doing with that? Well let’s just say that the other day my hubby walked in on me Googling “haven’t felt the baby move in 3 days with anterior placenta” and he simply said, “stop it.” I’m trying to stop it, really I am. I haven’t Googled anything today.

And last, but certainly not least. We found out the gender! With IVF baby #1 we didn’t find out until birth and that was pretty amazing, but this time around we decided to do it differently. We saw the telltale three parallel lines, clearly showing that we’re expecting a girl. So my daughter gets her wish – a little sister. I get all teary just thinking about it. I really thought she would never get to be a big sister and I am so grateful. Of course now all of a sudden she says she wants the baby to be a brother – but 3 year-olds are fickle little ones.

Pregnant After Infertility: First appointment with the new OB

09 Thursday Aug 2018

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tim-goedhart-334149-unsplashThis week I met with my new OB. He came highly recommended by my RE and many other moms in my area. He actually spent a good amount of time with me and did a much more thorough ultrasound than I was expecting. He also seemed sensitive to the fact that I wanted – no needed – to get right to the ultrasound part as fast as humanly possible. I don’t think the fear of loss gifted to us by infertility ever goes away during pregnancy, and possibly not even after birth. So like usual, I was pretty much in a state of panic as I walked into my appointment, fearing that the baby maybe be, well, you know. And so we got right to it.

With a tear of relief, I saw the familiar flicker of my baby’s heart beat even before my OB could get the words out. After all, by this point I know how to read the basics on an ultrasound – from follicles to heart beat. Then he went through and diligently measured all of my baby’s parts, sounded off measurements, and assured me that everything was normal, and there were no markers to be seen of any deficits or disease.

I did find out, though, that my placenta is covering or partially covering my cervix. He followed this fact with reassurance that this is really common at this stage, I’m 15 weeks pregnant, and the placenta usually moves around as the pregnancy progresses. He said in most cases, this will resolve itself, but if it’s still covering my cervix at 20 weeks then that could be a placenta previa. I’m sure he quickly realized his mistake in telling someone like me about this, as panic washed over my face. When I asked what that could mean, he said that I would need a c-section (a mute point for me, since I’m going to need one anyway) and could cause bleeding after 20 weeks. Although I hadn’t read much about placenta previa prior to this, I knew that it could also mean other “bad things”. But I’m doing my best to not go Google-crazy or think the worst. Hopefully, my placenta will pack its bags and settle in somewhere away from cervix land.

And speaking of my placenta (because that’s a phrase I use often), my RE had me come back the day after this ultrasound for one last progesterone check. I had been off all progesterone supplementation for 3 days so we were hoping to see that my placenta was pumping progesterone like a champ. After looking at my placenta and baby, my OB assured me that my RE would tell me my progesterone level is fine and I don’t need any more supplementation. But, no, that’s not what happened. Of course not. My progesterone level came back at 19 and I was told to continue using Crinone once per day until 20 weeks. At that point, I was told to simply stop. Not sure why we would stop then, but of course, I’ll be insisting that my OB check it again at that point. I’m not leaving anything to chance.I’m way too obsessive and controlling for that crap.

During the second trimester, a normal progesterone level is 17 to 147 ng/ml. That’s quite a range, and my level is in that range. I guess my RE continues to take a conservative approach with me, which I don’t mind. I mean, Crinone is a nasty little demon and I’d love to not use it, but hey – I’ll do it for the baby. I may completely forget what it’s like to have sex, but what’s a few more weeks? And in case you’re curious, yes you can have sex while on Crinone, but it leaves this chunky, waxy white substance in your vagina – think cottage cheese on steroids – that you have to periodically scoop out with your finger. Sounds attractive right? My fear is that if we have sex, the Crinone wax will get packed into places that I simply can’t reach. If I was planning a vaginal birth, I’d be afraid that my baby would be forever trapped behind a Crinone wax fortress. Good thing there’s another way out.

The last little bit of interesting information from my OB appointment, is that my OB asked if I’d like to have my tubes removed during my c-section. Wait, what? While preventing a natural pregnancy is laughable – as if that would ever happen – the main reason he offered to remove my body parts is that current research is finding that a majority of ovarian cancers actually originate at the ends of the Fallopian tubes. So the idea is that if you remove tubes you don’t plan on using anyway, you could prevent, or at least significantly reduce, your chance of developing one of the most deadliest forms of cancer. This info is completely new to me and I’ll definitely have to do some research. The procedure is called salpingectomy, and is not to be confused with a tubal litigation (i.e., “getting your tubes tied”). The former completely removes your tubes from your body, while the latter cuts, ties, or blocks your tubes and leaves them inside your body. I’ll post my finding on this topic in the future when I find out more.

So for now I have about 3 more week of peace until the panic returns the night before my next ultrasound. That one will be my anatomy scan, which is scheduled for my 18th week. I’ll be doing that with a maternal-fetal-medicine (MFM) specialist – the high risk pregnancy doc – not because I’m necessarily all that “high risk” (age blah, blah, blah), but because that’s who I saw last time around and so I was scheduled with him again. Besides the MFM has a much bigger ultrasound TV screen and the plushest exam table I’ve ever laid on. So yeah, I’ll take my anatomy scan luxury style.

Pregnant After Infertility: A day for me

26 Thursday Jul 2018

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Tomorrow is the full moon and also happens to be a lunar eclipse. It’s apparently the longest one of the century, clocking it at a whopping 103 minutes of darkness – too bad I won’t be able to see it here in North America, but still it’s pretty cool. For those of us who celebrate the Wheel of the Year, it marks the lunar Lughasadh, which is the exact halfway point between the Summer Solstice and Autumn Equinox, and is celebrated as the first harvest festival. It’s a time of reaping rewards, abundance, and gratitude. And if all that weren’t enough, it’s also my 41st birthday. Yeah me! Bust most importantly to me, it marks the first day of my second trimester. A milestone.

 

So to celebrate the plethora of events tomorrow, I plan on taking some “me time”. I’m off work and going to spend the day alone. Now I know that may not sound all that fun, and yes I do have a fun day at the lake planned over the weekend with some family, but to me it’s perfect. A walk on a nature trail, a treat of a decaf latte and something yummy to eat, a gratitude meditation, maybe some Netflix. But mainly just letting myself relax, at least a little bit more, into this pregnancy.

 

I’ve bought a couple of baby things. Very few, but still it’s something. It’s hope that this baby is going to be okay and will actually be born safe and healthy. It’s so easy to let the little stings of anxiety tug at the back of my mind. If I don’t cut them as soon as I notice them, they start to pull me in a scary direction. Most of the time I’m good at letting it go, but sometimes I give in to Google and Facebook posts that highlight the hard reality of all that can still go wrong. But not tomorrow. Tomorrow is just for me and this baby.

 

After continued monitoring of my progesterone levels (I wrote more about what’s been going on with in my last post), it looks like it’s finally raising. At my last check (on 13w4d) it was 22.8. Still my RE wants me to stay on Crinone a bit longer. So I’m to continue inserting that horrid gel twice daily until August 3rd. Then I stop for 3 days and have my progesterone level checked again. We shall see if my placenta notices the change and ups it’s production. I’m still not in a danger zone, just low normal I suppose. But it does need to be a bit higher in the second trimester. Maybe it’s already kicked more into gear these past few days. Let’s hope so.

Pregnant After Infertility: Wake up placenta!

11 Wednesday Jul 2018

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A common question that you will inevitably hear repeatedly in any pregnant after IVF group is, “when did you stop progesterone?” Whether it be PIO shots, vaginal suppositories, or pills, the stress surrounding stopping progesterone support is real.  The fear, of course, is that you might stop too soon, begin bleeding, and the ultimate fear – miscarry. So when is the right time to stop?

See, we assume there is actually one right answer to that question (how silly of us), but, like all things infertility related, there just isn’t. Some RE’s have their patients stop progesterone supplementation as early as 8 weeks, while others have you injecting, inserting, and popping until a whopping 12 weeks. It seems like 10 weeks is a pretty common stopping point though. But we’re all afraid when the magic week hits. Some women are certainly relieved to finally be able to set the needles down and let the rear heal (and yes, it will get back to normal eventually). But still, there is that touch of fear. Or sometimes unrelenting anxiety.

So why all the variation in protocols? Well for one, if you Google “when does the placenta take over” you will get multiple answers. Of course. The responses tend to range from 8 to 13 weeks. Apparently, each woman can be a bit different. But clearly most RE operate under the assumption that that the placenta will be producing enough of the hormones needed to sustain the pregnancy by week 10. So we’re just supposed to trust that we fall into this norm, right?

There’s another factor that often isn’t talked about, and it has to do with how progesterone is normally made by the body in early pregnancy before the placenta takes over. In a non-medically assisted pregnancy, once the follicle releases the egg during ovulation, the follicle becomes a Corpus Luteum. That little corpus luteum has a big job – it produces all the progesterone needed to sustain the pregnancy until the placenta steps up to the plate. Now think about this. When we do IVF, we retrieve anywhere from a couple eggs (although a few struggle to even get one) up to a crazy amount of eggs that probably results in ovarian hyperstimulation syndrome. Let’s just say, for the sake of argument, that you retrieved 10 eggs. So now you have 10 corpus luteums pumping out progesterone. If one of those buggers can sustain a whole early pregnancy, just think about how much progesterone you’re getting with 10.

So the point of this dive into the ovaries is to say that if you do a fresh transfer following an egg retrieval, or even a natural FET where you ovulate first rather than being suppressed, you don’t actually need any progesterone supplementation. Yep, you read that right. At my last fresh transfer, when my RE said I wouldn’t need to do PIO, I was surprised. When we did my first IVF/fresh transfer 4 years prior, which led to my first pregnancy,  I did PIO for 10 weeks. So I asked him what had changed. He explained the ovary operations to me and also told me about a recent study that compared progesterone supplementation to no supplementation in women who had a fresh transfer. They found that both groups of women had comparably high levels of progesterone. So I was happy to forego the  dreaded PIO that cycle, but I still wanted more evidence for my own peace of mind. They obliged my paranoia and tested my progesterone levels even before my beta, and sure enough my progesterone was quite high.

So when women who have “ovulated” either naturally or through an egg retrieval say that they stopped PIO at 8 weeks, or whenever, it’s really not the same as it is for women who did a FET and were medically suppressed to keep them from ovulating before the transfer.  The former group didn’t actually need PIO in the first place.

The situation is quite different for those of us who did a FET and did not ovulate. We are completely dependent on those injections, or whichever form you take, to support the pregnancy until the placenta starts doing it’s job. And that’s why it’s so scary to stop in this situation. That’s why when I read that the placenta takes over anywhere from 10-12 weeks (or insert other time frames since there are differences depending on what you read), I’m left to wonder, “but what if mine hasn’t taken over quite yet?”

Apparently my RE is just as cautious as me. When I brought up my concern, without missing a beat he agreed with me and suggested we test my progesterone level. That way, we would be making our decisions based on what is actually going on in my body rather than relying on averages and assumptions. I appreciate that. So, at my second ultrasound we drew my blood since I had been off of PIO for 2 days. Apparently that’s enough time for it to be out of the blood enough to get an accurate reading of what my placenta is up to. The ultrasound was great – baby was growing on time, moving, and had a healthy heart rate of 158. Thank the Universe!

Later that afternoon I got a call from my nurse saying that my estrogen was great, and my progesterone was 15.2. She said above 10 is fine, but my RE would have liked it to have been closer to 20. She said mine was low-normal. So, for the sake of being cautious I was instructed to go back on crinone 2 times daily (great- twice the grossness. I fear I may never get all of that wax out of my vagina, but I digress) for one more week and then they will re-test my progesterone. Unlike PIO, which does show up in your blood, vaginal suppositories don’t make it into the blood stream. So by only taking crinone, I would be getting enough support where I needed it, but we’d still be able to keep monitoring just what my placenta is producing. Not bad, and I don’t mind the cautious approach. I know my RE is doing everything to make this work – we all tried so hard and for so long to get here.

Yesterday, one week had passed and I was re-tested. I fully expected to see a jump indicating that my placenta had kicked into gear by 11 weeks 4 days. But my level was 14.6. The nurse that called me, who was different from the first, basically said it was fine and I can stop progesterone. But I didn’t like that answer. I mean, if 15 wasn’t ideal, why would 14 be when the level should be going up? So the nurse checked with my RE, and reported back that he said to stay on crinone for 1-2 more weeks and re-test. So I’m scheduled to re-test in 2 weeks. By then I’ll be just over 13 weeks and my progesterone level should be consistent with the normal range for the second trimester, which is about 17 to 146 ng/ml. So here’s to hoping that my placenta does it’s thing and starts pumping more progesterone. If it doesn’t? Well, some say that is a reflection of an unhealthy baby that will miscarry, and others say that the baby may be healthy and continual progesterone supplementation helps to get to full term. I’m sure the answer varies pregnancy to pregnancy. At this point, I’m reminding myself that my level is still in the normal range and I have about 2 more weeks before I hit the second trimester, so there is plenty of time for that to increase. I also haven’t had any bleeding or cramping, which could (or could not) signal an issue with progesterone.

In case this post has peeked your curiosity about progesterone levels, know that they vary based on trimester and the normal range is pretty broad. Most RE’s don’t test when they discontinue your progesterone, and most women are perfectly fine. I’m overly cautious, and I guess I worry that my age (I turn 41 in 2 weeks!) maybe my placenta isn’t working as well as that of a younger, perkier placenta. Of course, then I remind myself that when I was younger and going through infertility the first time around I found plenty of other reasons to worry about why my body wasn’t working right. I think it’s simply infertility that makes us this anxious and we always find some reason to worry. In any event, below are the supposedly normal ranges of progesterone by trimester, and you can read more about early fetal development and hormones here.

Guideline to Progesterone Levels During Pregnancy:

9-47 ng/ml First trimester

17-146 ng/ml Second Trimester

49-300 ng/ml Third Trimester

* There are many averages for progesterone levels. These charts are a very broad guideline – speak with your health care professional for more specific guidelines for you.

** Remember – these numbers are just a GUIDELINE – every woman’s hormone level can rise differently. It’s not necessarily the level that matters but rather the change in level.

Source: American Pregnancy Association

Pregnant After Infertility: The first ultrasound

19 Tuesday Jun 2018

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Last week I had my first ultrasound just after 8 weeks. I was terrified. While I hadn’t had any cramping or bleeding, I simply couldn’t let myself off the hook. I mean, women have missed miscarriages right?!  Oh and if you are wondering, a missed miscarriage is when the baby stops growing but you don’t know it because you didn’t bleed or cramp. Since old habits die hard, I googled all the symptoms of missed miscarriages, like any good infertility patient.  Apparently, it might be a missed miscarriage if all of your pregnancy symptoms completely stop. Or you can still have all of your symptoms and still find out that you’ve had a missed miscarriage. Just lovely. My symptoms had decreased, but I guess it could happen either way.

So with trepidation, I went to my clinic and my husband met me there. I swear it was like I was approaching the stage for a big presentation or race. All eyes were on me. As I walked down the hall, every staff person stopped and smiled at me reassuringly, wishing me luck, but it almost looked like they were nervous too. My clinic is relatively small, I think, with only 2 RE’s and everyone discusses the cases together. Each nurse or tech has been involved with me multiple times over the past 5 rounds of IVF, 2 FETs, 3 ERAs, and lots of tests and procedures. They’ve all had a hand in my reproduction. Strange, but also oddly heart warming.

My RE did my ultrasound and right away he found one tiny baby. He quickly assured me that the baby was measuring right on time and had a heart beat. Relief flooded me. The nurse handed me tissue for my tears. Then my RE measured the heart rate and it was right on target at 155. More relief.

After we were done, each and every staff person, from my RE to the receptionist at the front desk, came and hugged me. There were cheers and tears. It had been a long road. And the caring support felt great.

So here we are. Pregnant with a singleton and off to a good start. But still I think about the worse case. Infertility seems to wire us to think this way, and it’s something I try to let go of. Still, I had heard from the grapevine that once you confirm a healthy heart beat in the ultrasound, the risk of miscarriage drops to 5%. I asked my RE to verify if that’s true. He said that at this point, 8 weeks, the risk drops to 10%, then once you still find that things are going well at 10 weeks the risk drops to 5%, then gets even lower at the end of the first trimester. So I guess I have a 90% comfort level right now. I was hoping to be 95% confident, and yes that extra 5% seems like a big deal.

When the anxiety comes up, I logically remind myself that my chances for a successful pregnancy are great. Sometimes I mindfully let the negative thoughts float past me. Acknowledging them, but simply letting them float by without judgment. Most of the time I can do this. My husband said he wished he could spray me with a “dumb spray”. I know it sounds bad, but his heart is in the right place. He wishes he could take the fear away and turn me into one of those blissfully naive women who don’t worry about early pregnancy and can enjoy it. He knows the toll infertility has had on me, and how hard it can be to let the fears go and celebrate the moment.

I think it gets a tiny bit easier each day. This time around I’m more prepared for how this works. I’m grateful to be pregnant after IVF and I’m trying my best to enjoy the moment. I still don’t feel particularly connected to this baby, as I have this lingering notion in my mind that my pregnancy isn’t secure until after the first trimester. I know that horrible losses occur after the first trimester, but I’m not allowing myself to go there.

bookI have a book called, “Spiritual Pregnancy” that interestingly was written by an couple who both happen to be OBGYNs. I find this book unique in that it is written from a spiritual perspective, but authored by MDs. Not to say that MDs can’t be spiritual, but it’s not often what you find in sterile, clinical settings. The book contains lots of meditative practices and journaling ideas for connecting with your growing baby, yoga poses to support the different stages of pregnancy, info on baby’s growth, as well as many other topics to support connection and a mindful pregnancy and birth. I think anyone who has a spiritual pull, regardless of religious affiliation or lack thereof, could enjoy this book. I started reading the beginning section for the first trimester, but I find myself not really engaging in reading much while I wait for the second trimester. I guess I’m still afraid to connect with the baby in case something goes wrong.  I suppose I have some reading to do.