And Then There Was None

Miracle will be 2 yrs old soon. Hard to believe it. I mean how cliche is it to say time flies, but boy is it so true. The past year or so I have found myself struggling through stages of infancy and toddlerhood only to blink and see a new stage upon me and miss the old stage like crazy.

Back in early 2014, we had 18 eggs retrieved via IVF with ICSI, 8 of which made it to day 6 blasts. 7 were put on ice and 1 transferred back fresh at that time. 5 transfers total, 6 embryos miscarried, 1 miracle baby boy & 1 embryo that never implanted.

Our last embryo was transferred back to us early this month. We had high hopes that it would complete our family and bring Miracle a sibling. The cycle failed. I sort of knew going into it that it would not work. That sounds awful, and so much for the power of positive thinking. I blame myself sometimes for my ‘mindset’, that maybe if I had been more positive it would have worked. If I would have taken it a little easier after the transfer. If, if, if.

And of course I blame my body. The actual transfer itself was a nightmare. The catheter would not go in correctly which was never an issue in our prior 4 transfers. I guess since I dilated the full 10cm during labor with Isaac things changed down there. Who knows. Finally it worked but the cramping was not ideal. I wasnt exactly relaxed.

And then there was the quality of the embryo itself. 30% of it did not survive the thaw. The inner cell mass was still in tact as it was the trophectoderm (aka future placenta) that died off. We were told that successful pregnancies have occurred with even 50% not making it and to stay positive. Sigh. It was just another sign in my mind that things wouldnt work.

But the truth is none of this even matters because in reality if it was meant to be it would have been right? So now we pick up the pieces and try to move on from life after IVF. There will be no more IVF for us. It has taken up too much of our lives for too many years and I dont want it anymore. This cycle brought back so many ugly feelings that I remembered all too well once they surfaced. And I dont want those feelings anymore.

IVF #1-Stim, Retrieval, Transfer, & the 2WW (all you ever needed, or wanted to know)

As promised, this post details our first IVF from the “stim” start to the pregnancy test.

Our goal is to share our experiences to those who are thinking of doing IVF, getting ready to do IVF, or have a friend or family member going through IVF.

Although every individual’s journey is different, we hope that this can provide you with some general insight on what to expect.  When we began IVF, we had a lot of these questions ourselves.

ivf

How often I went to the doctor for monitoring

Since we knew I would be going to the fertility practice a lot once our “stim” began (before egg retrieval, when you are pumping up your body to produce a zillion follicles that will hopefully produce nice, mature eggs), we arranged to start it over my Spring Break (teacher perk) so I didn’t miss work.  And if I felt lousy, I could relax at home.

Our stim was 10 days total.  Here are the days I went in for blood & an ultrasound, with my estradiol (fancy for estrogen) levels and follicle amounts (future eggs):

  • Stim Day 1-estradiol level 18
  • Stim Day 4-estradiol level 211; 16 follicles
  • Stim Day 6-estradiol level 744: 18 follicles
  • Stim Day 8-estradiol level 1556: 20 follicles
  • Stim Day 10 (trigger day!)-estradiol level 2619; 22 follicles

NOTE: It is important monitor the estrogen levels frequently because if they get too high, you can hyper-stimulate.  My doctor never wanted to see these levels rise much above the 3000 mark before retrieval to prevent hyperstim.  Many doctors will cancel the cycle before the trigger shot/retrieval if the levels are too high (we knew someone personally this happened to).

The doctor told us that our stim was textbook perfect! We were soooo happy since this was one of our worries. My body was reacting fine to the meds and we were moving on to the retrieval on day 12.

IVFbloodwork

The medications I was prescribed during “stim”

  • Follistim– 150 units once daily into stomach, rotating sides.  Easy injection, must be refrigerated.  Tip: Take it out of the fridge about 15 minutes before so the liquid isn’t so cold when injecting! Be sure to do this injection at the same time each day.
  • Menopur-75 units once daily into stomach, rotating sides.  This one stings a little & is a pain in the you know what because it doesn’t come ready.  You have to mix it! Unreal for the amount of money you are paying right?! I think a nurse should come with the meds for the cost. LOL.  We messed up the mixing once and I cried (those tears we talked about in prior post).  Thankfully, if you mess up, there will be (a little) extra of the meds, so don’t worry too much.
  • Pregnyl “Trigger” shot-this injection is done only 1 time which is 36 hours before the egg retrieval.  For me, it was on day 10 of my stim.  It is different for every woman based on how follicles are maturing when the ultrasounds are done.  I won’t lie, this shot royally sucks.  It is an intramuscular injection, unlike the Follistim  & Menopur which are subcutaneous injections (right beneath the skin).  They tell you to have your husband do this injection because it needs to be in the a*** in a specific spot. Initially, I thought I would have him do my injections for me.  When it came down to it, I would grab the needle from him.  Don’t ask me why, but I was more scared to have him do it than do it myself.  So, needless to say, I injected the Pregnyl & it hurt!
  • Prenatal vitamin/Folic acid/Baby aspirin 1x per day
  • Doxycycline- antibiotic to start the night before the egg retrieval and 2 days following

The medications I was prescribed after the retrieval until the day of the pregnancy test (if pregnant, continue Estrace, Crinone, Prenatals, Folic Acid, & Baby Aspirin until out of 1st trimester!)

  • Medrol-oral 4x per day, for 4 days after retrieval
  • Estrace-oral or vaginal pill 2x per day, this is estrogen
  • Crinone-vaginal suppository 2x per day (Yucky!), this is progesterone
  • Prenatal vitamin/Folic acid/Baby aspirin 1x per day

ivffollistiminjection

The Retrieval 

It was finally the end of March (remember we started birth control in February).  We couldn’t believe we made it to this day! This is a big step for an infertile. With IVF, you have to remember that anything can go wrong at any given time. So we were elated nothing had gone wrong…yet.

I remember feeling so ready to get those eggs out of me by the time the morning of the retrieval rolled around. I literally felt like a goose ready to lay a bunch of eggs LOL.  Totally bloated. Surprisingly, I wasn’t that nervous, just a little thirsty since I hadn’t eaten or drank since the night before.

When we arrived, my husband was taken to the “man room” to do the most important count ever.  I could tell he was pretty nervous.  Maybe that is why I wasn’t.  I knew if I was, it would make it worse for him, especially since he is usually so calm.  Turns out, all went well with Shane’s count; it was the highest it had ever been. Still low, but definitely an improvement.

He couldn’t be in the room during the retrieval, just the doctor, RN, & anesthesiologist. Once I was prepped and in the surgery room, the doctor showed me a tiny window pass through where the embryologist (and the sperm) wait for the eggs to be handed off to her immediately after they are retrieved. We elected to do ICSI along with IVF (where the embryologist chooses the bests sperm and injects them into the eggs).

I chose to be under general anesthesia for my egg retrieval rather than localized, or twilight anesthesia.  General anesthesia costs more, but it was worth it to me. When speaking with fellow IVF’ers, many told me the retrieval was the worst part of the process. Maybe.  When I woke up from the retrieval, we were informed that everything went perfect again! Another BIG step. We had heard horror stories of no eggs being retrieved and were scared to death it might happen to us.  We had 19 eggs retrieved.  Woohoo!!  The doctor seemed really happy & told us we would hear from the embryologist the following day.

#ICSI

The Days Following the Retrieval

Now we were biting our nails on whether or not any of these eggs and sperm would actually form embryos.  Remember, I told you it’s 1 worry at a time while you are breathing, sleeping, and eating IVF.

The embryologist called us the next day and told us that overnight:

  • 18 eggs were inseminated via ICSI
  • Of the 19, 13 fertilized normally with Shane’s sperm, forming embryos

More fantastic news! The embryologist would continue to be in touch with us over the next few days so we knew when we would be transferring.  In IVF, supposedly the longer the embryo grows, the better.  Why? It is like survival of the fittest.  The best embryos make it and the others usually don’t.

This made me laugh!!
This made me laugh!!

Day 3 after the retrieval we learned that:

  • 5 of the 13 embryos were no longer viable
  • 8 of these embryos were still viable and growing 🙂

Again, we were very pleased with the news.  However, the next few days I began to be a nervous wreck.  What if all of the remaining embryos die off like the 5 others did???  I was reassured it wouldn’t happen.  No one can assure you of anything during IVF.

Day 5 following the transfer we were informed that:

  • Our 8 embryos were still viable!  Thank God.
  • The embryos were graded as follows:
    • 3 embryos were 6AA (best grade you can get…hooray!!!)
    • 2 embryos were 6AB (second best)
    • 3 embryos were 6BC (not the best)
  • TRANSFER DAY WAS SET FOR TOMORROW!!
We made it to day 6!!
We made it to day 6!!

The Transfer

We welcomed the month of April 2014.  This is was the day/month we had been waiting for for years! Our transfer was 6 days post retrieval, the latest a transfer can be done before the embryos must be frozen. Many people have transfers as early as 2 or 3 days after their retrieval, depending on how well the embryos are doing.  Since this was our first IVF, and our embryos were graded great, we decided to transfer only one 6AA embryo.

The actual transfer itself is a piece of cake compared to the rest of what has been going on (it only takes about 5 minutes).  You get there about 30 minutes prior and they prep you.  You need to have a full bladder for the transfer so the uterine cavity is able to be clearly seen on ultrasound. This was hard for me because I have a really small bladder to begin with!  If you are in the same boat as me, you can ask them to fill your bladder for you (I learned this on IVF #2) right before they transfer the embryo.  This way you don’t even worry about drinking & miserably holding it.  After the transfer, they will drain it for you while you rest.  Ahhhhh.

Good news-this time hubbie gets to be in the room with you, and you are awake!! He sat by me & held my hand the whole time.  We were in the same room as for our retrieval so the embryologist can access the room with the embryo when the doctor is ready.  The embryologist actually comes in with a picture of the embryo before the transfer and discusses it with you. Again, all was going very well.  I was starting to think maybe this wasn’t too bad after all!

Then the RN begins by doing an abdominal ultrasound to make sure the bladder is full & the uterine cavity is clear.  If this looks good, the doctor cleans out the cervix since you have been sticking that gooey Crinone (progesterone) up there for a week now! Ughh. My doctor always plays music during transfers. Hey, whatever floats your boat I guess.  The lights are dimmed so it is actually more of a relaxing atmosphere than you would think.

AbdominalUltrasound

She then inserts a catheter (painless) into the uterus, and what’s nice is that you are seeing all of this take place on the ultrasound screen right next to you.  After the doctor makes sure the catheter is in the right place, she calls for the embryologist to bring the embryo in.  It feels like an eternity for this to happen.  Literally.  The embryologist brings the embryo in a catheter that fits into the doctors catheter.  You are praying that they both have very steady hands.  You start thinking what if they drop the catheter? What if they insert it in the wrong place?  Dear God.

The doctor releases the embryo and you actually see what appears to be a little white dot on the screen in your uterus! Super cool.  It could be your future baby!  After the embryo is in the uterus, you rest there for about 30 minutes. I make my hubs tell me jokes so I can laugh.  It’s good for the soul right?

Before we left, the doctor explained that everything went perfectly with the transfer.  Another step in the process accomplished.  We set the date of the blood test to see if we were pregnant for exactly 10 days later.  Yes, this my friends is what is called the excruciating 2 WEEK WAIT (even though it’s not really 2 weeks, it feels like 4, so it’s earned its name for sure).

#IVF, transfer

The 2WW

The next 48 hours are strict bed rest (missing more work for sure).  A lot of doctors aren’t big on bed rest, but mine happens to be.  If yours is too, make sure you have some movies, books, and good food of course.  We watched Frozen and I started reading Wild.  My hubs made sure I was off my feet and pampered me.  It was nice.

transfer

Then the new phase of worrying began.  I can’t lie, the next 8 days were difficult mentally.  Anyone who has been through IUI or IVF knows this. We both went back to work and tried to keep our mind off it.  Thankfully, I had state testing going on at school so that kept me somewhat focused.  But the thought of what if it didn’t work kept creeping into my mind.  It’s pretty consuming.

Day 6 post transfer we decided to go out to dinner with our family.  It was a Friday night, and my aunt & uncle were in town.  I remember sitting across the table from my mom and I could smell her wine.  A little later, my hubs came back from the bathroom and I could smell the soap on his hands.  I felt off.  That’s when I knew it had actually worked.  I was pregnant; for now.

#pregnancytest

 

To IVF or Not to IVF?

After the sperm count showed little improvement well after a year of his Varicocele surgery, we decided we would go back to meet with a fertility specialist.  Don’t get me wrong, we kept busy from 2012 up until 2014…I got my master’s degree, we got a new dog, we remodeled our master bathroom, we put in new floors throughout our house, we traveled. We pretty much did everything we could to take our minds off trying to get pregnant. But deep down inside our minds were still there.

We ended up choosing a different fertility practice this time than where we had done our IUI’s.  Let me tell you why.  As I mentioned in a prior post, the previous office had numerous doctors with various locations.  During our short time at the practice, we drove up to 2 hours away for an appointment.  And we knew if we did IVF there, it would be even more driving (not done at all locations).  We also disliked the idea of a different doctor possibly performing the procedures each time. The more times the same doctor is examining your uterus, the better we thought. Getting a second opinion from another fertility practice was very important to us as well.

We found another practice about 30 minutes from home, with a woman doctor this time.  Both of us just felt more at ease when we went to our initial consultation with her.  She spent at least an hour with us. We would not have to drive to different locations or see different doctors either.  Of course, I had taken all of our records with all of the “test” results to this appointment.  By now, these tests were over a year old, so guess what? Yep, you guessed it…REPEAT all tests! This entailed: a pap, blood work & a sperm count, genetic testing for both of us (a must before IVF), another HSG and SIS, etc.

All was normal with 2 exceptions: the sperm count and the genetic testing done on me.  It came back that I was a carrier for Prothrombin Thrombophilia, Hemochromatosis, & Gaucher’s, and I had the MTHR deficiency condition.

After you do genetic testing, the genetic counselor calls you and reviews the results with you.   I was told that none of what I was a carrier for, nor had a condition for, would affect reproduction.  The new fertility specialist we were seeing confirmed this at our next meeting.  In the case I became pregnant, all I would need to do is take baby aspirin for the Prothrombin & folic acid for the MTHR.  Easy enough!

She went on to tell us what we prayed she wouldn’t; without IVF with ICSI there was no real chance of us conceiving on our own.  And she said she wouldn’t bother to do IUI again and waste our money.  OUCH.

So, we met with the financial coordinator to see what we would be in for if we decided to do IVF.  We had already heard how costly it was. There are about 1 million different packages to choose from.  Seriously!  Packages can range from (here comes the jargon) 1 fresh cycle with 3 frozen cycles, to 3 fresh cycles with 2 frozen cycles, or you can just pay for one cycle at a time. To give you an idea, the price for a single fresh cycle with meds was around $14,000, and a multi-cycle (both fresh and frozen) was about $28,000. YIKES! Talk about breaking the bank.  After talking with the financial coordinator, we both needed a stiff drink to say the least.  How could we ever afford to have our family? 😞

ivfcost

Coping with Male Factor

Male Factor.  That was our official diagnosis as to why we were infertile back in 2011.  When they do a sperm analysis, they don’t just look at the count as many people think.  They look at about 7 other major factors too.  NOTE: I do not claim to be a doctor in anyway, all of this information is based purely on experience. Some of these factors are sperm volume, concentration, motility (IMPORTANT!), viscosity, PH, and morphology (ANOTHER BIGGIE!). When it comes down to it, the 3 most important factors are: count, motility, and morphology.  In other words, the amount of sperm, the rate at which they swim, and if they are shaped normal or not.  Don’t worry, I won’t get into all of the details and percentages like a doctor will and bore you to death, however feel free to ask if you are curious.

When we had our 2nd sit down with the fertility specialist after the 2nd count, he told us our only option was to do In Vitro Fertilization (IVF) with Intra-cytoplasmic Sperm Injection (ICSI).  WHOA! What? These are very common terms to the infertile couple even though they may sound foreign to a fertile myrtle (notice I emphasize may).  Basically, we figured out on our own that IVF meant retrieving my eggs and putting them with my husbands sperm in a dish in hopes they would form an embryo(s) that could be transferred into my uterus.  The ICSI part meant that instead of allowing the sperm and egg to join together on their own in the dish, the embryologist would pick the best sperm and inject them into the best eggs.

Initially, we wanted NOTHING to do with IVF.  It was so scary to even think about it.  We had friends that went through it and we knew what hell it was for them, whether they finally achieved the pregnancy or not.  Emotionally, physically, financially…we didn’t want anything to do with it.  So, we insisted that the doctor allow us to do an Intra Uterine Insemination (IUI) first. The doctor clearly told us there was no chance it would work as we only had a tenth of the sperm they recommend for this procedure.  We didn’t care.

Here’s why:  In my opinion, IUI is wayyyy easier than IVF.  The amount of hormones and monitoring by the doctor is significantly less.  Plus, it is much less evasive and significantly cheaper (IUI is only about $1,000 each round).  For us, IUI involved taking Clomid (sometimes referred to as the “gateway drug” for infertile couples) for a few weeks before ovulation, with ultrasounds in between to measure the size of my follicles, and when they were the right size, I would inject myself with a “trigger” shot (OUCH! This one was in the stomach though, not like the big daddy IVF one in the a** which is so much worse).  The trigger shot meant I would release my eggs (ovulate) within 36 hours. During that window of time, we would go into the doctor, Shane would do his part, and they would inject it into me.  It was definitely worth a shot to us.

Here’s the catch-the only way you can proceed with an IUI or an IVF is to have MORE tests done first.  Anyone embarking in the field of assisted reproduction should understand and accept that there will always be tests to be done on them. The two most common diagnostic uterine tests are the Hysterosalphigogram (HSG) and the Saline Infusion Sonohysterography (SIS).  Ask any woman who has had an IUI or IVF done and I bet she will know exactly what these are.  The HSG is an x-ray that checks your uterus to make sure your tubes aren’t blocked.  You go into the same type of room as you would for an x-ray, except you lay down and they inject a “dye” into your uterus through a catheter so they can see the uterus better.  I HATED this test the most of all tests (all 3 times I had it done).  It was uncomfortable and took about 20 minutes.  And there was an issue.  The doctor said my right tube appeared to be blocked and we would need to repeat the test to be absolutely sure (there was a chance I was just having a spasm that was causing it to appear blocked).

#HSG

So, I repeated the evil test and it came back normal, no tube blockage, just a spasm.  Next on the list was the SIS.  This one isn’t as bad.  I’ve had it done about 5 times.  Here a catheter is inserted and saline is injected into the uterus.  This test looks for things like polyps, fibroids, and scar tissue.  My first one came back normal and we were finally ready to give the IUI a go!  As you can see, it takes a while for anything in the fertility world to actually happen.  From the time we decided to do the first IUI until we actually did it, it was around 3 months later.

The day following my trigger, we went to the doctor for the insemination.  My husband did his job in the “secret room” while I was prepped in the room adjacent.  It took about 20 minutes because they have to wash, or spin out his sperm, finding only the moving ones with nice shapes.  There weren’t many they told us.  But, we were still hopeful.  Hey, it only takes 1 right?! I laid back and the doctor injected the sperm into my uterus through a tiny catheter.  Piece of cake! After I rested there for about 30 minutes while we talked. I took the day off work even though they said I could return to my normal activities. We went back in the following day & went through the same steps trying to make sure we timed the IUI perfectly right.  I took off another day to relax.  And then 2 week wait began (2WW).

In the world of infertility, this is one of the most dreaded times.  Seriously, Google it and you will see. During the 2WW, I tried to stay busy at work and at home, and so did my hubs.  We didn’t tell anyone we did the IUI, other than our fertility buddies at the time. The doctors tell you that you should never take a pregnancy test early, but we did anyways.  Negative.  We still thought it might have worked.

That’s the viscous cycle with infertility; you are always hopeful and sure THIS is the time.  But, the day my blood was to be drawn at the doctor, I got my period and it confirmed the BFN.  It was now 2012.

#negativepregnancytest