Five Snowflakes

The thing about IVF is that it's relatively unpredictable. Most people who haven't been through it don't realize the combination of steps and gambles, twists and turns, along the way. We just had one of these happen to us. Fortunately, it may be a blessing in disguise.

First of all, I've mentioned before that I was overstimmed during my first IVF, which was likely the cause of my low egg maturity rate, and that my stim dosages were decreased this time, in an attempt to avoid overstimulation. Well, it seems to have worked! IVF #1: 21 sizeable follicles, 19 eggs retrieved, 8 mature, 5 embryos after fertilization with ICSI. IVF #2: 9 sizeable follicles, 11 eggs retrieved, 7 mature, 5 embryos after fertilization with ICSI. So you can see that the success rate at each step has been higher.

Today was the third day after egg retrieval (which by the way, was curiously more painful this time). We learned from the Embryologist that all 5 embryos are still growing, although one is slacking. A healthy embryo should be 6 or more cells by this point. Today we had a 9-cell, two 8-cells, a 7-cell, and a 5-cell. If my memory is correct, with IVF #1, we had an 8 cell, three 6-cells and a 5-cell. So the theme of higher success rates at each step of IVF #2 is continuing!

This IVF cycle has been more complicated because we want to do preimplantation genetic screening (PGS) at the day 5 stage, instead of day 3 like last time. In IVF #1, we had a single-cell biopsy done of our embryos at day 3, to test them for a severe chromosomal abnormality, and hopefully prevent another miscarriage. The results came back on day 5, and we had one competent embryo. Two tested as incompetent, and two were inconclusive. Unfortunately, the two that were inconclusive had already ceased growing on their own, or we would have given them a try.

A day 5 biopsy collects more than one cell for testing, and it takes longer to get the results. But it's also more accurate. However, it does require freezing. So our first plan for IVF #2 was to do a freeze-all cycle. But then, considering that we could easily end up with only 1 or 2 embryos to test at day 5, and that the 5-day growth process culls some of the genetically incompetent embryos anyway, we decided to have a back-up plan of preparing for an embryo transfer. In the case that we ended up with only 1 or 2 embryos at day 5, doing PGS seemed pretty pointless. But the result has been that I have had to prepare for both circumstances - a freeze-all, and a day 5 transfer. Having to explain this over and over again to confused nurses was no picnic.

Today, when the Embryologist called with our day 3 results, I was so relieved when she said we still have all five. If we had already been down to 1 or 2 poor-grade embryos, we would have gone in for a transfer today, and I am still in pain from my egg retrieval on Thursday, so I really don't feel ready to get pregnant. I was already getting worried about the very realistic possibility I would need to do a transfer on Tuesday, wondering if I would still be in pain. But, she also had some surprising news.

The Embryologist told me that they always grow a batch of mouse embryos to test the culture medium and lab environment, and that all her mouse embryos had just died. She needed to pull all embryos out of culture. In other words, they all had to be either transferred or frozen. So we froze all five of our embryos. The more accurate term would be "cryogenically preserved", but "froze" is easier to type.

Of course, the idea of something being seriously wrong in my embabies' first nursery concerns me, but I couldn't be happier with the Embryologist's response time, and her focus on saving them. The amazing part is this feels like a blessing. My body does not feel ready to become pregnant right now. This will give me a few weeks to feel completely healthy again.

So when will we get PUPO (pregnant until proven otherwise-describing my state after an embryo is transferred)? Probably anywhere from late September to late October. Vague enough for you? I'll write more about what that part will entail in a later post. For now, we have five snowflake babies resting peacefully. Please pray for them and for us!

As always, please feel free to ask any questions. This often seems like science-fiction to me, but at this point I've probably become so familiar with it, I brush over some points that need explained. No question is too simple.

Friday Freakout: IVF Meds

I’m calling this post a “Friday Freakout” as a tribute to the fact that my greatest psychological challenge is anxiety. It rots my gut on a regular basis.

So guess what? We’re there. Where? IVF number 2. I started my morning injections of Lupron on Thursday, and start stimming next Thursday night. My protocol is 10iu of Lupron daily until next Thursday, then drop it to 5iu, and add 225iu daily of Follistim. My last birth control pill is tomorrow, so CD 1 should be about next Tuesday. I’m also taking Metformin, prenatal vitamins, DHA, CoQ10, and extra calcium and vitamin D, but these are all oral pills. Only the Follistim and Lupron are injections.

On August 26^th I’ll go in for a monitoring ultrasound, and my RE will decide whether to schedule me to trigger, or have me continue on Lupron and Follistim longer and return for another ultrasound before triggering. Our first IVF, we had a low percentage of the total eggs retrieved that had triggered properly. My understanding of the trigger is that it tells the eggs it’s time to go from 46 to 23 chromosomes, so they can be fertilized. My RE thinks it didn’t work on a lot of them because they had grown too fast. In other words, I was “over-stimmed”.

Even though we had a single, genetically competent, girl embryo that made it to transfer, since she didn’t implant and we didn’t have any others make it to blastocyst stage for freezing, that cycle was a total bust. The only thing it did was give us very expensive clinical data showing we end up with a lot of chromosomally abnormal sperm and eggs, thus conceiving chromosomally abnormal embryos. That is, when they are able to actually conceive.

This time, my dosage of Follistim has been decreased, and an additional stim dropped entirely, with the hope that this will allow more of my eggs to mature a little slower, and properly trigger. This is what we are now hoping and praying for virtually every day.

I’ve also decided that I’m going to learn how to give myself the injections this cycle. That does not mean I will actually be doing them all myself. Nurse Stepmom is again generously giving me my injections, but I’m going to have her teach me how. I’ll do a couple under her tutelage, on the off chance I get stuck having to do it myself. But until that happens, I’m having her do it! I haven’t had pain or a bruise from any of these injections yet, and I firmly believe I owe that to her expertise and skill! This process is stressful enough without having to stab myself every day.

And no, the Wacky Wicketeer is not allowed near my shots. You see, my big, strong husband is afraid of needles. Despite this fact, he grudgingly said to me one day, “I guess I could try giving you a shot.” I replied with a firm, “no way!” I love him for wanting to help, but what I don’t need is a husband passed out on the floor and me still standing there, having to stab myself.

Finally, I promised my tweeps (friends on Twitter, for those who aren’t) that I would share another use for the insulated bags Dove gave us at BlogHer ‘11. Here it is: Transporting our IVF meds that are supposed to be refrigerated! Hey, if it’s good enough for ice cream…

If you have any questions about anything I’ve discussed in this post, please don’t hesitate to ask!

The IVF Experience: Egg Retrieval through Day 3

We last left off at the HCG "trigger" injection. I used to think the sole purpose of the HCG was to make you ovulate, so I wondered what it's use was in an IVF cycle, when they don't want you to ovulate before they retrieve the eggs. It turns out it also tells your eggs to switch from 46 to 23 chromosomes-an important step if you want room for the 23 chromosomes a sperm will add!

Thirty-five hours after triggering, I had my egg retrieval (ER). This entailed not eating or drinking anything-not even water-from 5 in the morning until my retrieval just after noon. The water was absolutely the toughest part of that! At the clinic, I filled out more forms, changed into a hospital gown, hairnet, and booties. I was allowed to keep my bra and socks on, so I wore my special silly socks to help keep my spirits up and my feet warm!  Besides, other than your hoohah, your feet and calves are what your surgery team ends up seeing most of the time, and you want them in a good mood!

Nurse "Sweet" was my prep and recovery nurse, and first she tried to put the catheter in my hand for the IV. It didn't go so well. So, the anesthesiologist, Dr. "Silent" took care of it, hooked me up, then walked me into the OR. As I'm climbing onto the table and swinging my knees up over the stirrups, I'm already feeling like I've had a couple drinks, and frankly, I don't even remember laying down, that sedation worked so fast! I do remember asking my main IVF Nurse, Nurse "Mellow" if she liked my socks! She said yes, they're great!

Next thing I knew, I was feeling awesome and back on my original gurney, and I just really wanted to keep sleeping, but Nurse Sweet insisted I had to wake up! I vaguely remember telling her and maybe someone else in the room they they all did a great job, that it was awesome, that they were awesome and I loved them all, and that I would bake them zucchini bread. I was probably quite entertaining, but hopefully welcome comic relief after the cranky patient I overheard before me.

While I was asleep, here's what my team was supposedly doing: The RE takes a long needle, and using a speculum and an ultrasound machine, inserts it into the vagina, through the vaginal wall, and into each mature follicle in each ovary. Dr. Analytical said he retrieved 19 eggs, so that would be 19 follicles. Fun, eh?

After a brief recovery period, I was sent home with painkillers and instructions to take it easy, not immerse myself in water, lift more than 10 lbs, have sex, or get my heart rate over 120 for two weeks, among other things. Pre-op was at 11:45, ER at about 12:45, and I was home at 3:30.

The next afternoon, Nurse Mellow called to give me the fertilization report. Out of 19 eggs, I only had 8 that were mature. This was a big drop to start this process with, and I was horribly disappointed, not to mention still in physical pain. Only five had fertilized, with a sixth runt that was a possibility. This made me cry. Looking forward, I knew we still had to get to Day 3, then through genetic screening, and to Day 5, for transfer or freezing. Then, of course, there's my history of pregnancy loss. All those hurdles seem awfully daunting with 5, maybe 6 embryos. (Not to mention-only 8 out of 19 were mature?! No wonder we're infertile!)

Today we got our Day 3 report, and while number 6 didn't make it, the other 5 did! We have another one falling a little behind, but still ok. Ideally, they want 6 or more cells on Day 3, and when Nurse Mellow called me this morning, she said number five only had 5 cells. However, three of my embies were already up to 7, and one of them even had 8 cells! This is blessed news!

So, we still have five embies growing like the little stubborn warriors we know they are. Please continue to send them your prayers, good vibes, and well-wishes. As their mother, I know they can feel the love, as do the Wacky Wicketeer and I.

How we got to IVF & Current Status

Last year, after going through two miscarriages at about 8 weeks, I had a bazillion tests done to see what could be wrong. We found nothing. No uterine factors, no immunology issues, no clotting factors, no infection. The Wacky Wicketeer and I were both karyotyped after the first miscarriage, which showed that we, ourselves, had no major chromosome defect that might be contributing to the loss. My general practitioner did find that I had a severe vitamin D deficiency. However, my Reproductive Endocrinologists (REs) would not attribute my losses to this factor. (Despite the fact that there are recent studies coming out showing a possible relationship between uterine lining and vitamin D.) Go here for more information on causes of Recurrent Pregnancy Loss (RPL): http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/recurrent_preg_loss.pdf)

We were very disappointed in the attention and lack of customer service we were receiving at our first clinic. So, we went to a new one last fall.

Our new RE, Dr. "Analytical", diagnosed me with a mild form of Polycystic Ovarian Syndrome (PCOS). You can learn more about PCOS here: http://haveababy.com/infertility-education/causes-of-infertility/pcos.html. PCOS is a syndrome, thus it occurs on a spectrum. At my end of the spectrum, I still ovulate regularly, but my eggs are immature and/or poor quality.

Dr. Analytical has a theory that, between poor-quality eggs caused by PCOS, and abnormal sperm, as exemplified by the Wacky Wicketeer's abnormal sperm morphology, we end up with a non-viable embryo on the rare occasions that sperm actually fertilizes egg. This then results in a pregnancy loss.

Dr. Analytical has explained to us that our best chance at having a biological child is through In Vitro Fertilization (IVF) with Intra-cytoplasmic Sperm Injection (ICSI) and genetic screening. In this way, we are the most likely to become pregnant with a viable embryo.

So, here we are. We decided to do IVF with ICSI and genetic screening, and are now in the midst of treatment. It is a trying process, and we are attempting to approach it with grace, with respect for our marriage, and with love for the embryos conceived in the process. I'll explain more of the details in another post, but for now, know that we have five, maybe six, embryos in their first home at the clinic, each fighting to grow. Please send them, and us, your prayers, hope, love, luck, and well-wishes. Thanks in advance, and lots of babydust to those looking for it!

A Due Date: Our Story of Blessing and Loss, part 1

Today is the day my first baby, Athanasios, was due. If I had the healthy, normal pregnancy that we expected, I would have been giving birth to my first child this week.
This is a difficult day, and week, for me. Nevertheless, I’m glad it has finally come to pass. It feels cathartic, like now it’s time to turn a new page in our story. So, I’ve decided to take this opportunity to go back and share the details of our infertility and miscarriage journey thus far.

Since the last time I posted specifically about our TTC attempts and our IUI protocol, etc., was almost a year ago, I thought I would briefly review the protocol that I started to describe there, and then get on telling you about the rest of the journey. If you need reminders about what certain procedures, medications, etc. are, head back to the August 20, 2009 post. And if you need to get caught up on the whole history of our TTC journey, read the July 30, 2009 post.

Last August we started a medicated IUI cycle that included me taking Clomid on CDs 3-7. Side effects that I had from it included hot flashes, bloating, headaches, and blind spots (like stars you see when you get a concussion or a migraine). I have heard from other gals that mood swings are also very common, and the doctor warned me that the Clomid could thin out the uterine lining and decrease cervical mucus (which is an important fluid present around ovulation (“O”) that helps the sperm swim through the cervix and into the uterus).

Because of the last couple of side effects from Clomid, the next drug was Estrogen, or Estradiol, which I took on CDs 8-12. The bloating continued, but the other side effects subsided. Starting on CD 11, I had to use an ovulation predictor kit (“OPK”) first thing in the morning, and as soon as we had a positive result, call the clinic and go in for an intra-vaginal ultrasound (“IVUS”) to see how big my mature follicles were and how thick my uterine lining was, and from that, predict how close I was to O. We also had to abstain starting on CD 9 until the insemination, so that my dear husband (AKA “the Wacky Wicketeer”) could build up a good store of soldiers before making his deposit! They start you on CD 9 in case you have to get the IUI on CD 12, so that you have three days of storage, but I didn’t O until CD 14 (as usual), so it was a long time, I tell ya! And mind you, those days are your most fertile, so for the previous two years, that had been prime baby-dancing time! What a switch…

On CD 13, I had a positive OPK, and we went in for my IVUS. I had two good, mature follicles and a nice uterine lining, so then I was injected with a form of HCG, AKA, the pregnancy hormone. This injection is commonly called a trigger shot, because it is supposed to trigger O. It also means that for a period of time, you could get a false positive on a home pregnancy test (“HPT”), because you had the very hormone it tests for injected into your system. The Doc then told us that the Wacky Wicketeer would need to be back early in the morning and make his deposit, and two hours later would be my second round with the IVUS, to make sure everything still looked good and see if I had O’d yet or not, and then an IUI.

Late that night was one of the most painful I’d had up to that point. My ovaries felt like they were going to explode! Sure enough, when I returned the next morning, I had already O’d. So, we had just the one shot at IUI.

After the Wacky Wicketeer made his deposit, they took the soldiers, “washed” them, to get rid of dead and useless ones, and then gave them a special vitamin solution to swim around in on their voyage.

Now, my turn. The tiny room we were in already contained me, the Wacky Wicketeer, the RE (doctor), and the nurse. As I’m laying there with my feet in the stirrups, all pride gone, into this sardine can walks two more people - a lab tech, with an assistant in tow. The lab tech is carrying what we’ve all been waiting for – the troops have arrived! In her hand is what looks to me like a two-foot long straw. It was labeled, and she very formally read our names from the label, and we said, yep, that’s us! The RE then took the straw from her, and the lab tech and her assistant left. Whew. A little more breathing room. That’s when the RE, having already used the speculum on me like a regular gynecological pelvic exam, inserts a catheter connected to the straw through the vaginal canal, past the cervix, up into the uterus, and aims as close to the fallopian tubes as he can get, so those little soldiers have a shorter swim. It wasn’t real painful, just a little weird, and I had a little cramping start when it passed my cervix, sort of like mild menstrual cramps. It took a couple of minutes (seemed like an eternity to me!), and when the RE was done, he set an egg timer for 10 minutes, and said I could get up, dressed, and go when the timer went off. Oh, and that we should boink like bunnies that night to add to our chances!

Not that night, but the following night, I started taking a prescribed compound vaginal suppository nightly. It was a compound that was primarily intended to deliver progesterone, to support a possible early pregnancy, and make sure I didn’t start menstruating earlier than I should. The suppositories are messy, so you take it right before you go to bed. I was instructed to take it until either my period came, or I had a blood test that showed I was negative for pregnancy, at least sixteen days post-IUI.

Normally, good ol’ “Aunt Flo” (or “AF”, as the TTC community so quaintly refers to a woman’s period) arrives on CD 26 or 27 for me, not 29 like for the “average” woman. This would have been only twelve days post-IUI for me, but the progesterone prevented my period from starting normally, so I took a HPT. OK, I took several HPTs. They were all that dreaded BFN (big fat negative)! But, just in case, hope beyond hopes, I had to continue waiting another four days, then went in for the blood “beta” test. (I have no idea why they call it a beta test.) Of course, it was negative.

So, our first IUI was a failure. It was also very stressful. Not having gone through the process before, and, at the time, not understanding everything I was supposed to do, or why I was supposed to do it, but being the sole person responsible for making sure that everything happened at just the right time – whew! Add the hormones to that mix, and you can imagine. And everything else in life doesn’t just go on hold because you’re going through this, either.

The toughest point for me was getting the negative home tests, because I knew at that point, that it hadn’t worked. After the blood test confirming that we were NOT pregnant, I stopped the progesterone, and AF showed up three days later. My first instinct was to give up. But my determined Wacky Wicketeer would have none of it. Ultimately, it was an easy decision to take a month off before we would try IUI again.

Come back soon for my next post, which will pick up with our second IUI cycle – when we were blessed with our first pregnancy, and lost our first Angel baby, Athanasios.

The Ups and Downs of Infertility

Today is the first day of a new chapter for my husband and I. Today I started the medication to prepare for assisted reproductive therapy, or ART. It has been a long road to get to this point, but, fortunately, not as bumpy as it is for some. Some people go through multiple miscarriages as they try to conceive. Not us. At least, not yet.

Two years ago, we decided we were as ready as we’d ever be to be parents, so we set aside the birth control and got down to business. We were 31 years old, and wanted to have two kids before we were 35, so I looked up what I needed to know so we could be as effective as possible at our “baby dancing”.

For those of you who don’t know, there is only a period of time of about 4 days, give or take, during each menstrual cycle, that baby dancing (BD) can result in a pregnancy. The window generally consists of the three days before ovulation (O), and the day of O. With busy lives, it can be easy to miss that precious window.

The average woman of child-bearing age ovulates on about cycle day (CD) 14, but it can vary. The average woman also has a menstrual cycle of 28 days, but this can vary, too. To establish her particular fertile window, a woman can take her temperature every morning with a special, sensitive thermometer, and she can use ovulation predictor kit tests – or “pee on a stick” (POAS).

I did all this, and continued doing it off and on for the past two years. My own cycles average 25 days long, so they go faster than a month, but there were multiple times when we had to take off from trying to conceive (TTC). First, because I had to get an MMR vaccine and a TDAP vaccine, and then because I donated blood for my Dad’s surgery.

In the summer of 2008, we started talking to our doctors about fertility, and both got certain tests done. It turns out we have low sperm morphology, creating mild, male factor infertility. That’s the only diagnosis we’ve been able to get. It’s not that we can’t get pregnant, it’s just that we have a lower statistical chance.

So, we spent 22 cycles trying, then hoping, praying and waiting, for the wonderful news. Each cycle, counting down the days, getting negative pregnancy tests, crying when that time of the month came that “Aunt Flo” showed up with her cramps, bloating, backache and all, until I felt like I was going insane.

Today, I had lunch with a good friend and colleague, and we caught up on our TTC misadventures. I mentioned to her that about 16 babies had been born around me, to friends, family, and physically near acquaintances, during the time we have been trying to have a baby of our own. After I got home, I sat down and actually made a list. The total count of babies born or currently pregnant mothers in my world in the last two years is actually 32. And four of those are to two women. The same two women I jealously watched have their first children almost two years ago are already having their seconds.

Please don’t misunderstand me. I love all these parents, whether as friends, family, or just through the love of humanity, and I would never, ever, want to replace their joy with sorrow. I am happy for them. But I am also sad for myself and my husband. I would like more people to realize that every belly pic, every joyous, “it’s a boy!” every baby shower, and every adorable photo of their little ones brings tears to my eyes, and rips open a hole in my heart. Maybe it will help them better appreciate the challenges that kids bring. Maybe when the kids are screaming, and the baby’s crying, they’ll realize that it could be worse – they could have never had those beautiful babies. Moral of the story: Take nothing for granted, including the ability to get pregnant.

Albert Einstein is attributed with the quote, “Insanity: Doing the same thing over and over again and expecting different results.” I definitely reached that place. I thought, well, maybe we’re not meant to be parents. Maybe God has another plan for us. But, really? How could that be possible, when I can feel with all my heart and soul that there’s supposed to be a baby in my arms? I struggled with the idea that we should just give up, but I couldn’t do it. My whole life, I’ve been taught, and lived by, the concept that I must never give up.

Now, I have a new protocol, something different that my dear husband and I can do to have our babies. For the first time in months, I feel cautiously optimistic, like my head is starting to come out of a fog. I can physically feel depression lifting, despite the additional hormones and chemicals that are starting to course through my body. I’m ready, so bring it on.