The Decision to do DEIVF



Fractal Ovary by Gilberto Santa Rosa

So where are we now as far as trying to add to our family? What’s the next step?

Basically, we have decided our next step will be to use donor eggs, also known as DEIVF (Donor Egg In Vitro Fertilization). It’s been tough getting here. Not just because of all we’ve been through. Making the actual decision has been hard. And since we can change our mind at any time realistically until our donor has started meds, maintaining this decision is also challenging.

First, it took some time for the Wacky Wicketeer to come around to the idea. When I brought it up at first he was just negative about it. Then he told me why – because he couldn’t imagine his DNA combining with anyone’s other than mine. It was this really weird, romantic, unexpected reaction, so I was like, “awww!” and “WTF?” at the same time! Later, we talked about it some more and I told him I didn’t think he realized what he was taking away from me by deciding we wouldn’t use donor eggs. As opposed to donor embryo, he was taking away my opportunity to bring more of HIM into the world. This man I love so much…I just can’t imagine the world without him in it, and part of my safeguarding that, since I know it will happen someday, is in trying to duplicate him. LOL. I know, that sounds strange, but there it is.

As compared to adoption, which he was ready to go ahead with, DEIVF would allow me to be pregnant, give birth, and possibly breastfeed. I would still have the opportunity to be the child’s birth mother, if not its genetic mother. I might be ready for adoption someday, but I’m not right now. To be ready for it, I would need to grieve these things.

He was still reluctant. Then one day he came home from work and said he was ready to proceed using donor eggs. I asked him what changed his mind. He told me a guy at work told him he needed to “just get over it!” Hah! After all that I had said, it took some guy from work who had been through an IVF or two to have his child, telling my Wacky Wicketeer to get over it.

I have heard it recommended that once you have a failed cycle at a clinic, you should change clinics. I think if it was a complete failure, i.e., no frozen embryos remaining, this is likely excellent advice. Each clinic I’ve been to has made little mistakes here or there that impact my confidence in them as a major part of my Fertility Team. So, we decided to change clinics. That same work friend of his, and an online friend of mine, each recommended a particular clinic in the Bay Area. So, we are switching to that one.

Because of the change, and because our initial infectious disease testing has expired, we have a lot to do before we’d actually cycle. I found myself procrastinating in getting the records and such. I finally realized that I hadn’t fully come to terms with the loss of my genetic connection to this theoretical child. I was, and still am, in the midst of grieving this aspect. My therapist says it will continue through to the child’s birth, but that the important part is that I get through some initial stages of it first. What I realized was that I was still in some denial about this being what we need to do.

I have recently lost about 20-25 pounds. For the first time during this infertility roller coaster, I have a healthy BMI. As I’ve mentioned before, the primary cause of my infertility and miscarriages is poor egg quality caused by PCOS. Hence the egg donor route. However, the weight loss, and the fact that I’m now running regularly, can help regulate my insulin, and possibly result in my ovaries being less PCOS-ey. (How’s that for a made-up word?) In summary, my improved weight could mean better fertility. Of course, we still have that pesky little slow sperm problem, so it’s still unlikely we’d get pregnant on our own.

Over the course of this journey, I’ve become a fairly religious person. So here’s what goes through my head: What if God meant for me to get healthy again before having kids? What if he delayed my dreams coming true because I was headed down the same path to diabetes and kidney failure that killed my Grandma at age 63? So just in case, how about giving my body a few cycles of trying out the old-fashioned way? Now that my eggs might be better? Maybe after all, God does intend us to use an egg donor, a donated embryo, or to adopt a born child. Maybe the child or children that we are destined to parent are a different genetic combination. But we can’t know that. I just need to give my body this opportunity, to accept the reality that we need an egg donor.

So, we’re taking our time getting the paperwork and initial testing done for the new clinic. Then we have to pick out a donor. By then, we’ll have gone through a few cycles of trying to get pregnant on our own again. What’s meant to be, will be!

If you have any questions, please ask! Nothing is off limits here. Just please be kind. J

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!

Check it out: Info from "The Disappearing Male"

Most of you know that so far, our fertility diagnosis is one of male factor infertility. Specifically, the Wacky Wicketeer has abnormal sperm morphology, or too low a number of properly-shaped sperm, and sometimes borderline sperm motility. This male factor infertility issue is becoming more and more common, and for us, is likely one of the factors involved in our two pregnancy losses.

When the Wacky Wicketeer and I discovered our infertile status, it was estimated that one in ten couples of child-bearing age in the U.S. was infertile. That number has already gone up to one in eight. Moreover, reproductive and other problems in boys are on an alarming increase.

A little less than two years ago, and replayed earlier this year, CBC, a respected Canadian television network, did a documentary as part of its Doc Zone series, called "The Disappearing Male". Unfortunately, the website only allows those in Canada to view it online, here: http://www.cbc.ca/video/#/Shows/Doc_Zone/ID=1233750780

But even if you can't watch the video, you can find some of the alarming facts on their fact sheet on male infertility, such as: "The average sperm count of a North American college student today is less than half of what it was 50 years ago." They also include some great explanations as to just how and why this appears to be happening, in their document, "Backgrounder: Endocrine 101".

While the current state of information in this arena is fluctuating and largely theoretical, the statistics are staggering, and the anecdotes are heartbreaking. The Wacky Wicketeer and I have taken the approach that, if there is something we can do about it in our lives, then we might as well do it. Some examples of the steps we have taken include: Getting rid of all our kitchen plastics other than numbers 1, 2, 4 and 5; Not using any plastics in the microwave; Getting a new couch; Dusting and vaccuming more frequently; Decreasing products we use with phthalates and parabens, opting for goods that use other, known and recognizable ingredients.

I hope you'll take a minute to look at the CBC info, and consider what you can do to make a difference for the children and future children in your life.

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.

Our New TTC Protocol, Part One: Yes, Women ARE Complicated!

I’ve often heard men say that women are complicated. Men, you have no idea! So read on.

There are basically four levels of assisted reproductive therapy ("ART"): (1) a medicated cycle, (2) intra-uterine insemination (“IUI”), (3) in-vitro fertilization (“IVF”), and (4) intra-cytoplasmic sperm injection (“ICSI”). Because timing, and everything after intercourse, relies so much on the woman’s body, medicated cycles alone can help women who have unexplained infertility, irregular, or unpredictable cycles. The medication also has a higher occurrence of more then one egg being released, increasing the opportunity for a sperm to fertilize an egg.

The average woman’s menstrual cycle is 28 days long, and she will ovulate (“O”) usually on cycle day (“CD”) 14. Ovulation refers to the release of a mature egg from an ovary. Cycle day one is the first day of a woman’s full-flow menstruation. These are the dates that conception, and therefore assisted reproductive therapies, are based on.

My cycles are rather predictable, with O arriving on CD 14 like clockwork (unless I get sick earlier in my cycle). They are a little on the shorter end, at 24-25 days long, but this is not short enough to be diagnosed with a defect because of it. Since we have moderate male-factor infertility (“MFI”), the least-invasive step that could help for my husband and I is IUI. In proceeding with IUI, many fertility specialists like to have the woman on medications also to make her cycle extremely predictable, stable, increase the number of eggs released to increase the odds, and make her as fertile as possible. It made me feel like a bionic baby-making machine!

Anyhow, I liken IUI to the turkey-baster method. This seems to be a working metaphor, and it sticks in my friends’ and family members’ heads so I don’t have to repeat the descriptions over and over again! It also contrasts nicely with the next step, which is IVF, or what I refer to as the petrie dish method. A quick description of IVF and ICSI: For IVF, the sperm are donated and treated as in an IUI, and mature eggs are extracted from the woman’s body, then the two are put in a container together, and hopefully, sperm meets egg there. ICSI is IVF with the sperm being injected into the egg(s). We have been told that if IUI doesn’t work for us after about three times, ICSI would be the next step.

So, back to our current cycle, new protocol and IUI. It all starts with me taking Clomid on CDs 3-7. As it was explained to me, Clomid acts like a little general in your brain telling it to stop listening to certain hormones and to listen to the Clomid instead, which mainly tells it to mature extra follicles (in which eggs are maturing). 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 modd 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 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 is 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, call the clinic and go in for an intra-vaginal ultrasound (“IVUS”) to see how big my mature follicles are and how thick my uterine lining is, and from that, predict how close I am to O. We also had to abstain starting on CD 9 until the insemination, so that my husband 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 last two years, that’s been baby-dancing time! What a switch…

Next post will continue at CD 13 when we went in for my IVUS to check out the follies. Make sure to check back!

-J