IVF – Embryo Transfer

It’s been a long time since I updated this blog. This wasn’t an intentional break. In fact it was very hard to take more than a month off from writing, because I find it so therapeutic. Still I felt the need to go on a retreat. When I’m processing my emotions in a healthy way, even if I’m in the depths of despair, I like to be open and welcome other people into my life, and truly enjoy human connections. But when I can’t process for one reason or another, I’m blocked, frozen in time, and not able to reach out. It’s hard.

I’ve never been susceptible to depression, and that is a true blessing. I’ve never had a single day when going through the motions of life has been hard, despite having been through some devastating times. My dad and stepmom died. I went through grad school. I nearly died and had a child spend two weeks in the NICU. I’ve been in shock, but then I process the emotions and work through them. I enjoy putting the pieces back together, exploring the new shape of my reality.

But when it came to processing the fact of having frozen embryos, I was out of my depth. I didn’t know where to begin. I very much felt frozen in time myself, even though arguably I was preparing my “vessel” for the newest inhabitant. That’s useful work, right? Still it just felt like a strange limbo.

Finally I’m emerging from that deep freeze, and I have the spark of life inside of me. I am ready to bravely face whatever lies ahead. It might be the beginning of a new child. It might be the start of a chemical pregnancy or a miscarriage. It might be absolutely nothing at all. It could be the highest high or the lowest low, but either way it will be real and it will always be part of our story as a family. We can withstand anything. Of course, I hope for the miracle of new life. And I’m an optimist at heart. So right now, at this moment, I know that I carry a spark of life inside.

That’s what I call it now, a spark. Sure, it’s a cluster of cells. Sure, it’s a potential human, maybe with a soul already. I don’t know. I don’t pretend to know God’s mysterious ways. It doesn’t feel right to call it a baby or a fetus or anything as physical as that, yet. It feels like a spark, more of an abstract concept. A spark that I already love and cherish. I felt the moment I connected to the spark, early Thursday morning. I imagine that was the moment of implantation, although of course “implantation” is a process, not a single moment. But it felt like a minuscule fire in my uterus, over in the blink of an eye. It was unmistakable but so tiny I could have ignored it, especially if I’d been in the middle of a busy work meeting. But I wasn’t. I was just alone on the couch reading about meditation. And then there was a spark, and I wasn’t alone anymore.

The embryo transfer process itself was easy as can be. By far the easiest procedure I’ve ever had. Granted, they gave me a Valium a half-hour beforehand. The hardest part, for most people, is that you have to go in with a very full bladder (that helps get the uterus into a good position) and then remain lying down for a full hour after the transfer before you’re allowed to get up and pee. Ouch! But Valium is incredible. It takes the stress out of everything and just puts you to sleep, so even a painfully full bladder was just a blip on my radar.

We got to see the little embryo on the screen before the transfer. It was beautiful. They all said so. And I’m sure they say the same for everyone, but you know if it weren’t beautiful you wouldn’t be there! I hadn’t even thought to worry about the defrosting process, and it’s a good thing too, because apparently that can go wrong. It’s rare. But in our case it went without a hitch. The embryo was already hatching by the time of transfer, which is good. It means the timing of implantation could very likely have actually been Thursday morning. A hatching embryo is super ready to implant, so it won’t be more than a couple days.

The beauty of the process is that it’s either going to work …. or it’s not. There are dozens of myths about how to increase your odds of implantation (eat pineapple core! get acupuncture! lie with your legs elevated! etc etc) but all of that is nothing more than little strategies to give you peace of mind. Peace of mind ain’t nothing – but it also ain’t pregnancy! If it’s going to work, it will just Work. There’s nothing you can do to prevent it (just ask any pregnant-by-accident teenager) or make it work if it isn’t (just ask anyone who’s infertile and has tried every fertility diet and relaxation strategy known to man). That’s why I like to say “Give it to God” and just let go.

Of course, I already don’t drink alcohol or caffeine, or smoke, or eat (much) sushi. I do sometimes eat deli meats, but it’s not hard to throw that on the skillet before putting it in a sandwich to make it safe for pregnancy. Soft cheeses are the only thing I have to consciously remember not to buy, but even those are “almost certainly” fine during pregnancy because I live in the U.S. where it’s basically impossible to find unpasteurized cheese. Still, I don’t mind giving up a few treats for nine months. It makes the reunion with the forbidden foods that much sweeter!

So here we are. I am, strangely, 3 weeks and 1 day pregnant. Gestational age is a weird thing, because it’s counted from the start of your last period. But in the case of an IVF FET (frozen embryo transfer), what matters is the age of the embryo (frozen at 5 days) and the date of transfer, which my body was prepared (by exogenous hormones) to believe that it had just ovulated, even though it hadn’t. It’s a mind trip, and super confusing, but there are calculators online to help figure it all out.

It’s possible that my microscopic placenta could start producing hCG (the pregnancy hormone) as early as Sunday, and that there could be detectable levels as soon as Monday. I could theoretically take a pregnancy test on Monday. But I won’t. I think I can hold off, though it will take some will power.

The last thing you want is a false negative, or a “squinter” (that’s when the hCG line is so faint that you have to put it in photoshop and up the contrast X100 to see anything) that is hard to either celebrate or mourn. I made that mistake with my second pregnancy, which we had been trying for, and I had tracked down to the day. The first testable day, I tested, and there was barely a hint of a positive. I showed it to Louis and there was a moment of confusion, and then after some squinting it was just … pretty anticlimactic because the line was barely visible. Not what you want in a pregnancy reveal!

So I’m hoping that I can be brave, and keep writing no matter what. Through everything. It’s always better to put your life out there than to just grit your teeth and survive. Even though you will survive, without a doubt, it will be a shallow survival. I’m going to try to rise above that!

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IVF – Blastocyst Report

We finally got results from the genetic screening, and both embryos were normal!! This is the best possible news, and means that we have two chances to get pregnant. The 3AB blastocyst has a 70% chance of success and the 5BD has a 65% chance of success, so altogether that’s a 90% chance that one of them will result in a pregnancy. I like those odds! I’ll take it! So we will go ahead and transfer the 3AB blastocyst, because that one has the highest chance of success.

So, most likely this means that we won’t have to go through another IVF, which would be amazing. The transfer date is set for September 17th, 2019. That seems like an eternity from now, but we’ll get there somehow. They have me on birth control until September (I have no idea why) and then another boatload of meds starting on September 1st leading up to the transfer. The good thing about this phase, what is called the “transfer cycle”, is that none of the meds are injections! I’m sure being on crazy hormones again is going to be a bore, but I’ll get through it. Onwards!

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IVF – Embryo Report

Just got the call, and we have two blastocysts! That’s 100% more than I expected last week, so I am thrilled. Now feel free to let your eyes glaze over for a minute, because even I do not understand the following: We have one Day 5 grade 3AB blastocyst and one Day 6 5BD blastocyst. I know. Your guess is as good as mine!

I’m fairly certain we’ll try a transfer with the Day 5 3AB, as that’s a more promising grade, but either of them could potentially become a perfectly healthy child if found to be chromosomally normal. The early slow start can mean something, or it can mean absolutely nothing (Biology has a lot of self-correcting mechanisms).

Still, this is all good assuming one or both of them are chromosomally normal. If they aren’t, then we’re back to square one. But at least for now it’s reasonable to hope that we can move forward and try to implant one of these blastocysts. Still so much has to go right for it to work, but some steps in that process are more of a “sure thing” than others.

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IVF – Fertilization Report

Just got a call from the embryologist with results from the ICSI (intracytoplasmic sperm injection). They collected 8 oocytes yesterday. Of those, 6 were mature, and 3 fertilized. The remaining 3 are what they call “questionable” which means they may still develop into embryos, but perhaps not. This is overall a very good result, given that we only started with 8 total! Women in their early thirties tend to start off with more like 15-20 oocytes, so the attrition is less grim. But for being 38, this is quite promising. We’re off to the races.

I’m not sure if it makes sense to just start another IVF cycle right away, to see if we can get better numbers. We could very easily end up with only 1 embryo at blastocyst phase, and would have to get pretty lucky for that one to be chromosomally normal. But then we could be done, and it’s temping to imagine just being ready to implant and not go through another two month long IVF cycle!

I’ll hold out hope until Monday, when we get the call to see how many embryos made it to day 6 blastocyst stage (at which point they freeze and send off for genetic testing). Then I’ll make an appointment with the RE to talk about the best course of action. Waiting any amount of time seems unwise, but at the same time, maybe waiting just another month for the results of genetic testing to come back wouldn’t be a disaster. I can at least start priming for IVF maybe, since that’s relatively unexpensive, and then if it turns out we don’t need another cycle, I can just jump in and get ready for implantation. I’m not sure if that plan makes sense at all, so I’ll have to get more information.

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IVF – Egg Retrieval

The eggs have officially launched their bright careers as students in an embryology lab! You gotta start them early working with grad students if you want to have any hopes of being a scientist, of course.

The procedure could not have been simpler. I mean, from my perspective – I don’t have a medical degree, so maybe “routine” is a better word than “simple”. We got to the hospital much too early for my scheduled check-in time. You know, I always like to be early for being early, but a whole hour is a lot, even for me! But you can never be too safe when going down to Denver on I-25. Accidents and 40 minute delays crop up there all the time. (In fact we ended up going home via 470 because of a backup that had materialized).

So we sat around in the waiting room for a while. I didn’t want to drain my phone battery, so I went straight for the pile of magazines, and amazingly there was a copy of Physics Today on the table. I don’t believe I’ve ever been in any kind of waiting room and seen a physics journal, so I just had to read it! Did they stock that just for me? I’m sure not, but it felt like a good omen anyway.

Fairly soon my nurse came to get me checked in, took all my vitals, asked a bunch of questions, and had me sign various consent forms. She was extremely reassuring about how I’d been in good hands, and she has very good experiences working with patients who have either PTSD or some form of anxiety. Then she put an the IV in so I’d be all ready for the happy sleepy drugs.

The effect of versed was much different than I’ve experienced before, namely I seem to remember at least a few minutes (versus a few seconds) after the injection. Now that I think of it, I do remember the OR itself! But I can’t be 100% certain of that. Did I dream it? Wait, I remember the nurses attaching those leg holders to the side of the gurney and having me scootch forward. I don’t think I could be making that up. Either way, it doesn’t matter because I was obviously super chill and had no issues whatsoever with freaking out or anything.

Our first “date night” in quite some time! Not a bad view, but in retrospect it was a little too hot outside, even in the shade. Worth it though!

Then I woke up some time after the procedure, spent maybe an hour in post-op, devoured a pile of crackers, and then went straight to the Snooze cafe for some breakfast at 1:30pm, just an hour before closing time. Success! I had a bacon, poached egg, cream cheese, arugula and challah sandwich which was just exactly what I needed. I also had some kind of green cold pressed juice which tasted very strongly of cucumber, dill, and freshly mowed grass. It was a little startling, but always fun to try new things (I’m normally not a juice drinker at all, but I needed to get my electrolytes back).

I am super sore and crampy and spent the rest of the day on the couch or at my desk, but that should subside in a few days. That’s all for today, more updates later!

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IVF – Follicle Ultrasound #6 (Stims Day #11)

Another trip to Lone Tree, CO today (Sunday). The follicles all seemed to grow by 2mm this time, an improvement! So it looks like we might finally be on the exponential growth curve, at the very last possible day. I always was a procrastinator, so it’s only natural.

Best outcome it seems right now is that we’ll retrieve 4 or 5 follicles. This is about half of what we really wanted, and what the Dr. expected going into this cycle. So we’ll almost certainly jump into another cycle as soon as the retrieval is over. Of course I’ve been wrong about a lot over the course of this process, so we will wait for more news.

[Update:] Aaaahhhh, finally! We are triggering tonight at 12:45am! Egg retrieval will then be 35 hours later at 11:45am on Tuesday. I didn’t even think to ask what my estrogen levels are because I am so excited to get this show on the road. Let’s do this, y’all.

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IVF – Follicle Ultrasound #5 (Stims Day #10)

Pretty non-eventful trip to the CCRM in Lone Tree, CO today (Saturday). The ultrasound showed that the follicles are still growing, but slowly. I’m still hopeful I guess? But each follicle only seemed to gain about 1mm since yesterday, so the main cohort is at 10-13mm. We need to get to 17mm. Can it happen in two days? It will all depend on whether my estrogen is still doubling *, or whether it’s starting to plateau. I’ll have that answer this afternoon, but will be biting my nails down to the quick meanwhile. I’ll be pretty bummed if this one is a loss.

The anesthesia consult went great. Of course the anesthesiologist I spoke with will probably not be the one I’m assigned to on Tuesday or Wednesday or whenever the egg retrieval happens, if it happens, but at least they will have her scrawled notes, and I’ll be able to review it with them on the day of. It doesn’t take a lot of time to convey what’s needed anyway: just give me versed and let it work before rolling me into the OR. Pretty easy.

So I don’t know. Welcome to the roller coaster. If this doesn’t work, I’m sure we’ll just start over with another cycle immediately **. But gosh what a long haul it has been already.

* [Update: Estrogen levels are still rising, up to 1264 from 1081 yesterday and 800 the day before. So that is optimistic, I believe!]

** [Actually, we will probably dive into another cycle immediately, whether this egg retrieval is successful or not. That’s because even the most optimistic result is 7 eggs retrieved, which is sort of borderline on likelihood of having even one healthy embryo to implant.]

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IVF – Follicle Ultrasound #4 (Stims Day #9)

Wow this is such a roller coaster. So much monitoring and uncertainty! Well, today was the first completely optimistic day at the IVF races.

I had my physical exam, to make sure I’m going in to egg retrieval healthy. I came in with fifteen billion questions to ask, so with all of that, my brain was too full to remember all the follicle sizes, but they are growing. And now it looks like there’s only one lead follicle for sure, so that is good and it means we’re definitely going to wait for the 5 to 7 in the trailing cohort to mature. Apparently at some point they do get on to exponential growth, which I didn’t realize, so that means I may need only an extra three days on meds.

“Only” an extra three days! Twelve days of injections is basically as long as they ever go, so I’ll be maxed out. This is getting towards $7,000 of medications y’all. But if it does the trick, it’ll be more than worth it!

Tomorrow is Saturday, so I have to drive down to the very southernmost tip of Denver for my ultrasound and blood work and a consult with anesthesia. Ovaries don’t take breaks on weekends, apparently.  So that’s it for today, big day tomorrow (driving-wise, if not otherwise). My therapist thinks I’m as prepared as I could possibly be, and has offered to support me via email next week when things get really real, if necessary. She’s an angel!

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IVF – Follicle Ultrasound #3

I’m glad they do such close monitoring of follicles at CCRM, because it means they can tweak medications very precisely and catch anything that’s off early. Not all clinics do such frequent ultrasounds and blood tests. But it also means that the patient gets almost too much information! I mean yesterday there were two lead follicles, but now it looks like there’s just one that’s really out in front. So that makes a big change in strategy after just one day. Here are the follicle measurements (in millimeters):

Left: 18.5, 14.5, 10, 9, 8

Right: 11, 10, 10, 4

So now it’s looking like the strategy might be to wait even longer for those five follicles that are in the 9-11 mm range. That will mean more medications and more waiting. I don’t think they will ever go beyond 12 days of stimulation, which would be Monday. But if that’s necessary, it could be a nail biting time. It’s possible that I will have the option to retrieve just those larger two. In order to decide that, I need to know what the chances are that the other five just won’t ever get big enough. And also whether or not we could tweak medications to get more even growth and then just do another cycle.

Will meet with the Dr. on Friday to discuss everything. Of course tomorrow is the one day that we haven’t been able to find a babysitter for, so it might end up being the whole family at the fertility clinic!

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IVF – Follicle Ultrasound #2

Well it’s starting to look like I might have two lead follicles (14 mm and 15 mm), and a trailing cohort of six much smaller follicles (between 8 to 9 mm). This isn’t what you hope for. What it means is that you either do an egg retrieval very soon and collect only two follicles, or you wait an indeterminate period of time for the trailing cohort of follicles to grow and let the lead follicles get overcooked. It might seem like an obvious choice to collect 6 follicles instead of 2, but those 6 might never mature and then you’d have zero. And I’ve seen some sources say that the lead follicles are the higher quality ones anyway, most likely to survive to implantation.

So it’s not ideal. We may have to do another cycle and tweak the meds so that I can get more even growth across all follicles. But before then, I am going to push for doing an egg retrieval if at all possible. At age 38, I can’t really afford to cancel a cycle. Two eggs are two eggs (all it takes is one!) so it doesn’t make sense to let anything go to waste. Especially not time.

There is still hope for the trailing cohort though. The Dr. is upping my Gonal F dose to 450 units (up from 300 units) in hopes of encouraging growth of those six. If we see a good response tomorrow or Friday, then the path forward will be more clear. If they don’t respond well, we’ll retrieve the leading two and just call this IVF round an educational experiment, and try again (or just get extremely lucky and get a healthy embryo from those two).

There are many ways forward, and baby is in there somewhere, I’m certain of it!

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IVF – Injection Day #6

Until today I was mainly able to continue with all my usual chores, running around, taking Emily here and there. But it is clear now that the remainder of the time until egg retrieval is going to require a severe scaling back. I feel mostly normal except for, well, my ovaries. I’m told they can become the size of grapefruits. It is not comfortable. So I’m trying to reduce physical exertion as much as possible. It’s hard. Whenever I’m outside I find myself absentmindedly weeding (I don’t even like weeding, but it just happens!) and then have to stop myself. I really do not want to overdo anything right now.

I wrote up a short document that I’m going to bring to the anesthesia consult on Saturday. This was good preparation for me to go over everything I want to discuss and to list my various requests. And hopefully having a document will help convey how very much I’m interested in making sure the procedure goes well and have done my homework, etc.

And we’re still collecting an army of babysitters for next week, but Louis is working on that so I don’t even have to think about it. Otherwise, we’re as prepared as we can be. The days are passing extremely quickly and I know I’m going to blink and be in surgery any minute….

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IVF – Follicle Ultrasound #1

This post is just a lot of boring details that I might want to remember later. The short version is that everything is progressing well so far.

First ultrasound today and all seems to be progressing pretty much as well as we could expect. Uterine lining was at 6mm. We’d like to see that climb up towards 14mm by egg retrieval day.

They saw 8 follicles, which is the same number that I had at the baseline measurement last month, so that’s expected. The follicles ranged in size from 5mm to 12mm, although most of them were 6-7mm. Nurse Emily said this variability in size is pretty normal, although the 12mm follicle may have to be sacrificed for the rest of the cohort. In other words, it may end up being “overcooked” by the time of retrieval. It sounded like that’s fairly common.

So for now I’ll stay on the same dosages of Menopur (2 vials) and Gonal F (300 units), but I’ll add in Cetrotide starting tomorrow morning. Cetrotide blocks GnRH and prevents premature ovulation, and is thus extremely important. That’s all for today. The next ultrasound is on Wednesday.

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