Wednesday, May 12, 2021

IVF Cycle 2 Wrapup / IVF Cycle 3 / CD 6

When I posted last, we'd received the update that three of our seven embryos had made it to the blastocyst stage and were being sent off for preimplantation genetic testing for aneuploidy (PGT-A), which is a test to see if they're euploid, or genetically normal (have the expected number of chromosomes). That update was on Sunday, May 2, and the samples were shipped off on Tuesday, May 4 for testing. Results take about a week to ten days, so we had some time to wait and marinate.

Although we anticipated a better outcome with three blastocysts (cycle 2) than with one (cycle 1), we were aware that it was highly unlikely that all three blastocysts would come back normal. Even if they did, we know that a euploid embryo does not guarantee a live birth of a healthy baby. (Spoiler alert: absolutely nothing is a sure bet!) As we waited, my mind was already looking toward my next menstrual cycle and what action we were going to take.

I talked with our RE on Thursday about next steps. He said he was hoping for one to two normal embryos from our second retrieval, which was what I had calculated as well--hoping for two but trying not to be greedy. My main question was if there would be any reason not to go forward with a third retrieval. Medically speaking, my RE said that back-to-back-to-back cycles are fine. Richard and I had discussed taking a break, but I have found myself so panicked about my eggs running out and wanting to have the best/youngest embryos possible that I want to pull a Michael Jackson and "don't stop 'til [I] get enough" eggs. As with many of my thoughts in this process, my thinking isn't quite right because (1) this isn't exactly how diminished ovarian reserve works, and (2) we still don't really know what "enough" is until we transfer an embryo and see if I have a successful pregnancy. 

Our RE did mention that once we had a few embryos in the freezer, we could try intrauterine insemination (IUI) to see if I can conceive that way before we tap into our supply of frozen embryos. I hadn't considered that possibility, but it has several benefits, including being more affordable (no costs for retrieving eggs, watching them in the lab, testing, etc.) and less invasive. He also suggested that we could try to conceive naturally for a few months if we wanted. I think I might've actually laughed out loud at that suggestion; as delightful as the 36 cycles of trying and having no success were, I'm not sure that's a path I want to revisit before we attempt a transfer.

After consulting with Richard, we decided to go ahead with a third cycle and (hopefully!--nothing is guaranteed) retrieval this month. The instructions were the same as they always are: call on cycle day 1-ish, come in for ultrasound and labs on cycle day 3-ish. I went Monday (which was CD 4) for my ultrasound and bloodwork, and I had one follicle already trying to grow--13 mm! Instead of the five or six days of birth control that I had in the first two cycles, I have nine days this time around. Hopefully, that will be sufficient to suppress my rogue follicle. We go back for an ultrasound and bloodwork next Thursday (May 20); if everything is looking good, we'll start Lupron on the 21st and full stims on the 23rd. 

All of that took place on Monday. I received a call from my RE yesterday (Tuesday) after work that two of our three embryos came back euploid/normal, which was fantastic news! He had received the report and wanted to call and let me know immediately. He also told me the nurse would probably call in the morning, so I could either act surprised or let her know I'd already heard the news. I opted to act surprised since the nurses have to deliver bad news, but my RE said that he is the one to deliver bad news. I said I would still pretend.

When the nurse called this morning, she knew I'd already spoken to my RE but played along with our charade anyway. She asked if I had any questions, so I asked about our third blastocyst--another highly aneuploid (40 to 80 percent of cells abnormal) in the freezer. She also said we could find out the genders of our euploid embryos, but Richard and I have decided we don't want to know. 

With all of these latest updates, we are feeling better about our situation and are ready for another (potentially final) IVF cycle. Although nothing is guaranteed, this feels like we've overcome some major hurdles. I ordered our medications today, so cycle 3 is getting real!

Something that made today great: The [in-person] Junior League General Membership Meeting tonight was great fun!
Time I woke up: 7:20 am

Sunday, May 2, 2021

IVF Cycle 2 / CD 28

I just realized that I made an Instagram/Facebook post with our fertilization results on Tuesday. All 7 of our eggs retrieved also fertilized with intracytoplasmic sperm injection (ICSI), which we were of course thrilled to hear.

Today, we got our update of how many made it through day 5 and would go for preimplantation genetic testing for aneuploidy (PGT-A). The answer was three! (Recall that last cycle, we had one make it through day 5, but it came back mostly abnormal.) Knowing that 30-50 percent of fertilized eggs make it to the blastocyst stage, we could expect 2.1 to 3.5 (which we'll say is 2 to 4), so 3 was in the middle. Overall, this is good news. Three is triple what we had at this point in the previous cycle. We know that statistically, less than half will test normal. If we are lucky, we'll have two come back as normal/euploid.

With our goal of eventually having two or three children, we're likely looking to go for at least one more retrieval. Since I have never been pregnant, we have no idea what will happen once we transfer an embryo. Even if all three of our blastocysts come back normal (unlikely), we might not end up with three (or two, or one...) live births.

Our mantra, learned from our RE, is, "Every cycle is different." No matter when we go for a third retrieval, we could end up with better, worse, or the same results. We are weighing the options of taking a break for a few months, but I don't see that helping my stress level. I'm constantly reading Facebook groups and blog posts or listening to podcasts. I cannot stop consuming infertility-related content and thinking about what the future could hold. At least with another cycle, I'd feel like we were doing something. 

There's still a lot to think about while we wait. I think we are going to try to chat with our RE this week. While we expect him to tell us that every cycle is different, the fact that we are expecting to have a euploid embryo or two in the freezer changes a few things and creates some additional questions and options for us. 

Maybe we'll transfer.

Maybe we'll change our family goals and aim for a smaller family. 

Maybe we'll go straight for a retrieval. 

But for now, we'll wait.

Something that made today great: I made some salsa that was quite tasty!

Time I woke up: I don't know how to answer this because I was in and out of sleep all morning but didn't get out of bed until after 2:00 (woah)

Monday, April 26, 2021

IVF Cycle 2 / CD 22 / Retrieval Day

 Yesterday was really difficult. It started with not getting restful sleep on Saturday night and seemed to snowball. I had plans to go to a brunch book club with Elena, and I wanted to look cute for the loose Derby Day theme we had planned for the brunch. I got up and weighed myself only to find that I am currently tied for my highest weight ever. I'm under instruction from my RE to "eat eat eat," and I know that numbers on a scale don't tell a full story of health, but that put me in a bad headspace. Then after I got out of the shower, I found myself staring at my bruised, enlarged stomach. Generally, I would guess that I feel more confident about my body and myself than the average person. Yesterday, though, I felt defeated by it all.

Compared to some stories I have read, I have had a pretty easy time with stims and procedures. The results of the last cycle were a big blow (as I discussed in detail previously), but we know that I respond to medications, I can make eggs, and Richard and I can make embryos. I'm gaining weight and I miss running hard and/or for long distances, but it could be so much worse. As my RE said, every cycle is different, so we just have to hit the right one.

After book club, I spent most of the rest of the day worrying about this cycle potentially turning out like the last one. Even if we had some normal embryos, I have never been pregnant, so then I worried about what would happen if we used all of our embryos without ever finishing a pregnancy? The thoughts overwhelmed me, and I spent a lot of last night alternating between reading devotionals and crying. It felt kind of like I used to feel every month when we'd try, I'd think I could maybe, possibly be pregnant, and then my period would come. At some point, I pulled myself together to finish proposals for the ASHE conference in November, and then I went to bed. 

Once again, I did not sleep well last night. We had to be at the hospital at 8:30 this morning, but I woke up early to shower and at least make sure I had clean hair and a fresh booty. (Success!) The ride to the hospital was quiet, and the anxiety from Sunday spilled over into today. Whereas everything was new last time, I found it difficult to be hopeful about a different outcome....even though every cycle is different.

We got checked in, and they whisked Richard off to provide his sample. By the time he was finished, I was in my gown, and it was almost time to start my IV. I don't have great veins, and it took two tries to get started. Meanwhile, I was crying because I was anxious about the outcome of the surgery, not the needle. The nurse asked if I wanted some medicine to calm down, but I told her I was fine.

In the middle of my breakdown, my RE came to say hello, so that was a delight. He did give me some encouragement by mentioning that the embryologist said the eggs I made last time were great, and he still had hope for us. That made me feel a lot better. After consulting with Richard, I agreed to have a little bit of medicine to calm down, so they brought me a little bit of Versed to go through my IV and take the edge off. It seemed to help, and I didn't even cry when I had to tell the nurse how much I weigh. We took this photo that I proceeded to put on social media without realizing how much I look out of it. At least my mask was covering most of my face. I blame the Versed and the lack of sleep, but now this photo will probably end up framed in our house someday.

The procedure went as planned, and we retrieved eight eggs! My RE came to tell me the numbers while I was still coming down, and I had a bit of trouble counting his fingers. By the time I had my snacks--Scooby snacks and a Coke--we'd already gotten word that seven of the eight were mature. It's expected that about 80% of the eggs retrieved will be mature, so we were happy to not fall below that range. Tomorrow, we will find out how many fertilized with ICSI. We expect 80 percent again, but I'm hoping that all seven will make it. I guess I am a little greedy, but also, every cycle is different.

We still have a long way to go before we know how the cycle turns out, but our work is done. Now we wait and try not to worry. 

Something that made today great: We retrieved twice as many eggs as the last cycle!
Time I woke up: 7:00-ish

Saturday, April 24, 2021

IVF Cycle 2 / CD 20 / Stims Day 9 / NIAW Day 7

Well, my guess was correct: we triggered today! As they say, even a broken clock is right twice a day. 

We go Monday morning for our egg retrieval. My RE is hoping to retrieve five or six eggs, but I have my sights set a little higher. When my ultrasound results were uploaded later this morning, we only had measurements for six follicles. I am not sure if he only measured the ones that looked most promising or if something happened to the other four we had on Wednesday. My estradiol has continued to climb (up to 3126.19 today from 1543.22 on Thursday), so I am taking that as a good sign.

Of course, that didn't stop me from trying to learn more. I did some Googling and found that the "vanishing phenomenon" is a thing that has been studied by actual scientists. However, that refers to follicles that seem to vanish between the trigger shot and the egg retrieval, so that's not exactly me either. So, we'll just wait and see what happens on Monday. Hopefully, all of our follicles will still be there...I definitely didn't need anything else to be anxious about heading into the retrieval. I need to stay away from Google and infertility Facebook groups for a few days.

We did our morning injections but ceased our 5 pm injections in favor of the trigger shot tonight at 9:30 pm. My job now is to wait, rest a bit, and not eat or drink anything after midnight tomorrow.

Something that made today great: Good running miles with Slow Mode this morning! 
Time I woke up: 7:15 am

Thursday, April 22, 2021

IVF Cycle 2 / CD 18 / Stims Day 7 / NIAW Day 5

Wow, this week has been busier than I anticipated! Fortunately, I am finding healthy ways to cope with my anger and am starting to feel more like myself again. Sandra and I did a 4-mile run in my neighborhood on Tuesday before meeting Elena and the taco gang for tacos, and I rode my bike with Ellen today after I got out of class. Richard is also off for the next few days, so I'm enjoying having him around more.

It also helps that this IVF cycle is looking more promising than the first one. At this point in our first cycle, we had to make the difficult decision to move forward with four follicles or convert to IUI. My RE was hesitant about triggering on day 7 of stims but was supportive of our decision. This cycle, we have more follicles, and they don't seem to be growing quite as fast as the first crew.

After our ultrasound and bloodwork appointment this morning, we learned that we have three more follicles than we had on Monday! That brings our total up to ten. I have been chatting with a few friends who've been through IVF, and one told me she was hoping for more at our next scan, and another said he'd hope for 10 or more for us. I was doubtful, but then we had three more today! Our nurse told us not to be surprised if we needed to come back tomorrow, but she would call with instructions later today.

When the nurse called this afternoon, she told me to keep doing all of my same injections. She also said we need to come in for another ultrasound and labs on Saturday, which will be day 9 of stims. (Recall that people typically stim for 8-14 days, so I am in the expected range this time.) Based on last time, I was expecting to be told to trigger tonight or tomorrow for retrieval on Saturday or Sunday, but this cycle keeps revealing how circumstances can be totally different from cycle to cycle, even with the same medicine protocol. My estrogen reading was 1543.22 pg/ml, so we're not quite over the 200 per follicle mark that we'd like to see. However, we jumped from 690.58 on Monday to 1543.22 today, so hopefully, the two additional days will put us where we need to be with mature eggs.

During the first cycle, we joked about naming our follicles after the Beatles, but our ultrasound tech told us today we might want to start looking at basketball teams. I guess I'm taking nominations for worthy teams to name them after? Our smallest follicle is only 6 mm, which is a bit small, but we're hoping it can catch up. Our largest is currently 21 mm, and I think 24 mm is about as big as is desirable before triggering. We want to have as many as possible in the 18-24 mm range without anything getting too big. So, Saturday is likely our last ultrasound and bloodwork visit for this cycle unless I'm wrong again. Stranger things have happened.

I'm going to try to make a cutesy letterboard after our appointment on Saturday, but I'm currently a bit frantic trying to balance the end of the semester, work, conference proposals, trying to exercise, and going through IVF. It's a lot! So, here's some more of my fantastic PowerPoint art. These circles are not actual size, but they're to scale relative to each other. 

Something that made today great: The weather and company were fantastic for riding bikes today!
Time I woke up: 6:40 am

Monday, April 19, 2021

IVF Cycle 2 - CD 15 / Stims Day 4 / NIAW Day 2

I have heard others describe IVF as an emotional roller coaster, but I am not sure if a good day would be represented by going up on the roller coaster (because of going up and getting out of the valley) or by going down (it's easier, faster, and thrilling). Whatever the correct answer is, today was a slightly better day. 

We had an appointment for an ultrasound and bloodwork, and there is more going on in my ovaries than at this point in our first cycle. (Edited for clarification: We now have 7 follicles growing!) Last time, I had 4 follicles on day 5 of stims, and that's all we had before we triggered and went in for the egg retrieval. On day 5 of stims last cycle, my four follicles ranged in size from 10 mm to 18 mm. Today (one day earlier), we are looking at 7.5 mm to 14 mm, so these follicles seem to be growing slightly slower or maybe at about the same pace. As with the first cycle, my left ovary is more active than the right one. I wasn't feeling a letterboard tonight, but I did make this little picture using PowerPoint.

Whereas I was rightfully excited to have follicles at all last cycle, I'm guarding my heart and emotions a bit more this time around. As I knew before and have now personally experienced, the road is long, and a lot can happen. After the last few days, though, I am happy to accept any glimpse of positive news.

My RE kept my injections the same for the next few days, and we'll have another ultrasound and more bloodwork on Thursday. If history is any indication--which it might not be because every cycle is different--we could be looking at a trigger shot and retrieval at the end of the week. Then again, roller coasters make sudden turns in addition to going up and down hills.

Something that made today great: I had fried Oreos, a corn dog, a snowball, and jambalaya at Spring Fling today! (Also my HESPA friend Daniel was good company at the event.)
Time I woke up: 6:30 am

Sunday, April 18, 2021

IVF Cycle 2 - CD 14 / Stims Day 3 / NIAW Day 1

 Yesterday, I drove up to Bossier City to attend a bachelorette party for my friend Megan. This was my first time transporting fertility medications and doing my injections somewhere other than my house, and everything went fine. We had a great time hanging out, eating, laughing, and playing games. Although Megan offered to let me sleep over (and I’d packed a bag in case I needed to), I ended up driving home late last night because I felt up to it and didn’t want to have to wake up and drive. For those unfamiliar with Louisiana geography, it’s roughly a four-hour drive from Baton Rouge to Bossier City. That meant that I had lots of time in the car. I filled some of the time by catching up with friends, and I listened to the Fast Times at Ridgemont High soundtrack a few more times. I also threw some podcasts into the mix.

When I tired of the Fast Times at Ridgemont High soundtrack (yeah, it finally happened), I decided to look for a new Spotify playlist to try. I love a good playlist, but I am not great at building them myself. Last week, I discovered 70’s Road Trip and liked it, so I tried my luck for some comforting tunes by searching for “Infertility.” There were a few options to choose from, but I went with the first one I saw since I needed to be watching the road.

The playlist was called “Infertility Warrior,” and it contains several songs that I sort of expected. It’s also heavy on Christian/worship, which I don’t mind. I like a lot of praise and worship music. The second song on the playlist is Laura Story’s “Blessings,” which is a song I like but had sort of forgotten about until I had a Facebook status with some of the lyrics in my memories a few weeks ago. The chorus goes,

'Cause what if your blessings come through raindrops
What if Your healing comes through tears
What if a thousand sleepless nights are what it takes to know You're near
What if trials of this life are Your mercies in disguise

As I listened to the song last night, I found that I was not comforted by the lyrics as I had been in the past. All I could think of was my struggle with infertility. I said to myself, “I already know God is near. I don’t need tears, pain, or sleepless nights. This is pointless.“

Then, the next song was “Scars” by I Am They, which was a new one to me. It’s similar to “Blessings” but takes it to another level:

Darkest water and deepest pain
I wouldn't trade it for anything
'Cause my brokenness brought me to you
And these wounds are a story you'll use

So I'm thankful for the scars
'Cause without them I wouldn't know your heart
And I know they'll always tell of who you are
So forever I am thankful for the scars

Again, as I thought about my own pain, I couldn’t identify with the song in the least. I can think of a lot of things I’d trade to stop having to deal with infertility, and I’m absolutely not thankful for the scars. Even when I try to stretch my mind to think, “How will God use this experience for His glory?” the best I could come up with was, “I can use my words and my story to encourage others if they go through this.” But what if God just eliminated infertility altogether? What good does this struggle do for anyone other than help other people going through this seemingly unnecessary disease?

I felt myself growing upset at the singer and the song, and then it hit me: I’m angry. On Friday night, I was texting my friend Willie, and she offered her support if I needed to talk, cry, or be mad. I responded, “Thank you. I am mad and crying, but I’m eating pasta which is happy.” That was the first time I’d admitted that I was mad, but I let the feeling pass.

When I coached for Girls on the Run, one of my favorite lessons was on emotions. Rather than framing emotions as “good” or “bad,” the GOTR curriculum encourages us to think of emotions as “comfortable” and “uncomfortable.” Infertility has brought out a number of uncomfortable emotions in me; sad, disappointed, and hurt are a few that I have allowed myself to feel over the last few years. Then there are other uncomfortable emotions that I prefer to repress: jealous, bitter, and angry are the big three. When I think of words to describe myself, “angry” doesn’t make the list. I want to be known as intelligent, passionate, and driven. I want people to think of me as a kind and dependable friend they can call upon. Being angry doesn’t align with who I am or who I want to be.

Thinking about the “Scars” song, my life has been relatively easy; I have few true scars. I count losing my dad to cancer as a scar, but every other trial I have been through seems more like a minor inconvenience or setback. Most of my unanswered prayers have been related to schools I didn’t get accepted to or romantic relationships that didn’t work out. After everything played out with those situations, I was grateful that I didn’t get what I wanted, but this feels different. None of those dragged out for years or challenged me like infertility has, and none of them have made me this angry.

Initially, I also worried about being angry with God. In the back of my mind, however, a small voice reminded me of something I heard a long time ago. I don’t remember if it was in a sermon, a devotion, or even a casual conversation, but I was told once that it’s okay to unleash our anger on God. He can take it. As I was pulling back into Baton Rouge around 2:00 am last night, I allowed myself to speak the words aloud: “God, I am angry.” My eyes immediately filled up with huge tears. Normally when I’m about to cry, my eyes water a little bit, but last night was more like a flood. On one hand, I felt like a weight was lifted by finally saying out loud how I am feeling. On the other, I am still angry. It still hurts. It’s going to hurt for a while.

While I was inclined to resist these uncomfortable emotions, I am now allowing myself to feel them--not permanently, but at least for the moment. Better to embrace it now than let it fester into something worse. Meanwhile, we have an ultrasound and bloodwork tomorrow morning to see how things are progressing in my ovaries. Hopefully, we'll have news that leads to comfortable emotions rather than uncomfortable ones.

Something that made today great: Sleeping in with no alarm!

Time I woke up: 10:45 am