Wednesday, April 7, 2021

IVF Cycle 2 - CD 3

It's been a little while since my last update, but there has not been much going on with our fertility journey since our news that one embryo made it through day 5. I was pretty down last Thursday night and Friday, but I had the welcome and well-timed distraction of two of my sorority sisters coming for an extended ladies weekend from Saturday through this morning.

While we wait for the genetic testing on our one remaining embryo from our first IVF cycle, IVF Cycle 2 is officially underway.

I spoke to my RE on Friday, and he was very excited that we had one embryo make it to be tested. I asked if we should plan for a second cycle, and he indicated that we should unless we just really wanted to try to be pregnant right now. When I mentioned that we still would like to try for multiple children, he suggested another cycle to try to bank more embryos. We felt ready to try again immediately. My period showed up on Monday--isn't this the kind of thing everyone wants to read about on the internet?--so today I went in for bloodwork and an ultrasound.

Something that was a little different this time was that the ultrasound tech noted a cyst on my left ovary. As with seemingly everything in [in]fertility world, cysts can mean a variety of things ranging from "It's okay, let's proceed," to "We need to wait a bit," to "Cycle canceled!" In my case, we had to wait on my bloodwork to see if the cyst was producing estrogen, but it seemed like I was going to get the green light today or have to wait it out and take birth control for a longer period. (Actually, I don't think they make the cancellation call this early in the cycle, but I could be wrong.) I left the clinic with a calendar, but the caveat was that we might have to extend my time on birth control if the cyst was causing trouble.

This afternoon, I got the call that my bloodwork was fine, so we could go ahead with the original calendar. I am doing birth control pills for five days, then we go back next Tuesday for another ultrasound. Assuming that everything looks good, we will start our injections on the same schedule as last time beginning Wednesday the 13th: two days of Lupron, then the full stims.  I'm interested to see how the amounts of medication will be different this cycle, because things look the same thus far.  We still have a decent amount of medication from the first cycle, but we had to replenish a few things; I have already authorized the order with the pharmacy.

Something that made today great: Richard starts his time off today!

Time I woke up: 8:00 am

Thursday, April 1, 2021

IVF Cycle 1 - CD 26

Well, our good luck streak ran out this morning. We're not below expectations, but we're meeting rather than exceeding.

Based on these percentages reported by the Reproductive Medicine Associates of Connecticut, we should have expected to have 1 embryo at the blastocyst stage after day 5 after having only 80% of eggs be mature (we had 100%) and only 80% of eggs fertilize (we had 100%). If we had roughly followed those percentages, we would have expected to have 2 or 3 following fertilization. Then, we would expect 30 to 50% to make it to the blastocyst stage, which would be 1 to 2 (2 rather than 1.5 (a) to be generous and (b) since half of an embryo isn't exactly a thing). 

When the embryologist called this morning, she shared that we had one embryo that made it to the blastocyst stage and could be sent off for testing to see if they are euploid (normal number of chromosomes) or aneuploid (abnormal number of chromosomes). This was lower than we expected and definitely lower than we'd hoped for. From what I am reading (including this website) half or less of day 5-7 embryos are euploid. In our case, that means it is more likely than not that our one is aneuploid. I am hoping and praying for our one embryo to come back euploid. When I think about the numbers, however, a twisted part of my mind tells me that if we have success with our one, someone else will have to balance out the numbers with no success. I know it is not helpful or even rational to think this way. 

I have so many mixed feelings. I am happy that we are still in the game, but I feel guilty about hoping for my own success. Even if our one embryo comes back euploid, we still have to see if it would implant following a transfer. It's overwhelming. I also feel guilty for being sad that we only have one while Richard is ecstatic that one made it this far. Ultimately, we ended up where the numbers predicted we would, we were just stronger coming out of the gate. 

My clinic ships samples on Tuesday and Thursday but did not ship today due to the upcoming Easter holiday. Thus, our one sample will go out on Tuesday. Testing results follow in 7 to 10 days, so we were told that our next update would be in about two weeks. My instructions following the retrieval included calling on the first day of my next cycle, which I expect will be around the time we receive our next update. Until then, we wait. I have enough to keep me busy over the next few weeks, but somehow I doubt that I'll be able to stay calm the entire time. Hopefully, I'll be able to watch some TV shows or movies when I am not doing stuff for work or school. That sounds much nicer than fretting about infertility.

Overall, we are still glad we made the decision to try with IVF rather than IUI this month. We still stand a chance that we were less likely to have with IUI. We were already expecting to have to do another retrieval, but today's news has cemented that for us. While it's true that it only takes one, it's much more challenging to have multiple children--which was our main reason for choosing IVF over IUI--with just one. In some ways, it's helpful that we don't have to waffle on that piece. The question now becomes when we want to do that, which I suppose we will discuss with our RE. We still have a decent stash of medications and supplies in our refrigerator and bathroom cabinets, and we know what to expect going into our next cycle (whenever that is). I have heard from others who have been through IVF that the first cycle is often diagnostic to figure out how each person responds to medications and what to watch for. While this is a costly diagnostic/learning experience (I wanted to throw up when I paid my credit card bill a few hours ago), we are hopeful for the next cycle. Financially and emotionally, we cannot do this forever, but in the immediate future, we can do at least one more. It's a little like running in that way; you might not be able to make it 10 more miles, but you can almost always make it 10 more steps. 

Note that I changed "PGS" (Preimplantation Genetic Screening) to "PGT-A" (Preimplantation Genetic Testing for Aneuploidy) because I looked back through our IVF folder and noticed that our clinic calls it PGT-A. PGT-A is the updated name according to this website.

Something that made today great: I cooked a pretty good dinner tonight - we just started Green Chef Meals today.
Time I woke up: 8:45 am

Monday, March 29, 2021

IVF Cycle 1 - CD 24

I'm still unsure if the current cycle day means anything, but I am going to keep providing that information.

We've had a big few days, but fortunately all of the news has been good. Like...scary good. 

As scheduled, we had the egg retrieval procedure on Friday morning at 9:00 am. I was surprisingly relaxed about the whole thing. We had a fantastic nurse named Allison who checked on me frequently and made me feel so comfortable. They had cheerful music playing overhead, including a few Jimmy Buffett tunes. After they rolled me into the operating room and I was starting to feel the anesthesia, I made sure to tell the whole team that my deceased (that's the specific word I used) dad liked Jimmy Buffett, and having Jimmy Buffett playing brought me happy memories of my dad. That's the last thing I remember before I woke up back in recovery. 

Once I realized I was done, I asked Richard if they'd gotten all four follicles, and he reported that they had. Of course, I was very excited about the news. I was also excited about the post-surgery snacks I was offered, including Scooby Snacks (baked graham cracker snacks), pretzels, and a Coke. The snacks helped the recovery time pass quickly, and I was fortunate that I was not in any pain. Richard brought me home to rest, but it was a fairly easy day.

After our part was done, the lab got to work. Richard had to bring a semen sample to the hospital on Friday morning, which while a bit uncomfortable and embarrassing does seem simple compared to my role in the gig. At our RE's recommendation, we chose to do intra-cytoplasmic sperm injection, or ICSI. With ICSI, each mature egg is injected with a single sperm (one wearing a tuxedo, just like I mentioned with IUI). ICSI is more common among couples with male factor infertility (MFI), which is not a concern for us, but we want to give our eggs the best possible chance of success.

The embryologist called me early Saturday morning with an update. I did not realize how nervous I would be when I saw the call pop up on my screen. I was out running (this was not exactly in line with doctor's orders, but it worked out okay this time) and was totally alone, which would be both good and bad if the news was not good. Fortunately, it turned out that the news was not just good but great (or GRRRRRR-eat as Tony the Tiger would say): all four eggs were mature, and they all fertilized.

After that news, Richard and I were extremely glad we decided to follow through with IVF despite the low number of follicles. We are waiting patiently (for now) and hoping that we have more good news on Thursday. So far, it seems that we have quality over quantity, and I am okay with that. I thought for sure that we would need to do another round of stims and egg retrieval, as we want to have a comfortable amount of normal frozen embryos before attempting a transfer. However, our RE told Richard that might not be the case. Ultimately, we could have 0, could have 4, and will likely have some number in between. For now, however, we are celebrating these victories after making a risky decision last week. We are so thankful for the prayers and support as well as the enthusiasm from others and celebration as we share this good news!

Something that made today great: I never do two things, but I'm making an exception today: (1) Lunch at The Chimes with Julianna and (2) An amazing card from my friend KT that arrived in the mail today! 
Time I woke up: 8:40 am

Wednesday, March 24, 2021

IVF Cycle 1 - CD 19 / Stims Day 7

Speaking broadly, couples do not tend to end up doing IVF because the journey will be easy for them. Beyond the attrition I described in yesterday’s post, there are numerous places where a couple can hit a snag in the process. In our case, the first snag was this morning.

During my ultrasound, the same four follicles I had on Monday were still growing. My 10, 13, 17, and 18 had become 14, 18, 21, and 23. Shortly after the tech measured my follicles, my RE came in and said it looked like I was ready. At first, I thought, “Wow, I’m such an overachiever! We’re ready! Go ovaries!” As I mentioned last night, however, we don’t want the follicles I have to get too big. To prevent that from happening, we would need to administer my trigger shot to let my ovaries know it’s time to release the mature eggs. (This website explains more about the trigger shot.) This also meant that unless I have a follicle hiding undetected (as opposed to hiding detected?) somewhere, the most we will be able to retrieve would be four. Keeping the attrition I discussed last night in mind, that does not leave us with much to work with, statistically speaking.  

With so few follicles, one option was to cancel the IVF cycle and switch to intrauterine insemination (IUI). IUI involves placing sperm directly into the uterus, but it relies on the sperm finding the egg. The fertility clinic offers a little assistance for the sperm by “washing” the semen sample and picking out the best sperm. (Our RE explained it as “the ones wearing tuxedos” which still makes us laugh.) Before we knew how few eggs I had, we’d planned to try IUI anyway. Since we hope to have more than one child, however, we chose to pursue IVF once we knew the egg situation. As we weighed options today, we determined that the primary pro of doing IUI over IVF is the financial savings. IUI costs much less because we skip the costs involved with retrieving eggs, having an embryologist create and monitor the embryos, testing the embryos, and freezing anything we do not transfer. If the cycle ends with no genetically normal embryos, we are out a considerable amount of money for a learning experience. On the other hand, IVF ensures that the sperm and egg find each other, and testing the embryos decreases the likelihood of miscarriage. Also, if luck is on our side, we could end up with multiple normal embryos! 

It feels like a huge gamble.

Our RE asked Richard and me to discuss our options and told us he’d give us a call back this afternoon and let us know how the bloodwork looked. Another piece of the puzzle is the estradiol (estrogen) level; our RE explained that for mature eggs, estradiol should measure around 200-250 pg/mL per follicle.  Thrilled that we had eggs at all, much less four, Richard was supportive of going forward with IVF. We also discussed that if we converted to IUI, we might always wonder what would have happened if we had done IVF instead. I agreed, and with that, we decided that we wanted to do IVF unless the bloodwork indicated we absolutely should not.

After I changed out of my fertility clinic outfit (one of two “This is terrible. Keep going.” shirts I ordered from the My Favorite Murder store and jeans), ate breakfast, and dropped Richard off at home, I headed into work. For some reason, I really wanted to listen to “Set It Off” by Boosie on the way to work. I don’t know most of the words, and some of the words offend me, but it felt really good to ardently scream the lyrics I do know as I drove to work in my grandma car. I liked it so much that I played the song on repeat until I arrived at work (which isn’t that many times, but still). 

When our RE called around 1:30, he reported that my estradiol reading was 1550 pg/mL, which averages out to about 388 pg/mL per follicle. Richard and I shared our thoughts about going forward with IVF with the RE, and he said he understood our reasoning. He wanted to speak with the other physicians about a plan to trigger, but he said a nurse would call later with instructions.

About an hour and a half later, the nurse called and told me that we would trigger tonight at 9:00 pm and come in Friday morning at 8:00 for an egg retrieval at 9:00. She reminded me of the instructions for the trigger shot and told me to discontinue my stims. Whereas I thought I had two to eight more days of stims, everything changed today. I’m not exactly sure when I expected to stop stims and trigger, but it certainly wasn’t today. I spend a decent amount of time reading infertility and low AMH/DOR Facebook groups, and I see people post about how they have been stimming for days. I thought I would be a bloated hormonal mess for ten days to two weeks, but I’m just a little bruised up and tired. I’m not complaining, though.

We did the trigger shot as planned at 9:00, and it was not a huge deal; we are accustomed to injections now. I am doing my best to stay in the moment and focus on preparing for the best outcome from this cycle. Primarily, that will mean more rest and less stress tomorrow before the retrieval on Friday. I have to remind myself that we are still in the game, and the estrogen levels are indicative of mature eggs. When my mind drifts to the future and I start thinking about how we’re likely to need another round of stims and retrieval before we can transfer, I have to pull myself back to the present. We are so thankful to be covered in prayer and well wishes as we press on through IVF. It makes the whole experience feel much less lonely.

Something that made today great: Richard has been referring to the follicles as “chonks” and “chonky boiz,” and it’s making me laugh pretty hard every time he says it.

Time I woke up: 6:30 am

Tuesday, March 23, 2021

IVF Cycle 1 - CD 18 / Stims Day 6

Note: I'm starting this blog post at 11:33 pm and hoping to publish by midnight, so this might seem rushed.

I'm realizing that I don't really know how to count the days...the date of my last menstrual period seems to matter less when you throw birth control, suppression, and stimulation into the mix. For what it's worth, though, today was Cycle Day 18 and Day 6 of ovarian stimulation (stims). 

Richard and I returned to my RE's office yesterday for bloodwork and another ultrasound, and there were follicles visible on the ultrasound! Eggs grow in follicles (but not always all of them), so seeing follicles on the ultrasound is a good sign. IVF is basically a giant funnel with attrition expected at several points. This website explains it in detail, but after we see how many follicles contain eggs, we'll get a count of mature eggs retrieved. From there, we will see how many eggs fertilize into embryos, followed by how many embryos make it to day 5 (blastocyst), and how many of those are chromosomally normal. Then, we see if the embryo implants during a transfer.

So, we have a few steps to go. Right now, though, we are focusing on follicles. 

With my diminished ovarian reserve (DOR), we are not expecting to be on the high end of normal, or even in the normal range at all. I mentioned before that something to note about DOR is that it doesn't tell us much about egg quality. However, if there are fewer eggs overall, proportionally, it is likely that the number of high-quality eggs is also lower. 

Our ultrasound showed four follicles. Three are in my left ovary, and one (the biggest one!) is in my right ovary. Their sizes are 10 mm, 13 mm, 17 mm, and 18 mm. (That's micrometers, not millimeters...but everywhere I have looked, it's written as "mm" rather than "μm." I don't know why that is.) In the picture below, you can see where I printed and cut out little circles to represent each follicle. They are not actual size, but they are proportional to each other. I need to figure out a better way to display them on future boards.

We still have somewhere between two and eight days of stimming to go, so hopefully, we'll have some more follicles appear. We also don't want the ones I do have to get too big, though. It's a balancing act, and I'm glad I am not the one who has to make the major decisions to manage it. I just do what I'm told.

My RE mostly left my injections the same, except we cut out the evening Follistim. I am fine with fewer injections, though I am fortunate that the only side effect I have had is being tired. Tomorrow, we go back to the RE for another ultrasound and bloodwork. Hopefully, I will need to cut out or draw a few more little circles.

Something that made today great: Taco Tuesday with Elena and friends followed by excellent dissertation writing!

Time I woke up: 9:30 am

Saturday, March 20, 2021

IVF Cycle 1 - CD 15

It's common knowledge that becoming pregnant changes a person's body, but what is less widely known is how simply trying to become pregnant can change someone's body.

My belly is beginning to bruise.

We have been stimming for three days, so this is not surprising. They're just little bruises, and they don't hurt. Still, they're visible reminders of our process and what we're putting my body through (as if we could forget with twice-daily injections). My stomach is also peppered with little red marks where we've done injections that didn't lead to bruises. Inside my belly button and just below the waist of my shorts are more permanent scars from the laparoscopic surgery I had in December where my OBGYN discovered (and removed) endometriosis and noticed that my ovaries looked unusual. Those little incisions are what led to the discovery of my diminished ovarian reserve (DOR). In addition to what we hope is going on inside, my body has changed on the outside.

While I have been fortunate that I am feeling pretty good overall, I am having to take a step back in other areas of my life besides running. I had planned to go to Shreveport for the afternoon to attend a wedding shower for my friends Megan and Aaron and visit my work wife, Tricia, and then I was going to drive back to Baton Rouge. However, I woke up feeling so tired, and the thought of driving eight hours round trip and having to transport my evening shots in a cooler and do them alone somewhere on the way home started to feel like a lot. Instead, my day consisted of going to Slow Mode and walking the 4-mile loop before coming home to crash for hours. 

At times, I feel as if we are asking my body for a lot by putting it through this process. Other times, I am frustrated that we are undergoing so much for what I was told for years that my body is "supposed to" do. I worry that it could fail and that we'll have to make a decision of whether or not to do another cycle of IVF. Yet somehow I feel less anxious about IVF than I did in the many months of never getting pregnant and wondering what was wrong. I am comforted by a process, even one as intense and uncertain as this one is.

In some ways, these little spots and bruises are a reminder of the bigger point of all of this. Short of a miracle, IVF is the way for Richard and me to become biological parents. We have known for a long time that we wanted to have our own children, and this is what seems to be the most promising way to reach that goal, even if it's not a guarantee either. It is easy for me to get wrapped up in what IVF is doing to my body, but coping with infertility as a couple is extremely challenging, too. I have been so fortunate to have Richard as a partner, as he is an excellent injection giver and all-around supporter. He also never blames me or tells me our fertility problems are my fault, even though the tests suggest they are. As I take a step back from things and say no to more opportunities or activities, I have to remember the long game and what this means for Richard, me, and our family. My job, for now, is to take the best care of myself that I can, and sometimes that means taking a day to rest.

On a lighter note, I have some pretty hilarious and unflattering photos from attempting to capture this shot of my belly. The pictures I took using flash showed the bruises a little better than this one does, but the flash makes my belly look super pale (which it is). Also, I'm really enjoying my pajamas that include steak shorts that Lyndsay bought me and a "Powerline Stand Out Tour 95" sweatshirt that I ordered a few weeks ago after confessing my fictional character crush on Powerline to Tricia over FaceTime. The side where we've been doing my night injections has more bruises, so I think we'll be switching up the routine tomorrow. Hopefully, I won't become too overwhelmed with all of the excitement.

Something that made today great: I enjoyed being able to catch up on rest today!

Time I woke up: 7:20 am

Thursday, March 18, 2021

IVF Cycle 1 - CD 13

Today was the first day of the full deal of injectable medications. In IVF world, that's known as ovarian stimulation, or "stimming." Richard worked last night, but he FaceTimed me at 5:00 am so I wasn't alone for my injections. (Scooter was still asleep.)

I had a pretty busy day today between work and other tasks I needed to manage. I had class on Zoom from 4:30 to 5:30, so Richard agreed to prep everything for the PM injections and bring the supplies to my desk. My plan was to turn off the camera but still try to listen to class. 

Richard opted to do Follistim first. As he was actively injecting the piece of belly I'd chosen, I asked, "This is 125?" The rest of our conversation went something like this:

        R: No, it's 250. Right?
        K: I don't think so. I think it's 250 in the morning and 125 at night. 
        R: I thought it was the same both times.
        K: No, I don't think so.
        R: Shit.
        K: Shit.

Richard went to the back of the house and came back with the calendar in hand. It was indeed 125 at night. After the Menopur (which has a bigger needle and burns a little bit but still wasn't *too* bad) and Lupron, my next move was to text our RE. I lovingly threw Richard under the bus but was not actually mad at him.

Updated calendar

My RE returned my call within a few minutes and eased our worries. The good news is that it's not really possible to overdose on Follistim, but I jokingly said I wouldn't mention that to Richard because he's not much on moderation with anything. My RE reminded me that it's an expensive medication--the most expensive in our collection by a long shot (pun not intended)--so it's best not to overdo it. However, a little extra Follistim at the beginning is more likely to provide a boost than cause harm. That was reassuring!

It feels as if we might need a variation of one of those workplace accident signs to hang in the bathroom that reads, "____ days since our last medication error," but hopefully we won't have any more of these. I do not have any more class meetings until April 8, so we should be able to check each other's work in the future. 

Also, I think it bodes well for us that we were good grown-ups and asked the doctor what we needed to do rather than having an argument or playing blame games. Richard really is the dreamiest. Fortunately, it was a minor error and we have laughed about it several times since, but who knows how I might react in a few days when I'm deeper into these hormone injections? Hopefully, we won't find out.

Something that made today great: Fantastic weather following yesterday's storms!
Time I woke up: 8:30 am (I go back to bed after my injections are done)