Sunday, November 28, 2021

IVF Cycle 4 - The Beginning

 It's almost been a month since I had the bloodwork appointment where I was a little pregnant. In most ways, the month has flown by--on top of my regular work and school routine, other things such as travel for conferences, the LSU/Arkansas football game, travel for fun, and Thanksgiving have kept me busy. What I haven't been doing is going to any of the races I signed up for in November. I've also decided I am done drinking alcohol for a while, which hasn't been a huge change in my day-to-day routine but has been surprising for some people in social situations. However, as many of my friends will attest, I love a good mocktail as much as I love a cocktail.

Despite staying busy, I haven't been quite able to shake the grief that's followed the chemical pregnancy from our first frozen embryo transfer. I know these things take time, and I also know that I'll never be exactly the same after experiencing this loss (and the [in]fertility journey more broadly). It seems like I get a little closer to normal every day, but some days are definitely tougher than others. As evidence that I can still smile and have fun, here are a few photos from The Office Experience that Brooke and I went to in Chicago. (If you're a fan of The Office and are going to be in Chicago between now and January 17, go check out the experience! We loved it.)


Brooke and me in Michael's office

Enjoying the Finer Things Club--I'm smiling under the mask

I was supposed to go back to the doctor on November 19 to prepare for our fourth IVF cycle, but when I looked forward in my calendar, I realized I was going to be out of town for the Association of Fraternity and Sorority Advisors Annual Meeting during the late stims/possible retrieval portion of the cycle. I want to attend the annual meeting for a number of reasons, including hopefully promoting my dissertation study, but I also didn't want to lose a month. Fortunately, when I realized this was going to be an issue, I called my nurse and got approval from my doctor to stay on the Nuvaring for an extra week. With everything pushed back a week, I went back for an ultrasound and bloodwork on November 26. Everything looked as expected, so we start Lupron injections tomorrow at 5 am. Full stims will start on Wednesday.  

I'm approaching this next cycle with a mix of emotions. Our doctor told us when we first started seeing him that we might not hit the right cycle (I forget his exact words) on the first try. The second cycle was the best by far (two euploid embryos as opposed to zero), and I'm hoping we will see similar (or better!) results from this time around. I remain grateful that this is something we are able to attempt multiple times, but I also can't help but wonder why Richard and I--or anyone else for that matter--would have to endure such a long and difficult road to (hopefully, but still not guaranteed) biological parenthood. I probably won't understand on this side of Heaven. We will continue doing everything we can and then hoping for the best. Please remember us as we embark on our fourth round of ovarian stimulation and (hopefully) egg retrieval. 



Something that made today great: Video chatting with Ashley, Emma, and [briefly] Brittany
Time I woke up: 11:45 am

Friday, November 12, 2021

FET Cycle 1 Wrapup

It's been two weeks since my last update, so I guess it's time for another one.

When I left off, I'd just gotten the news that my first beta result was 25, which was a gray area, or "a little pregnant." This was not the news we'd hoped for, and despite wanting to not stress out all weekend, I stressed out all weekend. On Friday night, I took a home pregnancy test for the experience of seeing what a "little pregnant" test looked like. Something just felt wrong all weekend. I met my friend Megan for late lunch/early dinner on Sunday afternoon, and I could barely eat. On Sunday night, I decided to try another test, and the second line on the test--the one that separates the "pregnant" from the "not pregnant"-- was all but gone. In two short days, our pregnancy faded away. The test from Sunday is still sitting on my bathroom counter with the second line barely there; it is simultaneously a reminder that I was once pregnant and a reminder that I'm not pregnant anymore. I probably need to throw it away.

After consulting with another friend who's had a failed transfer, I decided to message my nurse and ask if I could come in for bloodwork on Monday instead of Tuesday to save myself the waiting and the progesterone shots I would have needed if the pregnancy has been viable. This is probably a bit dramatic, but I felt like I was on a death march. My nurse responded early on Monday morning, and I went in at 9:00 for the bloodwork. 




The nurse called Monday afternoon to let us know that my HCG had dropped to 5, which is considered negative. She told me I could discontinue the medications I was on and wait for my period to start. Looking to the future, she said that before we attempted another transfer, my doctor wanted to do an Endometrial Receptivity Analysis, or ERA. There's more information on this website, but to put it simply, I will do a mock transfer cycle (complete with the meds and shots) but not actually transfer an embryo. Instead, they'll take a sample from my endometrium (uterine lining) to see if we actually timed the transfer correctly, if I need more days of progesterone, or if I need fewer days of progesterone. Looking at the calendar, that meant that another actual transfer before the end of the year was not in the cards.

For those keeping count at home, though, the other issue is our number of euploid (normal) embryos: we're down to one. Regardless of when we do the ERA, we knew we'd have to make a decision about whether to go for another retrieval or try to transfer the second embryo. This was something we wanted to discuss with our doctor, but we also wanted to take some time to process what had just happened and what was about to happen. We called back on Wednesday and scheduled a time to talk with our doctor on Friday.

Meanwhile, I had to decide whether I wanted to cancel my plans to attend the Association for the Study of Higher Education (ASHE) conference in San Juan, Puerto Rico. I wanted to go, but I was nervous about what would come next. Ultimately, Richard agreed to travel with me, so I canceled my flight, booked a new one for both of us, and scheduled Scooter for boarding. I also made the decision to go ahead and tell my supervisors what was going on. Truthfully, I'd been minimally productive at work since Friday afternoon's news--I completely threw in the towel and took Monday afternoon as personal time--but my supervisors were supportive and encouraged me to do whatever I felt I needed. I tried (with mixed results) to do what was critical and put everything else on hold.

After I learned that I was going to miscarry, I thought a lot about what that would be like in an unfamiliar place compared to in my own home. I pictured myself bleeding and sobbing while I wondered if the baby had come out yet. Regardless of where it happened, I realized it was going to be rough. Even the fact that I could prepare for the moment felt strange. I've reflected a bit, and I think it was better to know what was coming than to be caught off guard. I worried that it would be painful, too. It was like a different version of the same death march I had been on, but at least there was an end in sight. 

I started bleeding on Thursday. While I found myself wondering if I'd just flushed what could have been our child down the toilet, I never cried. It was slightly more painful than my regular periods, but I managed the pain with over-the-counter meds. I was oddly at peace, and I truly think it helped that so many people have been praying for us. I also appreciated the change of scenery and the fact that Richard was there with me.

We talked with our RE on Friday morning about next steps and determined that we would go for a fourth retrieval before attempting another transfer. Despite everything we've been thrown this year, Richard and I are still hopeful that we will be able to have children using my eggs and his sperm. Our doctor had several anecdotes about couples going through IVF and then getting pregnant naturally, which is a lovely thought but one that feels completely out of reach at this point in our process. With our desire for multiple children and only one normal embryo in the freezer, another retrieval seemed to make the most sense. I'm not getting any younger. So, we're at the beginning of IVF cycle 4.

Coming home from the conference was a bit of a challenge. I have felt very left behind as we continue down this road. I'm also learning that I feel the best when I am totally distracted. I want to think about conferences, work, and anything but [in]fertility. I don't have the energy or emotional bandwidth to work at the level I would like, but I've mostly been working until I'm tired enough for bed. This is effective for me in most ways, but I also realize that there is now a volatile can of emotions just waiting in the wings to explode. Below is a picture of me presenting some of my dissertation research (as research-in-progress) at a [different] conference this week. I think I look happy and proud. I love my dress, and my hair and makeup were on point too, despite the number that the New Orleans humidity did on my curls. But when I zoom in on my face, I see how tired I look and how much hurt is in my eyes. I have tried to bury this immense grief because I can't shake it off. The best I can do is suppress it.


Despite my sadness, there are several positive things that I can say about all of this. The failed embryo transfer and chemical pregnancy have absolutely affirmed the strength of my marriage and the dreaminess of my husband. The years of trying have been difficult, but this year especially so. Richard assures me that he's going to love me no matter what, and we're going to get through this. Even if I already knew all of that, it's good to hear again. Similarly, I have felt lots of love and support from friends and family in the form of Facebook messages, Facebook comments, text messages, and calls from family and friends. There are so many people who have offered sympathetic thoughts and words of encouragement while I've been down in the dumps. I'll also give myself a little bit of credit and state that even though I don't feel fully like myself, I'm pretty darn strong, tough, and resilient...and that's pretty cool. 

So, time marches on, and we're moving forward with it. I picked up a Nuvaring from a CVS in San Juan last Friday, and our fertility medications will deliver on Tuesday. I return to the RE on Friday for an ultrasound and bloodwork, and I think we'll get our calendar for this cycle at that appointment. I never thought I'd be a repeat IVF-er, but my hopes are high for the upcoming cycle. Please remember us as we prepare for whatever is next.

Something that made today great: I had a lovely dinner out with family tonight. 
Time I woke up: 9:00 am

Friday, October 29, 2021

FET Cycle 1 - Update 6 (10dp5dt, Beta 1 Day)

 Right after my transfer, I posted on social media that I was Pregnant Until Proven Otherwise, or PUPO. Today, beta day, was the day I could drop the UPO and confirm pregnancy. As I have said repeatedly, nothing—especially a live birth—is ever guaranteed with IVF, but today’s beta test was the next step along the journey.

I was a few minutes late for my 9:15 blood draw, but there was nobody else in the waiting room. I was called back shortly after I sat down. The draw was quick, and they told me they would call with results in a few hours. The clinic closes at noon on Friday, so I figured I would not have long to wait. I watched the clock and was not very focused on my work. At 12:14 pm, my doctor called. He asked if it was a good time to talk, and I told him I needed to go wake Richard. When Richard was ready, our doctor told us that my beta was 25, which is a gray area. It’s lower than desired at this point, but I am technically pregnant. I tried to put a positive spin on the situation by saying, “Well I’m more pregnant than I’ve ever been,” which my doctor agreed was true. The next test (because of course there’s a next test) is to see if my beta is at increasing. So, I go back on Tuesday (14dp5dt) at 7:45 am to see what the situation is. The expectation is that the beta should double every 48 to 72 hours, which would mean I hope to be in the 60-100 range by the next test. Sometimes it takes babies a little longer to get going, which I totally understand as someone who’s not an early riser and is tough to get going. (For those who are wondering, when the issue isn’t just being slow to grow and the levels fail to rise, this becomes what is known as a chemical pregnancy—this article covers the topic. I’m not ready to discuss this possibility.) In the meantime, we hope, pray, rest, and try to be happy.

Upon receiving this news, I had two reactions at the same time. As I reflected on them later, I had to laugh at how graduate learning has molded my way of thinking but hasn’t made me completely stop flying off the handle when I initially receive disappointing news.

Reaction 1 (the more dramatic one – skip over this one if you’re not one for colorful language):

Everything I ever learned in the public school system about pregnancy was fucking bullshit. It’s not as simple as “pregnant” or “not pregnant.” How the hell can a sperm can fertilize an egg, and a person could still not be pregnant? Fuck the entire system and all of the structures that fail to educate people about how to take control of their fertility and just tries to scare people out of having sex. I hate everything.

Reaction 2 (the one I’m prouder of):

The more I learn, the more I realize how much I don’t know. I can learn a lot from this experience. How can we more adequately define pregnancy (or are we already doing the best we can)? I thought this would be a simple “pregnant” or “not pregnant” situation, but it’s more of a dimmer switch than a light switch you flip on or off…and it’s looking pretty dim right now. I was never guaranteed a viable pregnancy, and I will not be guaranteed a viable pregnancy even if the beta does increase, so really I would have been waiting for the next thing—whatever that was—regardless.

Truthfully, I knew in my heart that being PUPO really meant being a little pregnant. I had lunch with some friends last Sunday and opted for a mocktail with my meal since I was PUPO. I explained to them that the sperm had fertilized the egg, and the embryo was in my uterus, but we were waiting and hoping it would implant and grow. Saying that aloud and typing it just now does truly feel ridiculous. In a poll, even of educated people, I think most people would agree when the sperm and egg meet and are in the uterus, a person is pregnant. There’s so much we take for granted and expect bodies to do when in fact, it’s difficult for some bodies.

The good news in all of this is that we now know I am capable of becoming pregnant. I have wanted this and hoped and prayed for it for years. Another thing I’ve learned from (a) graduate school and (b) working in positions where I had to hold young people accountable is that you have to ask the questions you’re actually trying to get an answer to. As I’ve asked and dreamed of being pregnant, I didn’t specify how pregnant I hoped to be. I have learned to pray for a viable pregnancy ending with a live birth, but I never said anything about betas. So really, I got what I asked for. In the future, I’ll ask for high betas.

I’ve been jamming to Tom Petty and James Taylor tonight, and Tom Petty says in “The Waiting” that the waiting is the hardest part. I’m not sure that’s exactly true, but it’s definitely a part. Please remember us and pray for us through this next chunk of waiting time.


Something that made today great: The higher education student association had a mix and mingle on Zoom today that was pretty fun!

Time I woke up: 8:15 am

Wednesday, October 27, 2021

FET Cycle 1 - Update 5 (8dp5dt)

Oops, I definitely didn't realize that two weeks had passed since my last update. I am now 8 days past a transfer of one thawed 5-day embryo (with transfer day being day 0), which is referred to in the lingo as "8dp5dt."

Since my last post, we started the PIO shots. Overall, they are going well! We have received several tips that have made the process a little better for us (at least I think they have--we didn't have a control for this experiment). Warming the oil (either in a cup of warm water or in our armpits) helps thin the oil a bit, and going for a walk or easy run after has been helpful for my muscles. Admittedly, I have gone back to sleep more days than I have gotten up and moved. I definitely notice the difference when I don't exercise...it's that way with other parts of my body and exercise, too. 

For comparison, I included a photograph of the needle Richard uses to inject the PIO compared to the one we use to inject Lupron. Since starting down this road, I have learned that a larger needle gauge means a smaller hole in the needle. Whereas the Lupron syringe (also commonly known as an insulin syringe) is a 31 gauge, the PIO needle is a 22 gauge. I think the Lupron needle is 5/8" long, compared to 1.5" for the PIO. Fortunately, the worst part is piercing the skin with the needle. The actual injection is not bad, and I eat a piece of chocolate every day when it's done, which is good. What might present a new challenge will be if I am actually pregnant, as I am traveling to a conference next week and will have to do my own injections or find a conference buddy and get really close with them really fast...but we aren't there yet.

Photograph of two syringes (one larger than the other with a longer needle) and two bottles of progesterone (one empty and one half full) on a black bathroom counter
A comparison of needles: PIO vs Lupron

Other than PIO injections, I had my last lab visit on Monday, October 18, and then Tuesday, October 19 was the transfer date. (Yay!) There is a risk (of course there is, there's always a risk) that something could go wrong in the thawing process, but our embryo thawed exactly as expected. Our doctor even called it "gorgeous" and gave us a picture as proof. While "gorgeous" is a different term from the "beautiful" word that I resist, it still makes me nervous to put much stock in those sorts of comments. Richard and I were not sure if the embryo looked more like him or me, but our doctor said the comparison is difficult to make unless we have photos of ourselves five days after the sperm met the egg, and technology has changed considerably since the 1980's. I guess time will tell. 

Although I'd talked with a few people who have been through the FET process, I was still a little unsure of what to expect. It was a short process and was not painful, but it shares many uncomfortable characteristics with a pap smear, including a hospital gown, stirrups, and a speculum. (But as a bonus, I got a warm blanket for this one!) Something different about this procedure is that Richard was able to be in the room with me. I think his presence helped keep me calm. Also different was that it felt a little like being on a medical or scientific TV show. The embryologist entered the room and asked me to confirm my name, date of birth, and what I was there for. (I got all three correct.) Then, a few moments later, she returned and said, "One embryo for Davis," and passed it to the doctor. I didn't get a good look at the container, and I kind of regret not paying better attention. Richard was able to watch on the ultrasound screen while the doctor inserted the catheter and put the embryo in. I didn't really know what I was looking at, so I looked at the ceiling more than the screen. In total, the procedure only lasted a few minutes. A moment after we finished, the embryologist returned and stated "all clear." In other words, the catheter was empty--no embryo left behind. Our doctor was satisfied with the transfer and said it went exactly as it should have. That was good news!

After the transfer, we went to McDonald's to pick up lunch and lots of fries, because it's IVF community folklore that they're supposed to bring good luck after the transfer. (Richard and Scooter ate fries as well for good measure.) I rested all day after that and made sure to keep my feet warm (more IVF folklore). I continued to take it mostly easy for the rest of the week. Richard was off all week, so we enjoyed having down time at home together.

Over the last few days, the waiting has gotten more difficult. I've increased my napping frequency once more, which could be a sign of pregnancy or could be a sign of estradiol and progesterone. Friday (10/29) is the day I go to my doctor and have a blood test for pregnancy. The test is referred to as the Beta, short for beta human chorionic gonadotropin (HCG). HCG is known as the pregnancy hormone because blood or urine tests measuring HCG levels can confirm pregnancy. The over the counter/at home pregnancy tests check HCG levels in the urine.

On Sunday night, my mom asked me, "Why do you have to go to the doctor for a pregnancy test? Can't you just take a test at home?" Those are interesting questions indeed. The short answer is that while urine pregnancy tests are 97-99% accurate, blood pregnancy tests are more like 99% accurate. A risk of a false result on an at-home test could be worrisome or devastating for many reasons. With a false negative urine test and a positive blood test, I could be thinking the FET failed when it didn't. With a false positive urine test and a negative blood test, I could be getting my hopes up about a failed transfer. People make different decisions about whether to test at home, and the choice is highly personal. Regardless of testing choice, the wait until the beta doesn't go away. 

My beta is Friday morning, so I am about a day and a half from the test and a little longer than that before we have results. I'm hoping that Thursday isn't too agonizing with the waiting. I have a few things scheduled that will keep me busy.

Something that made today great: I video chatted with Ashley and Emma and laughed about all kinds of silly stuff!

Time I woke up: 8:30 am


Wednesday, October 13, 2021

FET Cycle 1 - Update 4

Okay, we're gaining momentum! Richard and I went for our last ultrasound today, and my RE said things looked beautiful. I kind of resist using that word for anything fertility related after our beautiful embryo from the third retrieval turned out to be highly aneuploid, but at the same time, I know my doctor meant it in a positive way. My ovaries are chilling out (which is what we want before a transfer), and my endometrial thickness was 10. Research has suggested (this article cites 5 studies) that pregnancy and live birth rates are significantly higher when endometrial thickness is is greater than 9-10 mm, so I'm where I need to be.

After our ultrasound, our nurse gave us a small packet of instructions for before the transfer, after the transfer, and the PIO shots. She also told us the time for the transfer: October 19 at 10:30 am! Tomorrow's PIO shot has to be at exactly 10:30 am (something about lining up with the transfer time), but the other days can be whenever I want them. I'm happy to be able to work from home for the first one. I've been advised to go for a brisk walk to work my glutes after the shot, but I'm going to do it big tomorrow: Ellen is coming over for a pre-lunch run.

Toward the end of last week, I heard from a connection I met through an infertility group that her transfer was canceled because her endometrial lining was not where it needed to be for a transfer. After that, I was worried that we might not get to move forward on October 19 as scheduled. Thus, I was relieved to get the green light today. I was also surprised by how different I felt leaving our appointment knowing that my next visit would be the day before the transfer. It all feels really real, but in a good/exciting way.

A bright spot since my last update is that my body seems to have grown accustomed to the estradiol, and I have not had to take any naps in four days. I love naps, but it's nice to not need a nap to feel functional. I'm sure I'll take a nap or two this weekend.

Something that made today great: Getting our transfer time and instructions was pretty great!

Time I woke up: 6:45 am

Saturday, October 9, 2021

FET Cycle 1 - Update 3

We went back to the doctor yesterday, and things seem to be proceeding as expected. I started taking estradiol on October 1 (which was actually very early on October 2 thanks to pharmacy mishaps and airline delays!), and that has been mostly fine. I was notably more tired this week than I have been lately, but I traveled and ran the Oklahoma City Memorial Marathon last weekend, so I can't fully blame the medicine. As scheduled, we upped my estradiol from two tablets daily to three, and we added estradiol patches yesterday. We're not quite 24 hours into the patches, but so far they're a non-issue. All normal life stuff (showering, taking a bath, swimming, exercising) is okay with these, which definitely makes things easier. After 72 hours, I'll take these off and put two more on the other side of my belly...and repeat every 72 hours until further notice. I guess we'll see this week if the estrogen is to blame for my tiredness this week or if I've just been trying to do too much.
 



I have talked a lot about injections, but I don't think I have ever said much about the oral medications/supplements I take for fertility purposes. Some I've been on for a while, others I started when we started seeing our RE. So, here's a short list of what goes into my body every day.
  • Prenatal vitamin - started over-the-counter prenatals in late 2017/early 2018 and switched to a prescription prenatal in April 2019. I don't know that the prescription makes a difference.
  • Folic acid - 2 mg (1 mg 2x/day) - started this in April 2019
  • DHEA - 25 mg - started this in February 2021 when we started working with our RE
  • CoQ10 - 200 mg - started this in February 2021 when we started working with our RE
  • Vitamin D3 - 2000 IU - started this in February 2021 when we started working with our RE. I take the fruity gummy ones--this is my favorite part of the daily routine. 🙂
  • Baby aspirin - 81 mg - started this last Friday for FET prep, though I also took these during the second retrieval cycle
  • Estrace - 6 mg (2 mg 3x/day) - started this last Friday for FET prep. 
We're also still doing 5 units of Lupron once by injection; it's not yet time for the progesterone in oil (PIO). 

There's a lot of preparation involved in a process that offers no guarantees, but we're plugging along and hoping for the best. Someone I know from an infertility group just had their cycle canceled this week a few days before their scheduled transfer due to issues with the uterine lining, and that was a wake-up call that even this far in, things can still deviate from the plan. With only two precious euploid embryos, we definitely wouldn't want to move forward if conditions were not right. Still, we've been through so much this year (and in the previous years) that it would be devastating to have to abandon the mission and wait to try again. So, we hope and pray that my body responds to the medicines as expected.

We'll go back to our RE on Wednesday, and that is our last scheduled ultrasound before the transfer. I'll have labs on the 18th before the transfer on the 19th. I'm doing my best to keep calm, but I don't think it's possible to be completely at peace at this point.



Something that made today great: I usually write these at night...but so far today, it'd be sleeping as late as I wanted.

Time I woke up: 8:28 am initially, but I went back to sleep for a few hours after playing on my phone for a bit.

Thursday, September 30, 2021

FET Cycle 1 - Update 2

With just a few minutes left in September, we are now eagerly looking to October. It's Richard's birth month, but it's also (hopefully) our FET month! It's been a bit since I have made one of these boards, so I'm a little rusty. But...

Letter board that reads "Hooray, we have a transfer day! October 19"

At our appointment today, we got a new calendar complete with an anticipated transfer date of October 19 and a schedule of medicines (and medicine changes) to follow until pregnancy test day on October 29. I fell into the birth control/Lupron lull and forgot to stop taking birth control last Thursday, so I had two extra days of birth control. Fortunately, things still look fine, and I am going to pay closer attention to this schedule. Starting tomorrow, I'll be decreasing my Lupron from 10 units to 5 units daily and adding estrogen and baby aspirin to the regimen. I'm still two weeks out from the infamous progesterone in oil shots, but I'm currently so excited to be approaching a transfer that I'm not worried about big needles or thick oil going into my rump. 

Photo of medication schedule for Frozen Embryo Transfer

As much as I have worried and wondered about IVF in general, I really hadn't thought about the steps leading up to a transfer. It's definitely more complicated and lengthy than I anticipated, but if it gives us a better chance of a pregnancy and live birth, I'm all for any process. I have plenty to keep me busy over the next few weeks, so October 19 will likely be here before I know it! We also have two more appointments on October 8 and 13 for bloodwork and an ultrasound, so that will break up the waiting. Our focus will be following the schedule between visits and hoping that my reproductive system keeps looking the way it's expected to.

__________ 

Here are some outtakes from making my letter board. When I lived in Natchitoches, Papa's Bar and Grill sold their Big C burgers for $4 on Tuesdays. One night, I went with some of my co-workers, and Susan convinced Mary Bess to order some 1 lb burger. Mary Bess agreed, though I don't think she ate the burger in one sitting. I completely forgot about it until I couldn't find my big "C" letters, so that was a fun memory. I then found not one but two big "C"s on my other letter board. 



Something that made today great: Taco Thursday/lunch catch up with Jennie today!

Time I woke up: 6:40 am