Thursday, September 16, 2021

FET Cycle 1 - Update 1

Well, it's been a bit!

I last posted after our first intrauterine insemination (IUI). IUIs have about a 15% success rate, and my RE was willing to try up to three of those. All three failed, which was not surprising but was a bummer. September is a tough month to not get pregnant because it means I won't have a baby before my next birthday (assuming a full-term pregnancy), but it was easier this year than the last few. If not when I'm 30, 31, 32, or 33, maybe 34...maybe.

After the third IUI failed, we talked with our doctor last Tuesday (9/7) about what was necessary to move forward with a frozen embryo transfer, or FET. We're now on our way!

As with my retrieval cycles, the first step in preparing for the FET was to take birth control. So, I started that last Tuesday. Since we are working with a limited number of precious euploid embryos--two to be exact--we want to take plenty of precautions to hopefully have a pregnancy that results in a live birth. Last December, I had laparoscopic surgery to check for endometriosis (and remove it once it was found). When we first met our RE in January, he explained that the laparoscopic surgery would buy us about six months before we would have to worry about the endometriosis returning. For those keeping score at home, it's been nine months since the surgery, so my RE wanted to check out my uterus for a status update before we went for a transfer. To do that, he recommended a saline infusion sonohysterogram, which is a fancy way of saying that he would inject some saline into my uterus and then look at it on the ultrasound to make sure everything was good. We did that this morning, and I rolled into the clinic in my traditional "This is terrible. Keep going" T-shirt and my good luck/friendship/happiness charms that I bring to almost every appointment: a friendship token from KT and a little squirrel from Cate. I held tightly onto them during the procedure. I have not had many issues with pain during the various procedures over the last few years, but this one was definitely the most uncomfortable of anything I have done so far. Not painful, but definitely uncomfortable. Fortunately, my reproductive system looked "very normal" according to my RE, so we are moving forward.

Tomorrow, my medications will arrive, and we'll be back to injections of Lupron. This is a different kind of Lupron from what I have had before, and we'll do it twice a day for two weeks. I'll discontinue the birth control pills next Thursday, and the Thursday after that, I'll go for an ultrasound and labs. Eventually, I'll start injections of progesterone in oil, or PIO, which is famous for being thick and requiring a large Pile it on top with the other medications, supplements, and procedures. Ha. 

Preparing for the FET is exciting, but I do feel more pressure than I did with the IUIs. If the first FET does not take, we will have to pause and decide if we want to try for another retrieval (or retrievals) or transfer the second one quickly. If the first one fails but the second one works, we would be out of euploid embryos, and I would be older. For now, however, I am doing my best to not think about that. Right now, we're going to give the first FET our best shot (no pun intended). 

I'll probably be mostly quiet between now and our next appointment on the 30th, as there will not be much to update.

Something that made today great: I had a dissertation homework party with Catherine and Diana, and it was so nice to catch up! (And we got our homework done!)

Time I woke up: 7:00 am

Friday, July 23, 2021

July and IUI

In fall 2005, my friend Ashley was dating a college boy, and she was able to get access to high school Facebook—yes, that was a thing—pretty soon after it came out. At that time, high school Facebook users could invite some allotted number of friends to join as well, then those friends could invite friends, and so on. Since that time, I have been a loyal and heavy Facebook user…until June 14.

I knew I spent way too much time on social media, especially Facebook. I’d made efforts in the past to reduce my Facebook consumption, but I always ended up reinstalling the app on my phone and getting right back where I started. Under the weight of our latest batch of bad news in June, however, I was completely crushed and needed to step away. So I did.

And I liked it.

Here are some things I did in my social media absence:

  • Went to Mexico for six days with Richard
  • Turned 33
  • Ate an enormous steak for my birthday
  • Visited my mom and sister
  • Reunited with my best friend group from high school, the BAKErs
  • Kept up with my running…sort of
  • Started a new job that is a-mazing!
  • Kicked off the new Junior League year and started my role as Chair-Elect for the Diaper Bank Committee
  • Lots of academic stuff – made good progress on my dissertation, worked on some manuscripts, and submitted several conference proposals
  • Read two non-academic (and actually kind of trashy) books

Here are some things I did not do:

  • Get pregnant. Well, maybe.

It’s possible that I got pregnant yesterday or today, but there’s no way to know just yet.

In a previous post, I mentioned that our RE suggested trying intrauterine insemination (IUI) before attempting to transfer one of our euploid embryos from the freezer. We jumped straight into that in June, and it failed. IUI has about a 15% success rate (this page from our fertility clinic estimates 10-15%, but some research suggests the success rate could be as high as 20% ). We’re trying again this month, and my RE will do up to three before moving on to transferring a frozen embryo. (One study found that 88% of pregnancies from IUI happen within three cycles, and 95.5% happen within four cycles.) If we don’t have success after three, I might beg for a fourth, but (a) I’m not sure my RE would agree, and (b) I might not want a fourth after three failed cycles. Of course, a better scenario is that we have success within three cycles and don’t have to cross that bridge (or even come to it).

Compared to IVF, IUI is almost a non-event. I take 100 mg of Clomid for five days, get a few ultrasounds and a little bloodwork, and when the follicles look good and ready, I do a trigger shot. For both cycles, I have had two good looking follicles in my left ovary (21 and 22 mm last time, 18 and 24 mm this time). Then, 35 hours later, Richard does his semen sample. The lab pulls out the best sperm (the ones wearing tuxedos), and an hour after that, what’s left is placed into my uterus using a catheter. The process is about as [un]comfortable as a pap smear and only takes a minute or two.

Within 24 hours of the procedure, Richard and I make whoopee without a catheter for good measure. (I chose that euphemism for sex from this list of historical euphemisms partially because it’s funny and partially because Macon—the city where I went to college—once had a hockey team called the Macon Whoopee.) Starting the night of the day after the procedure (that’s a mouthful) and every day until I get my period (which I of course hope I won’t), I have the delightful experience of inserting a progesterone suppository to help my uterine lining be all ready to receive an embryo. All in all, though, it’s pretty painless. Some aspects—I’ll let you guess which ones—are in fact the opposite of painful.

I don’t have anything particularly profound to say about my time away from social media. I think some people step away from social media and realize how much they were living through others or that they were not really living because they’re stuck on a screen. In my case, it’s not as if I was missing out on real-life experiences because I was spending so much time on Facebook. I lead a busy life, so I did not suddenly find myself with an abundance of time to fill.  

What I was missing, however, was the time to process and decompress. I thought I was processing as I was sharing our story—and I think in some ways I was—but I never let my brain stop working. I found that it was healthy for me to not know any time someone else got pregnant and not inundate myself with infertility-related content.

I have a lot of mixed feelings about the best way to approach the next steps with infertility. I know that we have another IUI and two frozen embryo transfers in our immediate-ish future, but I don’t know what we will do if those all fail. While I don’t want to think too much about that possibility, I also have to be realistic: this is a difficult path, and there are a lot of things that don’t seem to be working for us. Mentally, I’m in a place where I think I could take another cycle or even several more cycles of IVF if that became necessary, but I will need to seriously consider what boundaries I need to set and uphold.

Something I have discussed repeatedly with my therapist is that I have not put other aspects of my life on hold to try to get pregnant. Working on my doctorate, running, volunteering with Junior League, and traveling have all kept me busy when our attempts to have children have not come to fruition. The world keeps going, and I don’t want to be left behind.

At the same time, I can’t help but wonder if I might have had a different outcome if I had made motherhood my only priority. I’m a person with many identities, and I don’t think I can relinquish all of them to be a mother. I shouldn’t have to. The gamble here—and there are so many things that have felt like gambles over these last few months—is that if I never have my own children, I could be left wondering forever. I try not to have regrets, and I probably won’t as long as there’s even a tiny possibility that I’ll get pregnant. But once that door closes (if it closes), I have no idea how I’ll feel.

So, that's the status update. For the foreseeable future, I am going to continue keeping my distance from Facebook and other social media. I think I’ll get back to blogging regularly, but I’m still not in a good space for engaging on social media. No matter how happy I am for other people, it's still very painful for me to see pregnancy announcements and baby pictures, so I'm finding it best to avoid those things where I can.

Time I woke up: 6:45 am

Something that made today great: Junior League social at City Roots followed by an unofficial afterparty at La Carretta!

Monday, June 14, 2021

IVF Cycle 3 Wrapup

Since Richard works nights, I cook dinner around 4:00 during his workweek. This afternoon shortly after 4:00, the phone rang with a call from our fertility clinic. I guess I was distracted by the couscous I was boiling because my brain tripped up and declined the call. When I tried to call back, I got the answering service, which only forwards after-hours calls that are medical emergencies.

I waited a few minutes for a voicemail to appear, then I sent my doctor a text to see if he'd tried to call me. He replied, "Calling you in a sec," which commenced the longest four minutes I have experienced in a while. Somehow, I just knew it was bad news. It felt as if the bottom of my stomach had fallen out. Then, I reminded myself that our embryo was beautiful, so the news was probably good.

Finally, my phone rang.


"It's another high mosaic."

I was right the first time.

I talked with my doctor for a few minutes about how having two normal embryos in the freezer is actually pretty good. I told him it doesn't feel good at all, which he said he understood, but we've ultimately had relatively good results for my dismal (my word, not his) AMH level. We discussed the possibility of trying a few IUI cycles before attempting an embryo transfer, and I said I'd talk with Richard about it and let him know. Richard and I will most likely go ahead and try IUI, and we go for a scan first thing tomorrow.

I have a few people (mostly close friends and family) that I try to update about our progress before I post on social media. I can usually come up with a silver lining or at least something to say before I drop the bad news bomb, but I couldn't do it today. I'm over it. So, everyone got a variation of this message, the main variation being inclusion or exclusion of an expletive about the hole I want to crawl into.

There just aren't words to describe how much this hurts or how unfair it is. I am furious, sad, and numb. I feel a little bit like the vase of flowers from last week that's still sitting on our kitchen table. Some of the flowers have started to wilt, but I'm letting them stay anyway. Sometimes in life, we have to sit with the less beautiful aspects for a little while, even if that means our life doesn't look like we want it to. When we're ready, we can replace the old or unpleasant bits with new experiences, just as we can replenish a vase with fresh flowers. 

Continuing last week's theme of feeling the feelings, I'm giving myself permission to feel all of the feelings. This time, that includes taking a step away from social media and most likely blogging. I need time to deal with the ugly stuff. I'll be okay--I always am--but I need some space to process. Please continue to remember Richard and me in your thoughts and/or prayers.

Something that made today great: I'm making good progress toward starting my dissertation--including progress made over donuts and coffee with Tori today.
Time I woke up: 8:15 am

Tuesday, June 8, 2021

IVF Cycle 3 / CD 32 / 7 Days After Retrieval

Six days after the egg retrieval, the embryology lab calls to give an update of how many of our embryos made it to the blastocyst stage. The statistics tell us that 30-50 percent of fertilized eggs make it to this point, and I always do the calculations to project our next outcome as soon as I hear a new number. With 6 fertilized eggs, we'd expect 1.8 to 3, so 2 to 3. From there, fewer than 50 percent of embryos are found to be normal/euploid.

In our first two cycles, we fell where expected with the number of blastocysts we could test. Our first cycle had one out of four (25%) fertilized eggs make it to blastocyst, and our second cycle had three out of seven (43%). Based on our history, I never doubted that we would have at least two to test from the third cycle, which would hopefully give us one more normal one in the freezer. Then, we could start preparing for our first transfer.

Instead, I was caught completely off guard when the embryologist called yesterday morning and said we had one ~beautiful~ embryo that was sent off for testing. She was so excited about how beautiful the embryo was, which is not something I had heard in our first two cycles. All I could think about was the next calculation--fewer than 50 percent--and what that meant for our one embryo. Then I thought about the last time we had only one embryo and how that turned out: one highly aneuploid.

I said before the retrieval that hope was what we were left to do when we have done everything else. After the retrieval, I talked about how releasing control (relaxing) also releases anxiousness. I will at least acknowledge that hoping and relaxing helped me with the waiting period between our fertilization and blastocyst updates. Part of the point of shifting my focus to hoping and relaxing was that we had done what we could do and could no longer change the outcome, but I guess I lost sight of that somewhere. I let myself believe that hoping and releasing control would bring the best possible outcome when what I needed instead was a reminder that anything that happened would not make our results better or worse.

I have struggled with the news since I first heard it. When we had one blastocyst in our first cycle, I hoped so hard that it would come back normal, and instead, it was mostly abnormal. I know that every cycle is different--I tell myself that all the time--but I am so afraid of the same outcome. There is nothing I can do to change the test results, so I just have to wait, hope, and try to relax. The sample should have been shipped off today, and we expect to hear something in 7-10 business days. Right now, that feels like a long time.

I'm in an ugly cycle of feelings as I continue to process another cycle with one blastocyst. I try to be grateful and remember that there are families who have no blastocysts, no fertilized eggs, or even no eggs retrieved at all. The fact that we have made it to the blastocyst stage each cycle puts us ahead of many people who struggle with infertility. There are families who only get one shot at IVF because of the financial burden, and others never attempt IVF because they would have to sacrifice too much to afford it. Our savings and student loan repayments have taken a hit, but we are okay. 

At the same time, I find myself helplessly frustrated and angry about how unfair this all is. When I started seeing my therapist in early 2020, she introduced me to the idea that infertility is a version of grief. Every month, I was grieving what I thought my life and family would look like. I started seeing a therapist after we'd been trying for nearly two years, and Richard and I were both worn out with the monthly routine of being brought down by crying spells. It was exhausting for me because I was going through it and for Richard because he couldn't do anything to fix it.

We started trying to conceive when I was 29 years old. If someone had told me that I would be sitting in my house with my 33rd birthday approaching, and there would be no nursery or child's bedroom because there would be no baby or child, I don't think I would have believed them. The upper limit for when I expected to have a child was 31; 33 and never been pregnant was nowhere on the radar. June is a particularly challenging month with infertility grief because it's the month of our wedding anniversary and my birthday. Something about wrapping up another year of marriage and life without "solving" the infertility problem is discouraging. I feel the same way in December when the holidays are upon us and we wrap up another calendar year still hoping and waiting. It doesn't stop there, though; March and September give me similar feelings as I put pressure on myself because, "If I'm not pregnant this month, I won't be pregnant before my birthday/this year." 


I'm trying to give myself some grace and permission to feel all of the feelings that emerge in this process. After all, that's the kind of advice I give to other people when they're going through anything difficult. I often tell people I'm there if they need to talk, scream, yell, or cry, but I'm not the best at taking my own advice. I'm working on that too and am so appreciative of the friends and people who remind me that it's okay to own my feelings.

My little letter board reminds me that we have one more update to come, and the news could always be good. It's entirely possible that we will find out we have another euploid blastocyst. After all, our embryo is beautiful! However, I can't help but wonder what happened to our other five and how we were dealt this unpleasant hand. Earlier today, I expressed to Richard how outraged I was that we only had one blastocyst when the numbers predicted two or three, and Richard reminded me that we were only off by one. I try to be gracious when he is right or brings up a valid point, but that one stung. 

My goal is to stay hopeful about the future, thankful for what we have, and distracted from wondering what our next result will be. Easier said than done, but I am trying!

Something that made today great: Taco Tuesday at Blue Corn...yum!
Time I woke up: 9:30 am

Thursday, June 3, 2021

IVF Cycle 3 / CD 28 / 2 Days After Retrieval

The second devotion in the Hope Strong book I wrote about on Monday night is called, “Anxious: Just Relax.” In my devotional-reading frenzy on Sunday, I marked a quote that stood out to me: "Releasing control (aka relaxing) releases anxiousness." I'll be the first to admit that I like to exercise a significant amount of control over my life and its course. 

Spoiler alert: infertility is really horrible for controlling your family planning, and it wreaks havoc on other aspects of your life with its appointments, injections, and procedures.

I wouldn't consider myself on the extreme end of tightly wound or high strung, and I often identify adaptability and flexibility as personal strengths in interview settings. Still, I like to be in control while I'm going with the flow...if that's possible. What was most notable to me about this quote was that it defined "relaxing" as "releasing control." When I think of relaxation, I frame it as binge-watching a TV show and eating ice cream on my couch or going on vacation somewhere and not focusing on work, school, or other stressors. That's different from releasing control.

“Just relax” is among the magical baby-making advice I have received from well-meaning people, and I sort of resent hearing it. In concert with the idea of reserving hope for when you've done everything else, though, relaxing by releasing control makes a lot of sense. Accordingly, I have been working on releasing control this week.

At the egg retrieval on Tuesday, we retrieved seven eggs. After the procedure, I slept and stayed in my pajamas most of the day other than when we took Scooter for a walk. Richard and I ordered dinner from Olive or Twist, and the poutine was particularly delicious. I am proud to report that I didn't fret even a little bit about what was going to happen with the eggs (though I did hope that all seven would be mature and fertilize). I slept with my phone on silent and missed the call from the embryologist giving our fertilization report, which is unlike me. Fortunately, she left a voicemail to let me know that six of our seven eggs were mature, and all six fertilized with ICSI. Yay!

Following that bit of happy news, I allowed my relaxation to extend through Wednesday. I could be worrying about how many of our fertilized eggs will make it to the blastocyst stage, but so far I have avoided that. I know what the statistics predict--30 to 50 percent, so 2 or 3 out of 6--and always hope to outperform the expectations. However, I'm at the point where I have to release control and hope for the best, so that is what I am doing.

I was back in business today, including starting the day with a run around the LSU lakes with a friend from Slow Mode Running Club. After a shower and some breakfast, I went to campus in the late morning and stayed until 4:30 doing some reading and planning for my practicum course that I'm doing this month. I'm still waiting on some data, but I'm excited about the progress I have made.

In IVF news, our next update will come on Monday when we find out how many made it through day 5 to the blastocyst stage. I have graduated from the "Every cycle is different" mantra to these cycle-specific mantras in the meantime: "Grow and divide--make it to day 5!" and "6 has some mighty tricks (mainly turning into maybe babies)." Also, calling blastocysts "maybe babies" is one part of IVF that makes me smile.

Overall, I would say I am doing well. Richard and I were pleased with the results of the retrieval and continue to hope for more good news. If we have a few (or maybe just one) euploid embryo from this cycle, I think it'll be time to talk with our RE about attempting a transfer, which is very exciting! But first, we will hope, relax, and wait.

Something that made today great: I made good progress with my practicum research!

Time I woke up: 6:45 am

Monday, May 31, 2021

IVF Cycle 3 / CD 24 / Night Before Retrieval

Since we started our second IVF cycle, “Every cycle is different” has been our mantra. When I start to fret or worry, that’s the first thing I tell myself. It works to varying degrees.  

Now that we’re on our third cycle of IVF, what I’m finding is that the time in each cycle when the anxiety ramps up is different too. The intensity also varies from cycle to cycle. When we went back to our RE’s office for bloodwork and an ultrasound on Sunday, I was hoping that we would have ten follicles this time since we’d had eight on Thursday. We had eight again, which was a bit disappointing, but it was still better than our first round. Twice as many follicles, in fact! 

Later that morning, our nurse called to let me know my egg retrieval had been scheduled for Tuesday morning at 9:30 am. As with previous cycles, we would stop the regular stim shots in exchange for a trigger shot at 9:30 pm.  When I checked my app for the results, I saw that of our eight follicles, we had several that were looking small. That was when I started to panic. Last cycle, eight follicles gave us two normal embryos, and that was on the lucky side. I started to dread getting one or none again, which was not helpful. 

I ordered a devotional book that I think was recommended by someone on Instagram or in a Facebook group. The book is called Hope Strong: Navigating the Emotions of Your Infertility Journey: Overcome the Pain and Thrive with Hope, and each devotion concludes by tying the theme (alone, anger, anxious, confused, and so on) to hope. I sat on my couch and read over 100 pages—most of the book—and didn’t find much comfort. There were a few lines I highlighted to refer to later, but something was still missing. 

Perhaps what frustrates me about the recurrent reminders to have hope is that it suggests that I haven’t had hope this whole time. I have hope, and I still do, but it sure would be nice to have something else to fall back on right now. IVF and infertility are exhausting, and there are no guarantees.

I have mentioned before that I love the podcast Harry Potter and the Sacred TextThere is an episode from the first season where Vanessa and Casper read a chapter through the theme of hope, and Vanessa draws attention to how we are often quick to surrender and leave everything to hope. I listened to the episode—one of my favorites—again last night. In the episode, Vanessa states, “I think that we use hope way too early as a society, and I guess what I’m calling for is not for no hope, but I’m calling for a critical use of hope and what a wonderful thing to do, when you’ve tried everything else.”  

What a wonderful thing to do when you’ve tried everything else. 

The trigger shot signifies the end of ovarian stimulation. I have eaten whenever I was even slightly hungry, increased my water intake, limited exercise, done the injections, and rested. There is nothing else I can do to help these follicles in this cycle, so now I can hope. I have tried everything else that will help us up to this point. With that realization, I granted myself permission to continue to hope in spite of my anxiety. 

I revisited the devotion book and found a quote I had marked: “We can be hopeful in spite of despair and resignation.” As difficult as it has been to stay hopeful after so much pain, disappointment, and frustration, I'm learning that hope doesn't have to exist in isolation from everything else. 

Something that made today great: I had a delicious Blendini from Rita's after my run tonight.

Time I woke up: 6:45 am

Friday, May 28, 2021

IVF Cycle 3 / CD 21 / Stims Day 5

Note: I'm actually posting this on CD 22 / Stims Day 6 because I ran out of time yesterday. 

Wow, it has been quite a week! The IVF cycle is going about as expected; we are accustomed to the routine now. Monday was a bit of an adventure because I had to fly with my medications, but that was much less dramatic than I expected. I purchased a small cooler bag for the trip, and TSA was more concerned about my ice pack than the actual medications or needles. Thanks to a flight cancellation on my layover, I got to experience taking medications through security not once but twice! The first time was at MLU (Monroe Regional Airport, the birthplace of Delta Airlines!), and the second was at DFW (Dallas/Fort Worth, an American Airlines hub that is much larger than MLU), and both were remarkably easy. Perhaps the highlight of the adventure was doing our Monday evening injections in the car as Richard dropped me off at MLU on Monday. I was fortunate that I did not have to do any in an airport bathroom or onboard an aircraft thousands of feet in the air, though that could have been a fun story.

I was traveling by plane to retrieve my car from my sister-in-law's house in Houston. With flooding in south Louisiana last week (where I drive to get back to Baton Rouge), we were unsure about the road conditions along my route. I had several appointments (including an RE visit) Wednesday and Thursday (5/19 and 5/20), so I opted to fly out Tuesday night (5/18) and left my car in Houston. What started as a quick trip to retrieve my car turned into an overnight adventure. My friend Blake was kind enough to offer me a place to stay at his house in Fort Worth, but a Lyft was going to run me $137.99. (OMG!) So many people were stranded that there were no Ubers available, and hotels started filling up as I refreshed the booking website. Blake ended up coming to rescue me (fortunately!) and dropped me back off the next morning after I moved my rebooked flight from 4:35 pm to 10:25 am.

I was supposed to go back to my RE's office on Wednesday morning, which would have been day 4 of stims. Unfortunately, I was pretty beat down from my travels after waiting on the runway for over two hours and having our one-hour flight extended to two hours. I calculated that by the time I made it back to my sister-in-law's house, it would be nearly 5:00 pm. With that in mind, I called my RE's office about moving my appointment to the afternoon, and my nurse said I could come on Thursday (day 5) instead of Wednesday. Phew!

Adding to my travel woes, I cut a turn too short and hit a curb on the way out to my appointment yesterday morning. This resulted in me blowing two of my tires...YIKES. Richard was staying home because he did not feel well, so I had him come pick me up, then I took him home and headed to my appointment. 

After all of the obstacles and drama that tried to stand between this appointment and me, there was at least some good news: eight follicles are growing! This cycle, my right ovary is taking the lead, which is what the antral follicle count (AFC) on last week's ultrasound predicted. On day 4 of stims during our second cycle, we had 7 follicles, and 10 appeared by day 6 of stims. Based on the last cycle, it is possible that we will see a few more follicles at our next visit. We will go back on Sunday (day 8) and find out for sure. I am happy about 8 for now, though.


Something that made today great: I submitted revisions to my IRB application for my dissertation research 
Time I woke up: 8:30 am

Friday, May 21, 2021

IVF Cycle 3 / CD 15

I have been quiet lately because I have not had much to update, but everything is going fine. Back in my first cycle, everything was new and fresh, and I didn't think I'd be going through the process multiple months in a row. I was so young and naive back in March!

I finished my nine days of birth control without incident, and I had another ultrasound with bloodwork yesterday morning. The ultrasound technician measured the 13mm follicle from the beginning of the cycle but said it looked like it was going away (as we hoped it would). Since everything looked good, we got our updated calendar to start Lupron today and full stims on Sunday. Our medication schedule is the same as it has been: Lupron twice daily (10 units AM and PM), Follistim twice daily (250 IU in the morning, 125 IU in the evening), and Menopur (2 amps) in the evening.

In the vein of "every cycle is different," something new and different from yesterday's ultrasound was that my AFC--Antral Follicle Count--was higher than it has ever been. The AFC can be an indicator of how successful an IVF cycle will be. (This website explains a AFC in more detail.) In my previous cycles, my AFC readings have always been "0 to 2" or "3 to 4" when I have had ultrasounds, but never "3 to 4" on both sides. Yesterday, we had "3 to 4" on the left and "8 to 9" on the right, so that was really exciting! While AFC is not a guarantee for follicles that will grow and have mature eggs, I am taking this as good sign and excuse to be optimistic about cycle #3.

Our next appointment is on Wednesday, May 26, which will be day 4 of stims. Hopefully, everything will be progressing--but not too quickly--and we can get back to thinking of basketball team names for our follicles. If I recall correctly, Tune Squad was winning in the comments on my Facebook, and I'm completely on board with that.

Something that made today great: Delicious dinner (including the discovery of Freakshow wine) at Roma!

Time I woke up: Noon, though I didn't get to sleep until after 5:00 am.

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 but no blog post. 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 follicle” 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