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)