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. 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

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 needle...cool. 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.

"Hello?"

"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