Wednesday, May 12, 2021
Sunday, May 2, 2021
I just realized that I made an Instagram/Facebook post with our fertilization results on Tuesday. 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
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.
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.
Time I woke up: 7:00-ish
Saturday, April 24, 2021
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 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.
Thursday, April 22, 2021
Wow, this week has been busier than I anticipated! Fortunately, I am finding healthy ways to cope with my anger and am starting to feel more like myself again. Sandra and I did a 4-mile run in my neighborhood on Tuesday before meeting Elena and the taco gang for tacos, and I rode my bike with Ellen today after I got out of class. Richard is also off for the next few days, so I'm enjoying having him around more.
It also helps that this IVF cycle is looking more promising than the first one. At this point in our first cycle, we had to make the difficult decision to move forward with four follicles or convert to IUI. My RE was hesitant about triggering on day 7 of stims but was supportive of our decision. This cycle, we have more follicles, and they don't seem to be growing quite as fast as the first crew.
After our ultrasound and bloodwork appointment this morning, we learned that we have three more follicles than we had on Monday! That brings our total up to ten. I have been chatting with a few friends who've been through IVF, and one told me she was hoping for more at our next scan, and another said he'd hope for 10 or more for us. I was doubtful, but then we had three more today! Our nurse told us not to be surprised if we needed to come back tomorrow, but she would call with instructions later today.
When the nurse called this afternoon, she told me to keep doing all of my same injections. She also said we need to come in for another ultrasound and labs on Saturday, which will be day 9 of stims. (Recall that people typically stim for 8-14 days, so I am in the expected range this time.) Based on last time, I was expecting to be told to trigger tonight or tomorrow for retrieval on Saturday or Sunday, but this cycle keeps revealing how circumstances can be totally different from cycle to cycle, even with the same medicine protocol. My estrogen reading was 1543.22 pg/ml, so we're not quite over the 200 per follicle mark that we'd like to see. However, we jumped from 690.58 on Monday to 1543.22 today, so hopefully, the two additional days will put us where we need to be with mature eggs.
During the first cycle, we joked about naming our follicles after the Beatles, but our ultrasound tech told us today we might want to start looking at basketball teams. I guess I'm taking nominations for worthy teams to name them after? Our smallest follicle is only 6 mm, which is a bit small, but we're hoping it can catch up. Our largest is currently 21 mm, and I think 24 mm is about as big as is desirable before triggering. We want to have as many as possible in the 18-24 mm range without anything getting too big. So, Saturday is likely our last ultrasound and bloodwork visit for this cycle unless I'm wrong again. Stranger things have happened.
I'm going to try to make a cutesy letterboard after our appointment on Saturday, but I'm currently a bit frantic trying to balance the end of the semester, work, conference proposals, trying to exercise, and going through IVF. It's a lot! So, here's some more of my fantastic PowerPoint art. These circles are not actual size, but they're to scale relative to each other.
Monday, April 19, 2021
I have heard others describe IVF as an emotional roller coaster, but I am not sure if a good day would be represented by going up on the roller coaster (because of going up and getting out of the valley) or by going down (it's easier, faster, and thrilling). Whatever the correct answer is, today was a slightly better day.
We had an appointment for an ultrasound and bloodwork, and there is more going on in my ovaries than at this point in our first cycle. (Edited for clarification: We now have 7 follicles growing!) Last time, I had 4 follicles on day 5 of stims, and that's all we had before we triggered and went in for the egg retrieval. On day 5 of stims last cycle, my four follicles ranged in size from 10 mm to 18 mm. Today (one day earlier), we are looking at 7.5 mm to 14 mm, so these follicles seem to be growing slightly slower or maybe at about the same pace. As with the first cycle, my left ovary is more active than the right one. I wasn't feeling a letterboard tonight, but I did make this little picture using PowerPoint.
Something that made today great: I had fried Oreos, a corn dog, a snowball, and jambalaya at Spring Fling today! (Also my HESPA friend Daniel was good company at the event.)
Sunday, April 18, 2021
Yesterday, I drove up to Bossier City to attend a bachelorette party for my friend Megan. This was my first time transporting fertility medications and doing my injections somewhere other than my house, and everything went fine. We had a great time hanging out, eating, laughing, and playing games. Although Megan offered to let me sleep over (and I’d packed a bag in case I needed to), I ended up driving home late last night because I felt up to it and didn’t want to have to wake up and drive. For those unfamiliar with Louisiana geography, it’s roughly a four-hour drive from Baton Rouge to Bossier City. That meant that I had lots of time in the car. I filled some of the time by catching up with friends, and I listened to the Fast Times at Ridgemont High soundtrack a few more times. I also threw some podcasts into the mix.
When I tired of the Fast Times at Ridgemont High soundtrack (yeah, it finally happened), I decided to look for a new Spotify playlist to try. I love a good playlist, but I am not great at building them myself. Last week, I discovered 70’s Road Trip and liked it, so I tried my luck for some comforting tunes by searching for “Infertility.” There were a few options to choose from, but I went with the first one I saw since I needed to be watching the road.
The playlist was called “Infertility Warrior,” and it contains several songs that I sort of expected. It’s also heavy on Christian/worship, which I don’t mind. I like a lot of praise and worship music. The second song on the playlist is Laura Story’s “Blessings,” which is a song I like but had sort of forgotten about until I had a Facebook status with some of the lyrics in my memories a few weeks ago. The chorus goes,
'Cause what if your blessings come
What if Your healing comes through tears
What if a thousand sleepless nights are what it takes to know You're near
What if trials of this life are Your mercies in disguise
As I listened to the song last night, I found that I was not comforted by the lyrics as I had been in the past. All I could think of was my struggle with infertility. I said to myself, “I already know God is near. I don’t need tears, pain, or sleepless nights. This is pointless.“
Then, the next song was “Scars” by I Am They, which was a new one to me. It’s similar to “Blessings” but takes it to another level:
Darkest water and deepest pain
I wouldn't trade it for anything
'Cause my brokenness brought me to you
And these wounds are a story you'll use
So I'm thankful for the scars
'Cause without them I wouldn't know your heart
And I know they'll always tell of who you are
So forever I am thankful for the scars
Again, as I thought about my own pain, I couldn’t identify with the song in the least. I can think of a lot of things I’d trade to stop having to deal with infertility, and I’m absolutely not thankful for the scars. Even when I try to stretch my mind to think, “How will God use this experience for His glory?” the best I could come up with was, “I can use my words and my story to encourage others if they go through this.” But what if God just eliminated infertility altogether? What good does this struggle do for anyone other than help other people going through this seemingly unnecessary disease?
I felt myself growing upset at the singer and the song, and then it hit me: I’m angry. On Friday night, I was texting my friend Willie, and she offered her support if I needed to talk, cry, or be mad. I responded, “Thank you. I am mad and crying, but I’m eating pasta which is happy.” That was the first time I’d admitted that I was mad, but I let the feeling pass.
When I coached for Girls on the Run, one of my favorite lessons was on emotions. Rather than framing emotions as “good” or “bad,” the GOTR curriculum encourages us to think of emotions as “comfortable” and “uncomfortable.” Infertility has brought out a number of uncomfortable emotions in me; sad, disappointed, and hurt are a few that I have allowed myself to feel over the last few years. Then there are other uncomfortable emotions that I prefer to repress: jealous, bitter, and angry are the big three. When I think of words to describe myself, “angry” doesn’t make the list. I want to be known as intelligent, passionate, and driven. I want people to think of me as a kind and dependable friend they can call upon. Being angry doesn’t align with who I am or who I want to be.
Thinking about the “Scars” song, my life has been relatively easy; I have few true scars. I count losing my dad to cancer as a scar, but every other trial I have been through seems more like a minor inconvenience or setback. Most of my unanswered prayers have been related to schools I didn’t get accepted to or romantic relationships that didn’t work out. After everything played out with those situations, I was grateful that I didn’t get what I wanted, but this feels different. None of those dragged out for years or challenged me like infertility has, and none of them have made me this angry.
Initially, I also worried about being angry with God. In the back of my mind, however, a small voice reminded me of something I heard a long time ago. I don’t remember if it was in a sermon, a devotion, or even a casual conversation, but I was told once that it’s okay to unleash our anger on God. He can take it. As I was pulling back into Baton Rouge around 2:00 am last night, I allowed myself to speak the words aloud: “God, I am angry.” My eyes immediately filled up with huge tears. Normally when I’m about to cry, my eyes water a little bit, but last night was more like a flood. On one hand, I felt like a weight was lifted by finally saying out loud how I am feeling. On the other, I am still angry. It still hurts. It’s going to hurt for a while.
While I was inclined to resist these uncomfortable emotions, I am now allowing myself to feel them--not permanently, but at least for the moment. Better to embrace it now than let it fester into something worse. Meanwhile, we have an ultrasound and bloodwork tomorrow morning to see how things are progressing in my ovaries. Hopefully, we'll have news that leads to comfortable emotions rather than uncomfortable ones.
Something that made today great: Sleeping in with no alarm!
Time I woke up: 10:45 am
Friday, April 16, 2021
During my first semester in my Ph.D. program, I took an educational statistics class, ELRC 7006. This is a required class for my program that trips many students up initially, though we all manage to get through it in the end. One of the worst feelings I ever had in ELRC 7006 was following the second quiz. I had spent hours preparing for this quiz by watching videos, reading the textbook, and doing practice problems, yet I stumbled over several of the questions. For one multiple choice question in particular, I stared at the answer choices and could not find one that seemed right. I finished the rest of the quiz, went back to the question, and still could not identify the correct answer. Finally, I picked an answer choice and turned the quiz in.
The next week, my professor uploaded our quiz grades, and I’d made a 100. In disbelief, I e-mailed him and asked if I could stop by his office to review my quiz because I was sure I had missed at least three questions based on the number of guesses I made. He agreed, and when I got to the question that had taken so much of my time during the quiz, I asked how I should have known that my choice was the answer. His response?
“Oh, the correct answer choice got cut off by the copier, so everyone received full credit for that question.”
I had a similar experience today where the answer I received was not among the options I had considered.
After receiving no news yesterday, I called my RE’s office this morning to ask about an update. They left a message for the IVF lab, and I received a call back a few hours later that the results had been ready on April 8, and my doctor had called me that day. The person on the phone couldn’t share the results with me but said she would have my RE call me.
My RE called a few minutes later, and he said he’d called and left me a message on the 8th. I have no idea whom he called or who received the message, but my call log and voice mail both indicate that it wasn’t me. Our one embryo was found to be “high-level mosaic,” which means that between 40 and 80 percent of the cells were abnormal. (Read more about mosaicism on this page from my fertility clinic.) While the research around mosaic embryos is emerging, the rate of viable pregnancies and live births is not encouraging.
For the last two weeks, I have been so focused on whether our results would be “normal” or “abnormal” that I completely forgot about the other options in between. I thought the PGT-A number would be the end of the line, but now we have an embryo sitting in the freezer that we will likely never implant. In some ways, it feels worse than if we had a completely abnormal embryo. I'm also really frustrated with the communication mixup that led to waiting an extra week for an update, but in retrospect, it's probably better that I did not receive the news the day before my dissertation proposal meeting. That's a silver lining.
As I told everyone I texted, I am sad but doing okay. (If I didn’t text you, I’m sorry!) It’s been a weird night including the following activities:
- I cried in the refrigerator while I thought about what I wanted to eat for dinner.
- I cried into the bowl of pasta that I decided to eat after crying in the refrigerator.
- I went to the Diaper Bank to count inventory because I hadn’t been by in a few weeks, and I didn’t cry there. I did listen to the Fast Times at Ridgemont High soundtrack while I counted. (Actually, I have listened to the Fast Times at Ridgemont High soundtrack on repeat for hours. I don’t know why that’s what I wanted today, but “Raised on the Radio” is a real bop in case you didn’t know or had forgotten.)
- I went for a run—2.9 miles of straight running at 10:46 min/mi with my heart rate never higher than the green zone-- and listened to a podcast. I didn’t cry.
- I baked and frosted a cake with the Fast Times at Ridgemont High soundtrack on loop. I didn’t cry.
- Now, I’m parked on the couch eating some of the extra cream cheese icing from the cake I baked and writing this post while 13 Going on 30 is playing on the TV. I’m mostly not crying.
I guess the takeaway from all of this is that running and baking cakes will help me not cry. But not too much running (as discussed extensively in prior posts) and probably not too many cakes either unless I find enough people and places to pass them off. The frequency of my visits to the Diaper Bank is limited by donations; I am not going to recount the inventory just for fun!
On a serious note, this is going to hurt for a while. The timing of this news as we're injecting extra hormones into my body (today is the first day of stims for our second IVF cycle) is less than ideal, but we're rolling with the punches. I'm resisting the urge to crawl into a hole or even just my bed. As I've heard about grief so many times, "The only way out is through." As my shirt that I wear to all of my appointments says, "This is terrible. Keep going."
We knew this was not going to be an easy process. We are still glad we decided to go forward with this IVF cycle, as we would have always wondered what might have happened. Another valuable lesson is that I can make embryos. My RE explained that some (perhaps many?) patients who have AMH levels under 1 do not have follicles that turn to eggs that fertilize. We made it through all of those stages, so we just have to keep trying for a cycle where we "wake up" more eggs. My mind wants to jump to questions like, "How many cycles will we do this?" but I'm trying to stay grounded. If the trend continues, it's going to take a lot of Led Zeppelin's "Kashmir" (which is NOT on "Led Zeppelin IV" despite what the film might lead you to believe) and other related tunes, but we will make it through this next step.
Something that made today great: My run tonight was encouraging.
Time I woke up: 8:30 am
Thursday, April 15, 2021
Wednesday, April 7, 2021
It's been a little while since my last update, but there has not been much going on with our fertility journey since our news that one embryo made it through day 5. I was pretty down last Thursday night and Friday, but I had the welcome and well-timed distraction of two of my sorority sisters coming for an extended ladies weekend from Saturday through this morning.
While we wait for the genetic testing on our one remaining embryo from our first IVF cycle, IVF Cycle 2 is officially underway.
I spoke to my RE on Friday, and he was very excited that we had one embryo make it to be tested. I asked if we should plan for a second cycle, and he indicated that we should unless we just really wanted to try to be pregnant right now. When I mentioned that we still would like to try for multiple children, he suggested another cycle to try to bank more embryos. We felt ready to try again immediately. My period showed up on Monday--isn't this the kind of thing everyone wants to read about on the internet?--so today I went in for bloodwork and an ultrasound.
Something that was a little different this time was that the ultrasound tech noted a cyst on my left ovary. As with seemingly everything in [in]fertility world, cysts can mean a variety of things ranging from "It's okay, let's proceed," to "We need to wait a bit," to "Cycle canceled!" In my case, we had to wait on my bloodwork to see if the cyst was producing estrogen, but it seemed like I was going to get the green light today or have to wait it out and take birth control for a longer period. (Actually, I don't think they make the cancellation call this early in the cycle, but I could be wrong.) I left the clinic with a calendar, but the caveat was that we might have to extend my time on birth control if the cyst was causing trouble.
This afternoon, I got the call that my bloodwork was fine, so we could go ahead with the original calendar. I am doing birth control pills for five days, then we go back next Tuesday for another ultrasound. Assuming that everything looks good, we will start our injections on the same schedule as last time beginning Wednesday the 13th: two days of Lupron, then the full stims. I'm interested to see how the amounts of medication will be different this cycle, because things look the same thus far. We still have a decent amount of medication from the first cycle, but we had to replenish a few things; I have already authorized the order with the pharmacy.
Something that made today great: Richard starts his time off today!
Time I woke up: 8:00 am
Thursday, April 1, 2021
Well, our good luck streak ran out this morning. We're not below expectations, but we're meeting rather than exceeding.
Based on these percentages reported by the Reproductive Medicine Associates of Connecticut, we should have expected to have 1 embryo at the blastocyst stage after day 5 after having only 80% of eggs be mature (we had 100%) and only 80% of eggs fertilize (we had 100%). If we had roughly followed those percentages, we would have expected to have 2 or 3 following fertilization. Then, we would expect 30 to 50% to make it to the blastocyst stage, which would be 1 to 2 (2 rather than 1.5 (a) to be generous and (b) since half of an embryo isn't exactly a thing).
Monday, March 29, 2021
Wednesday, March 24, 2021
Speaking broadly, couples do not tend to end up doing IVF because the journey will be easy for them. Beyond the attrition I described in yesterday’s post, there are numerous places where a couple can hit a snag in the process. In our case, the first snag was this morning.
During my ultrasound, the same four follicles I had on Monday were still growing. My 10, 13, 17, and 18 had become 14, 18, 21, and 23. Shortly after the tech measured my follicles, my RE came in and said it looked like I was ready. At first, I thought, “Wow, I’m such an overachiever! We’re ready! Go ovaries!” As I mentioned last night, however, we don’t want the follicles I have to get too big. To prevent that from happening, we would need to administer my trigger shot to let my ovaries know it’s time to release the mature eggs. (This website explains more about the trigger shot.) This also meant that unless I have a follicle hiding undetected (as opposed to hiding detected?) somewhere, the most we will be able to retrieve would be four. Keeping the attrition I discussed last night in mind, that does not leave us with much to work with, statistically speaking.
With so few follicles, one option was to cancel the IVF cycle and switch to intrauterine insemination (IUI). IUI involves placing sperm directly into the uterus, but it relies on the sperm finding the egg. The fertility clinic offers a little assistance for the sperm by “washing” the semen sample and picking out the best sperm. (Our RE explained it as “the ones wearing tuxedos” which still makes us laugh.) Before we knew how few eggs I had, we’d planned to try IUI anyway. Since we hope to have more than one child, however, we chose to pursue IVF once we knew the egg situation. As we weighed options today, we determined that the primary pro of doing IUI over IVF is the financial savings. IUI costs much less because we skip the costs involved with retrieving eggs, having an embryologist create and monitor the embryos, testing the embryos, and freezing anything we do not transfer. If the cycle ends with no genetically normal embryos, we are out a considerable amount of money for a learning experience. On the other hand, IVF ensures that the sperm and egg find each other, and testing the embryos decreases the likelihood of miscarriage. Also, if luck is on our side, we could end up with multiple normal embryos!
It feels like a huge gamble.
Our RE asked Richard and me to discuss our options and told us he’d give us a call back this afternoon and let us know how the bloodwork looked. Another piece of the puzzle is the estradiol (estrogen) level; our RE explained that for mature eggs, estradiol should measure around 200-250 pg/mL per follicle. Thrilled that we had eggs at all, much less four, Richard was supportive of going forward with IVF. We also discussed that if we converted to IUI, we might always wonder what would have happened if we had done IVF instead. I agreed, and with that, we decided that we wanted to do IVF unless the bloodwork indicated we absolutely should not.
After I changed out of my fertility clinic outfit (one of two “This is terrible. Keep going.” shirts I ordered from the My Favorite Murder store and jeans), ate breakfast, and dropped Richard off at home, I headed into work. For some reason, I really wanted to listen to “Set It Off” by Boosie on the way to work. I don’t know most of the words, and some of the words offend me, but it felt really good to ardently scream the lyrics I do know as I drove to work in my grandma car. I liked it so much that I played the song on repeat until I arrived at work (which isn’t that many times, but still).
When our RE called around 1:30, he reported that my estradiol reading was 1550 pg/mL, which averages out to about 388 pg/mL per follicle. Richard and I shared our thoughts about going forward with IVF with the RE, and he said he understood our reasoning. He wanted to speak with the other physicians about a plan to trigger, but he said a nurse would call later with instructions.
About an hour and a half later, the nurse called and told me that we would trigger tonight at 9:00 pm and come in Friday morning at 8:00 for an egg retrieval at 9:00. She reminded me of the instructions for the trigger shot and told me to discontinue my stims. Whereas I thought I had two to eight more days of stims, everything changed today. I’m not exactly sure when I expected to stop stims and trigger, but it certainly wasn’t today. I spend a decent amount of time reading infertility and low AMH/DOR Facebook groups, and I see people post about how they have been stimming for days. I thought I would be a bloated hormonal mess for ten days to two weeks, but I’m just a little bruised up and tired. I’m not complaining, though.
Something that made today great: Richard has been referring to the follicles as “chonks” and “chonky boiz,” and it’s making me laugh pretty hard every time he says it.
Time I woke up: 6:30 am
Tuesday, March 23, 2021
Note: I'm starting this blog post at 11:33 pm and hoping to publish by midnight, so this might seem rushed.
I'm realizing that I don't really know how to count the days...the date of my last menstrual period seems to matter less when you throw birth control, suppression, and stimulation into the mix. For what it's worth, though, today was Cycle Day 18 and Day 6 of ovarian stimulation (stims).
Richard and I returned to my RE's office yesterday for bloodwork and another ultrasound, and there were follicles visible on the ultrasound! Eggs grow in follicles (but not always all of them), so seeing follicles on the ultrasound is a good sign. IVF is basically a giant funnel with attrition expected at several points. This website explains it in detail, but after we see how many follicles contain eggs, we'll get a count of mature eggs retrieved. From there, we will see how many eggs fertilize into embryos, followed by how many embryos make it to day 5 (blastocyst), and how many of those are chromosomally normal. Then, we see if the embryo implants during a transfer.
So, we have a few steps to go. Right now, though, we are focusing on follicles.
With my diminished ovarian reserve (DOR), we are not expecting to be on the high end of normal, or even in the normal range at all. I mentioned before that something to note about DOR is that it doesn't tell us much about egg quality. However, if there are fewer eggs overall, proportionally, it is likely that the number of high-quality eggs is also lower.
Our ultrasound showed four follicles. Three are in my left ovary, and one (the biggest one!) is in my right ovary. Their sizes are 10 mm, 13 mm, 17 mm, and 18 mm. (That's micrometers, not millimeters...but everywhere I have looked, it's written as "mm" rather than "μm." I don't know why that is.) In the picture below, you can see where I printed and cut out little circles to represent each follicle. They are not actual size, but they are proportional to each other. I need to figure out a better way to display them on future boards.
We still have somewhere between two and eight days of stimming to go, so hopefully, we'll have some more follicles appear. We also don't want the ones I do have to get too big, though. It's a balancing act, and I'm glad I am not the one who has to make the major decisions to manage it. I just do what I'm told.
My RE mostly left my injections the same, except we cut out the evening Follistim. I am fine with fewer injections, though I am fortunate that the only side effect I have had is being tired. Tomorrow, we go back to the RE for another ultrasound and bloodwork. Hopefully, I will need to cut out or draw a few more little circles.
Something that made today great: Taco Tuesday with Elena and friends followed by excellent dissertation writing!
Time I woke up: 9:30 am
Saturday, March 20, 2021
It's common knowledge that becoming pregnant changes a person's body, but what is less widely known is how simply trying to become pregnant can change someone's body.
My belly is beginning to bruise.
We have been stimming for three days, so this is not surprising. They're just little bruises, and they don't hurt. Still, they're visible reminders of our process and what we're putting my body through (as if we could forget with twice-daily injections). My stomach is also peppered with little red marks where we've done injections that didn't lead to bruises. Inside my belly button and just below the waist of my shorts are more permanent scars from the laparoscopic surgery I had in December where my OBGYN discovered (and removed) endometriosis and noticed that my ovaries looked unusual. Those little incisions are what led to the discovery of my diminished ovarian reserve (DOR). In addition to what we hope is going on inside, my body has changed on the outside.
While I have been fortunate that I am feeling pretty good overall, I am having to take a step back in other areas of my life besides running. I had planned to go to Shreveport for the afternoon to attend a wedding shower for my friends Megan and Aaron and visit my work wife, Tricia, and then I was going to drive back to Baton Rouge. However, I woke up feeling so tired, and the thought of driving eight hours round trip and having to transport my evening shots in a cooler and do them alone somewhere on the way home started to feel like a lot. Instead, my day consisted of going to Slow Mode and walking the 4-mile loop before coming home to crash for hours.
At times, I feel as if we are asking my body for a lot by putting it through this process. Other times, I am frustrated that we are undergoing so much for what I was told for years that my body is "supposed to" do. I worry that it could fail and that we'll have to make a decision of whether or not to do another cycle of IVF. Yet somehow I feel less anxious about IVF than I did in the many months of never getting pregnant and wondering what was wrong. I am comforted by a process, even one as intense and uncertain as this one is.
Something that made today great: I enjoyed being able to catch up on rest today!
Time I woke up: 7:20 am
Thursday, March 18, 2021
K: I don't think so. I think it's 250 in the morning and 125 at night.
R: I thought it was the same both times.
K: No, I don't think so.
Wednesday, March 17, 2021
Other than feeling a little tired, I haven't noticed any side effects from the Lupron. I'm hopeful that my luck in this area does not run out, but I'm preparing for possible issues. (Mainly, I have plenty of ice cream and Tylenol on hand.)
Something that made today great: My group chats/text messages were excellent today!
Time I woke up: 9:00 am
Monday, March 15, 2021
I was quiet for a week, but that is mostly because I did not have much to report! The Nuvaring was pretty much a nonevent, but I did get really tired on Thursday afternoon and took one of those deep naps that feels more like mini-hibernation than a nap. I tried to blame it on the Nuvaring, but that's probably unfair. We received our medicines on Friday, and Richard and I went to my RE's office today for another ultrasound, more bloodwork, and instructions for what to do with each medication.
Things are progressing as expected, so we will start injections tomorrow! They have to be done every 12 hours. Richard will be home to help with both tomorrow and Wednesday, but I'll be on my own for one shot per day once his workweek gets rolling. (Unless I want to show up at his work for an injection...ha!) I could tell he was a little nervous about this when he first saw me try on the practice pad, but my technique improved.
Also, I have noticed from Instagram that having a letter board (see above) is all the rage, so I bought one. Thus far, I have found that sorting and arranging the letters on the board is actually pretty calming. Richard helped me think of something clever to say. As a treat to myself for doing a good job thinking about giving myself injections, I ordered additional letters (big ones and cursive ones!) for future board decorating.
Something that made today great: Waking up with no alarm
Time I woke up: 8:58 am
Monday, March 8, 2021
When I first opened up about my infertility last April, I said that I wanted to spread awareness and end the stigma that surrounds this disease. What I knew then is that talking about infertility is difficult for a number of reasons, and that has continued to prove true as I have waded deeper into figuring out what is going on and starting to take action. It seems that at every turn, something happens that makes me feel like a failure as a woman and wife, and to say it's unpleasant would be a tremendous understatement. My best friends and family members found out about IVF over text messages and Facebook messages because for several weeks, I couldn't talk about it without crying.
With that said, I am also touched and encouraged by the outpouring of support (from praying hands and heart emojis to offers of support to tales of personal experiences and so much more), and I still want to spread awareness and end the stigma. A few weeks ago, I did a bible study called "Longing for Motherhood" with a group of childless Christian women, and one of our devotions said, "Suffering is hard. Suffering alone is unbearable." I have kept that in mind as I have thought about the people I talk to and how much I want to share. For as long as I am comfortable, I am going to post blogs about various aspects of my experience. I imagine that I'll drop off around the time of our egg retrieval and show back up at some point in the distant future when I know the outcome. However, I am finding that writing about IVF is easier than I expected, so that could change.
For the first time on record, I was excited to start my period because that meant we could get started with IVF. As we are approaching three years of trying to conceive, any sort of actionable step was welcome. My instructions were to call on the first day of my cycle (Cycle Day 1, CD 1, or the day the period shows up) and set up an appointment to come in on CD 2 or 3 for an ultrasound and baseline bloodwork. I waited all last week through CD 27, 28, 29, and even 30 thinking "any day now..." Of course this would be tied for my longest cycle since we started trying and my longest unmedicated cycle in a year and a half. I even entertained naive thoughts such as, "Wow, maybe all it took for me to conceive was to say we'd do IVF!" but CD 1 showed up on Saturday, when my RE's office is closed. So, I set an alarm to call as soon as they opened today at 7:30 am.
I scheduled an appointment for 10:00 am, and it was as easy as possible considering pandemic-related security measures at the hospital, being in a pandemic in general, being stuck with a needle, and having an ultrasound. These things are not particularly painful, just a part of life and the process for me; I imagine they'll become even more routine over the next few weeks and months.
After the procedural part, I met with a staff member and got the nifty calendar pictured below with instructions of what to do next. This week, it's five days with a Nuvaring. Birth control seems a bit counterintuitive for this process, but the hope is that it will offer a little more control in the cycle. (Read more at this website.) I'll go back next Monday for more labs and ultrasound. They'll also give me a new calendar!
I also sent in the credit card authorization for my prescriptions tonight. They are coming from a pharmacy in California; later this week, we will be receiving a shipment of medications. At Monday's appointment, our calendar will be more involved than this week, as we will be learning about what to do with medications each day. For those especially unfamiliar with IVF, this part involves injections. Richard is enthusiastic about his role (giving me the injections), but this delightful process isn't exactly what we had in mind when we thought about making a baby together. He remains dreamy through it all.
Something that made today great: I scheduled my dissertation proposal meeting!
Time I woke up: 7:20 am
Friday, March 5, 2021
So uh...it’s been a while. Roughly 51 days according to my count, and a lot has happened.
Despite a promising start toward finally breaking the 5-hour wall in the marathon following the sudden death of my friend Ken, I began to fall off the wagon in mid-January. What followed was a complete derailing of any motivation to run...but let’s back the train up.
Last April during National Infertility Awareness Week, I wrote several posts about my experiences with unexplained infertility. As with many other things and life events over the last year, COVID-19 threw a wrench into solving my fertility mystery. In July, my OB-GYN started me on Clomid, a “first line” drug for fertility treatments. After a few cycles with no luck, he advised me to have laparoscopic surgery to check for endometriosis. Meanwhile, we doubled my Clomid dosage (still with no luck).
On December 8, I had the surgery, and my OB-GYN found stage 2 endometriosis. (When I wrote about Ken and said that I was tired from my semester, that was true….but also my body had been cut open four days earlier.) While the endometriosis finding was not ideal, my OB-GYN also expressed concern about the shape of my ovaries in some of the images from the surgery. The photos showed that they are not as round as is desirable, which could mean nothing or could mean that I don’t have as many eggs as one might expect for someone my age. If the latter were the case, we would need to be more aggressive with treatment. The way to find out is through an AMH (Anti-Mullerian Hormone) test that a reproductive endocrinologist (RE) would be able to order for us. With that recommendation, Richard and I talked it over and decided to take the RE referral.
We could not get in with the RE until January 21, so we had a bit of time to wait over the holidays. At our first appointment, we discussed treatment options and opted to try a few rounds of intrauterine insemination (IUI) and see what happens, as IUI is less invasive and less costly than other pathways such as in vitro fertilization (IVF). The RE ordered a round of bloodwork, including genetic testing.
A week after our first RE appointment, on January 28, we received a call back with our results, including the AMH results. Whereas a desirable AMH result is between 1 and 4, mine was .17. What that means is that my egg quantity is far from ideal. What that means about egg quality is...not much. We still don’t know, but if there are fewer eggs overall, proportionally, it is likely that the number of high quality eggs is likely lower too.
The AMH news was quite the shock to me. We went from a vague “We don’t know why you’re not getting pregnant” before surgery to “Your endometriosis is not ideal but also not impossible” to “There are not a lot of eggs” in a short period. I was crushed. I bawled so hard that my body shook. I apologized to Richard that he ended up married to me. It was ugly. Tears are streaming down my face as I wrote about this because it’s still so painful to deal with.
But the good news is that we’re dealing with it.
At our next meeting, our RE spoke with us about IUI and IVF and encouraged us to pursue IVF over IUI if we thought we wanted more than one child. While we’d joked about having 12 kids (enough for a football team and one sub), this was the first time we had to seriously discuss what size family we want. Following our conversation, we decided to pursue IVF.
As the type of person who likes to plan ahead and do what I can to prepare for any situation, I asked the RE what I should be doing to improve our chances of a successful IVF cycle. He already had some supplements in mind for me to add to my daily medicine/vitamin regimen, so I made a note of those and purchased them quickly.
After asking if I needed to eat anything special or avoid certain foods, I casually mentioned that I am a distance runner. I know the term “distance runner” means different things to different people, but it definitely didn’t mean “I have a 39-mile race this weekend and a marathon in 4 weeks and a half marathon two weeks after that” to my RE. (I ended up getting sick and missing the 39-miler.) He encouraged me to limit my strenuous exercise to about five hours per week (which you might recall was my time goal for one race on one day). Rather than being reasonable and observing that limit, I let the pendulum swing the other way and acted like a toddler choosing to completely avoid something rather than engage in it in some limited scope. Other than walking Scooter and a few short run/walks with Ellen, I didn’t run for weeks. I also used the ice storm that hit Louisiana and Texas as a convenient excuse to avoid exercise, but really I was mad at my body, my situation, and the world.
Eventually, I regained my grip on myself and my goals. Marathon/ultra running has done many wonderful things for my body and has brought me some of my best friends. However, I have had to make the decision to slow it down lately. I am caught at the crossroads of who I am (a runner) and who I want to be (a mother). While these pieces of my identity are not mutually exclusive, I cannot fire on all cylinders with both at the same time right now. I hate it because I know logically that I did not run my egg supply away. Infertility is a disease, not a result of any exercise regimen or racing schedule.
I spent a lot of time deliberating over what I wanted to do this weekend. I am still not completely sure what will happen when I toe the line on Sunday morning. The Louisiana Marathon has been my favorite marathon since I first ran it in 2015, and it’s my hometown marathon now that we live in Baton Rouge! I so badly wanted to make this weekend a PR race for Ken and for me. When I think about it now, though, that is not the best choice. Even if I had completed my training plan, now is not the time to push my body beyond what it has done before with running.
The half marathon turns off from the full marathon course between 10.5 and 11 miles. I will run at least that far with a buddy and an angel rider from Ainsley’s Angels of Northwest Louisiana. Whatever I decide after that point--finishing the half with my buddy and my angel or finishing the marathon for Ken and for me--will be the right thing, but I don’t know now what that will be and might not know until mile 10.5 or 11.
If you’re the praying type, I could use prayers in the short-term to make the best decision for the race on Sunday, and Richard and I could use prayers in the long-term for the best outcome for us from IVF.
Something that made today great: Zoom and FaceTime falls with Alpha Gam sisters and my work wife!
Time I woke up: 7:52 am