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