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.