Friday, December 31, 2021

Fresh Embryo Transfer 1 - 15dp5dt (a day late)

Yesterday was day 15 since our transfer of a five-day-old embryo, and it was our third round of betas for this cycle. I was cautiously optimistic after the beta was 38 at 7dp5dt, then I was a bit nervous when it was 151 at 13dp5dt, meaning it was doubling every 72.34 hours (whereas the expected doubling time was 48-72 hours). My doctor brought me back 48 hours after my last blood test (that is, yesterday morning) to check how things were progressing. Before I headed to the hospital, I took a home test when I first woke up--in trying to conceive (TTC) world, that's known as first morning urine, or FMU)--and it was still positive. I promised myself I would not look at my patient portal until at least 1:30 pm, and I stuck to that.

As it turns out, my watch has a stress feature. When I checked a few times yesterday morning, I was hanging out in the medium- and high-stress zones. My watch also has a feature that will walk me through breathing exercises (inhale, hold, exhale, hold, repeat...) so I did a few of those to try to stay cool, calm, and collected. It sort of worked.

When I logged into the portal at exactly 1:30, I had an update: 272! I had already done some calculations at home to figure out what the number would be if I was still doubling every 72-ish hours, Thus, I knew the number I wanted to see was a minimum of about 240. I hopped over to Betabase to calculate the doubling time and was pleased to see we'd moved from 72.34 to 56.53 hours; that seemed promising. Until I heard from the fertility clinic, I didn't want to get too far ahead of myself. However, I felt like I could breathe a bit easier. The stress level on my watch dropped, too! How fascinating.

My nurse called at 2:13 pm, and the first thing she asked was how I was feeling. I was honest and said, "Well, I already peeked at my results, so I'm feeling pretty good." She told me that my RE still wants to keep an eye on the progress since the numbers are low. I agreed to come in on Monday for another blood draw. As I was sending out update texts later that afternoon (after Richard was awake and had heard the news), a friend said, "How many tests are they going to do before they let you relax?" which is an excellent question...but we also agreed that the frequent updates are a silver lining (at least as long as the news stays good.)

Not that there's any normalcy or standard in all of this, but a person who has a 28-day menstrual cycle would be expected to ovulate about 14 days before their next period. (Here's an article about why pinpointing the ovulation date can be confusing.) After estimating when they ovulated, people who are TTC track time in days past ovulation, or dpo. In IVF world, it seems (from reading message boards and such--I haven't read anything super scientific) that retrieval day and ovulation day are roughly the same. 

With that in mind, a person with a 28-day cycle would have missed their period (expected at 14 dpo) around 15 dpo. I've been thinking about when a person becomes "actually pregnant" and coming up short. Thus far, the day after a missed period seems reasonable. My 15dp5dt is approximately 20 dpo, so we have cleared that hurdle. Most people who are just looking for a missed period would have received a positive test by now and felt pregnant, so why not me too? I even said, "I'm pregnant" aloud to myself in the car yesterday, and it felt kind of real, kind of fake. I'm hoping that the numbers continue to increase and that I'll find myself able to celebrate and not feel like a pregnancy impostor. 

With repeated blood tests, it's difficult to settle in and enjoy the moment, but I'm doing my best. Still, it feels incredible that we have made it this far. I think the affirmations are helping! I have also been writing down five things I am grateful for each day. It's helping to get my mind right for sure. I'll be praying, keeping my fingers and toes crossed, saying my affirmations, and doing my breathing exercises until I get the next round of blood results. Join me!

Something that made today great: Good girl talk before bed :)

Time I woke up: 8:15 am

Tuesday, December 28, 2021

Fresh Embryo Transfer 1 - 13dp5dt

Welcome back! 

I left off two weeks ago, which was the day before our transfer of one embryo five days after our egg retrieval. We transferred the embryo on December 15, and everything went as expected. This time, we got our fries from Whataburger instead of McDonald's. After a good, salty breakfast, I went back to sleep and rested most of the day.

From our fourth retrieval (fourth??!), we had two eggs that were mature and fertilized, but only one was suitable for transfer. The embryologist watched the second one through day 6 but determined that it was not a candidate for freezing and testing. Although I wondered what happened to the second embryo when we went for our transfer, I didn't ask any questions and just figured it stopped growing. When my RE called the day after the transfer to let me know that the second embryo was not going to be frozen, I wasn't even sad because I had already counted it out.

With the holiday and my travel plans, my RE had me come in last Wednesday at 7dp5dt--that's seven days after the transfer of a five-day-old embryo--for bloodwork. My RE called while I was at lunch, which made me nervous because he's the one who calls when the news is bad. Sometimes, however, he calls when the news is good, too. In this case, it was the latter: my beta came back at 38. My RE seemed excited to share this news and confirmed that a beta of 38 on day 7 is better than a beta of 25 on day 10. He scheduled me to come back for another blood test when I returned from my holiday travels, so I went back this morning.

I did not take any pregnancy tests with us on our trip. After the experience with the chemical pregnancy in November, I did not want to be aware if my HCG levels started to drop. Even if the news was good, I didn't want to hyper-focus on whether or not the lines on home pregnancy tests were getting darker. I held out on taking a home test until this morning after I got back from the doctor, and the test was still positive, but I had no idea what the levels would be and had no basis for comparison.

Generally, at this point in a pregnancy, HCG should be doubling every 48 to 72 hours. Being the math nerd that I am, I had already calculated that with six days of growth, the result today should be between 152 (if doubling every 72 hours) and 304 (if doubling every 48 hours). Around 12:30, I started checking my patient portal for updates. Finally around 1:30, my results were posted: 151.35. While I waited for someone to call, I hopped right over to Betabase, a website I discovered while prowling forums about beta doubling rates, and calculated what this meant for me. The result? I'm doubling every 72.34 hours. 

While this was just outside of the 48- to 72-hour range if we're looking at four significant figures, it does round down to 72, which is normal. This was the kind of information I was simultaneously glad to have but not thrilled to know without guidance from my RE. Fortunately, I didn't have to sit with my imagination (or furiously Google things) for too long.

My nurse called at 2:22 pm. Since it was my nurse, I knew things couldn't be too bad. I thought the low numbers might send up a red flag or merit an adjustment to my medications, but she told me to keep doing what we have been doing and come back Thursday for another blood test. My nurse did admit that 151 is low, but the increase is a good sign.

I have heard pregnancy and childbirth described as liminal spaces, but I feel like I'm stuck once more in some weird transition between "pregnant" and "not pregnant." After the first beta following our FET, I ordered a book of affirmations called Conversations with my Belly by Tina Azucena. The book arrived after I already knew the fate of our embryo, but I pulled it out tonight to read through a few. Admittedly, I feel a little silly reading them aloud to myself (or sometimes to Scooter), but at this point, I'd stand on my head in my underwear in public if I thought it would help. The book has many excellent affirmations, but here are a few I like for this moment. I also appreciate that many of them are applicable to parts of life besides pregnancy.

For body:
  • I trust my body.
  • I am capable of carrying, nurturing, and sustaining the life inside me.
  • I am confident in my ability to nourish and grow my baby.
For mind:
  • In this moment, my mind is free to feel grateful.
  • I choose positive thoughts.
  • In times of uncertainty, I call myself back to balance.
For fear:
  • I let go of the need for control. I accept things as they are.
  • I give myself permission to trust my body.
  • I am confident that my body will work efficiently during this pregnancy.
For spirituality:
  • I have faith in myself and my ability to have a healthy pregnancy.
  • I choose to have faith in God and all the love that He brings to me and my baby.
  • I am grateful for the generous blessings I have received and am receiving.
As my friend Bob would say about running and racing, you've got to get your mind right. Rather than fretting and worrying for the next day and a half, I will focus on relaxing and being strong mentally. "Relaxing" might translate into "taking excessive naps," but that's okay. 

Something that made today great: A walk and [decaf] coffee treat with Ellen!

Time I woke up: 6:45 am

Tuesday, December 14, 2021

IVF Cycle 4 - Retrieval and Fertilization

The last few days have been incredibly busy, but I am finally making time for an update. Let's start with Friday.

After triggering on Wednesday night, the retrieval went as expected on Friday morning. We retrieved three eggs, which is what my RE expected. I'm unsure what happened to the other three follicles that were on the ultrasound (Were they empty? Was there an egg in there that just wasn't mature?) but Richard spoke with the RE after the retrieval, and Richard said he seemed satisfied. Pretty quickly, I decided that the other three were ones that would not have made it anyway and committed to thinking of the eggs we recruited as a "quality over quantity" matter. Funny enough, I heard someone at AFA two weeks ago say that "We were going for quality over quantity" is what many fraternities say after they did not have a good recruitment. (Who knew infertility and fraternities had so much in common?) I thought we had a pretty good shot at having three eggs fertilize, which would be excellent.

That afternoon, our nurse called to give me instructions for the medications we would be adding. SHe also let me know that someone would call on Monday to schedule the transfer if there was something to transfer. Friday night, we started the pre-transfer medications, which included four days of methylprednisolone, two estradiol tablets daily, and one progesterone in oil (PIO) shot daily. I was out of town on Saturday night and did my own shot, but otherwise, Richard has assumed the role of shot giver.

Saturday morning, the embryologist called with our fertilization update. I was asleep with my phone on silent, but they left a message to let us know that two of the three eggs had fertilized. While not the three I'd hoped for, I had also read that transfers of three embryos have lower live birth rates than transfers of three embryos, so I felt reasonably good about this news.

Monday was our next big milestone because I was going to find out if and when we would have our embryo transfer. Typically, the nurse calls with updates between 2:00 and 2:30, so I didn't worry much in the morning. To an extent, I am getting better at not worrying since these things are out of my control, but I still worry sometimes. Our nurse didn't call until 2:54, so the minutes between 2:30 and 2:54 were not particularly peaceful for me. Even knowing (and personally witnessing last week) that Monday can be a busy day at our clinic, I started to worry that we had nothing to transfer, and our doctor would be calling after 4:00 with bad news. (Our RE is the one who delivers the bad news.) When the phone rang at 2:54, I was somewhat relieved to see our clinic's name instead of our RE's name, and I was more relieved when I heard my nurse's voice on the other end...but I was still quite nervous. However, she let me know that we had one embryo to transfer and that I should show up at the clinic at 9:45 am on Wednesday with a full bladder for a transfer at 10:00 am.  


I asked our nurse if we just had one embryo, and she said, "For now," which I was unclear if that meant, "Your one could go away," or, "Your other one might catch up and be sufficient for transfer." I decided not to inquire in case it was the former--less to worry about. 

In the same way that fraternities that had a low turnout during recruitment tout the "quality over quantity" line, something said often in [in]fertility world is, "It only takes one," which is true. The question is will this be our one, and that remains to be seen...but we certainly hope so. I feel at ease about the procedure, and I am surprisingly not concerned about the fact that our embryo(s?) will be untested before the transfer. Hopefully my body will take over, and we'll have amazing news in a few weeks. That's the dream anyway!

Something that made today great: I got a few responses to my dissertation recruitment e-mails!

Wednesday, December 8, 2021

IVF Cycle 4 - Stims Day 8

A year ago, I had laparoscopic surgery to check for endometriosis. My OBGYN found and removed some endometriosis (stage 2 of 4), but what raised a red flag for him was that my ovaries weren't looking as round as expected for someone my age. With that, Richard and I took a referral to our RE, and I have since had more people, wands, and devices up in my lady bits than I would expect in a year that didn't involve getting and staying pregnant. Also, there's been quite a bit of bloodwork.

Today, we finished ovarian stimulation for our fourth IVF cycle. But before I recount the events of the day, let me back up first. Here's what a typical appointment has looked like for me at my clinic:

  1. Arrive/check in (which is a non-event because the staff recognizes us at this point)
  2. Wait in the big waiting room
  3. Have the blood draw
  4. Empty my bladder (optional/if needed)
  5. Wait in the small waiting room
  6. Have the ultrasound
  7. Wait in the small waiting room again
  8. Talk to the nurse about next steps
  9. Pay (if there is anything to pay) 
  10. Leave 

Today during step 6, we noticed that there were more follicles on the ultrasound, which I thought was good news after our conversation on Monday. Two more appeared on the right, and the one on the left was still there. That brought our total to six follicles.

Despite the fact that I just named ten steps, our appointments are generally pretty quick. Sometimes we're in and out in 20 minutes. I mentioned that Monday was not one of those times, but it turned out that today wasn't either. We waited in the small waiting room for longer than usual. In contrast to Monday, however, the office was not swarming this morning. So of course I let my brain take over, and I started to worry during step 7.

Then during step 8, our nurse told us we were going to have to have the conversation we'd talked about on Monday. I was a little puzzled by this since we were looking at more follicles today. I guess part of why we had to wait longer today was that our nurse and RE had to consult. Our RE came in shortly after we sat down in the nurse's office. To make a long story short, of the three options I described yesterday, Option 1 ("Go forward with the retrieval as planned") won.

What happens next, however, looks different. 

Our RE told us that we might want to shift our focus to trying to achieve a pregnancy rather than trying to bank more embryos. Certainly, we'd been prepared (and hoping) for a pregnancy when we did the frozen embryo transfer in October. What he offered up was proceeding with the egg retrieval but attempting a fresh transfer next week. As the name suggests, a fresh transfer is different from the past where we biopsied and froze embryos while we waited for the testing. Financially, the choice of attempting a fresh transfer makes sense: there are extra costs (over $3000--one day I will get into the finances of IVF) involved with the biopsy, cryopreservation (freezing), testing, and storage that we avoid with a fresh transfer. We still have one euploid embryo in the freezer that's frozen in time at the age of 32, I am still under the age of 35 (a big deal in [in]fertility world), and I'm not knocking it out of the park with follicles this cycle. Our RE said this is the path he would recommend but told us to take some time to think about it.

This suggestion was a bit surprising to us for a number of reasons, first and foremost that we'd literally never discussed a fresh transfer. Also, this was the same physician who told us about a month ago that we'd need to do the endometrial receptivity analysis (ERA) before attempting another transfer. Well, that specifically meant a frozen transfer, not a fresh one. (And it's entirely possible that we missed that critical F word when we talked last month.)  To keep it simple, our RE explained that my body is already doing a lot of what we were trying to achieve with the transfer medications, and my uterus and lining look great. (My RE actually said that we have a great car and just need something in the driver's seat, hahaha.) Pending bloodwork (primarily that my progesterone stayed under about 1.5), he said we could try the fresh transfer.

On November 21, I wrote, "Looking at the calendar, that meant that another actual transfer before the end of the year was not in the cards." I think God is probably laughing right now. While another frozen embryo transfer before the end of the year was not in the cards, we unexpectedly have the option of a fresh transfer. This is just another instance of something I didn't think of as an option becoming our reality; I have had at least one of these in every cycle but the second one.

Our nurse called back this afternoon to confirm that we could go ahead with the retrieval on Friday. Specifically, I would need to administer the trigger shot at 9:30 tonight for a retrieval on Friday morning at 9:30. Something different about this cycle is that we did our evening stim shots instead of discontinuing after the morning shot. I think it's because my biggest follicle is currently a 20, compared to 25+ in other cycles on the day of the trigger shot.

Looking to the retrieval, the quantitative researcher/data analyst in me wanted to detect a pattern. I took a look at my handy spreadsheet of IVF cycles and saw that we had a monitoring appointment on day 8 during our third IVF cycle. As it turns out, the six follicles I have right now look a lot like the middle six follicles I had in the third cycle. In that cycle, we retrieved seven eggs, and six were mature and fertilized. Although every cycle is different and I'm only comparing with one other cycle, this piece of information made the situation seem less bleak. What we need next is to have a higher (or at least the same) blastocyst rate than our third cycle.

So, the next few weeks are filled with possibility and lots of steps. Here are a few things we're hoping for now:

  1. That the follicles I have stick around and and are retrieved on Friday
  2. That the retrieved eggs are mature 
  3. That the mature eggs fertilize after the retrieval
  4. That the embryos make it to day 5
  5. That the transfer goes smoothly
  6. That something sticks
  7. That I have a healthy pregnancy with a live birth

As always, please join us in hoping and praying for the best possible outcomes. 

Something that made today great: More follicles + confirmation of the egg retrieval

Time I woke up: 7:00 am

Tuesday, December 7, 2021

IVF Cycle 4 - Stims Day 7

Richard and I returned to our RE's office for bloodwork and an ultrasound yesterday. This was our first check since the ultrasound we had on November 26, and we were on day 6 of stims. I think it's been a while since we had a Monday appointment, but the clinic was swarming! I guess everyone had some sort of appointment after not going in over the weekend. Our RE saw us instead of our regular ultrasound tech or the physician's assistant. Rather than watching the ultrasound screen, I chatted with my doctor about the podcasts I listened to while driving back from Dallas this weekend. He reported that although my right ovary had three follicles growing--a 12, a 14, and 16--there was not much going on with my left ovary. 

When we talked with the nurse, she wanted to get a pulse on how we might want to proceed if there were still only three follicles when we returned for our next visit, which she expected to be Wednesday. If we didn't see any new growth, the three options would be:

  1. Go forward with the retrieval as planned
  2. Convert the cycle to IUI
  3. Cancel the cycle completely
The idea of this conversation was not to blindside us if we weren't seeing more follicles at our next appointment and needed to consider options 2 and 3, which is considerate of our care team...but it still didn't feel good. I learned from thinking through this that my arbitrary number of follicles where I feel comfortable is apparently four. We retrieved four in our first cycle and managed to have one blastocyst. Even though that one turned out to be highly aneuploid, it could have been four seemed significantly better than three in my head. (This is all disregarding the third cycle where we retrieved seven, had six mature/fertilized, and still only ended up with one blastocyst that was, again, highly aneuploid.) 

After three failed IUIs this summer and years of trying to conceive without intervention, Richard and I were not thrilled about option 2 or 3. While doing an egg retrieval requires anesthesia and higher costs than IUI, we have already sunk so much money into medications and monitoring for this cycle that option 1 seemed like the best choice. Knowing that our numbers will always be low, it seems like a waste to stop at this point.

When my results were uploaded to my patient portal yesterday afternoon, there was one little 9 mm follicle listed on the left. I'm not sure if someone else took a look at the ultrasound and decided to count that one or what. So, that put us at four follicles, which somehow feels like it comes with much better odds than three follicles. Four is still low.

Needless to say, yesterday's appointment was yet another reminder that our follicle counts will probably always be low, and we will continue to need to have these difficult conversations and make expensive decisions. In the infertility world, a phrase that gets tossed around a lot is, "It only takes one," and it's seeming more and more like we need to set our sights on one euploid embryo per cycle. This is a strange place to be because some people retrieve so many more eggs than that, but others do not respond to it's all a bit of a crapshoot.

Somewhat surprisingly, I'm doing well with this latest batch of news. A friend sent me a devotion about trusting God the other day, and it made me feel totally seen.
Trusting God can feel hard when our life doesn't look anything like we thought it would.

But can you imagine how much less anxiety, fear, angst, and heartbreak we would have if we truly trusted Him?

I don't mean just saying we trust God because it's the Christian thing to say. I don’t mean just singing words of trusting God because it’s in the praise song. I mean having a marked moment. A real live moment we can point to and remind ourselves that we declared we will trust God with this suffering. With this disappointment. With this situation. 

Okay, ouch. Talk about getting called out...but also it's all fair and true. I think I might've finally had that marked moment of shedding some of the anxiety and heartbreak because I didn't cry yesterday, and I didn't worry (too much) while I waited on my results and the nurse's afternoon phone call. 

When the nurse called, she told me to continue our same medication protocol and return to the office on Wednesday. Richard believes my left ovary will rally before tomorrow morning, and I'm doing my best to mimic his hope and enthusiasm. As long as we have the same or more follicles tomorrow, I suppose we'll be looking at an egg retrieval in the next few days...but I will update about that tomorrow when we know more. Join us in hoping for more follicles tomorrow and a smooth retrieval later this week.

Something that made today great: The Junior League holiday social was fun!

Time I woke up: 8:40 am