Pregnancy after infertility

Apologies for the radio silence, and rest assured that it’s not because anything has gone wrong. It’s partly because I’ve been really freaking busy with work and visitors, and also partly because I’m still figuring out how to talk about pregnancy in an infertility blog.

First, there are the questions about my blog name/Instagram handle. Then there’s the matter of adjusting to a new reality after such a long road. And finally, there’s the fact that I still don’t look or feel particularly pregnant. Let’s tackle them each in turn.

The formerly bunless oven?

“You’re not bunless anymore! You’ll have to change your name!”

I can’t tell you how many times I’ve heard this over the last couple months. The thing is, this donor egg IVF pregnancy — while a scientific miracle — doesn’t change the fact that I’m infertile. I don’t mean that in a mopey please-feel-sorry-for-me way, but as a matter of fact. Obviously I feel immensely lucky that modern science ultimately still made pregnancy possible for us. Nevertheless, that doesn’t just erase everything it took to get here.

There’s also the issue of ever having another kid, assuming this one makes it out alright. We’re extremely fortunate to have three more frozen embryos from Marie’s eggs, which is a luxury many people don’t have. Still, if we ever wanted to try for a 2nd — a decision most couples make over a casual dinner, or not at all (#bonusbaby) — that means more hormone therapy, long drives to Belgium, and potentially even finding a new egg donor in yet another foreign country to start the whole process from the beginning.

So in summary:

  • Super grateful to have gotten where we are today
  • Still definitely keeping the name.

Fitting in with the ‘fertiles’

Transitioning from the infertility community to the pregnancy community has been strange, to put it mildly. Many people assume that the transition happens instantaneously the moment you get the news, which couldn’t be further from the truth. Going through what we did was a massive emotional and physical burden — I didn’t just magically wake up pregnant one morning like all the other women in my pregnancy yoga class. I feel like a warrior among lottery winners, and coming to terms with the full extent of this new reality will take some time.

One of the ways this manifests is in the way I feel comfortable talking (or not) about the pregnancy. I’m not the type to gush about baby stuff or write carefree ‘Lovin’ pregnant life!!’ posts anyway, but this has made me probably even less so. Part of this is because I’m super-conscious of all the couples still struggling — I’ll be the first to admit that pregnancy-related posts were a big trigger for me during our multiple IVF attempts. But it’s also because it’s hard to endure so many years of failure without experiencing a little bit of post-traumatic stress. When you finally get something that you’ve fought for for so long, it’s natural to treat it more seriously than those who ended up there by chance.

Nothing to see here

The final reason I haven’t posted much is that even now at 17 weeks, I still don’t feel (or look) particularly pregnant, and not much has been going on. We had two more ultrasounds at 10 and 12 weeks when I tapered off the estrogen and progesterone, but everything looked perfectly normal. We also had another small bleeding scare at around 12 weeks, but thankfully nothing more since. The genetic testing came back with no evidence for Down’s, Edwards, or Patau syndromes. In addition, my blood work all came back looking excellent, and my blood pressure has always been extremely low. Aside from the whole prematurely-failing-ovaries thing, I’m really the absolute picture of health. Honestly, the most exciting thing to happen during the last couple months was learning that my blood type is not O+, despite having believed that my whole life. (My real blood type is apparently A+, which seems perfectly fitting if you know me at all.)

Since everything seems to be going well, we finally announced our pregnancy to our wider network a few weeks ago. So in case you haven’t already seen it, here’s our long-awaited pregnancy announcement featuring all of the used needles from our IVF attempts:

“Today we want to introduce a project that we’ve been working on for over half a decade*. After a very difficult journey, including 6 attempted IVF embryo transfers, 5 medicated (and >55 unmedicated) two-week waits, 4 separate egg retrieval surgeries, including 3 for Allie in 2 different (foreign) countries, and ultimately the generosity of 1 amazing friend who donated her eggs, we are happy to report that we are finally expecting our miracle baby. *This is longer than it took me to get my PhD in Physics. I think I should get to put this in my tenure report.”

A poor quality embryo success story

Last week, after what has been a 5+ year battle with infertility culminating in a donor egg IVF pregnancy, we had our first ever ultrasound not at a fertility center. Instead, we went to a regular old midwife practice…like normal people. I know some IVF’ers who have felt out-of-place when they make this transition, as if they still don’t belong. I kind of felt the opposite, to be honest — like after the number of ultrasound wands I’ve had shoved up my hoo-ha to get here, they should present me with some sort of elite membership card.

With that said, we went into the appointment with significant trepidation. I’d had a non-negligible amount of red spotting/bleeding two days before, which left me completely panic-stricken. Combined with the strong cramps that started the next day, things weren’t looking so good. “I don’t think I’m strong enough to go through a miscarriage too” I cried pitifully to my husband from my perch on the toilet.

You see, what’s been in the back of my head this whole time is the knowledge that the embryo we transferred was not the best quality. It was rated a 3BC before freeze, and had developed into only a 5CB upon defrost. The number is the stage of development, and the letters (A–D) rate the appearance/quality of the inner cell mass (which becomes the baby) and trophectoderm (which becomes the placenta), respectively. Since both things are required to make a baby, both grades are important. For a 5-day blastocyst transfer, the ideal grade is therefore 5AA. Since D-grades (=poor) aren’t even frozen, this meant our embryo barely made the cut.

While you have a chance with any embryo, studies show that the quality of the embryo correlates strongly with both the chance of implantation and the ultimate live birth rate. The best quality (5AA) embryos have a pregnancy rate >60% and a live birth rate >50%. With the embryo I transferred, on the other hand, I had only a ~30% chance of a positive pregnancy test, and only a ~15% chance of a live birth. In other words, although I had managed to beat the odds and become pregnant, my chance of miscarriage was a whopping 50%.

To make matters worse, those statistics were compiled for ‘ideal’ 5-day blastocysts, but our little dude/dudette didn’t make it to blastocyst until day 6. That means it was growing at a slower-than-normal rate, and that our true chance was likely even more pessimistic. Combining these statistics with my sudden bleeding and cramping, my husband and I went into our first pregnancy ultrasound unsure of what we would find.

The 8-week ultrasound

After explaining our situation to the midwife and having her narrowly stop me from taking my pants off (…old habits…), I climbed onto the exam table for my abdominal ultrasound. I was in tears before the exam even started, so conditioned by our ‘journey’ to expect the worst. But almost immediately, she told us it was good news — she could see the growing embryo!

She then asked me to remove my pants for a trans-vaginal ultrasound (see!) and she told my husband he could get out his phone. (She had told him phones weren’t allowed earlier in case it was bad news…won’t fall for that twice.) The raspberry-sized embryo was measuring right on track for its age, and we could even see a heartbeat. Despite our worst fears, everything was progressing just fine.*

At this point, I should note that I’m still taking two different IVF medications: a form of estrogen (orally) and a form of progesterone (via vaginal suppositories). I assumed this was self-evident to the midwife, both because she knew it was a donor egg IVF pregnancy and because the progesterone leaks out in massive white chunks. I was therefore caught off-guard when she started delicately hinting that if I noticed any symptoms like discharge, itching, or redness, I should call my doctor. I smiled politely and tried to rack my brain (“Have I noticed any itching??”) when my husband piped up that I was on vaginal progesterone, to which she replied “Ahhhh, that’s what it is then.” From this, I learned two things: 1) They apparently don’t get many IVF patients, and 2) From the amount of white goo leaking out of me, she must have thought I had a vaginal infection to rival all vaginal infections. So that’s not embarrassing at all.

Success with a poor-quality embryo

Technically, our embryo wasn’t poor-quality, it was fair-quality. Still, this seemingly minor distinction didn’t ease my anxiety during the two-week-wait when confronted with the dozens of ‘Perfect 5AA!’ embryos that my fellow IVF’ers seemed to post about online. Perhaps there’s some bias where people only post about the grade if it’s good?

Since I had such a hard time finding success stories for anything less than BB, let me add our own small success story here for those still in the trenches. Our embryo was only a 3BC (and by day 6, at that), our donor (Marie) was a month shy of 37, and while we won’t stop worrying ’til the very end, here is the 8-week scan of our bean.

* When I called Ghent to share the good news, the midwife I spoke to thought I had used the eggs of ‘my partner’. So either known donations also aren’t that common, or Marie and I come off as an adorable lesbian couple.

A different kind of two-week-wait

Trigger warning: This post discusses a positive pregnancy test, which means that I’m now one of those annoying ‘pregnancy bloggers’ I used to avoid like the plague. My sincere apologies.

You’d think that after finally receiving our first ever positive pregnancy test, the anxiety would have subsided. After all, this is what we’ve been working toward all these years, right??

Wrong — what we’ve been working toward is a fully formed, living and breathing baby, and we’re still quite a ways from having that in the bag.

I’m not complaining, of course — a positive test is the first necessary step, and it’s one that eluded us cycle and after for >60 months (not that I’ve been counting). But after working so hard for it, and waiting for so long, the very real possibility of a miscarriage has not escaped my notice.

I realize, of course, that the odds are in our favor — which is definitely the first time I’ve been able to say that in this whole painful process. But while being a member of the online infertility community has been a HUGE support, I think I may have finally discovered one downside. In particular, seeing daily posts from other women having trouble getting (or staying) pregnant has given me a heightened awareness of everything — and I mean everything — that can possibly go wrong*. (Having severe cramps in the middle of the night on Wednesday didn’t help either.)

2nd blood test (‘beta’)

Luckily, one good thing about getting pregnant through (donor egg) IVF is that we’ll be followed fairly closely through the process. Our mythical Big Fat Positive (BFP) was originally confirmed via an HCG blood test (‘beta’) over a week ago now, and last week we had a second beta to see how things were coming along.

In a normal pregnancy, the level of HCG in the blood should double approximately every ~48 hours. With an initial beta of 160, and a second beta scheduled for 6 days later, I was therefore hoping for a number greater than 1,280. From the amount of dizziness I was experiencing, and from peeing on sticks like a madwoman, I was pretty sure my HCG was rising — I just didn’t know by how much.

Have you ever waited to hear if the only pregnancy you’ve ever achieved — a pregnancy which took multiple years and donated genetic material — was still viable? I can tell you that it’s not completely stress-free, no matter how much you want to ‘Just enjoy it!’. After a tense day of glaring at my silent phone, and multiple communication issues between my local clinic and Ghent (one involving a fax machine, because apparently it’s 1995…), I finally got word from the nurse: My second beta came back at 4,815. I’m definitely still pregnant – or at least I was as of last Thursday!

Another two-week-wait

What they don’t tell you is that after you get pregnant, the two-week waits don’t go away — they just change into a different form. Now that the clinic is satisfied with my HCG level, our next step is a 7-week ultrasound. That means another two-week-wait, which I’m finding nearly as nerve-wracking as the first one.

Part of the problem is that ever since that bout of bad cramps last week (which were the night before my 2nd beta), the dizziness I experienced in the first few days has mostly gone away. Since that was really my only symptom, that means that I no longer feel particularly pregnant. I’m really hoping that it’s just the normal ebb and flow of symptoms, but it’s hard to know so many women who have experienced losses and not be a little paranoid. I may come to regret having said this, but right now, I would really kill for some morning sickness.

xx

*For example, if you are in the very early stages of pregnancy, I highly recommend NOT — under any circumstances — googling ‘blighted ovum’.

The outcome of embryo transfer attempt #6 is…

I often plan my posts several days in advance in my head, but I’m not really sure how to begin this one. Ever since my last post about our 6th embryo transfer attempt, I had been planning to start this post with an analogy between an infertility ‘journey’ and being stuck on the side of the freeway in a broken-down bus next to a smelly drunk guy. But then my blood test results came back, and now I’m not really sure that’s accurate anymore*…

Because I’m pregnant.

I’m freaking PREGNANT, guys. After >5 years trying, 6 embryo transfer attempts, and our 3rd attempt with our friend Marie’s donated eggs.

I found out on the train to a marathon five-hour work meeting. The local clinic where I had my blood drawn earlier that morning was supposed to fax my results to Ghent, who would then call my husband so that I wouldn’t receive bad news during work. When I saw my phone light up with our local clinic’s number, I therefore thought ‘Maybe they’re calling me because it’s actually good news?!’ In retrospect, I think I hadn’t properly communicated to the local clinic not to call me as well, so I narrowly avoided what would have been a five-hour nightmare.

Did this two-week-wait feel any different?

The classic question that any woman undergoing a two-week wait (2ww) wants answered is: Did this 2ww feel any different than those that resulted in a negative? Now that I’ve actually experienced a successful cycle, I can say that the answer is (for me): not really. The progesterone side effects always hit me hard, and this 2ww was no different. I had the same cramping, bloating, and backache that I’ve become accustomed to during our failed cycles, and my husband can attest that I was equally delightful company (i.e., super moody).

I also didn’t have any of the early symptoms you read about if you scour the 2ww forums: boobs weren’t the slightest bit sore even after being prodded from every conceivable angle, and I definitely didn’t ‘just feel’ pregnant. What I felt like was a woman on a sh*tload of hormones who desperately wanted the 2ww to be over.

That’s not to say that there weren’t a few possible signs this cycle. The day before my blood test, I started feeling sort of dizzy/drunk during the departmental colloquium (which I was definitely not drinking during) and had to leave work early. I was also absolutely freezing. Then when I was lying down at home, I sneezed, and every muscle in my abdomen cramped up in unison for about 3 seconds.

While these things did strike me as sort of odd, literally every past cycle has resulted in at least one new ‘symptom’ as well, and they clearly never resulted in a positive. My coldness this round could easily be explained by the frigid weather, and if you google progesterone side effects, dizziness and cramps are two of the main offenders. What’s more — these ‘symptoms’ (which I dismissed anyway) only presented themselves the very last day before my blood test. So in summary, if you don’t feel any different after your transfer, don’t automatically assume you’re out.

What happens now?

I’m technically only 4 weeks pregnant, so it’s still very early days. Our clinic told me that around 1/3 of such pregnancies end in miscarriage, which is an uncomfortably high number. And while I’d like to think that the universe wouldn’t be that cruel after such a long struggle already, I have definitely seen it happen.

Thankfully, the dizziness/drunk feeling has stuck around and even increased, which, at least at this point, I find very reassuring. I think it might just be low blood pressure, but it’s like I can literally feel my hormone levels increasing. I have another blood test to officially check my progress this coming Thursday, so we’ll be on pins and needles until then.

In the meantime, I made my husband go buy an at-home urine test so I could see it with my own eyes. So here it is, ladies and gentlemen: our first ever Big Fat Positive.

xx

*This is not to say that the bus-trip-from-hell analogy itself no longer applies. It’s just that the bus driver has finally gotten the engine to start, and the smelly drunk guy seems to have temporarily locked himself in the bathroom.

Embryo transfer attempt #6

This past week brought what will be our final embryo transfer attempt for 2018. It’s our 6th transfer attempt overall, our 4th attempt this year, and our 3rd attempt using one of the embryos from our donor egg IVF cycle.

If you’re wondering how a person stays sane through this many attempts…you’ll have to ask someone else.

After hovering nervously over the phone all morning, we finally got the call that the embryo had survived the defrost, and that we were expected at the clinic at 2pm. That gave us just enough time to grab our huge binder of paperwork, borrow our friends’ car, and make the ~2-hour drive to Belgium*.

This transfer went a little more smoothly than our last frozen embryo transfer and a lot more smoothly than our fresh donor egg embryo transfer. My bladder was just the right amount full for the ultrasound technician to see my uterus, and the doctor was my normal IVF doctor, who is much friendlier than the guy we had the last two times.

The doc also told us that the embryo was progressing well — it had been rated a 3BC before freeze, and it had already expanded to a 5CB since defrost. Although the letter grade (C) for the inner cell mass was only “acceptable”, she was pleased that the embryo had already started hatching out of its protective outer shell. This is exactly the stage you’d want an embryo to be at by day 6, and it’s also the last stage before it’s ready for implantation.

The day-6 5CB hatching embryo we had transferred last Wednesday.

What does the transfer feel like?

If you’re wondering whether the embryo transfer procedure is painful, it’s not. The only slightly uncomfortable part is the hard metal speculum they insert first, which any woman who has visited a gynecologist is already familiar with. You can’t even feel the actual transfer. Given that, I’m always surprised that it still manages to cause cramping for 24-48 hours afterward, which makes for a fun little mind game. (“Implantation cramps?!”)

Regarding the emotional/psychological side of undergoing a transfer, I’ve heard some women say things like: “The moment they put the embryo inside me, I felt teary/filled with joy/a strange sense of calm”. Here, I have to disagree. Maybe it’s from having so many failed transfers, or maybe it’s just me, but I really only felt like I’d had a catheter shoved up my uterus while three other people watched.

What now?

We’re now well into the two-week wait, which any IVF’er can tell you is one of the most agonizing parts of the process (injections included). Caffeine intake should be limited, which means I had to brave a 7am train to an all-day meeting on Friday with only (crosses self) a decaf latte. Then, I couldn’t find anywhere near the meeting location to lie down the requisite 30 minutes after inserting my afternoon progesterone pessaries**, so I had to make do on the floor of a public toilet. Mixing IVF and work is not for the faint of heart.

The floors of public toilets are usually clean, right?

Thankfully, my pregnancy test is already coming up this Friday, which means we only have a few more days to wait. This will be our last attempt this calendar year, as I have a three-week-long work trip in December. I’m not feeling particularly hopeful, but then again, I’ve only ever experienced it not working.

While I’m sad that this will be our last try for 2018, the husband and I have devised a win-win scenario to deal with the news: we bought (mostly refundable) plane tickets to a friend’s wedding in an exotic (but Zika-prone) location. So either I’m pregnant, and we pay a small fee to cancel my ticket, or I’m not pregnant, and I’m going to INDIA!!!

xx

*It would normally be a ~2 hour drive at that time of the day, but as a classic ‘nervous pee-er’, I made my husband stop at multiple rest stops before I was convinced my bladder was empty enough to chug the >1L of water required for the transfer.

**Fun fact: A pessary is a suppository for your vagina.

How to talk about infertility

Two weeks ago — and a mere five days after my last failed in-vitro fertilization (IVF) embryo transfer — I started up the estrogen again for another frozen embryo transfer (FET). This will be our sixth attempted transfer (our third with donor egg embryos), and it got me thinking about why I started this blog in the first place.

It was partly to keep our close friends and family up-to-date on our progress, since it’s well known that I’m terrible at phone calls or keeping in touch in general*. But it was also to help shed light on a process which is often endured in secret. As a result, many well-meaning folks have no idea how to talk about infertility.

For instance, imagine that you’ve been trying to conceive (TTC) for not just months, but years. Imagine everyone else around you continues to fall pregnant. Imagine you’ve tried everything you could think of to help your body and mind: exercise, yoga, mindfulness, vitamins, time off work, drastic diet changes, numerous specialists, some weird Chinese massage guy who asked you to bring a jar of your own pee to the first appointment**, and etc, etc. Imagine you’ve slowly and painfully come to the devastating realization that you will never get pregnant without countless injections, hormone supplements, and surgeries, and that even then, (in my case), there is literally zero chance that it will ever be with your own eggs.

Now imagine that someone who had their kids naturally tells you “It will happen!”

Be honest: do you sort of want to punch them?

It’s for just this reason that many people choose not to talk about their infertility struggles with friends/family in the first place. For example, this is precisely the reason that my fellow IVF’er Elizabeth hasn’t told her mother. “The things she would say…I’d kill her! She’s safer not knowing.”

What not to say

Since coming out about our own (5+ year) infertility journey, my husband and I have definitely gotten our fair share of tone-deaf comments and unsolicited advice. While I obviously try to focus on the underlying good intention, it can be quite difficult when you’re hearing a similar comment for the Nth time. And so, in the spirit of education, here is some unsolicited advice back on what NOT to say to someone who is struggling with an infertility diagnosis:

  1. “I struggled to get pregnant too…it took us [X] months.” Many people say something like this in an attempt to empathize. However, to someone with an infertility diagnosis, this is like comparing the minor engine trouble you had on your boat to the sinking of the Titanic. There’s a huge difference between having sex with your partner for a few months in a row and resorting to assisted reproductive technology. I understand the desire to relate, but it’s probably best to keep this to yourself.
  2. “My friend’s nephew’s dermatologist did IVF and she has two beautiful children!” That’s great. I’m very happy for them. I wish it could work so easily for all of us. But even within the infertile community — and this is a key point — there is a huge spectrum of diagnoses that range in severity. There’s also a huge difference between those who were successful on their first attempt, and those who have endured multiple failed cycles with maximum-dosage hormones. Unless your friend’s nephew’s dermatologist tried just as hard for just as long, they are, by comparison, lucky.
  3. “It only takes one.” (Referring to eggs.) This one comforted me very briefly at the beginning, when I first received my premature ovarian failure diagnosis. However, it quickly became clear that I didn’t have even one good egg left, and that I would have to find an egg donor. Even for those going through IVF with their own eggs, it trivializes what is an extremely complex and emotionally taxing process.
  4. “It will happen!” This is one of the most unhelpful comments. It’s also extremely dismissive. Personally, I’ve spent the last ~2 years coming to terms with the fact that it will never happen for me, at least without resorting to egg donation. For some women, it won’t happen ever. Life isn’t fair, and acknowledging that is far more helpful than throwing around fallacious niceties.
  5. “There’s always adoption!” If I had a nickel for every time someone said this to me…we still couldn’t afford adoption. But in all seriousness, this topic deserves its own post at a later date. For now, suffice it to say that this option is no replacement for one’s fertility, and it’s also much more difficult than most people realize.
  6. “I hope it works — my children are my everything.” A colleague of mine actually said this to me at a conference recently. I know they meant well, but it’s basically just rubbing salt in the wound. I get it. Kids are great. But emphasizing how much you love your children is like telling a deaf person how great music is. “It’s so amazing! You’d love it!”
  7. “God has a plan.” I’m not sure where to even start with this one. First off, it’s making quite a big assumption about someone else’s religious beliefs, which may not mirror yours. Secondly, even if there is some big master plan, people are still allowed to be sad when things are royally sucking. I actually do think things will work out for us eventually, somehow, but that sure as heck doesn’t mean I’m not allowed to rage against the unfairness of the Universe in the meantime.

What to say instead

While comments like those above are obviously said with the desire to impart optimism, the truth is that they often have the opposite effect: they can make those struggling feel unheard or unseen — like they’re making a big deal about nothing. Usually, it’s actually way more helpful to just say “I’m so sorry, that really sucks.” Such a simple confirmation can be (counterintuitively) MORE energizing. That’s because it prompts the person to think: “Other people acknowledge this sucks, but I’m surviving…because I’m strong!”

And speaking of strong, we’ll be driving to Belgium on Wednesday of next week for our 6th attempted embryo transfer. That will catch us up with my friend Elizabeth, who has herself gone through six transfers. As she pointed out to me after our 5th failure, there is actually a small upside to enduring so many attempts: Those around you may have finally gotten a sense of how difficult this process is, and thus how to respond appropriately. “If there’s any silver lining, it’s that by now, people will have stopped saying ‘It will work this time — I can FEEL it!'”

xx

*Apologies for this to my mother, who has been known to excitedly answer the phone with “It’s so great to hear your voice!!!” before I’ve even uttered a word.

**This may have happened to a very distant friend-of-a-friend who shall remain nameless. Yes, she drove to the appointment with a jar of pee. No, she’s not proud.