Our frozen embryo transfer

Some of you may remember that the fresh embryo transfer after our recent donor egg IVF cycle was a bit of a disaster. Out of 15 fertilized eggs that had been developing well as of day 3, we only had a single 5-day blastocyst, and it was not the best quality (4BC, where the number is the stage of development and the letters are the quality of the components). When I asked the doctor about the potential for the remaining embryos to catch up, he was a massive dick. And to top it off, I hadn’t properly timed my water consumption to fill my bladder, meaning that my uterus wasn’t visible on the ultrasound screen, and the embryo transfer had to be done ‘blind’.

It was not the best ending to our first donor egg IVF attempt, which had been going so well up until that point.

Well lo-and-behold, five more blastocysts ended up making it to freeze on day 6, and I’ve spent the last few weeks growing an exceptionally cushy uterine lining for a frozen embryo transfer (FET) attempt. I say ‘attempt’ because there’s always the possibility that the embryo will fail to defrost. Unfortunately, you don’t know if this is the case until the day of your appointment. Since our appointment was first thing in the morning in Belgium, we made our way there the night before without knowing if there’d even be anything to transfer.

The call

We were still at our Airbnb the next morning when we got the call: the embryo survived defrost! We were thrilled, and we vowed that this transfer would go better than the last. I immediately chugged twice as much water as I had the last time (followed by another 500mL for good measure), and I vowed that under no circumstances would I ask the grumpy doctor any questions. (“I’ll just nod mutely to whatever he says, scout’s honor!”) We also expected the embryo to be better quality (4BB), since we knew we had at least one of those in the freezer.

You can imagine our surprise, then, when we showed up at our appointment to learn the embryo was only a 3CC — i.e., not as developed and poorer quality than our best frozen embryo (Strike 1). I couldn’t fully take in what he was saying and immediately asked a question (Strike 2) about why we were transferring this poor-quality embryo, to which he responded that the defrosted embryo is chosen randomly (Whaaaaaat??)

IMG_3992
The 3CC blastocyst that we transferred on Thursday.

I kept a brave face and we went ahead with the transfer. There was a big screen where we watched a magnified video of them sucking the embryo up into the transfer device thingy (that’s the technical term), and then the technician handed it to the doctor through the window in the wall. My bladder was full enough to see my uterus on the ultrasound screen (though at 17mm, it’s probably hard to miss). After the transfer, we saw a new white mark where the liquid containing the embryo had been successfully deposited.

PUPO, but not hopeful

This all went down last Thursday, which means I am once again Pregnant Until Proven Otherwise (PUPO). But despite what my well-meaning friends/family keep assuming, I am neither excited nor hopeful. The thing is, once you’ve gone through multiple failed transfers, it becomes hard to imagine any other outcome, particularly when the doctor says the embryo ‘isn’t the best quality’. I understand that poor-quality embryos can still result in beautiful babies, but I have also seen the statistics on implantation rates as a function of embryo grade. I’m not being negative — just realistic.*

With that said, I am still extremely grateful to our egg donor, Marie, for giving us the chance to make it this far. I’m also grateful for the four more embryos (‘frosties’) still in the freezer. And I’m happy to report that we had to stop three separate times for me to pee on the 2-hour drive home from our transfer. So, you know, at least I’ve finally got the full-bladder part down for the next try.

xx

*Ok, maybe I’m being a bit negative, but I recently read that IVF is as stressful as divorce or cancer in the family, so it’s bound to happen. (The progesterone shoved up my hoo-ha probably isn’t helping either.)

A small (17mm) victory

The last couple of weeks didn’t exactly go to plan. I’ve been prepping for a frozen embryo transfer (FET), where they will carefully defrost one of the extra embryos that resulted from our recent donor egg IVF cycle, then place it in my uterus with what is essentially a high-tech turkey baster. To prepare my body, I stopped taking my birth control pills and started taking estrogen (Progynova) in order to grow a nice thick endometrial lining. And to prepare my mind, I timed all this to occur while I was sipping piña coladas on a Greek island.

Unfortunately, I managed to come down with a nasty little case of laryngitis on the last ~5 days of our trip, which instead saw me pitifully sipping chamomile tea in bed. My clinic assured me that the cocktail of pain killers and antibiotics I was taking wouldn’t negatively impact the upcoming transfer, but I was still bummed that I wouldn’t be as healthy and rested as I wanted.

Lining check

Fast forward to my first day back from holiday, where I started my workday nice and early with a date with Wanda*. The point of this 12-day scan is to ensure that the ovaries are quiet and the uterine lining is sufficiently thick to allow for implantation.

The ideal lining is at least 7 or 8mm thick and displays a distinctive ‘triple-line’ structure that indicates good ‘estrogenization’ and healthy growth of the endometrium. I’ve never had any trouble in this area, but growing a sufficiently thick lining is one of the hardest parts for many women facing infertility.

After confirming my ovaries were dormant (I could have told her that!), the doc headed over to my uterus (it’s like Mrs. Frizzle and the Magic School Bus over here). Immediately her eyes bulged, and she pointed at the screen like ‘Get a load of this’. She asked me to repeat what medication I was taking, and when I answered Progynova, 2mg, three times a day, she said “Well it’s working.”

Since I don’t have nearly as much experience as she does staring at fuzzy ultrasound screens, I still didn’t really know what she was talking about…until I saw her measure the endometrium thickness: 16.93mm.

My 17mm triple-lined endometrium in all its glory.

Since I posted this image on Thursday, Instagram has been losing its collective mind. And with good reason — studies show that pregnancy rates correlate with lining thickness. Many women struggle to grow a lining even half this thick, which probably explains the plethora of heart-eye emojis in the photo’s comments. From all the oohing and aahing, you’d think I posted a photo of a puppy in a mailbox rather than an ultrasound of my uterine tissue.

How did I grow a 17mm lining?

In addition to the heaps of admiration, one commenter asked the question everyone really wanted answered: “Holy hell. 16.93???? How?!”

At first I didn’t think anything of it. I’ve always grown a fairly thick lining (~11-12mm), so I thought maybe it was just a natural gift (& the world’s lamest superpower?) Still, it’s almost 50% thicker than usual, which seems like quite a large deviation. Maybe it’s a weird side effect of the antibiotics I’ve been on? Or maybe that wondrous week I spent spread-eagle in the sun somehow did the trick?

Then I had a realization so obvious that I’m embarrassed it took me as long as it did: I was taking an iron supplement this cycle. I didn’t think of it earlier because I was taking it for a totally unrelated reason. Namely, I’ve been feeling particularly tired lately, and a friend mentioned that low iron levels could be the culprit. I happened to have some sitting around in the medicine cabinet, so I popped it in my pill case without a second thought. I only took it for about 10 days due to unpleasant side effects**, so by the time my ultrasound rolled around, it was totally off my radar.

I can’t be sure it was the iron, of course. There are too many other variables, and I don’t have a control group. But it makes a lot of sense, since iron plays a vital role in the creation of healthy red blood cells. So if you’re looking for ways to thicken your uterine lining, you might consider some combination of taking a Greek holiday, developing severe laryngitis, and talking to your doctor about an iron supplement.

xx

* Wanda is the trans-vaginal ultrasound wand used to check one’s uterus and ovaries. We’ve been having a torrid affair for over a year (don’t breath a word to my husband).

** This is my polite way of saying severe abdominal bloating and constipation. At one point, there had to be at least five Greek salads in there.

A vacation & an injection

You know you were in desperate need of a vacation when, 10 days in, you still haven’t conjured up the energy to do anything besides lie comatose in the sun. When, between sunscreen applications and re-applications, one thing leads to another, and before you know it you find yourself in bed at 9:30pm. And when even then, you need to set your alarm for 9:00am to ensure you don’t miss breakfast.

So yeah, I think I was long overdue for a vacation, and this holiday in Corfu has been amazing — just what I needed. For the first 9 days, we were joined by our favorite British travel companion and partner-in-crime, the lovely Louise, who enjoys making silly jokes as much as I enjoy laughing at them. Highlights included a one-day trip to neighboring Albania via ferry (my 29th country!), and a rainy day car trip to an abandoned village, where we learned the fun and totally unrelated fact that Brits also count seconds in ‘Mississippis’*.

Preparing for a frozen embryo transfer

There’s no real vacation from infertility, of course, which means I’ve also spent this holiday preparing for a frozen embryo transfer (FET) with one of the embryos left over from our recent donor egg IVF cycle. I was trying to time it so it could happen as soon as possible after we get home, meaning I would be nice and relaxed from the long vacation and ready both physically and mentally for embryo transfer attempt #5.

Our first day here, I stopped taking the birth control that’s been necessary to control the timing of my cycles. This was a relief, as I had thought these ~6 weeks on birth control would be a ‘break’ for my body, but I conveniently forgot that the hormones in the heavy-duty birth control my clinic prescribed really do a number on me: nausea, severe mood swings, back pain and cramping — the whole kit and caboodle. If timing isn’t so critical next time, I’m definitely going to skip the pill and risk a natural cycle.

A few days after stopping the birth control, my period arrived as expected, and I started taking the estrogen pills needed to grow my uterine lining. I also cut back my caffeine and replaced beach-side cocktails with beach-side smoothies. My clinic actually said I can have a drink here and there during this stage, but I don’t want to overdo it. One quickly learns that the ‘what-ifs’ afterward are what kill you.

A surprise injection

So where does this injection I mentioned in the title come in? In a surprise twist, it has nothing to do with IVF. Rather, I have a long history of getting very sick on vacations**, and this one has proven no different.

I’ve been feeling like I was coming down with something for over a week, and yesterday I awoke with throat pain so bad that I couldn’t speak, eat, or swallow. My husband managed to find a 24-hour drop-in medical clinic, where I was diagnosed with a low-grade fever and acute laryngitis. The doctor prescribed antibiotics and paracetamol, and he told me to come back in two days.

Unfortunately, the paracetamol did approximately diddly-squat for the pain, nor did any of the five other things I tried in desperation. So this morning, after a brief panic where I felt my airway closing off with mucus because it was literally too painful to swallow, back to the medical clinic we went. This time the doc gave me a pain killer that was injected in my butt.

That’s right: I managed to develop such a bad case of sore throat that I had to have an intramuscular injection. I bet you didn’t know that was even possible!

Will this affect the FET?

I still can’t speak at all, and my breathing still sounds like Darth Vader, but the new meds have taken the edge off and allowed me to eat again. The big question now, of course, is will any of these medications (or infections/viruses/fever) affect the success of a frozen embryo transfer?

I’ve emailed our favorite Belgian egg donation nurse for the clinic’s official advice, but a brief bit of googling implies that it won’t. If the clinic confirms that it’s fine to proceed, then that’s probably what we’ll do. Still, I had hoped this vacation would put me in a very relaxed and healthy state prior to the transfer, and it’s disappointing that that’s not the case. These five frozen donor egg embryos required a massive effort, and we want to feel we’ve given them the best shot.

If there’s any good in all this, it’s that my general state of patheticness has really brought out the natural caretaker in my husband. For instance, this morning I sneezed unexpectedly in the grocery store, and he used his ninja-like reflexes to catch a 4-inch drip of my snot with his bare hands before it fell on my shirt***. So you know, if/when we finally manage to acquire a small human, he’s going to make a really great dad.

xx

*When I expressed surprise to Louise that the British didn’t have their own culturally-appropriate measure of a second, my husband helpfully suggested that they use ‘Yorkshires’, which led to a lot of yelling of ‘ONE YORK-SHIRE! …TWO YORK-SHIRES!’ in our best cockney accents (Louise included).

**On our honeymoon alone, I had the flu so badly that I spent three days straight in our hotel room in Venice, and then, as my grand finale, I broke my tailbone in Sicily and had to go to the ER.

***Sometimes I joke that my husband’s idea of romance is giving me the side of the bed with the outlet, but I have to say: Seeing him holding my snot in the middle of the cereal aisle was pretty darn #romantic.

Post-donor egg IVF cycle wisdom

Three weeks ago we found out that our 4th IVF attempt — and first attempt with donor eggs — had failed. In the week that followed, we had two different international visitors (from Australia and the UK!), which was a fun and well-timed distraction. Sadly, they eventually had to go back to their respective countries, and their departures also coincided with the arrival of a particularly unpleasant menstrual period (no doubt due to all the meds). As I lay on the couch with a hot bean bag on my crotch for the second day in a row, I finally had some time to reflect further on this last cycle.

Multiple people have commented on how quickly I was able to bounce back from this last failed attempt and focus on the the positives. I don’t want to give the false impression that any of this is easy, so I’ll tell you my secret why: it’s because the first three failed cycles were much, much harder. Those were the cycles where it became clear that we would never have children with my eggs…where people would tell me ‘it would happen eventually’, and I had to smile and nod, knowing they were wrong. Let’s all take a minute and be thankful that I wasn’t blogging yet back then, because it would have been one nonstop sob-fest.

That’s not to say that this recent cycle was all sunshine and lollipops. It was obviously hard too…but in a different way. As I was trying to figure out how to explain it, I got a nice message from fellow donor-egg-IVF mama Lauren of The Trying Times, who helped me put my finger on why.

The thing is, making the decision to use donor eggs is already a massive leap — it’s something that no one can really fully understand unless they’ve been through it. It’s a trauma that requires it’s own grieving process. After all, you’re giving up on a lifelong dream — what should have been a given for a heterosexual couple like us — of having kids that are half your partner and half you. When you do finally give up on your own chances and make that leap, you sort of feel like you’ve already paid your dues. Then when it still doesn’t work, it feels doubly unfair. It’s like, not only did you fail IVF with your own eggs, but now you have to go through the whole drawn-out process again with someone else’s.

The silver lining

It’s taken me a long time to find a silver lining in all this, but as I waited for the microwave to finish heating my crotch-warmer™️ for the fourth time in as many hours, it came to me: we can finally go on vacation.

You see, once we started the IVF phase of our 5-year (and counting) ‘journey’, it became a race against the clock to knock me up before my ovaries completely kicked the bucket. Even when we gave up on my own eggs, we jumped right into planning our donor egg cycle due to the timing of our egg donor Marie’s summer vacation. Between all of this and my busy work schedule, it means we haven’t had a ‘proper’ (i.e. >2 week, European-style) vacation in over two years. And of course, juggling all of this along with an uber-competitive career is exactly why I so desperately need a vacation.

Now that we’re using donor eggs, it totally changes the game. In particular, we’re fortunate in that there’s no evidence of any additional problems with my uterus or my husband’s sperm. Obviously I’d rather not wait ’til I’m in dentures to pop out a kid, but now when I close my eyes, I’m no longer terrorized by graphs of egg-quality nose-diving with age. If none of the embryos from Marie’s eggs work, our backup plan is to use an anonymous donor in Spain, where I’m sure we can find some fertile 22-year old who gets pregnant from merely being sneezed on. As a result, I feel a lot less pressure to make every month count, so we’ve decided to sit the next cycle out and finally take a long-overdue vacation.

Specifically, we’ll be heading to the south of France (near Bordeaux), and then Corfu, where I plan on lounging around various exotic beaches for hours on end. I’ll also be doing my best to avoid Facebook, where back-to-school photos are in full swing, and my mind can’t help but play the “Was that kid alive when we started trying” game. We’ll be going with our favorite travel buddy, the lovely Louise, who makes every trip about 10x more fun. I love our vacations with Louise — we’ve been dog-sledding in Norway, bathed elephants in Thailand, and have had countless other adventures in foreign lands that were made even more adventurous thanks to Louise’s unwavering faith in Google Maps (I’m looking at you, Cretan goat trail). I also acknowledge that we wouldn’t have gotten to take half these trips if we’d gotten pregnant when we originally wanted to. So I’m planning on enjoying the hell out of this next adventure, and we’ll wait and see what happens the month after.

And that’s a wrap

I had the stupid announcement already written in my head. It was going to be a play on the numbers: After 5 long years trying to conceive, including 4 cycles of IVF, 3 countries, 2 different fertility clinics, and 1 amazing egg donor, we are finally pregnant.

Except we’re not. I took a home pregnancy test yesterday morning (11 days after our 5-day transfer), and it was a definitive negative. This was confirmed by a blood test this morning.

I knew I shouldn’t have gotten my hopes up at all. I knew the chances were very low, and the embryo didn’t have the best grade. I told myself this over and over again, attempting to lessen the impact of the eventual failure. But this was also the first cycle we’d used donor eggs, and our egg donor Marie had both her kids on the first try. And even though that was a few years ago now, a small part of me was hoping that — somehow — those fertile genes would fight their way through all the necessary stages and help us to finally beat the odds.

The last few days, the progesterone side effects were also playing into the fantasy, with my lower back pain and other potential ‘pregnancy symptoms’ growing progressively worse. A few days ago, I got a weird spam email predicting big news today, and last night, I had a vivid dream that we got a positive pregnancy test. If I had actually been pregnant, it would have been very tempting to conclude the Universe was giving us signs.* Instead, we have to cope with the fact that after 5 long years, 4 cycles of IVF, 3 countries, 2 fertility clinics, and 1 amazing egg donor, it’s still not our turn.

The positives in the negative

I’m not going to pretend that this news didn’t suck big-time, or that I didn’t have a private pity-party after seeing the result. Sure — we can try again — but what if it doesn’t work next time either? Or the time after? What if it never works? When should we resign ourselves to that fact and, like, start breeding rare iguanas, or sail around the world?

The only way I’ve been able to cope with this latest negative result is by focusing on the immediate positives, of which there are several:

POSITIVE #1: I can stop taking these <expletive> hormones and hopefully return to feeling myself again! (If you’re pregnant, you have to continue taking them up to 12 weeks). This has been the silver lining of each of our failed IVF cycles, and you have no idea how excited I am about it.

POSITIVE #2: We have people in our corner. This is the first cycle since we ‘came out‘ about our IVF journey, and having that support has been a huge help. Not just the literal support from Marie and her husband — which has been immense — but the emotional support as well. If you’re going through your own IVF ‘journey’ (such a euphemism…) and haven’t come out yet, I highly encourage you to consider it. Nobody should have to go through this alone. For this latest cycle, it’s gotten us through the well-meaning questions from more distant acquaintances (“You don’t have any kids?”) without poking our eyes out with our plethora of used syringes.

POSITIVE #3: We have 5 more frozen donor-egg embryos thanks to Marie, which means 5 more chances. It’s true that I’m not particularly in the mood to go through everything involved in another embryo transfer at the moment — much less FIVE more — but I do acknowledge that it puts us in a privileged position compared to many other couples. It’s certainly never a luxury we had with my own eggs, and for this we are thankful.

POSITIVE #4: Each failure makes you stronger. This is something that took me a while to realize. I used to feel each failure wearing me down, making me weaker. But looking back, I now realize they have slowly-but-gradually been making me stronger. How many people can say they’ve gone through IVF, or donor-egg IVF? How many people have had four (or more!) failed cycles? If you’re in this camp too, I salute you, because you are next-level badass.

*This just goes to show that confirmation bias is a real thing, and we create our own ‘signs’ where we want to see them, true or not. (Also, how dorky am I that I chose to use an emotional post about infertility & grief to make a point about cognitive bias…)

Pregnancy symptoms during the two-week-wait

I haven’t posted in nearly a week for good reason: I’m tired. Like really tired. So tired that I had to skip the Gay Pride Parade in Amsterdam this past weekend, which I was TOTALLY looking forward to. Why? Because I was so exhausted from being awake for 2 hours that it apparently necessitated a 3.5-hour nap. (This is really not helping my reputation with my husband as ‘the most ridiculous human being ever’.)

If you aren’t familiar with the IVF process, this may sound really hopeful. After all, I’m nine days past my 5-day transfer (9dp5dt if you want to be hip with the lingo), and well past the point where the embryo should have implanted in my uterine lining (if it has decided to grace us with its continued presence). So…maybe the exhaustion is a promising sign…meaning that I’m pregnant!

That would be *awesome* if it were the case. Unfortunately, there’s no way to distinguish real pregnancy symptoms from those caused by the hormone supplementation that is also required at this stage. In particular, in addition to the estrogen pills I’ve been taking three times a day for over a month, progesterone is also necessary in the second half of the cycle to help prepare the uterine lining for implantation and potential pregnancy. It’s started right after the egg retrieval by both ‘regular’ (non-donor-egg) IVF patients as well as by the recipients of egg-donor IVF embryos, and honestly — I think it’s the worst part of the whole damn process (injections & vaginal surgery included). My progesterone comes in the form of vaginal suppositories that must be inserted three times a day*, and which manage to leak out even after the requisite 30-min period lying down. Because women facing infertility treatment clearly don’t have enough to deal with already, so now we also get to have leaky vaginas!**

‘Pregnancy symptoms’ on progesterone

The bigger problem with taking progesterone during the two-week-wait is that it it’s exactly the hormone you would be making naturally if you were, in fact, pregnant. This means that many of the side effects we associate with pregnancy are actually due to progesterone, and that taking additional progesterone during the two-week-wait can be a total mindf@$k. As a result, here is an incomplete list of just some of the ‘pregnancy symptoms’ I’ve experienced during my previous (failed) two-week-waits while on progesterone:

  • Cramping
  • Bloating
  • Nausea
  • Gas
  • Diarrhea
  • Constipation
  • Headache
  • Backache
  • Dizziness
  • Sore boobs
  • Vivid dreams
  • Fatigue/drowsiness
  • Mood swings
  • Loss of appetite
  • Increase in appetite
  • Shortness of breath

As I mentioned, those cycles failed, so these symptoms were definitely side effects of the progesterone (or just fabricated by my anxious brain). But when there’s finally a real chance you might actually be pregnant, and when you are experiencing any/all of these symptoms, it’s really hard to just dismiss them as false alarms.

Is there any way to tell between progesterone side effects and actual pregnancy symptoms?

So is there really no way to tell the difference? No small, previously overlooked symptom (e.g., a twinge in the pelvis!) which might finally and conclusively spell the difference between progesterone side effects and real pregnancy symptoms? (“Siri, are pelvic twinges a side effect of progesterone?!”)

Spoiler alert: basically every possible symptom can be a side effect of the progesterone. Having ZERO symptoms can also still mean you’re pregnant, or not! Different women respond differently to both the medication and actual pregnancy, and women can also respond differently during cycles, even if they have the same outcome. I’ve had sore boobs one cycle and not the next, and they both resulted in Big Fat Negatives (BFNs). There’s literally NO WAY to tell besides a pregnancy test, which for me, at least, is still several days away.

In future cycles (should it come to that), I hope that I will finally take my own advice and give up the symptom-spotting once and for all. For now, I’m going to google “9dp5dt cramping backache success stories”. Because for the next couple days at least, there’s still hope.

xx

*If you ever see a sticky note on my office door that says ‘telecon’, now you know what I’m really doing.

**Leaky Vaginas is going to be the name of my new FemRock band.