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.

Frozen embryo update!

In the words of children’s author Judith Viorst, this past Wednesday (the day of our embryo transfer) was a terrible, horrible, no good, very bad day. After things seemed to be going so ridiculously well in this IVF cycle — our egg donor Marie produced 15 mature eggs, 100% of which then fertilized and were looking strong in the days that followed — we learned on Wednesday that only a single embryo had developed into a viable day-5 blastocyte. Two others had also become blastocytes, but they were too poor-quality to be frozen. When I tried to ask if there were any other embryos still in-the-running, the doctor was — excuse my language — a ginormous dick. He sounded so pessimistic — admitting it was a below-average response, and even hiding his chart so I’d stop asking questions(!) — and I left feeling completely despondent.

I sobbed the entire 2+ hour drive home from Belgium. Once back at our house, I transitioned onto the couch for further sobbing. I had made a deal with my husband earlier in the day that he had to do whatever I said all day so that I’d feel happy and relaxed after the embryo transfer. Before the bad news, this had come in the form of sassy decries (e.g., “I decry that you escort me around on your arm all day”; “I decry that you stop sending me stupid Reddit videos”). After the news, and back at home, I decried that he leave me be so I could mourn the unfairness of the Universe in solitude.

A sudden turn of events

After such a miserable day, you can image my surprise when I received an email the next morning saying that 5 embryos had been successfully frozen. FIVE! Not trusting my Dutch reading skills, I copy-and-pasted the email into google translate just to be sure. It still said the same thing…FIVE EMBRYOS COULD BE FROZEN!!!

IVF is such an insane emotional roller coaster.

So why the sudden turn of events? Well, my husband and I are still complete newbies when it comes to blastocyte development, since we never made it this far with my own eggs (or lack thereof). Apparently, in addition to freezing any good-quality blastocytes on day 5, they let the remaining embryos continue to develop overnight, allowing the stragglers to catch up. These slower-growing day-6 embryos may still turn into blastocytes which can result in a healthy pregnancy, and they will freeze any good-quality ones as well. I had no idea that there could be such a big change from day 5 to day 6, and it would have been nice if the dick — Sorry, I meant doctor — told us that there was still some hope.

What does this news mean?

Obviously we hope that the embryo I currently have on-board will decide to stay put. However, based on its quality, it only has a 17% chance of resulting in a live birth (though a ~30% chance of pregnancy…fun implications there). If it decides not to stick around, then we can try what’s called a ‘frozen embryo transfer’ (FET) without having to go through the whole egg retrieval process again. Most of the embryos should theoretically survive the thaw, so that would hopefully give us another few chances.

In the meantime, I’m oscillating between cautious optimism and (more statistically realistic) extreme pessimism with the current embryo on board. It’s far more likely that it won’t stick….but there’s still a non-zero chance that it will. I seem to be growing (unwisely) more optimistic each day, which is probably the emotional equivalent of that slow upward climb on a roller coaster before the huge stomach-lurching drop. In that sense, the (potentially poorly translated?) advice that our favorite Belgian egg donation nurse gave me might actually make more sense: “Keep your head on.”

Embryo transfer: the good news and the bad news

Today was one of the biggest days in the donor egg IVF cycle (our fourth cycle in total) that we’ve been undergoing this past month. Not only did our egg donor, Marie, fly back to the U.S. (feeling slightly less bloated, finally), but we were also booked for a 9:50am embryo transfer in Belgium. I woke up at our Airbnb full of hope, filled my bladder as instructed, and made my way to the hospital with my husband.

The last we heard, most of our 15 embryos were still doing really well. On day 3, eleven of the embryos were exactly the right size (8 cells), three more were slightly too small (5-6), and one was too large (>8 cells). Even if those last four were out, eleven still seemed like a really good number. It was also exactly 11x better than my three previous IVF cycles combined.

On day 4, we only had a brief call with the egg donation nurse, but she said that most of the embryos were still doing really well. In particular, while they had not yet advanced enough to be rated & ranked, they were starting to ‘compact’ as desired, and were on their way to transforming into day-5 blastocytes. This gave us confidence that we should go ahead and make our way to Belgium the night before, since there should definitely be something to transfer.

The good news

The good news is that there was one blastocyte to transfer: an intermediate 5-day blastocyte rated good/fair. Since we didn’t have any embryos make it to day-5 with our last IVF cycle, and since our first two cycles used 3-day transfers (where it’s harder to tell if the embryos are good quality), this is officially further than we’ve ever made it before.

The doctor triple-checked my name, retrieved the embryo from the lab in what is essentially a high-tech turkey baster, and squirted that sucker in in probably less than 60 seconds flat. This means that I am now (for the third time) what we refer to in the infertility community as ‘PUPO’: pregnant until proven otherwise.

The bad news

In addition to the news that the embryo we transferred today isn’t of the highest quality (with only a 17% chance of sticking it out for the long haul), we were also a bit shocked to learn that it’s currently the only decent blastocyte. This news really came out-of-the-blue, since everything had been going so well (almost too well?) up until this point.

What about all of the other 14 embryos, you’re probably thinking? Well a lot happens on days 4-5, and it’s common for many perfectly good-looking 3-day embryos to not make it to the blastocyte stage. This is partly why clinics do 5-day transfers: so they can wait and see which embryos are really viable. I’ve seen the number 40% bandied about, so it seems like we’re doing below-average. On the other hand, while two of our remaining embryos are definitely already out (having reached the blastocyte stage, but being rated as poor-quality), it is theoretically possible that a couple of the remaining ones could make it to the blastocyte stage tomorrow. If they are good enough quality, they can then be frozen for later attempts.

So is this really that bad? Normally I would be thrilled to even get to this stage. But since we used an egg donor this cycle for the first time, and since her egg quality/quantity was an order of magnitude better than mine, I had let myself get my hopes up (rookie mistake!) that we’d end up with at least a couple high-quality blastocytes. That would make all of this effort (from Marie, in particular) seem more worth it, and it would give us an ‘insurance policy’ in the form of another attempt.

Without the insurance policy of frozen embryos, it means that if this current ’embaby’ doesn’t stick, we have to start all over yet again, most likely with another donor/in another country (not to mention the financial cost). And I’m getting really, really tired of starting over.

What happens now?

We’re still waiting to hear if any of the slower-growing embryos will be high enough quality to freeze. Other than that, it’s a tense two-week wait until my blood test on 13 August.

In the meantime, I’m finding support in the amazing community of fellow #IVFwarriors I’ve discovered on Instagram. And I’m getting wicked pleasure out of reporting all of the maternity-themed targeted ads in my Instagram feed as ‘Inappropriate/offensive’. Because #infertilitysucks.

Our egg donor’s egg retrieval

On Friday morning, my husband and I rolled up at the hospital in Belgium with our awesome egg donor Marie for her egg retrieval surgery. I’ve been trying to write a post about it ever since, but the past week was such a blur of ultrasounds and international road trips that we’re all pretty exhausted. So instead, allow me to present a brief highlights reel.

The ‘puncture’

The finale of Marie’s past two weeks of hormone injections was the egg retrieval surgery. Marie was never particularly thrilled about this part of the process, but she was even less thrilled when she learned that it’s referred to in Dutch as ‘the puncture’. This makes sense, as it’s performed by sticking a very large needle into the vagina, through the vaginal wall, and into each ovary. A fun way to spend a Friday morning!

Here in Belgium (& the Netherlands), this procedure is done while you’re awake. Our clinic uses a local (internal) anesthetic and a morphine IV to help minimize the pain. Ironically, Marie found the IV (which was placed in her hand) to be the most painful part of the whole procedure. I tried my best to distract her while we waited to be taken back with entertaining anecdotes from my husband’s experience one floor below.

The ‘sample’

At roughly the same time as Marie was being called in for her puncture, my husband had a finale of his own….so to speak. For our first two IVF cycles in Holland, the ‘sample’ (as it’s called) could be ‘produced’ at home and biked over in his jacket pocket. (Can you imagine what would happen if he had gotten into a bike accident??)

Here in Ghent, the ‘sample’ is instead produced in a small room with a tasteful silhouette of a naked lady on the wall and a collection of decidedly less-tasteful magazines. For maximum quality, the ‘sample’ should have ‘accumulated’ for 2-3 days. I’ll leave the rest to your imagination.

The number of eggs retrieved was…

Back in the operating room upstairs, Marie and I were 3rd in line (out of four ladies that morning) for her puncture. We were called back around 10am — almost exactly 36 hours after her trigger shot — and the actual procedure got underway. Marie was pretty out-of-it from the morphine at that point, but I got to watch the ultrasound monitor as the fluid was rapidly drained from each follicle and into a tray of waiting test tubes. Marie had WAY more follicles (17!) than I had ever produced, so she filled up test tube after test tube. No wonder she had been feeling bloated!

Marie’s large number of follicles also meant the fluid couldn’t be processed immediately to find the eggs like mine was (think panning for gold), since the procedure was all done in only about 30 minutes. But shortly after the procedure was over and Marie was back resting in her bed, the nurse came in to give us the great news: 16 eggs had been retrieved!!

If you recall my previous post about the odds of this cycle working, you may also recall that ~15 eggs is the optimal number as far as maximizing the odds of pregnancy. So basically, Marie and her overachieving ways freaking #killedit.

A slight hiccup

There is a downside to Marie producing so many eggs: it puts her at a higher risk for developing ovarian hyper-stimulation syndrome (OHSS), where the ovaries become painful and swollen. In order to mitigate the risk, our clinic puts anyone who produces more than 15 eggs on Cetrotide injections. So although we thought Marie had had her last encounter with a needle, she’s now being treated to 7 more days of daily stomach injections.

How many eggs fertilized?

On Saturday morning, back in Holland, I got the call that 15 out of 16 eggs had fertilized. This is a fantastic fertilization rate, and hopefully it increases our odds even further. When I relayed the information to my husband over the phone, I like to imagine his hands were clasped over his head in a victory gesture.

Now we are waiting to see how many of the 15 embryos continue to divide and develop into 5-day-old blastocytes, when we will hopefully transfer one to my waiting uterus and freeze any remaining for later attempts. Today is already day 3, which means my husband and I will make the drive back to Belgium tomorrow night for a Wednesday morning embryo transfer. Unfortunately, the necessary timing of the transfer also means we will miss the departure of Marie and her family! They all fly back to the U.S. early that same morning, wrapping up what must be one of the most eventful family vacations ever.

By the way, if you’ve ever wondered how you’d react if one of your friends traveled internationally to have elective surgery and potentially give you the gift of life, it may be something like this:

Decked out in surgical scrubs and #thankful

Egg donor’s retrieval scheduled

We’re currently in the thick of our fourth IVF cycle, and our first attempt using donor eggs. Yesterday morning our egg donor, Marie, and I made the ~8 min drive from the hotel where we’ve been staying in Ghent (Belgium) to the hospital there for her 3rd check-up. Marie is now a seasoned vet at the transvaginal ultrasounds that are needed to count and measure the follicles growing in her ovaries. So let’s get down to it.

This latest ultrasound showed she’s still growing around 17 follicles in total — same as the last check. The follicles are growing at different rates, which is totally normal, but it means that only some of them are expected to be the right size to contain a mature egg. In particular, in order to maximize the total number of eggs retrieved, sometimes the clinic decides to sacrifice the largest follicle in order to wait for a larger number of smaller ones to catch up. Even then, there are usually also some follicles that are still too small to contain a viable egg.

Marie now has one follicle that is probably too large (25 mm), but 9 that are the right size (18-22mm). In addition, she has around 5 more slightly smaller ones (15-17mm), some of which may (hopefully) be large enough by the retrieval. Then there are two that are definitely too small (12-13mm). These results are shown in the (embarrassingly poor-quality) screenshot below, which Marie and I shamelessly snapped from the ultrasound technician’s computer. If all of those follicles yield an egg (which is not guaranteed), then we will hopefully retrieve 9-15 eggs in total…a great result, and way more than they retrieved from me in all three of my previous IVF cycles combined(!)

Poor-quality screenshot showing size of follicles in millimeters (y-axis) versus date of exam (x-axis). Marie’s ultrasound yesterday morning (far right column) showed 9 follicles in the correct range (18-22mm), one at 25mm (probably too large), and 5 more (15-17mm) that may also be large enough to contain a mature egg by the egg retrieval. (The 12-13mm guys are sadly too small.)

When will the retrieval be?

After her ultrasound, Marie had a blood test to check her hormone levels. We got a call yesterday afternoon that the results came back in-range, which means that we are good to move on to the next step. So last night at exactly 10:30pm, we gave Marie her final hormone injection: a trigger shot in the stomach (#hardcore). This final shot helps the eggs mature so that they’ll be ready exactly 36 hours later for the egg retrieval, scheduled for tomorrow morning.

Does 9-15 follicles mean 9-15 embryos?

We’re super happy that Marie is responding so well to the medication and that we’ve made it this far. But before everyone gets overly excited, I just want to clarify that 9-15 follicles does NOT mean 9-15 embryos. If it did, our chance of a live birth from this cycle would probably be way more than the predicted ~25%.

To start with, we can’t be sure that all of the follicles (even the big ones) will yield eggs…

Then, of the eggs retrieved, only some of them will be mature…

Of the mature eggs, only some (maybe 70% on average) will fertilize…

Of the fertilized eggs, only some will divide normally into embryos…

And finally, only some of those embryos will make it all the way until the fifth day, when we will hopefully have at least one that can be transferred to me (and stick).

In other words, even with 17 follicles, it’s perfectly possible that we could end up with only one or two 5-day embryos. Of course, that would still be way further than we got with our last 5-day transfer (which was cancelled due to having 0 embryos)! So cross your fingers (or hold your thumbs) that we make it that far. And keep Marie in your thoughts tomorrow for the egg retrieval, which she was less-than-thrilled to learn is referred to in Dutch as the ‘puncture’.