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 piƱa 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.