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.

The outcome of IVF attempt #5 is…

Normally I would try to use my sarcastic sense of humor and sardonic wit to shield the reader from the more emotional parts of this “journey”. Normally, I would try to find the positives in the negative or end on an uplifting note. But some days are much harder than others, and yesterday was one of them.

My blood test came back negative.

Not pregnant.

Again.

This was our 5th embryo transfer attempt, our 4th actual transfer (no embryos survived to transfer in IVF#3), and our 2nd transfer using donor eggs.

I would like to say that I was a paragon of strength while waiting to receive the news, but I was already teary-eyed even before having my blood drawn — knowing it was probably over. I was supposed to go into work while the lab processed my blood, but instead I cleared my schedule, went home, and crawled into bed to wait for the call.

Does it get any easier?

Just as I wasn’t the model of bravery while waiting to receive the news, I haven’t exactly been a shining example of mental fortitude afterward, either. I had hoped to treat myself to a cozy Netflix binge session yesterday afternoon, but even watching TV required more focus than I could muster. Even today, when my husband texted me to ask how I was doing, I replied with a picture of a large pile of used tissues.*

You’d think that with so many failed attempts, we’d be used to it by now. And I am, unfortunate as that may be. But for some reason, this one was still a particularly tough pill to swallow. I think I had prepared myself for the fact that donor eggs may not work the first time around, but I was still hoping that we’d get lucky the second time. With each new failure, I feel us inching further out in the distribution toward the “unlucky” IVFers, and it’s not a fun club to be part of.

What now?

We’re not anywhere close to giving up, in case you were worried about that. I still maintain that every failure makes us stronger, and we also still have four donor-egg embryos in the freezer. If the Universe wants to keep testing my patience, I aim to prove that I am as zen as a freaking Buddhist monk.

With that willpower, and because I am apparently something of a masochist, we are diving directly into another attempt this next cycle. That gives me only a small (~few day) respite from the hormone therapy, but it means we can squeeze in one more attempt before my month-long international work trip in December. I will therefore start the estrogen again as soon as my period shows up (which, given the crazy-thick uterine lining I managed to grow this time, I expect to resemble the Red Wedding.**)

In the meantime, I will take these few days before the next cycle to grieve this latest loss, which — there’s no way around it — totally and completely sucks. I think my sweet, wholesome mother summed it up best when I texted her the outcome, and she texted back “Fuck!”

xx

*Even in my grief-laden state, I still found this quite amusing.

**The Red Wedding is a Game of Thrones episode where (spoiler alert) almost everyone at the wedding is slaughtered. Basically, a bloodbath.

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.)