Pregnancy after infertility

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

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

The formerly bunless oven?

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

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

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

So in summary:

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

Fitting in with the ‘fertiles’

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

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

Nothing to see here

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

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

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

A poor quality embryo success story

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

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

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

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

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

The 8-week ultrasound

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

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

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

Success with a poor-quality embryo

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

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

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