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’.

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.

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.

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…)

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