Thursday, 19 December 2013

No Christmas Miracles in this House.

On Monday I started spotting. I called the clinic and they moved up my pregnancy test day but it didn't look good, it was already 13 days in, I'd been testing at home and all negative, so I knew it was a failure. As soon as it was official, my first stop was Starbucks for a Gingerbread latte and big chocolate muffin. I hadn't had caffeine in nearly a month. Then I spent the rest of the afternoon Christmas shopping, which was a great distraction except for the mall full of babies. Worse, this was the mall in the South end of town, which is lower-rent, so the mall is full of teen moms with their babies. I try to avoid this mall for a few reasons, but teen moms everywhere is really painful when you're dealing with infertility. Last night I fixed myself a really really strong cocktail. Also, first in a month.

I went into this cycle very optimistically. I was enthusiastic that this would be it because the timing was so perfect, not just to take time off to do the cycle, but also it would have given me a late August due date and I cannot begin to explain how incredibly perfect that would have been with various elements in our life. I was so excited when, on day 3, I was told that I still had 7 really great embryos and I was scheduled for a day 5 transfer. Day 5! If your embryos are good enough to make it to day 5, then you've got about a 50/50 shot! Age no longer matters! I thought 3 would make it, transfer 1, two more frozen chances if the first doesn't work. It was sure to work. But no. I arrive on day 5, they get me ready, I'm in the stirrups, and the embryologist comes in to inform me that none have made it to Blastocyst stage. Given how well they were doing two days before, I know now that means they all started to fail the day before. It's not totally hopeless. According to the lab director, about 25% of day 5 morulas were successful last year in my clinic. The problem is that on the day of my transfer, no one in the room was able to share that information with me. I did feel mislead. And it's not the first time on this journey. If I'd had the information, I might have chosen to transfer more than one, but no one had ever discussed this possibility with us, and the doctor performing the transfer seemed to think single transfer was still best. The lab director would have advised me otherwise, but he wasn't there in the room. No one in the room suggested a change in plans. These are all issues to discuss with my doctor when we meet next to review the cycle.

I cry a lot. The promise of doing the cycle in the first place filled me with such hope. Now I am back to where I was when I first got the diagnosis. I don't know if I'm going to try again. If I try again, it won't be for four months (at least I know that much, which is better than when I first got the diagnosis and didn't know if, when, or ever). I'm back to feeling broken, damaged, and there is nothing I can do. No amount of relaxing, lifestyle changes, visualizing or praying is going to unblock my tubes. I can't go back and transfer more on day 3 (clearly in hindsight, that is going to be the best plan for me for any future attempts). So there is nothing to be gained from being angry about what went wrong. Which just leaves me with the deep sadness and patience.

I still look at adoption as an option. But there is still the complicating factor of having to wait until after we move. But at least the moving plans are beginning to firm up. 2013 was a bad year, my other half had a brain tumour, but it was treated successfully, he's recovering very well, and after a long hard search for his dream job, he finally landed it and in 6 months we will move half-way around the world! So adoption of a child in need of a loving stable family is still a possibility. It just means more waiting, and then navigating a new system. 2013 started so bad, and ended so good for him, I'm disappointed it couldn't end on a happy note for me too.

And that is where we leave things at the end of 2013, officially the worst year of my life. Pass me another bottle of Pinot Grigio.

Tuesday, 10 December 2013

2 days post transfer

Two days ago I transferred one morula. I was disappointed that none of the seven embryos had made it to blastocyst stage by day 5, given how well they were going before, but maybe they just needed a few more hours? That's what I'm telling myself, it's easier to think that if the average time to morula is 96 hours from fertilization, and my retrieval was 11am (not sure what time ICSI was performed after that), and then transfer was at 10am, that gave them less than 120 hours to become blastocysts. So I also don't want to know how many were frozen the following day because if it's none, then I'm going to lose a lot of hope. Instead, I'm carrying on with my day under the belief that they all became blastocysts by the next day, including the one inside me, and today it should be hatching. So that's where I am today. Thinking happy thoughts. And drinking lots of Gatorade because it really seems to help with my swollen tender ovaries.

Friday, 6 December 2013


The waiting is the hardest part.

Day 3 - still 7 perfect little embryos, dividing just as they should. Transfer set for Sunday. And I'm going crazy. They aren't even in me and I already feel like I'm pregnant, knowing they're growing so well, and wanting to shout it from the rooftops. At the same time, I have to wait to transfer, wait for implantation to occur, and then wait to see if the growth continues and progresses and for the positive pregnancy test, which won't officially happen for two more weeks!

Sometimes I worry that I'm putting too much hope on this working. Based on all the research I've done, the age effect sorts itself out in egg retrieval and survival to day 5, but there is little to no age difference for the blastocyst transfers. So I'm giving myself 50/50 odds for this single embryo transfer, and feeling confident that at least two will be frozen in case it doesn't take. So I don't know, does this make me overly optimistic, or cautiously realistic?  I really really really (infinity) hope this works, but if it doesn't, I can enjoy lots of wine and chocolate and coffee over the holidays because I have back-up. I haven't had wine or caffeinated coffee/tea and very little chocolate since the IVF cycle began. I've been a very good IVF patient. I already eat like I'm pregnant. I take my vitamins. I take my progesterone. I eat my veggies and fresh fruit and yogurt. I haven't dug out the maternity clothes box, even though I'm tempted (I was especially tempted with the extreme bloating leading up to retrieval). I wish there was something more I could do, but all I can do is wait. And the waiting is the hardest part.

Thursday, 5 December 2013

Verdict 1 - fertilization

I had to call it verdict 1, because obviously the pregnancy test at the end of all this will be the big verdict 2.

I'm thrilled that my fertilization report is very very good. 13 eggs were retrieved. 11 fertilized with ICSI. Today, day 2, 9 are dividing perfectly and are beautiful little 4-cell embryos. I know they won't all make it to day 5, but it looks very promising that we will have a day 5 single blastocyst transfer and some to freeze!

Wednesday, 4 December 2013

Retrieval day!

FYI - I started writing this post the night before retrieval. Then I was interrupted and didn't finish. Tried again after retrieval, but again didn't finish. Take-home message: retrieval is a busy time.

Yesterday morning was my egg retrieval and they found an extra one! So 13 retrieved total. I only expect 10 mature though, and I'll get the fertilization report and transfer time tomorrow (2 days after retrieval). Retrieval was not fun, but it's over, and after the pain meds wore off (and they gave me a lot  - their words), I was feeling pretty good, and the meds they sent me home with don't make me woozy, which I like. So now I "take it easy" - not bed rest, I need to get up and walk around for 5 minutes every hour. I need to stay well hydrated, and I need to thus pee a lot.

There was a lot I didn't know about IVF injections before I started, and now I feel like a pro. Everyone's protocol is different, but there are some consistent similarities. So I wanted to share what I learned.

Down regulation - I was on birth control pills for 20 days. This started on day 3 of the previous cycle, and then on the 18th day of taking the pills I was scanned to make sure my ovaries were "quiet" and lining thin. The purpose of down regulation is to get your hormones, ovaries, and lining to a good starting point before stimulation. Think lining up at the starting gate. When the scan looked good, I got my instructions when to stop and wait for the next cycle to begin. There are different down regulation protocols, and some women are put on what's called a short protocol, in which there is no down regulation. As much as we all want to get the show on the road, the short protocol is usually used with older women and women expected to be poor responders.

Follicle Stimulating Hormone (FSH) injections - it's just as it sounds. Naturally, your body would produce a surge of this at the beginning of each cycle. In IVF, you start around day 3 taking high doses. I was on two injections daily for 10 days: 225 units of Puregon (cut to a half dose on the last day) and 75 units Menopur. There are numerous brands of FSH, and dose will be determined by a number of factors, but this is a critical part of the protocol. These are also the most expensive of the drugs, easily accounting for 75% of my drug expenses in this cycle. So the older you are (or the older your ovaries think you are, regardless of what it says on your driver's licence), the more you will pay in drugs because this is where most of the variation in protocols occurs too. The higher your day 3 FSH level (naturally), and lower your antral follicle count, the more of these drugs you'll need to produce a decent number of follicles for retrieval. 

GnRH antagonists / agonists - there are several brands of these, and they don't all work in the same way, but they all have the same effect: to prevent you from ovulating before retrieval and let the non-dominant follicles catch up. Ordinarily, about a week into a cycle, one or two follicles would become dominant, and the smaller ones would shrivel up and die. These dominant follicles start producing more and more estrogen, which would eventually reach a critical level that says "we're ready" and initiate the LH surge to kick off ovulation. In IVF, you don't want that to happen, so on the 5th day of FSH injections, I began a 3rd: Orgalutran. It comes in pre-filled single-use syringes so I didn't pay much attention to the dose. I took that with the FSH for the next 6 days. Meanwhile, my follicles kept growing, my estradiol kept rising, but my LH stayed nice and low.

hCG Trigger shot - On the final day of injections (all 3 injections were taken at the usual time this day), and exactly 36 hours before my scheduled retrieval, I took a single shot of Ovidrel. This is a synthetic form of hCG (it's the CG, as 'h' stands for human) that is a stand in for the LH surge. It also came in a pre-filled single-use injection pen. This injection gives the follicles a final maturation push, as well as start to loosen up the follicles for retrieval. Timing of this injection is very precise. This is also the chemical that pregnancy tests react to, so as long as it's still in your urine, you will get positive pregnancy tests. Some women with pee-on-a-stick obsessions test out the trigger - take a test each day and watch for it to become negative or at least fade substantially, then if it starts to get dark again you know that is your pregnancy taking hold, not the trigger shot. I have every intention of doing this, simply because I have a big box of test strips ordered from before my diagnosis, and what else am I going to do with them? I don't see much point in starting this before transfer day but I might.

What the heck, I'll go do it now, I need to see what a positive test strip looks like!

Sunday, 1 December 2013

Day 10

I was back again for another monitoring appointment this morning. Everything looks great and I will take my final injections today, a trigger shot of hCG tonight, and retrieval is set for Tuesday morning! I'm so excited I don't know what to do with myself. I have 10 mature follicles, which is excellent. Also excellent is that I don't have to take any more shots after today. Yay! I have to take progesterone suppositories after retrieval, which I hear are gross and messy, but it sure beats more shots!

Today I also learned beware of units of measurement. I had been wondering why my estradiol numbers always seemed absurdly high. Come to think of it, my progesterone is always absurdly high. But now I know it's a different unit of measurement! I don't know what this means in terms of my progesterone numbers, but my E2 numbers have been right on track all along, which is good.

Now, what can I do to keep my mind occupied? This is the hard part. I have all day today and tomorrow to try and keep my mind busy. Then after retrieval, waiting for the call with the fertilization report. Then waiting for the call for the progress and whether it will be day 3 (Friday) or day 5 (Sunday). Then waiting to see if it works. I hope I'm not getting my hopes up too high, but I have high hopes for this to work! I can't help it!