The Results--Infertility Wins Again

The long wait is finally over.  This second cycle of IVF lasted nearly six months.  When we first started, the end seemed almost impossible to reach.  But, we are now nine days post frozen embryo transfer (FET) with results from the blood pregnancy test.

Before the transfer, we discussed whether or not we would use home pregnancy tests (HPT).  We were torn.  We knew I could get a false negative, which would cause stress.  Or I could get a positive without knowing that the HCG level is really too low or not doubling properly for a viable pregnancy.  But, as I scrolled through my online peer support group, I saw so many women sharing their positive HPTs (taken before their blood pregnancy test), and I knew that I wanted that too.  I started testing on day four, and kept testing every day until my blood test (today 12/16).  The results?

Negative.  Every single day.  It definitely caused a lot of stress and sadness for me.  I knew I should stop, but I became addicted, hoping to see a positive each time.

"Maybe it's a late implanter" is what many of my peers (from the support group) said.  But, I knew from that first test that it would not be a good outcome.  And today, we experienced what I feared--my HCG is negative, and we failed again.

How could this be??  We've been through so much in this journey.  I've been through multiple surgeries, I've transformed my diet (no more caffeine including chocolate--my favorite!, gluten-free, no alcohol, etc.), I've tried acupuncture, I've been poked hundreds of times between the injections and the blood work, and we've spent over $60,000 in the process.  I'm now being treated by a renowned physician at one of the nation's leading fertility clinics.  And we still failed.

We don't know what went wrong, especially since the embryo was chromosomally normal.  It could be the endometriosis.  Once the damage is done, there is no turning back.  The disease is not curable, the damage is not fixable.  We have a regroup scheduled with our doctor on January 5th.  So, at this time, we are taking a break and we will enjoy the holiday with our family and friends.

When I look back over this entire blog, I am reminded that we spent an entire year (all of 2015) in IVF.  The year and a half before that was just us doing what we could, trying to conceive naturally.  Two and a half years of the nightmare that is infertility.  We aren't done fighting, but we don't know what our next step will be.

Transfer Day 12/7/15

Monday, December 7th was the Transfer Day for our one surviving embryo--day 6, grade 5BB.  We were excited for this day, but we are both still nervous for the outcome.

Before heading up to the OR, we met with our nurse, who has been with us the entire journey at CCRM.  Since day one she has calmed us with her humor.  It continued as she told us "go get knocked up, you guys" before sending us up the elevator.

After blood work and my first round of acupuncture, the embryologist came to speak with us about our embryo.  We knew that there was a less than 5% chance that the embryo would not survive the thawing process.  But, the embryologist assured us that the embryo thawed nicely and was looking beautiful as it was starting to expand.  In the picture above you can see that it was already hatching, ready for implantation.

Here, I had just finished my first round of acupuncture (and a Valium!), and I was feeling ultra relaxed.

As I was being prepped by my doctor for the transfer, the embryologist was loading our embryo into a catheter.

The transfer itself was rather quick, but Andrew was able to video it on the monitor.  If you zoom in, you can actually see the embryo placed in my uterus.  Click here if you would like to view it.

I couldn't help but smile afterwards :)

It was simply amazing to watch the little ray of light enter me. 

It's crazy to think that we could already know the gender of our embryo.  It was determined during the chromosomal testing.  However, we have opted to wait until the first ultrasound to find out.  Chase, our 2-year-old, has requested a sister for months now.  He has even asked for two sisters, LOL!   What's amusing is that he said he wants to name his baby sister Frosty.  He has no idea that our little embaby WAS frosty (frozen) for two months. 

We now have the long 9 day wait until our blood pregnancy test.  It is currently scheduled for December 16th.  We will hopefully receive same day results.  We are nervous, but we hope to have exciting news to share with our loved ones.

One little embryo

Waiting three a half weeks for news that could potentially change your life feels more like three and half years.  This has definitely been the longest and most difficult wait for us thus far.  After our blast report, when we found out that we only had one embryo make it, we were told that the CCS (chromosomal) testing would take 2-3 weeks to determine if our embryo is normal.  Two weeks came, then three weeks, and still no news.  At three weeks and five days we finally got the call.

We knew that if we got a call saying our embryo is normal, we would be able to move forward with a transfer (yay!).  But, if we got a call saying that our only embryo is abnormal, then we would not have a transfer and we would be back to the beginning.

I was dreading this phone call.  While I wanted to be optimistic, I was certain that this one embryo would come back aneuploidy (abnormal).  My egg quality is shot, so it was really hard to stay positive about the whole thing.  While the wait for the phone call was long and agonizing, I was ok that the call didn't come each day, because I just didn't want to hear the words that the embryo is abnormal.

Turns out, I didn't have to hear those words.  My nurse called tonight after hours and shouted "It's normal!"  I cried happy tears to her over the phone, and I couldn't wait to tell Andrew.  We are both beyond happy, excited, joyful, you name it...  And now we are thrilled to share the news with all of you!  Our chromosomally normal, grade 5bb embryo will be transferred on December 7th.  We can't wait!

2nd blast report

One.  Today's call from the lab has left us with one embryo.  All of the other six embryos stopped developing, so we are left with the one grade 5bb embryo that we learned about yesterday.  We don't know why the embryos stopped developing, but we guess that it is due to my poor egg quality.  

While we are happy to have an embryo, we are devastated that this entire cycle, costing more than $30,000, has left us with only one.  Part of me hopes that this is a "Chase" embryo, meaning that it is strong and will make it through, but the other part of me doesn't want to hope for anything anymore because I am so tired of being let down.

Our one little embryo has been biopsied and will undergo genetic testing (did I mention that this test is costing us $7,000?!).  If the test reveals that the embryo is abnormal (non viable), we will walk away from the IVF cycle without a single embryo to transfer.  If it is normal, we will jump for joy and set a transfer date, likely in December, which is when my uterus will be ready.  We will be in suspense for the next 2-3 weeks until the test results come back.  

1st blast report

This update is a tough one to write.  I'm stuck in a whirlwind of emotions--sadness, anger, disappointment.  But at the same time, I just feel numb.

We just got the call from the lab with the first blastocyst report.  On day one, they were able to fertilize five eggs.  Today, three of those embryos are stuck at cleavage, approximately day three of cell division, when they should be closer to day six.  Chances are we will not be able to use those embryos.  A fourth embryo is at the early blastocyst phase, which is just slightly behind schedule.  The lab is going to grow this one out another day to see if it becomes a full blastocyst tomorrow.

The fifth embryo is currently our lucky one.  It is a full blastocyst, grade 5bb.  We are told this is good quality, but if you are really interested in learning about embryo grading, click here.
5 = hatching out of the shell
b = inner cell mass has several cells, loosely grouped
b = trophectoderm has few cells, forming a loose epithelium

On day two, the lab was able to fertilize two more embryos.  Today, one embryo is at cleavage, a bit behind.  The second embryo is a morula, which is at day four, when it should be closer to day five.   They will continue to grow these two embryos out another day in hopes of them becoming full blastocysts.

It's amazing how quickly things change in this journey.  One day we are beyond thrilled to have seven embryos.  The next day, we are saddened by the news that we might only have one embryo make it to blastocyst.  While we do have that one embryo, it still has to go through genetic testing.  If the testing reveals that the embryo is abnormal, it won't be transferred--not by our choice, rather by the policy of the center and lab.  We could walk out of this second round of IVF empty handed, just like the first.  And truthfully, if CCRM and the Fertility Lab can't make it happen, I don't think that anyone can.

The lab will call us again tomorrow with another update.  We hope to hear that several embryos finally made it to full blastocyst.  But, best case scenario, only two will.  

Fertilization report #2

From our first fertilization report, we were ecstatic to learn that five out of six mature eggs fertilized.  On Sunday we received the second fertilization report on the remaining four eggs.  Three of those eggs became mature in the lab, and two of them were successfully fertilized.  We now have seven embryos!  This is incredible and more than we were expecting.

On Thursday and Friday of this week we will learn how many embryos from the first and second fertilization report make it to blastocyst.  Then our little blasts will be biopsied and frozen until my body is ready for the transfer.

On a side note, our blog has reached 10,000 views!  As always, thanks for the support!

Fertilization report

Months of preparation and we were finally ready for egg retrieval yesterday.  Going into the retrieval, we knew that I had 11 follicles, but the number of eggs within those follicles could not be predetermined.  So, I went in with my new pink socks (a thing among CCRM patients), ready for whatever was to happen.

  When I woke up from the procedure, Andrew was there with a smile on his face.  He already knew how many eggs were retrieved--10!  That's a good number for me.  Embryology came in to speak with us and confirmed that 10 eggs were retrieved, and that they would attempt to fertilize those eggs within a few hours.

This morning I received a call from the embryology team with the fertilization report.  Of the 10 eggs retrieved, 6 were mature, and 5 of those mature eggs fertilized.  Again, this is a good number for me (considering that in our first round of IVF we had 9 eggs retrieved, with 7 of those eggs mature, and only 3 eggs fertilized).   So, it was good to hear that we have 5 embryos to work with.  But, it was also good to hear that they were trying to grow the other 4 immature eggs out to maturity in the lab and would try to fertilize them today.  We will get another call tomorrow with that fertilization report.  That will be last call we get until next Thursday, which is when the embryos will hopefully reach blastocyst, and then all embryos will be genetically tested and frozen until my body is ready for the transfer.

Stimulation, round two

I've been "stimming" for over a week now.  This means that I've been getting several injections each day, which stimulate my ovaries to produce follicles, which will hopefully have a mature egg once egg retrieval comes around.  This is the second time we've been through this, so we knew what to expect--bloating, cramps, moodiness, headaches, sleep deprivation.  The one thing we didn't expect--a prescription for Viagra.  For me.  That's right, I am now taking Viagra.  Apparently, the Viagra helps the stimulation meds be more effective.  I'm all for it if it's going to give us a baby.

After a few days on the "stims" I had a ultrasound and blood work to see how my ovaries are responding to the meds.  That ultrasound found that I had only 8 follicles--6 on the left, 2 on the right.  My right ovary has a large endometrioma, which is ovarian endometriosis in the form of a cyst.  The endometrioma is preventing the ovary from cooperating and producing follicles.  This leaves me with fewer than average follicles.  We were disappointed, but we also know that, in the end, it only takes one.

The few and slow growing follicles prompted the Viagra prescription.  By the second ultrasound, I had 10 follicles--8 on the left, 2 on the right.  However, many of them were still slow growing.  We only had three that were growing at an almost normal pace; the others lagging behind.  At this time, the nurse said one of two things could happen.  One being that the doctor could recommend retrieving the largest follicles at their appropriate time, which means that the smaller follicles will not be mature and cannot be fertilized (this would leave us with approximately three eggs).  Or, the doctor could recommend stimming a bit longer to grow the smaller follicles more.  However, in this case, we risk losing the biggest follicles and mature eggs, and stimming for too long can result in poorer quality eggs.  We knew we wouldn't have an answer until the next ultrasound and blood work.

Today, I had my third ultrasound.  I now have 11 follicles--8 on the left, 3 on the right.  The growth patterns indicate that I will likely be ready to retrieve on Friday, and that we may only get 8 mature eggs from the 11 follicles.

While eight sounds like a great number, it's really low, relatively speaking.  The attrition rate could knock us down to 1-2 embryos (just like the first round).  Not every mature egg will fertilize, not every fertilized egg (or embryo) will make it to the blastocyst phase, not every blastocyst will be chromosomally normal.

Once the retrieval happens, we will learn within 24 hours how many eggs were retrieved, how many were mature, and how many fertilized.  We will then have to wait five days to learn how many embryos grow to the blastocyst phase.  The embryos that make it to that phase will then be genetically tested to "weed out" the non-viable embryos.  We will have to wait 2-3 weeks to learn how many embryos we will have from this process for transfer.  Once we know that number, we can start prepping my body for the transfer, which will unfortunately take another 6-9 weeks.  We have been advised that our transfer will likely take place in December.  It's going to be a long wait, but will hopefully be worth it.  What a wonderful Christmas present it would be :)

Moving forward, round two

This round of IVF feels so much different than the first, in many ways.  We were so naive in the first round, thinking that all the work and money we put into it would give us a happy ending.  But, on May 1st, Chase's second birthday, we found out that we were wrong.  I think this is why I don't feel excited about this second round.  We haven't even been celebrating the small steps and progress we've made in this second journey.  We just want to get it over with.

"Get it over with."  I know that sounds terrible, but the process is grueling.  In the first cycle, I gained a lot of weight, I was emotional, and (Andrew would probably say) I was extra grumpy.  It's a series of highs and lows.  The medications and hormones are hard on the body, but are needed to retrieve the eggs and support a pregnancy.

"Get it over with."  We have our eyes on the prize, as the saying goes.  We are anxious to get through the brutal stimulation phase, the waiting-while-our-embryos-are-genetically-tested phase, and the transfer phase.  We want to fast forward to the date when we will find out if this was a successful round of IVF.

So, where are we right now in the cycle?  Well, after all the work up and testing and a surgery to correct a problem with my fallopian tubes, we are ready to rock and roll.  Last week, I started on some priming medications, and yesterday an ultrasound and blood work found that we are ready to start the stimulation phase.  For the next 2-3 weeks, we will be in IVF prison.  I have several injections that need to be administered at very specific times during the day.  Lupron has to be injected every 12 hours; right now we are on a 7am and 7pm schedule with that medication.  Menopur has to be injected in the morning, Follistim has to be injected in the evening, and Dexamethasone has to be taken at bedtime.  We either have to be home at the exact times that these meds are needed, or we have to take them with us wherever we go.  The latter is challenging because some of the meds have to be refrigerated (and sanitary conditions are needed).  Regardless, we are ready!

Those of you that donated to our online fundraiser helped us get to this second journey.  All of the money raised was used to pay for the initial work up and testing as insurance didn't pay for it all.  We applied for a grant, but were told that the committee won't meet until November or December of this year to determine if we are eligible.  We were finally able to take out a substantial loan, but this loan does not cover the total costs.  We are still fighting to pay out of pocket for the expenses while simultaneously making biweekly payments to the lender for the loan.  We initially estimated this round to cost $30k, but we are already over that amount and we aren't done paying yet.

This is our final attempt to build our family.  Financially, it has to be.  By the end of this year, we will know if Chase will be an only child or if he will have siblings.  

Post op

The long process of "IVF workup" is finally coming to an end.  All of my labwork came back normal, meaning that there are no deficiencies or blood clotting disorders.  My genetic screenings also came back negative, which means that I am not a carrier for any genetic disorders.  The uterine biopsy revealed that I have the necessary receptor cells for embryo implantation.  All good news!

The final step was to have at least one fallopian tube removed because it was retaining toxic fluid, which would destroy an embryo.  I went in for surgery on Thursday of last week.  We knew that one tube would be removed, and that there was a possibility of the second tube being removed depending on what was found once my pelvic cavity was cut open.

When I awoke after surgery, my doctor came in to talk to us.  I think he was floored by what he found, but it was really no surprise to us.  He was not able to remove either fallopian tube.  He said it looked like someone dumped a bottle of Elmer's glue inside of me because all of my organs are glued together.  He said it took him some time to even figure out what was what in there.  My tubes are buried in adhesions and glued to my bowel, which is glued to my uterus, and so on.  This, of course, is all due to endometriosis.  My doctor said that if he would have tried to separate anything it would have turned into a major surgery with potential complications (i.e. perforated bowel).  He was, however, able to ligate both tubes, which he found necessary to proceed with IVF.

It's kind of funny when you think about it--most women have their tubes ligated to prevent pregnancy, while I had my tubes ligated to increase my chance of pregnancy.  Of course, now our only hope of conceiving is through IVF.  We will never experience the miracle of natural conception again, but we can still have a miracle baby with the help of IVF.

Now we wait for my next cycle to start.  Once that happens, we will receive a calendar from our nurse, which will instruct me to take certain medications at certain times.  We will once again go through the priming phase and then the stimulation phase (lots of injections) before we get to egg retrieval.  If everything goes as planned, we could be pregnant by the end of the year.

Sad, but true

We have finally completed all IVF work up and testing.  Yesterday was the last of it.  I had an endometrial biopsy for Integrin, which will determine if I have the receptor cells necessary for embryo implantation.  I didn't know what to expect going in for this appointment, but it turned out to be a short uncomfortable procedure.  The doctor placed what looked like a plastic straw through the cervix and into the uterus, and scraped the inside of the uterus to obtain cells.  It felt like the worst menstrual cramps you can imagine.  But it was over pretty quickly, and now we wait 2-3 weeks for the results.

In the meantime, I will undergo a third laparoscopic procedure in which at least one of my fallopian tubes will be removed.  This is scheduled for August 6th.  Sadly, this is not deemed medically necessary in the eyes of our health insurance, so we will have to pay out of pocket for this as well--another $4,250.

The fees associated with infertility treatment keep piling up.  After the first failed cycle and going through the second cycle, we will have spent over $60,000--just to TRY to have another baby.  We are stressed and exhausted.

And, as I sit on the sidelines watching the many people around us celebrating their pregnancy, birth, twins, etc., my emotions are running high.  When people ask me "how are you," I smile and say "good" because it is an easy and polite response.  But actually, I'm feeling quite the opposite.  We are two years into this infertility hell, and tens of thousands of dollars are out the window.  I live this every single day.  There is not a day that goes by that I don't think about how badly I want to grow our family, hold another miracle baby.  It is Chase's smiling face and Andrew's strength and optimism that keeps me going.

I wonder what it must feel like to just decide to have another baby and then actually have one, without any struggles or complications.  Even to get to Chase (our two year old son), we had to go through a surgery, the agony and heartbreak of a miscarriage, and several months of trying.  And now, my reproductive health is worse.  I just want to have the choice and ability to grow our family.  We are hoping that Dr. Schoolcraft at the Colorado Center for Reproductive Medicine--one of the best in the world--can help us make our dreams come true.

    

Moving along...

As we continue with our IVF work up, the many emotions are hitting us again.  Yesterday, I received the call from our nurse confirming that my left fallopian tube will not be cauterized, but completely removed.  The HSG--xray of my uterus and fallopian tubes--showed that both tubes are blocked, and that the left tube is retaining fluid that becomes toxic.  Our new doctor has recommended that the tube be completely removed because of the toxicity risk to an embryo.  I will undergo a third laparoscopic procedure for this, and we are trying to find out if our insurance will cover it before we schedule the procedure.

On a positive note, my repeat doppler showed normal blood flow throughout the uterus without any caffeine in my system.  This is great--no further work up needed on that end!  Now, I just need to have the endometrial biopsy, checking for receptor cells that help an embryo implant.  That procedure is scheduled for next week.

We got the results back from Andrew's semen analysis.  Once again, he topped the charts in every category.  In fact, he has 5 times the average number of sperm.  If I didn't have endometriosis, or some other condition causing infertility, we could easily have the large family we hope for.

As we near the end of our work up, the large sum of fees is due to our doctor in order to proceed with the second round of IVF.  Just as before, we are looking into financing and grant opportunities. Today I am applying for a grant through Kids for Kyla at kidsforkyla.com.  Wish us luck!

IVF work up

After our initial consult with Dr. Schoolcraft, our new specialist, we decided to get a jump start on round two of IVF.  On Tuesday of this week, we started our work up and attended an orientation.  The room was filled with other couples from around the world going through their own infertility struggles.  We now know that THIS is the place to be.  While we are not 100% confident that we will have another baby, we are 100% confident that our new doctor will do everything it takes to make it possible.

My lab work so far has indicated that my ovarian reserve has decreased since our last IVF cycle.  My AMH is now 0.9, below average for my age.  An ultrasound found 8 resting follicles on my ovaries, while 12-13 is normal.  Although these numbers are low, our new doctor is confident that we will still get a good number of eggs from retrieval.  And since we made a child before, we should be able to get at least one normally fertilized egg--an embryo.  If we are lucky to have multiple embryos, our doctor will transfer two.

On Tuesday, I had a hysteroscopy where a microscope was inserted into the uterus to look for scar tissue, polyps, fibroids, etc.  I am happy to report that everything looked normal.  However, I still need to have a biopsy of my uterus to determine if I currently have the receptor cells needed for embryo implantation.  That biopsy has to take place at a certain time in my cycle, but I will likely have it done within two weeks.

Today, I had a hysterosalpingogram (HSG).  This is an xray of the uterus and fallopian tubes with injected dye.  I had this imaging done before, in May of 2014 by our previous fertility specialist.  She was not gentle with the procedure and I was terrified to have it done again.  I explained this to our new doctor, and he prescribed me Percocet to get me through the procedure.  However, it completely backfired on me.  I'm not used to narcotics, so this drug had me feeling very loopy, and I threw up three times before the HSG was done.  Not pleasant for me, and probably not pleasant for the lovely nurse and technician that were with me.  But, this HSG was so much better than the first one.  It wasn't painful and the equipment used was much more updated.  The results?  Both tubes are completely blocked again.  But, I am suspicious that they are both blocked in the exact same places as they were before--right tube blocked proximal, left tube blocked distally.  When these same results were found in May of 2014 by our previous doctor, I underwent surgery in which she claimed to clear both tubes.  So, is it a coincidence that both tubes are completely blocked in the same manner as they were before?  Something we will discuss with our new doctor at the next consult.  But, with these results, we now know that there is a good chance that the first IVF cycle failed because of the tube blockage.  Since the left tube is blocked distally (at the end, closer to the ovary), it fills up with fluid, which has no place to go except back down the tube and into the uterus.  This fluid is toxic and can destroy a thriving embryo.  We will never know for sure, but this is a probable cause for the failure.  To prevent a future failure, my tube (or tubes) will be cauterized to prevent the flow of toxic fluid into the uterus.  In a way, this makes me really sad.  Once cauterized, I'll never be able to use that tube (or tubes) again.  But, on the other hand, I can't use them anyway since they are blocked from scar tissue and adhesions that result from endometriosis.

Andrew and I have a lot of lab work that we are still waiting to hear back on -- genetic testing, semen analysis, general lab work, etc.  Tomorrow, I go back for a doppler of my uterus to ensure normal blood flow.  They tried to do it on Tuesday with the ultrasound, but I had caffeine in my system, which affected the doppler results.  We could see the way the blood was pumping so abnormally through the uterus, and it was a real eye opener.  I don't consume large amounts of caffeine, but what I do get from chocolate, coffee, and tea could affect a baby.  For that reason, I am completely cutting out caffeine during this cycle.  If the doppler is still abnormal tomorrow, without any caffeine, I will likely go through acupuncture again to get the blood flowing normally.

Once all of our results from the work up are in, our doctor will develop our IVF protocol.  It will likely be as aggressive as it was before, meaning a lot of medication to stimulate the ovaries.  We have already decided that all of our fertilized eggs will be tested for chromosomal abnormalities.  Since we have already failed one IVF cycle without chromosome testing, it would be wise to ensure that a future failure is not due to a chromosomal abnormality.

We knew that treatment with this new specialist would be more expensive, but we are willing to roll the dice.  While our last cycle with the previous doctor totaled around $20k, we are now looking at $32k, which includes the large amount of medications I will need and the chromosome testing of the embryos.  It's very scary to take another chance, but we just can't put a price on having a baby, and we are not willing to give up yet.  Hopefully, we will be pregnant by the end of the year.

Hello, new specialist

Today Andrew and I met with a new specialist in reproductive medicine.  He has been practicing for over 25 years, and he is the founder and medical director of one of the most renowned clinics in the nation.  Lucky for us, this clinic is right here in Colorado, less than 20 miles from our home.  Dr. Schoolcraft has restored some faith and hope for us that we will be able to conceive again.

Through our consult, we learned some significant and disappointing information.  Per his expert opinion, our Reproductive Endocrinologist (our first specialist) failed to administer specific tests prior to our IVF cycle--tests that could help us achieve the best possible outcome.  In addition, it seems that our previous doctor took a step in the IVF cycle that should not have been taken.

Let's see if I can break this down accurately...

In May of 2014, I had an HSG done, which is an xray of the pelvic cavity with dye.  This is done to look at the uterus and fallopian tubes.  At that time, my right fallopian tube was blocked proximally and my left tube was blocked distally.  Given the findings on this xray, along with my history of endometriosis and our failed attempts at trying to conceive, I underwent a laparoscopic procedure in August of 2014.  In that surgery, my Reproductive Endocrinologist was able to clear both fallopian tubes and remove adhesions from endometriosis.  She was certain that we would get pregnant within the next six months.  But, when we didn't, we decided to move forward with IVF.

Our new doctor, Dr. Schoolcraft, is concerned about that left fallopian tube, which was previously blocked distally.  Although it was cleared with the surgery in August 2014, it could have become blocked again by the time we started IVF.  When a tube is blocked distally, any fluid that tries to flow from the uterus through the tube it gets stuck at the end of the tube, and the tube dilates.  When the tube can't hold any more fluid, the fluid has no choice but to exit the tube from where it entered--back down into the uterus.  By this time, the fluid is toxic and could end a pregnancy.  This is one potential reason that the IVF cycle was not successful.  Our Reproductive Endocrinologist should have looked at the fallopian tubes again via xray prior to IVF.

This next one, I know I am going to screw up, but I will try to explain it.  Dr. Schoolcraft recommends that I have a biopsy of my endometrium (in the uterus) to ensure that I have the necessary beta 3 receptors.  Without these receptors, a pregnancy is not likely to be successful.  Another thing that should have been done before IVF, and another potential reason for the failed cycle.

When we started learning more about the IVF process and the embryo transfer, we learned that there are fresh embryos and frozen embryos.  Fresh embryos are what was recommended by our Reproductive Endocrinologist.  This just means that after the eggs were retrieved, they were fertilized and then transferred into my uterus (one on day 5 and one on day 6).  It was explained to us that going through IVF that way doesn't allow my body to resume to its normal state following all of the stimulation medications I was on for IVF.  The stimulation medications were to help my ovaries develop more follicles for egg retrieval.  Estrogen is present with eggs.  So, in a normal cycle where a female has one follicle/egg, her estrogen is around 300 pg/ml.  At IVF, I had 12 follicles with nine eggs, which means that my estrogen level was probably over 2,000 pg/ml.  The problem?  Estrogen is the fuel for endometriosis.  When estrogen is high, endometriosis flares, and the immune system responds by killing off anything that it recognizes as foreign (hmmm...an embryo, maybe?).  This is why Dr. Schoolcraft recommends freezing the embryos, giving the estrogen time to decrease back down to its normal level.  Once that happens, the embryos can be thawed and transferred, reducing the risk of the embryo being attacked by the immune system.  So complicated, right?!

Now, back to my earlier note that we had one embryo transferred on day five and one on day six.  While we were ecstatic to have that second embryo transferred on day six, we now know that it should have never been done.  Dr. Schoolcraft said that is unheard of and potentially put our first embryo in danger.  An embryo that isn't developed normally by day five should never be transferred at a later date because it is clearly not normal.  So, it is possible that this day six transfer disrupted the first good quality embryo or created a toxic environment.

So, we discussed going through a second round of IVF with our new doctor.  He believes that we will be able to get pregnant with my eggs.  We were told by our first doctor that donor eggs would be the next step for us.  But, our new doctor says it is much too premature to even consider.  He has helped other couples, in which the woman has worse ovarian reserve than I do, become pregnant with IVF.  He is optimistic!

Overall, we are so disappointed.  We put a lot of trust and faith (and money!!) into our first specialist.   How could this have happened?  She, too, has been practicing for over 25 years and is well known in the state.  But, we are now with Dr. Schoolcraft, who has come highly recommended by physicians and peers.  While his treatment will be more expensive, we have more faith now.

Our next steps with our new doctor are to get another HSG done (xray of the uterus and fallopian tubes), and let me just say to the ladies reading this, it is a very uncomfortable procedure to go through.  After the first one, I promised myself I would never go through it again, but here I am, getting ready to face the discomfort again.  In addition, our doctor would like to perform a hysteroscopy and the endometrium biopsy.  I will also have to go through quite a bit of lab work.  Once the results from all of these tests come back, Dr. Schoolcraft will be able to determine the protocol for our next IVF cycle.  We can potentially start within the next two months!  We are trying to stay optimistic that we will be able to financially go through this again (and soon!).

 

Patiently waiting...

Although we are emotionally and physically ready to start the second round of IVF, we are not financially there yet.  Those of you that have generously donated to our IVF fund, thank you, thank you, thank you.  All of our donations are sitting in an account, waiting to be put to excellent use--creating a baby!

We are gradually adding to the account ourselves as well.  In addition, we've applied for discounts, grants, and medical financing, but we have repeatedly been denied.  We make too much money for such assistance, yet, we don't make enough money to pay for multiple rounds of IVF, especially in one year.  And, thanks to our "great" state of Colorado, infertility isn't viewed as a medical need, so we have no insurance coverage.

This would be easier on our wallets if we had time to save and spread out the cycles.  But, given my poor reproductive health, having another baby is an urgent matter.  Per my doctor and lab results, I could reach menopause within two years.  Ugh...scary!

In the meantime, we have scheduled an appointment with a different fertility specialist in the area.  We are very happy with our current doctor, but it could be helpful to get a second opinion on my reproductive health and the avenue we take for conception.  This new doctor has been practicing for 30 years, is well known in the state, and has higher-than-average success rates.  The down side---he is much more expensive.  Our appointment is on June 25th, and we will provide an update afterwards.

Ready for round 2!

It's not even the end of the month yet, and we are already emotionally and physically ready to give IVF another shot.  We recently met with our Reproductive Endocrinologist (RE) to discuss the first cycle of IVF and what likely went wrong.  I was on the maximum protocol--as much medication as possible (to improve ovarian reserve and for egg retrieval) for as long as possible.  Our RE said there is nothing that we could do differently in a future IVF cycle that will likely change the outcome.  My eggs have been destroyed by endometriosis--I have a small supply of poor quality eggs.

Our only shot at having our own biological child is to go through IVF again, but with donor eggs.  I have accepted this 100%, knowing that our child won't have any of my genes.  My uterus is still healthy enough to carry, and the baby would be half of Andrew and a biological sibling for Chase.  And, our chances of pregnancy increase to 75-80%!  This is the direction we hope to move in.

After my initial diagnosis of stage III-IV endometriosis in 2011, I didn't really give it much thought.  I knew that infertility was a possibility, but it wasn't something that weighed on me constantly, especially since we were able to get pregnant twice after that diagnosis.  But now, after trying to conceive again for 20 months and knowing that I now have stage IV endometriosis, I think about it every single day.  Not necessarily because of the pain, cramping, and bleeding that comes along with it, but because it has truly affected my life--and Andrew's, too.

Sometimes I wish I knew why I have severe endometriosis.  Sometimes I wish I could say that the poor choices I made in my younger years caused it, just so I would have something to blame it on.  Instead, I have this disease that no one knows the cause of, which means that they can't find a cure.  Instead, I have a disease for no known reason, and it has taken away my choice, my right, to have more children.  People ask us all the time "are you ready for number two?" meaning another child.  Yes, we are ready!  If it were up to me, we would have five more.  But, it's not up to me, it's not up to us.  We no longer have the choice.

My endometriosis has attacked my abdominal cavity and reproductive system.  I have organs that are glued together from the scar tissue and adhesions from endometriosis.  My fallopian tubes have been crumpled and blocked from the disease.  I have reoccurring ovarian cysts.  And, worst of all, my egg supply and quality have been destroyed.  Not only has the disease left me with regular discomfort and pain, but it has stripped our hopes of growing our family.

We now have to pay thousands and thousands of dollars just to TRY to have another baby--whether it's through an assistive reproductive technology or through adoption (which we are considering).  As I mentioned above, we are now hoping to go through a second round of IVF, but with quality donor eggs.  Donors are young with a high AMH (indicating quality eggs), and they are thoroughly screened (i.e. communicable diseases, family medical history, tobacco use, etc.).  We will be able to choose our donor based on those results as well as physical appearance.  We have decided to choose an anonymous donor so there will never be any emotional issues between me and the donor.

We've learned that IVF with donor eggs is actually more expensive than IVF with my own eggs.  Luckily we have three options with donor eggs:

1)  We choose a donor and keep all of her eggs (typically, 15-20 eggs are retrieved from quality donors).  This choice is ideal to give us the best chance for pregnancy during this cycle and have eggs left over to freeze for a future cycle.  However, this choice costs around $35,000.
2a)  We can also choose a donor and keep half of her eggs.  So, where do the other half go?  Well, we can choose to share/split the eggs with another couple.  This means that we would only get 7-10 eggs, and the other couple would get the same.  This decreases our chance of having embryos left over for a future cycle.  We would never meet the other couple, but we would have to choose the same donor.  This could take months to a year before we find another couple that would just so happen to choose the exact same donor as us.  This option costs around $25,000.
2b) Or, we can choose to share/split the donor's eggs with our fertility center.  This means that we would again only get 7-10 eggs, and the fertility center would get the same amount to save for future use.  We wouldn't have to wait for them to choose the same donor, so it would be a much quicker process.  This option also costs around $25,000.

We have chosen the latter option.  We would love to have more eggs, which increases our chances of having a future cycle (more babies!), but financially, the split/share option is more realistic.  However, we are still struggling to find a way to make this happen since we drained most of our savings with the first cycle (our insurance does not cover infertility treatments).

Our families have graciously organized an online fundraiser (with YouCaring) for us in an effort to pay for a second cycle:  http://www.youcaring.com/medical-fundraiser/a-sibling-for-chase-walker/356677  We ask that you share our blog and YouCaring links with your friends and family.  We wholeheartedly thank those that do share our links as it raises awareness about endometriosis and infertility.  And, we can't thank our generous supporters enough for their donations--it means the world to us, and we will be happy to pay it forward some day soon.

Our final post

Earlier this week, on Monday, we learned that my HCG level was very low, at 6.  This meant that an embryo did implant, but the HCG level was not indicating a viable pregnancy.  On Wednesday, my HCG level was still at 6.  We were told that this is very unusual.  After two days, the level should have changed, either increased or decreased.  So, we continued with the progesterone injections and estrogen patches, hoping again for a miracle.  Our fingers were crossed...maybe it would increase!  But, on Friday, I had my third blood pregnancy test.  At 5pm we learned that my HCG level dropped to 3.  This means that the implanted embryo stopping growing, and this confirmed that the pregnancy is not viable.  We officially failed at IVF.  Needless to say, this post is written with a heavy heart.

It is believed that this fail is due to my egg quality.  The embryos that were transferred were likely chromosomally abnormal (due to the poor egg quality) and failed to further develop.  We would probably be more successful if we used high quality eggs from a donor.  Maybe one day we will explore that option...

If you are reading this blog because you are a caring friend or family member, thank you.  Your positive thoughts, prayers, and words of encouragement made it easier to move forward with every step in this journey.

If you are reading this blog because you are thinking about going through IVF, don't let our story scare you away.  There are so many success stories out there, and those success stories kept me motivated along the way.  There is this whole community out there filled with people just like us.  I never knew that until we became public with our fertility struggles.  Know that you are never alone, and there will always be someone somewhere that is willing to listen to your story and share theirs as well.

For now, our journey has come to an end.  Maybe someday we will explore the option of using donor eggs.  Maybe we will look into adoption.  Who knows...  But, for now, we are taking a break and getting back to normal life.  We will decide when the time is right again to start a new journey in trying to conceive.  Until then, this chapter is closed.

Results

Here we are, three and a half months after starting this journey, two weeks after the egg retrieval, and nine days after our first embryo transfer.  Today, we had our blood pregnancy test.  We waited and waited for the call that finally came around 4:45pm.

The results....not good.  My HCG (pregnancy hormone) was only 6.  At this point, a successful pregnancy would result in an HCG level of at least 50.  Our nurse called this a "gray area."  It's not negative, but it's no where near the level of a viable pregnancy.  I will have a second blood pregnancy test on Wednesday, just to confirm our failed IVF cycle.  We had two viable embryos, and we don't even get to have one.

We had so many people send us positive thoughts and so many people prayed for us.  I can't believe how many views our blog has had and how many people have reached out to us.  We are so appreciative of everyone's words of encouragement, support, and concern.  I wish we had better news to share.

Instead, we are in a complete state of devastation.  We put everything we have--emotionally, physically, and financially--into this.  I did everything I was supposed to do--acupuncture, the Fertility diet, vitamin D supplements, prescription prenatal vitamins, multiple injections for several weeks, took a lengthy list of oral medications, was on bed rest after the embryo transfer--and none of it mattered.

I know that we are already luckier than some couples because we have Chase, our son who turns two years old in four days.  But, I have to say that it doesn't take away the heartache that we are experiencing.  It doesn't remove the desire we have to grow and expand our family.  But, we have to move on, we have to put on a happy face, for Chase.  He is what matters most.  I don't know if this is the end of our journey.  We don't want to give up, but we don't know what other options we realistically have.  I never wanted an "only child," but I am so grateful for the only child we have.

Things are looking up!

The world works in mysterious ways.  Yesterday, we had one embryo with high quality grading--AB--and it was transferred.  The other two embryos were graded CC and were deemed not viable.  Our Reproductive Endocrinologist told us that the Embryologist would continue to watch those two embryos for another 24 hours.  If, and it was a big IF, those two embryos continued to grow and improve, they would freeze them for a future transfer.

We weren't really expecting that to happen, given the poor quality.  But then the phone rang at 10am today and I saw my doctor's name on the caller ID.  Without getting my hopes up, I answered the call.  I couldn't believe what I was hearing!  One of those CC embryos changed over night and became an AB embryo!  She wanted us to go into her office ASAP so she could make another transfer.  I had to pause and ask her, "are you serious?!?"  She said, "yes, I am serious...get here as soon as you can."  A very large smile emerged, and I think Andrew was filled with more excitement than I was, if that is even possible.

So, off we went, and within 1-2 hours we had our second embryo transferred.  Here is a picture of the little latecomer:

The picture of this embryo is unique as it is contracting.  Once it gets to the expanded blastocyst phase, it contracts and expands to get out of the shell, preparing for implantation.  It was transferred at just the right time.  

The end-all goal is a successful pregnancy.  While we are hoping that at least one embryo will implant, we will be ecstatic if both do.  

Below is a picture of us right before the second transfer today. You could not wipe these smiles off of our faces if you tried. 

Now, we anxiously await the 27th, when we will find out if either of the embryos have implanted!

Cautiously optimistic

Today is Saturday, the day of our embryo transfer, day 5 since the egg retrieval.  On days 1, 2, and 3 after the retrieval, we were updated on the status of our embryos.  On day 4, we did not get a status update because the incubator isn't opened on day 4.  So, our last update, on day 3, gave us hope as our three embryos were growing strong.  We knew that our Reproductive Endocrinologist would transfer two embryos as long as there were two that met the requirements for transfer.

Everything changed today.  In my last post, I included a picture of the embryo growth day-by-day, illustrating that the embryo should become a blastocyst on day 5.  The blastocysts are "graded" based on their morphology quality.  Both the "inner cell mass" (which forms the baby) and the "outer cell mass" (which forms the placenta) are graded.  A grade of AA is the best quality.  Today, two of our three embryos were graded as CC, which means they are not viable.  Only one embryo had a grade of AB, which is not perfect, but is still very good quality.  Here is a picture of our last remaining shot at this. This is our one and only embryo that made it to transfer day.

We started with 12 follicles, retrieved 9 eggs, and had 7 mature eggs.  Only three of those eggs fertilized normally, and now we are down to one good quality embryo.  One.

Today was a rough day for us.  We went in to our appointment expecting to transfer two embryos and have one left to freeze.  We weren't prepared for the news that only one embryo made it to the blastocyst phase.  It was like the wind was suddenly knocked out of us.

But, we did it--we had our one little strong embryo transferred today.  We are hoping for the best, but were told to be "cautiously optimistic."  I'm not quite sure how to feel.  Today should be an exciting day and we should be celebrating.  Rather, I am nervous and uneasy.  I will probably feel this way until our next appointment, which is our blood pregnancy test on April 27th.  Until then, we continue to live in suspense.

Embryo update

This roller coaster ride just won't end.  (But when it does, I hope we are left with a smile.)  I was reading another woman's blog of her journey in trying to conceive.  She said, "Life as an IVF patient means that you pretty much live in a state of constant suspense."  She couldn't be more right.

Our egg retrieval on Monday resulted in 9 eggs of 12 follicles.  On Tuesday we got the first call from the embryologist regarding the fertilization results.  Of the nine eggs, only seven were mature, ready for fertilization.  Of those seven mature eggs, only three fertilized normally.  Three.  How could it be only three??  We started with 12 follicles and now we are down to three fertilized eggs.

The problem is my endometriosis and the effect it has on my eggs.  Each of the seven mature eggs had to have any endometriosis cells removed, which also removes the binding agent that the sperm needs to fertilize the eggs.  In addition, the endometriosis attacks the eggs, leaving them with poor quality.  This is why we are left with only three normally fertilized eggs.

Once again, I felt heartbroken.  I realize that three embryos is better than zero.  But, at the same time, three is so few.  And if anything happens with those three, then we are left with even fewer embryos.  The fewer the embryos we have, the lesser the chance of a successful pregnancy from this cycle of IVF.  Some people go through multiple rounds of IVF, so if it doesn't work out the first time, maybe it will the next time.  But, I don't think we will have a "next time."  It's expensive; it's REALLY expensive, especially when insurance won't pay a penny.  Looking at Chase, we know that you can't put a price on having a child.  It's the BEST experience in the world, and we would pay any price to have Chase all over again.  But, the worst part of IVF is the stress, the emotional toll it takes.  And we are not sure that it would be healthy for us to go through all of this again, especially with Andrew's heart condition.

The tables turned again today when we got the day-2 embryo update from our embryologist.  The three embryos that made it to day-1 are still going strong.  They have made it to day-2!  Two of those eggs have divided into four cells and one of the eggs has divided into five cells.  On day-2, they look for four cells; that is what's ideal.  But, the 5-cell egg does not pose any problems right now, and all three embryos are of good quality.  The picture below will help you better understand what the embryos should look like at each day.  We hope that all three eggs make it to day-5, the blastocyst phase.  On that day, we will have the embryo transfer.

The embryologist will call us again tomorrow with the day-3 update.  They don't open the incubator on day-4, so tomorrow will be the last update we get until we go in for the transfer on day-5.  We will try to stay positive until then :)

Egg Retrieval

Today was the first of three major days in this process--the egg retrieval.  This is the day we have been prepping for since January.  The other two days that we are eagerly awaiting are the embryo transfer and the blood pregnancy test.

Our most recent ultrasound, on Saturday 4/11, showed 12 follicles.  At that time, my Reproductive Endocrinologist (RE) predicted that she would retrieve approximately nine eggs from those follicles because some of the smaller follicles would most likely not have a mature egg.

I was both excited and nervous going in to the egg retrieval today.  The number of eggs retrieved directly impacts the number of embryos we hope to have.  As I slowly awakened from anesthesia, I remember the first question I asked..."how many eggs did you retrieve?"  I remember the response..."the eggs are still being counted, but at least five."  I remember feeling happy and disappointed at the same time.  Happy because five eggs is better than zero eggs.  Disappointed because we hoped for so many more.

As I was transferred to the recovery room, Andrew was finally able to be by my side.  The embryologist came in to talk to us and gave us the good news--they retrieved NINE eggs!  The final count was complete.  My RE's prediction was spot on.  Nine!

The embryologist will now attempt to fertilize all of my eggs with Andrew's sperm.  Once the eggs are fertilized, the embryologist will monitor them and give us an update every day until it is time for the embryo transfer.  She will call me tomorrow with the initial fertilization results.  It's so crazy to think that we might have a baby (or babies) starting to develop right now!

Now that the retrieval is over, we will update the IVF calendar again with all of the new medications I will be taking, including another injection and patches.  The new injection I will be taking is progesterone oil.  It is needed to support the lining of the uterus and maintain early pregnancy.   I get to take this bad boy every day for the next 10 weeks.

We will continue to update our family and friends as we move to embryo transfer.

Follicle Growth

The good news continued on Thursday when we met with our Reproductive Endocrinologist (RE) again.  Ultrasound showed 11 follicles growing strong, and my estrogen level increased to 1920.  We were all smiles, and then we met with our RE again today.  Could we possible smile even more??  Yes!!  Today, ultrasound showed 12 follicles, and my estrogen level increased to 3813!  My RE expects to retrieve approximately nine eggs from those follicles (some smaller follicles might not have eggs).  My uterus lining is now at 11, which is incredible!  She claims that I am doing much better than expected!  We are so thrilled and are looking forward to the egg retrieval, which is scheduled for 9am on Monday 4/13.

In my last post, I shared a video of the Follicle Growth Dance that Andrew's sister and her friends created.  Since that video, at least three more have been made!  They are not on You Tube (rather, they are on Facebook), so I can't attach them to this blog.  But, I have to wonder if all of those dances have helped my follicle growth!  Thank you to everyone for so much support!

If you've never gone through IVF, you may not know exactly what goes into it.  We had no idea how much time, how many steps, and how much medication would be required.  We started this process in January, and we didn't start the stimulation phase until March 31st.  Once the stimulation phase started, we were hit with an incredible amount of information, steps, and medication.  Every day is not the same; the meds change and appointments are frequent.  For that reason, Andrew created an IVF Calendar that we keep with the mini pharmacy we built in the guest bathroom.  We update it every couple of days and it keeps us organized.  The colored items are the three stimulation injections.  The black items are all the other injections and medications that I have to take during this phase.  Today, we got to add the egg retrieval and potential embryo transfer to the calendar :)

Tonight was my last night of stimulation injections, which means that my belly is now free from being stabbed with needles!  Here is what my belly looked like after 10 days of injections (I took stimulation injections for a total of 12 days):

Swollen, round, puffy, bloated....and bruised.  I'm glad to finally give it a chance to rest.

I go back to my RE tomorrow, Sunday, for another blood draw.  (During IVF, my RE and her staff work every day, sometimes 28 days without a day off.)  As long as everything looks good, we will have the egg retrieval on Monday :)

Good News Tues!

I am officially puffy...swollen...bloated.  Everywhere.  I feel huge.  I've been on three stimulation injections for one week now.  Tomorrow I will start a fourth.  But, I am more than happy to say that everything is going well and we are right on track!

On Saturday 4/4, I went to my Reproductive Endocrinologist (RE) for an ultrasound and blood work.  My estrogen level was right on track.  At this point in the stimulation phase, estrogen should be at least 250; mine was 267.  By ultrasound, she found that I had 8 follicles growing.  Eight is not really a great number, but for ME, it was good news!  My RE said that over the next few days I could start growing even more follicles or that the 8 I had may not fully develop, meaning that I would end up with less.  This news kind of shook me.  Up until now, I was focused on how many embryos we would have and how many we would get to transfer.  It never occurred to me, until this point in time, that we might not even get ANY embryos--I might not have enough eggs, or the eggs that I do have will be of poor quality.  It's a harsh possibility that we must consider, but I am now prepared for that outcome if it does happen.

On a better note, we got great news today!  We had another ultrasound and blood work.  My estrogen has continued to rise (now 1,087), which is what should happen now.  My uterus is looking great; the thickness of the lining needs to be at least 8mm, and I am currently at 7mm.  My RE expects this to be on track at our next appointment.  Looking at the ovaries, she was able to see 11 follicles!  An improvement since Saturday.  They are growing appropriately, and she is now estimating that we will be ready for egg retrieval on Monday 4/13.  Based on my AMH level, she expects to retrieve eggs from 70% of the follicles (meaning that 30% of the follicles are expected to not have eggs).  If the retrieval does in fact take place on 4/13, she also estimates that the embryo transfer will be ready on 4/18.

So, it seems that the injections are doing their job!  But, if that wasn't enough, Andrew's sister and her friends created a Follicle Growth Dance to aid in our success.  (Ok, so there is a back story to this.  If you know Andrew's family, you won't be surprised.)  You can view the video yourself.   Enjoy!

Roadblock down!

Wow, what a ride this has been!  A few short days after we received the bad news that we could not proceed until the cyst was gone and the estrogen level was down, we started to see the light again.  I finally started the long-anticipated period this past Sunday.  When I gave my doctor the news, she wanted me to come in for another ultrasound and more lab work.  On Tuesday, the ultrasound showed that the cyst was gone and that everything looked good.  Great news!  Then, we just had to wait a few hours to get the lab work results back, hoping to see a drop in estrogen.   Later that afternoon I got a call from our nurse informing me that my estrogen did, in fact, drop.  For this process, the estrogen level needs to be below 90.  My first draw was around 150, much too high.  (The cyst was most likely contributing to that level.)  The more recent draw was 30.  So, with the cyst gone and the estrogen level down, we got the green light to proceed!

That night, on Tuesday, we started the injections.  That first night was a slow, shaky start.  It took quite a while to go through everything and figure out what was what.  We had to mix the right amount of medication and use the correct size needles for mixing and administering.  Andrew gave his first shot!  Three of them to be exact.  And he did a wonderful job.

In this phase of the stimulation, my three injections are Follistim, Menopur, and Saizen (growth hormone).  (These are just stock photos; I haven't taken my own pictures yet, but it's basically all the same).


I also take two Clomid tablets.  As we progress through the stimulation phase, the injections and tablets will change.


The roadblock could have been a lot bigger.  Instead, it was just a three day push-back.  We are estimating that the egg retrieval will occur around 4/9 or 4/10.  We won't know for sure until the day before or the day of, because everything depends on how I respond to the stimulation medications.  This means that we are hoping to see many many follicles on both ovaries by these dates :)
 

Roadblock

Yesterday we received the first batch of medications needed for the stimulation phase as well as what is needed for the egg retrieval and embryo transfer.  (More is on the way!)  Although I somewhat fear the stimulation injections, I got butterflies when opening the box of mail-ordered fertility drugs.  It really hit me that we are only days away from starting the injections and literally only weeks away from creating a baby.

Today, however, we hit a roadblock.  It saddens me to say that all of which I mentioned has been put to a halt.  I had an appointment with my reproductive endocrinologist (RE) this morning for, what they call, the baseline ultrasound.  Up until this point, I have been doing Estrace priming--part of my IVF protocol.  So, at this ultrasound, my RE would be happy to see a perfect uterus and no follicles on the ovaries.  As the ultrasound started, she described the lining of my uterus as exactly what she was hoping for.  The right ovary looked good.  But, then over to the left ovary....a large cyst.  Normally, if a cyst is found at this stage, they aspirate it, or drain it, in simpler terms.  However, the cyst I have has solidified and is more of a blockage, which means it can't be drained.  This caused some concern, so my RE had blood drawn to check my estrogen level.

A few hours went by, and I got a call from our fertility nurse with the bad news.  My estrogen level is elevated.  Following Estrace priming, at baseline, my estrogen level should be really low.  It's like my ovaries are not properly responding to the medications I have been taking daily for almost 2 months now.

This can negatively impact the IVF cycle, which means that we cannot continue at this point.

So, where do we go from here?  We wait...we wait until I start another period.  We don't know when that will happen, because it should already be here following the Estrace priming and Provera.  But, it's not.  So, we wait until that happens, and then blood will be drawn again to test the estrogen level at that time.  It is possible that the cyst will go away once the period starts.  If this happens fairly quickly and the estrogen level drops, we can proceed, and the next step is stimulation by injections.  If this does not happen quickly and too much time passes, we will have to start the whole Estrace priming phase over again.  We could ultimately be looking at several more months before we get to the point we are profoundly hoping for.

I can't help but wonder if the universe is trying to tell us not to have more babies.  We haven't been able to conceive on our own for 18 months.  We haven't been able to conceive following a laparoscopic procedure in which my tubes were unclogged and adhesions were removed (both due to endometriosis).  So, we turned to IVF, but we struggled with the financial aspect of this process.  And now we've hit a roadblock.  It's heartbreaking, the lengths we (and other couples just like us) have to go through for a process that should come so naturally.  I question a lot right now, especially when, every single day, there is a new story in the media about a child being abused or neglected or killed.  And I question things when I see babies being born as drug addicts or with fetal alcohol syndrome.  Why are those people able to conceive?  And why aren't we?

Roller coaster

The last two weeks have truly been a roller coaster of emotions for us.  If you have ever considered going through IVF, or think you might in the future, don't believe the initial price quotes you are given, especially if you are a self-paying (cash) patient.  If your health insurance covers IVF, you are one of the lucky few.  Our insurance does not cover IVF, so everything that goes into this process is coming out of our pockets.

A week or two ago, we received the final fees from our doctor and pharmacies.  Little things keep popping up with our doctor that are not included in the IVF package, which means more cost.  The injections were more than double what we were initially quoted.  Our hearts sank and we became scared.  Scared that we would either have to stop the IVF cycle or that we would drain everything we have just to continue.  We applied for several programs that offer financial assistance to families going through IVF.  We were either turned down or were presented with an offer that was not going to save us any money.  But, we held on for a few more days, and without going into details, a miracle happened and we are now able to proceed.

Andrew and I met with our doctor yesterday to discuss results from labwork for both of us.  We both passed the infectious disease screening with flying colors...woohoo!    But, my vitamin D level is in the low-normal range.  IVF patients are more successful with normal vitamin D ranges, so I will be adding a supplement to my long list of daily pills.

My doctor also ran a panel for recurrent pregnancy loss, which found some abnormalities.  Although I've had only one miscarriage, she wants to be sure that there is nothing going on that could potentially result in another miscarriage following IVF.  The initial test for lupus came back positive; however, every confirmatory test for the lupus inhibitor came back negative.  There is a good chance that the result for lupus is a false positive.  My doctor said that, for an unknown reason, there is a higher incidence of false positives in Caucasian females. Just to be sure, she will run the test again in 12 weeks.  In the meantime, I will take a baby aspirin every day as an anticoagulant.

Another abnormality that was found is the MTHFR A1298C gene mutation.  It seems that this mutation is of little clinical significance.  However, conditions associated with this mutation include recurrent miscarriage.  This could be because folic acid is not metabilized the way it should be.  For that reason, I will be switching to a prescription prenatal vitamin that contains easily-metabolized folic acid.  (In case you don't know, folic acid is crucial for the developing embryo.)

Andrew and I sat through an injection teaching yesterday, where we learned how to mix the medications and administer the shots (the part I am not looking forward to).  The mixing of powders and diluent is a complicated process!  I think we are both nervous that we won't mix the right amount of medication or that we won't be able to get it all out of the bottle.  And I'm definitely nervous about the long needles.  How can they expect non-clinicians to do this?!  Ugh...

So, that's where we are with things right now.  Next week I will have my baseline ultrasound, where my doctor will look at my ovaries and hope she finds what she is looking for.  My understanding is that they are hoping to see no follicles at the baseline.  A few days following that ultrasound,  I will start the injections, which will hopefully stimulate the ovaries to produce many follicles with good quality eggs.

So much to do

The amount of work that goes into this IVF process is overwhelming at times.  We received an email from our nurse with all of the final steps that we will take over the next month, which will hopefully lead to a healthy pregnancy.

There are several protocols for IVF, depending on why a couple is unable to get pregnant.  We are struggling with fertility because of my endometriosis.  We've learned that our IVF protocol is "growth hormone with Estrace priming."  So, what does that all entail?  Right now, I take DHEA one time a day, Ubiquinol three times a day, and Estrace two times a day.  And let's not forget the prenatal vitamin.  On March 16th I will add Provera to that list, one time a day.  And then, on March 28th, I will start the injections--SIX of them daily, to be exact.  Andrew will be in charge of administering these injections, since I am too much of a wimp to do it myself.  Hopefully he won't get too much pleasure from stabbing me with a needle six times a day for two weeks.  But, before we get to that step, we have to go through the process of mail ordering the injections from an approved fertility pharmacy, and we have to learn how to perform the injections (watch several videos and attend a class).

The hope is that all of this therapy will increase my egg production as well as the quality of those eggs.  This will be monitored by continuous ultrasound and blood work starting on March 26th (just about every other day for 1-2 weeks).  

As of right now, we are hoping that the egg retrieval will take place sometime during the week of April 6th.  Of course, this will all depend on when my eggs are ready.  If they are not ready on April 6th, I will continue with the therapy, and will have ultrasounds every day until it's time for retrieval.

In the meantime, I am continuing with the Fertility Diet and acupuncture.  This is all moving very quickly, much faster than we ever anticipated.  Of course, since starting this process, we've been hoping that we just might get pregnant on our own, but it's just not happening.  On March 18th, we will be signing over a large amount of money for this entire journey.  It's frightening, but also exciting to think about what a successful outcome may be.

written on 3/6/15

Moving right along!

We have completed some of the next steps in our IVF journey.  Moving right along!  On Friday 2/13/15, I saw my Reproductive Endocrinologist (RE) again for a Saline Infusion Sonogram (SIS) and Trial Embryo Transfer (TET). 

The SIS found no lumps or bumps in my uterus—it’s perfect and ready to go!  My RE took measurements of the uterus and ovaries, and she also looked for follicles in both ovaries.  While she would like to see at least 10 follicles between the two ovaries before harvesting, she only counted nine on Friday.  However, given my poor reproductive health, nine is a very good number.  We are hoping that the hormone therapy along with the fertility diet and acupuncture will help us get to 10 eggs before April, which is when we are hoping to harvest and transfer. 

The TET went really well and was a fast a process.  This is good news and it gives us hope that the actual transfer will go smoothly.  The process consisted of using ultrasound guidance to insert a catheter into the uterus.  In the actual transfer, the embryos will be placed into the uterus with the catheter. 

We also got results from the labwork I had done the previous week.  My AMH and FSH were tested.  Both are tests of ovarian reserve—the remaining egg supply and the quality of those eggs.  My previous AMH was 1.2, and it improved to 1.3 this time.  While the improvement is great, the number is still abnormally low.   For someone my age (33-years-old), AMH should be somewhere around 1.7-2.1.  My previous and current FSH level is 7.5.  Again, for someone my age, less than 7.0 would be ideal.  I basically have the ovaries of a 40-year-old.  So, again, we are hoping that all of the therapy I am going through will continue to improve these levels. 

After the labwork, SIS, and TET, my next step was to wait for ovulation, which I have been testing for every day since my last cycle.  Yesterday, 2/15/15 I finally got the “surge” we have been waiting for!  I contacted my RE’s office today to let them know, and now we will be moving on to the next hormone therapy—Estrace.  Normally, birth control would be the next step, which helps prepare the ovaries for stimulation.  However, this step is not ideal for someone like me who has very few eggs and poor egg quality.  Rather than helping, birth control can suppress the eggs so much that the eggs don’t come out of it, resulting in a poor outcome.   Therefore, we move on to Estrace.  This hormone is used to reduce symptoms of menopause, but is also used in IVF to supply estrogen, stimulate growth of endometrial lining, and make resting follicles more sensitive to the upcoming fertility medications.

In hopes of helping my emotional state (because I am certain to fly through many emotions), I recently joined a support group with other women experiencing fertility struggles.  I had my first meeting with them yesterday and was happy to meet another woman also going through IVF.  I am excited to have a supportive group of women that will let me speak freely about my journey and feelings, without bogging down my friends, family, or husband.  But, my fingers are crossed that this whole experience will be a positive one!

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I’ve been asked by several people why I have created this blog.  For some people, this may be way too much information or information about intimate situations that people don’t want to know about.  The primary reason for this blog is to document every step of this journey for myself and for Andrew, so we can always go back and read what we did and remind ourselves of test results and what emotions we experienced.  When all is said and done, these early steps may become a blur to us, but I never want to forget any part of this journey. 

Another important reason for this blog is to hopefully help other women and/or couples going through similar struggles.  It’s been helpful to me that so many people that have gone through fertility struggles and IVF have reached out and shared their stories.  I am appreciative of that, so I want to be open about our journey in an effort to help others. 

Andrew and I are so lucky to have so many loved ones in our lives.  We have many friends and family members that care so much about us, and we feel very thankful for that.  This blog also offers updates to those caring people, so they don’t have to feel awkward to ask us what is going on.

Once again, thanks to everyone for the love and support! 

written on 2/16/15