Wednesday, October 31, 2007

You've Got to Hide Your Love Away

Today's bloodwork & ultrasound were great. What a relief. After using the progesterone suppositories for one & a half days, my p4 level rose to 15.5, which is right on target.

As of this morning, Blobby was measuring 12.6mm and the heart rate was 158bpm, which is also right on target.

Just thinking about what could have happened if I had not thought to monitor my progesterone level makes me shudder. The good thing about infertility is that it makes you educate yourself on hormone levels and how your body is supposed to react at different stages of your cycle.

Now the tricky part is going to be keeping this pregnancy a secret, when all I want to do is shout it from the rooftops. We've already told our immediate family: my parents, DH's aunt, uncle, and cousins, and my SIL, given how supportive they all were while we were going through the IVF process. And of course, all of my fantastic online friends know, and my medical practitioners, including my acupuncturist, know. The problem is that DH and I promised each other that we wouldn't tell anyone else until we got to 12 weeks. This is going to be hard! No wonder so many women announce their pregnancies so early- it's nearly impossible not to tell.

Not to mention how bloated I am. I already look like I have a significant baby belly, thanks to all the meds. I don't even know what I am going to look like in a month. Hiding my belly is going to be quite tricky. Yes, this is going to be a challenge. It's a good thing that my hips are not proportional to my waist, so all of my pants have larger waists than I need. Trust me, I'll be needing them very soon.

Monday, October 29, 2007

Don't Let Me Down

After being told last Wednesday to discontinue the PIO shots, I asked my IVF nurse if she would write me a script to have my progesterone checked in a few days. I was nervous that my body wouldn't be able to produce enough of it on its own, since I've always had low progesterone in the past.

So I went this morning to have more blood drawn. Good thing I advocated for myself on this one because my progesterone dropped down to 6 (from 25+ last week). I was so nervous about losing this pregnancy that I left work early so I could go home and start using the progesterone suppositories that (thank god) I had left over from my last IUI cycle. I am to use them twice a day, and I'm going back on Wednesday to have my level checked again, and to have another u/s for my peace of mind.

My dear friend Teri calmed me down a lot. She told me that the placenta doesn't start producing its own progesterone until 12 weeks so it's normal for the progesterone to drop after stopping the PIO shots. She was relieved for me that I caught this in time before any bleeding started. Hopefully she's right and the pregnancy is not in any danger.

I'm hoping for the best on Wednesday. Fingers crossed.

Chapter Eighteen: Good Day Sunshine

On Wednesday, October 24, 2007 we returned to the clinic. DH accompanied me. I was glad that he was coming too, but in a way, I didn't want him to be there if we were to be getting bad news.

The commute into the city SUCKED. We hit so much traffic and it took an hour and 20 minutes to get there. Then we had to wait another half hour at the clinic to be seen. With only four exam rooms, it can get pretty crowded there.

I was shaking as I changed into the examination garment. I had been there so many times before for an ultrasound, but never to see if I had a baby growing inside of me. This was old but new.

I asked the doctor to check my tubes first. I was still so concerned about having an ectopic pregnancy. No, tubes appeared clear, and my ovaries looked normal too. Then we saw it. A little blob on the screen inside a black circle. That was our embryo. The doctor moved the cursor to a little blip of flashing light. That was the heartbeat. She turned up the volume and we could hear the rhythmic swish swish of the beat. Unbelievable. I was really pregnant, and we were watching and listening to evidence of that.

The embryo measured 4.4mm and the heart rate was 125. Right on target, according to the doctor. I was 6 weeks, 4 days pregnant!
I was to discontinue the PIO shots and schedule an appointment with my regular OB-GYN. As I am typing this, I am still waiting for that appointment. I don't think I'll ever be comfortable with the thought that I am pregnant until this baby is born!

Chapter Seventeen: Getting Better

So more waiting until beta #2, which was on Monday, October 8, 2007. I didn't have much hope for a higher number. A normally developing pregnancy is supposed to have beta HcG values that double every 2 days or so. I wasn't expecting much.
Surprisingly, my beta rose to 103, which was right on schedule. Things were looking up. However, the nurse, comparing my number to where a pregnancy should be at 17 days past ovulation, suggested that it could be an ectopic pregnancy. I was freaking out. I was under the impression that the chance of having an ectopic after IVF was far lower than with a natural pregnancy, because the embryo was placed directly into the uterus as opposed to the fertilized egg needing to travel through the fallopian tubes first. I was astounded when the nurse told me that the chances were about the same.

Then I started to wonder about the pain I had been having on my left side. Could that be an ectopic pregnancy in my left tube? I was freaking out even more.

I had to return on Friday, October 12 for beta #3. Four more days of waiting and I couldn't take not knowing anymore. After being so aware of everything that went on throughout the IVF process, no knowing what was happening inside my own body was driving me insane.

Beta #3 was 893. Unbelieveable. I was pregnant. When the nurse called, all I could say in response was 'Oh my god, oh my god, oh my god, oh my god'. I must have sounded like a complete idiot. That one little blastocyst was holding on. I was in shock.

My instructions were to continue with the PIO shots and return on Wednesday, October 24 for an ultrasound. By then, we should be able to see if there was a heartbeat. I couldn't believe I had to wait again. My husband was trying not to get too excited. I was trying to stay grounded.

Still, I couldn't help but POAS (pee on a stick). For the first time in my life, what I saw before me was a BFP (big fat positive). I ran out and bought a digital pregnancy test. There's nothing better than seeing the digital display say 'pregnant'.
It seemed like the 24th would never arrive.

Chapter Sixteen: Something

After two weeks of waiting, my beta day had arrived, Friday, October 5, 2007. I was so nervous because, despite everything that had happened, there was still a small chance that I could be pregnant. So I drove into the city early in the morning as I had so many times before, where my blood was drawn.

When the nurse called that afternoon with the results, I was shaking. She told me that my beta was 43. This was a very low number for 14 days past ovulation. A positive result, but a low number. The nurse suggested that it could be a chemical pregnancy. I was crushed. I wanted an answer. Even if the answer was negative, I wanted to be able to discontinue the PIO shots, move on, and prepare for the next step, whatever that may be.

So all that waiting, and I did not have a definitive answer.

Chapter Fifteen: With a Little Help From My Friends

One thing I haven't talked about yet is the wonderful support I had been (and still am) receiving from my friends in the online infertile community. For more than a year I have known many of these women who have been there for me during my most hopeless days. I am so grateful for so many of the friendships I have made.

When I would have a totally craptastic day, I could post about it and I knew that the IF girls would completely understand what I was going through. It has meant so much to me and I will always love these girls.

There's something about struggling with infertility that has brought so many different women together. These are women with very different backgrounds who live all over the globe, and who, other than sharing a history of IF, may have very little in common with me; and yet they have embraced me and shared with me their wisdom and empathy and friendship.

To all the IF-ers, I love you all dearly! ((hugs))

Chapter Fourteen: Wait

So now there was nothing to do but wait. I had to continue on with the very uncomfortable PIO injections. Why were we even bothering? With only one embryo making it to the blastocyst stage, and with the one blast not being of high quality, what should I even get my hopes up?

This was probably the longest two weeks of my life. When you're waiting to find out if you're pregnant, you don't know how you should act. Could I drink alcohol? Could I take medication? Could I eat sushi? What if that tiny blastocyst was implanting after all? It's such a state of limbo: pregnant but not really pregnant. It was seemingly, such a long wait.

Chapter Thirteen: I'm Down

I was feeling great. We had 18 embryos that were being carefully watched over by the embryology lab. Even if we lost half of them, we'd still have plenty to work with.

Wednesday, September 26, 2007 was my ET. DH & I had agreed, along with my RE, that we would transfer 3 if we had 3 good ones to transfer. I was willing to deal with multiples, and DH, well, he would have to deal with it! I was so excited to have our little embryos transferred.

Before the ET we met with my RE. It was then that she gave us the extremely disappointing news that out of the 18 embryos we had on Saturday, only one had grown and divided enough to be considered worthy of transfer. We had only one blastocyst. How terribly sad that so many of them did not grow. My RE also picked out two morulae, which, even though they were a day or two behind the blastocyst, we agreed to transfer them as well.

The ET was extremely painful. It was the worst pain I had ever experienced during any gynecological visit, EVER. And even more painful was the emotional pain I was feeling. Why did so many of our embryos fail to develop? Could we also be dealing with genetic problems as well? I cried during the entire procedure. I just knew this wasn't going to work, and here I was, laying on the table, spread eagle, going through all of this pain for nothing. This was probably the worst day of my life.

Chapter Twelve: Within You, Without You

So on the afternoon of Friday, September 21, I went in for my egg retrieval (ER). I was really nervous. The procedure consisted of long needles going through the vaginal wall in order to suck out the follicular fluid. Thank god I was given IV sedation and was completely under while the procedure was going on.

Upon waking up, I was told that they had retrieved 24 eggs! That was an amazing number, considering my age and that some women don't respond this well to the medication during their first IVF cycle. In fact, a good friend of mine had told me that in most cases, the first IVF cycle is considered more of a learning cycle, and does not work because there are so many variables to get just right. I was so thrilled that I had gotten over the first hurdle- I had plenty of eggs to work with. The goal was to have at least half of them fertilize, then transfer the best three and freeze the rest.

So after the ER I went home and rested. I was crampy but feeling pretty good about the way things had turned out.

The day of the ER I had to start taking two more medications, Medrol and Doxycycline. The following day I had to begin my Progesterone in oil (PIO) injections. These were also intramuscular injections and I relied on my DH to administer them. I would be on the PIO shots for at least two weeks.

The day after the ER we got a call from the clinic. Out of 24 eggs, 18 fertilized! This was fantastic news. This means we would have many more embryos to choose from. Our Embryo Transfer (ET) would be in 5 days. I was on cloud 9. I couldn't remember ever being this happy during the two years I had been TTC.

Sunday, October 28, 2007

Chapter Eleven: A Day in the Life

Simple, huh? There is a lot to learn and remember when you're starting an IVF cycle. Like when to start your meds, when to show up at the clinic for monitoring, when to stop certain meds and start others, when to overlap two or three meds, and most importantly, how to feign sanity.

The month of September, 2007 was a complete blur. I was grateful for my handy dandy IVF calendar.

First I was put on 28 days of Birth Control pills (BCP) so my cycle could be more accurately timed. While on BCP, I had to start on Lupron, which is designed to suppress the system so I wouldn't ovulate unless I was given a particular injection. After I finished the BCP, I was to lower my Lupron dosage and begin on my stims, Follistim & Menopur.

I had already had experience with the Follistim pen, which was very user-friendly. It was the Lupron and Menopur that terrified me. These involved regular needles and syringes and vials of medication that needed to be drawn and measured. I was pretty nervous about this. And the Menopur consisted of a liquid and powder that needed to be mixed. I felt like I was part of my own labaratory experiment.

And then there is the HcG trigger shot. Instead of being given in the belly fat subcutaneously, this was to be given right in the arse, through the muscle on the upper half of the butt cheek. The needle is 1 & 1/2 inches long. Because it needed to be given in the rear, my brave husband had to administer the shot. He was a little too eager, if you ask me. We had to wake up at 2am to get the shot, since I had a 1:30pm appointment for my egg retrieval a day later.

It's amazing how doing IVF changed me. Who would have thought that I would have had the courage to inject myself multiple times a day? I was brave to go through this. But most of all, I was grateful that I could. I know so many women who for various reasons, cannot do IVF, even though it is their only hope to conceive.

Chapter Ten: Tell Me Why

I spoke to my RE to see if she could offer some explanation for why, despite having the surgery and going through more ARTs, I still wasn't getting pregnant. She seemed to think that the remaining scar tissue could still be causing a problem. Even though she lased as many adhesions as she could during the laparoscopy, surgeons are never able to make it perfect. While I was better than before, I still had 'crappy tubes'. Fantastic!

After a long discussion with DH, we decided that trying IVF was worth a shot. My doctor didn't think I had any egg issues, like poor quality or low reserve. My BBT charts and bloodwork had always suggested that I had plenty of eggs left, and there was no evidence that they were of poor quality. For women with decent eggs but nowhere for them to go, IVF is usually the next step.

So we scheduled an appointment to meet with my RE for an IVF consultation. This was certainly a direction we never thought we'd go. But yet here we were. We discussed the procedure, all the various medications I'd be on and the increased dosages, how I had to follow a very specific protocol, and how my chances for becoming pregnant would be about 50%. The goal was to retrieve about 12 eggs and get three good embryos to transfer; the rest could be frozen for later use. It all sounded so simple and very promising.

Chapter Nine: I'm So Tired

In May, 2006 it was back to ARTs. What a bummer. Back to early morning wake-ups, schlepping my tired ass into the city for them to poke & prod my aching body, back to the side effects of the injectible medications, and back to having a belly that resembles a black & blue pin cushion. This just wasn't fair. Why do I hear stories every single day about accidental pregnancies? Why do those women deserve to become parents easily and I don't?

And more importantly, why were both cycles of injectable IUIs failures? I had the laparoscopy. My doctor had supposedly fixed me. Why couldn't I get pregnant, even with the aid of hormones, and doctors probing me, and nurses shoving sperm up my nether regions? Somethinig was still wrong but nobody could figure out what it was. I'm just so tired of all of this bullshit.

Chapter Eight: Why Don't We Do It In the Road?

So now I was fixed and I should be able to get pregnant on my own without the help of ARTs. Right? Sure! I went back to BBT charting with a vengeance. I could pinpoint the exact day that I ovulated. Surely we would be able to get this done without doctors, or nurses, or needles, or meds, or catheters. This was going to be great. We could procreate like normal people.

Or so I thought. Four months passed. Four cycles of charting, and four more BFNs, or 'big fat negatives' as we say in the online TTC forum world. But I was supposed to be fixed!

Saturday, October 27, 2007

Chapter Seven: Fixing a Hole

After two failed IUIs, I didn't know how to proceed. Clearly, something was wrong. My RE suggested that it could be the presence of scar tissue that was left over from my myomectomy. I had remembered that first u/s at the RE consultation appointment and hearing her comment about how my left ovary was stuck to the back of my uterus. While it wasn't likely that this was causing the problem, I didn't want to go through more medicated IUI cycles if there was another roadblock. It just wasn't worth going through the emotionally and physically taxing process of doing more ARTs.

So we decided that I would have a laparoscopy. It would be an outpatient procedure that would only require a few days for recovery. It would be worth it if she could find something that was causing my infertility and fix it.

I had the lap surgery in December of 2006. After the surgery, while I was in recovery, my RE came to talk to me. She told me that she had lased a lot of scar tissue. I didn't quite comprehend exactly how much scar tissue was removed, until I had my post-operative appointment. As she read her surgical notes to me, I was shocked to hear about how messed up my insides were. This was what she found:
  1. My left ovary was adhered to the back of my uterus (we knew that already).
  2. My right ovary was adhered to the right fallopian tube and to the pelvic sidewall.
  3. My uterus was adhered to my intestines.
  4. I had mild endometriosis.

Wow. All of these adhesions were a result of the myomectomy I had had a little over 2 years before. So my fibroids, although gone, still were having major after effects. No wonder that, even though my two IUIs appeared to be the solution to my problems, both were a huge failure. My poor little eggs were probably getting all caught up in all that scar tissue and had nowhere to go. But now it all was gone. I was fixed.

Chapter Six: I'm a Loser

IUI #1 was a failure. So was IUI #2. I just couldn't understand why I couldn't get pregnant, even under such ideal conditions. What more could we want than my husband's sperm being placed where it needed to be? I responded well to the medication. I had always ovulated on my own, but this gave me even more eggs for the sperm to find. So what the hell was the problem?

There's something about being the only married couple you know without children that is extremely isolating. It's like a club that you're not qualified to join. Infertility is a very lonely place. I felt like I was broken- damaged goods. Our friends were having babies left and right. It seemed like everyone else could have kids except us. What's worse was that no one understood the loneliness and isolation. People would make inappropriate comments such as, 'Be happy you don't have kids- they're so much work!' (right, because I didn't realize that before- thanks for the warning; now I'm so relieved that I'm infertile!). Once, a friend of mine, who was fully aware of the medical intervention I had been through, was complaining about how her toddler was starting to throw temper tantrums and asked, 'Are you sure you really want one of these?' There's nothing more hurtful than someone who can have kids speaking lightly of your situation. There was no one in my real life who would understand. Which is why I sunk lower and lower and stepped farther and farther away from my friends.

Chapter Five: Come Together

The day had come. I had gotten my HcG trigger shot the previous morning, and now we were ready for my IUI. DH & I got to the clinic early so he could do his part. After a leisurely breakfast at Sarge's Deli, we returned to the clinic for my insemination. After verifying that the contents of the little tube did indeed belong to my husband, I was able to see the results of the semen analysis. Stellar, as always. While I'm always so happy to see that my DH's sperm are of good quality, it often puts more of the blame for our troubles conceiving on me.

I was really nervous the first time I did my insemination. It involved stirrups and speculae, two things that I never enjoyed. This time it also involved a long catheter, through which my husbands sperm would be sent directly into my uterus. The procedure was very uncomfortable and caused a lot of cramping, but after 20 minutes of relaxing, I could leave.

Now there was nothing stopping his sperm and my egg(s) from meeting. Before IUI, you never knew if those little swimmers could get to where they needed to be. Now, there was nothing stopping them. So we thought.

After the IUI we hung out in the city for the remainder of the day. We went to see The U.S. vs. John Lennon and then walked through Strawberry Fields in Central Park. I thought that would bring me good vibes for conception. I was so hopeful that cycle. My first IUI with injectables just had to work.

Chapter Four: I'm Looking Through You

One of the dangers of ARTs is something called Ovarian Hyperstimulation Syndrome (OHSS). In order to make sure that this does not happen, my clinic monitored my hormone levels and follicle growth. The goal with ovulation induction therapy is that you want there to be two or three dominant follicles which grow much larger than the rest. The ones that grow large enough to be considered mature will release mature eggs once the HcG trigger injection is given. However, if the follicle growth is not properly monitored, they can be stimulated too quickly and many more follicles can reach mature size. This causes the ovaries to become very bulky and heavy and there is a risk of them twisting around upon themselves and cutting off the blood flow to the ovaries. There is also a risk of fluid being released from the cyst-like follicles and causing severe discomfort.

This is why I was required to return to my clinic every few days for careful monitoring of my cycle. This would consist of blood draw to check my estradiol (e2) level, and a follicle scan so the doctor could measure the dominant follicles. It was very much up to the doctor on call that morning to determine if the follicles had reached mature level. That, and my e2 level would determine when I was to receive my HcG trigger shot. I would watch the the doctor click his or her cursor on the u/s monitor at various places on each follicle to measure it. A follicle of 18mm or greater is considered mature.

Each day that I visited the clinic, one of the nurses would call me that afternoon to give me instructions for that evening's medication dose. These instructions were based on the e2 level and the size of the dominant follicles.

Chapter Three: What Goes On

IUI seems like such a simple concept: you go to the clinic, they place sperm in your uterus, and the little spermies swim around, find the egg, and fertilize it. There- instant pregnancy!

Well, it really wasn't all that simple at all. First of all in order to increase our chances, we decided to start on an injectible medication. This would help me to produce more eggs each cycle, which would increase the number of targets for the sperm. It also increases the chances of multiples, but that was a chance we were willing to take. After all, if I could get pregnant with twins, we wouldn't have to worry about doing any of this ever again.

So I went to my injectibles class and learned how I was to inject the medication. It seemed so simple: the medication came in a pre-filled cartridge that you placed into a pen. You attach a micro-fine needle and inject it into your belly fat. Simple.

Before I could start the cycle, I had to go in to the clinic for a baseline blood draw and u/s. They needed to be sure that my body was ready to start stimming. This was the first of many early morning visits to the clinic. My clinic was open from 7-9am for monitoring. Which means that I had to drive into Manhattan, find parking, and get to the clinic with enough time to have a scan and my blood drawn, while still getting to work on time. Which means that I had to wake up at the crack of dawn, battle rush-hour traffic, all while experiencing the side effects of the medication: mood swings, hot flashes, headaches, ovary pain, and a sore & bruised belly which resembled a pin cushion. The medication was enough, but add to it the early wake-ups and rush-hour traffic, I was quickly losing my mind.

Chapter Two: It Won't Be Long

So we moved on to the wonderful world of ARTs, or Assisted Reproductive Technology, in September of 2006. It's amazing how our views on this had changed. At the beginning of our TTC journey, we were in agreement that if we couldn't conceive on our own, that we'd pursue adoption. A year later, after 12 cycles and 12 disappointments, we thought we'd give ARTs a whirl. By this time I was involved in an online community of women who were experiencing infertility as I was, and my exposure to medical intervention was increasing. It seemed to be such a common thing, at least among the infertile crowd.

Fortunately, my health insurance would cover up to six Intrauterine Inseminations (IUI) and all the medication I would need. Fantastic. Except I was confident that I wouldn't need six. With my new RE and our new plan, this would surely work. I'd be pregnant soon.

Chapter One: The Long and Winding Road

First, a brief history about our journey. DH & I got married in October of 2002 at the ages of 34 and 32. We knew from the beginning that having our own biological children might be a challenge. I had been diagnosed with multiple uterine fibroids, which could cause major complications if I ever managed to get pregnant. Since we weren't planning on TTC (trying to conceive) for at least a couple of years, we decided to be proactive and remove the fibroids surgically. I had a myomectomy in August of 2004, during which 9 fibroids were removed. We weren't allowed to start TTC for at least a year, which brings us to October of 2005. However, we were told by my surgeon that I shouldn't have any difficulty conceiving; my uterus had been beautifully surgically reconstructed. Ha!

It's a scary thing to have unprotected sex for the first time. If everything I believed from Junior High School was true, I'd be knocked up the moment my legs were spread. They really don't teach you a lot in school about making babies.

For 6-8 months we continued this naive behavior. I was already 35/36 so I figured it might take me a little longer. I consulted my OB-GYN who sent me for some tests. I had hormone levels checked, I was sent for a HSG to determine if my tubes were open. That was such a fun test! It was performed by a male radiologist with absolutely no bedside manner and was extremely painful, uncomfortable, and humiliating. All of my testing came back completely normal. DH was also sent for a semen analysis, which also was normal. So why wasn't I getting pregnant?

So I decided to start BBT charting. Charting is good because it helps to pinpoint your most fertile days. Charting is bad because you find yourself becoming obsessed with it. Did my temp go up or down? Did I ovulate yet? Why didn't I ovulate yet? Oh no! I only got 2 hours of sleep before I took my temperature! Should I record the 4:30am temperature or the 6:30am temperature? You completely lose touch with reality and can't even remember what day it is, unless you're talking about what day it is in your cycle or how many days past ovulation you are. I won't even go into how you're supposed to check your cervical fluid.

To say I was obsessed with my chart is an understatement. My poor DH had to put up with my behavior. I hear so many people make jokes about how fun it is to try to get pregnant. After all, it's about having as much sex as you can, right? Well those people have never had to TTC while charting. No way. If you're a long-time TTCer, you know what I mean. Sex on demand is not fun at all.

This is turning into much more than a brief history. It's almost at the end, I promise.

In September, 2006, we were almost at the one-year mark of TTC. They say that the average healthy couple can take up to a year to conceive. Once you hit that year point, you're considered 'infertile' by the medical community (and by TTC forum standards too). So we decided to seek help from a specialist. I had my consultation with a Reproductive Endocrinologist (RE). She ordered blood tests, looked at my BBT charts, and did an ultrasound (u/s). Upon performing the u/s, she discovered that one of my ovaries was stuck to the back of my uterus. She thought it was most likely due to residual scartissue from my myomectomy. She didn't think it would cause a huge problem with conceiving, but as we would learn later on, that was just the tip of the iceberg.