Moving

I decided to try out Wordpress and have moved the blog over.

Please follow us and our journey to a new URL: http://infertileinseattle.wordpress.com/

I'm looking forward to seeing you there...

The Period

The slight cramping that gave me hope on Saturday morning was foreshadowing of the news I was to receive that afternoon. I got the pregnancy test news at 1 pm and by 7 pm, my period had arrived. It was as if my body was holding out for the official word that this cycle was over.

I must admit that this month's friendly visitor comes with new meaning. It is a daily reminder of the embryo that no longer is and the baby that never was.

I bet there are hundreds, if not thousands, of young girls and women out there that breathed a sigh of great relief when their period arrived this month. It is amazing to think I was once on that side of the fence. It is hard to believe that there was a time in my life (noted 11+ years ago) when a positive pregnancy test was unwanted.

It is now the one thing in my life that mysteriously eludes me. It is the one thing in my life, I want the most.

A look back

As we decided what we want to do next, I wanted to take some time and remember and reflect on the road we've traveled thus far.

Here is a documentation of our journey over the past 2 years. Although I've been keeping detailed notes on each of our cycles, seeing the list of what we've gone through all in one place is a crazy reminder of the emotional and physical challenges we've faced. 8 medicated cycles. 4 rounds of IUI. 1 round of IVF. I wonder where our story will go from here...

May 19, 2008 -- Birth Control Ends. Let Baby Making Begin!

October 20, 2008 -- 161 days without a period. In to the Dr. I go for some Provera.

October 31, 2008 -- Provera brings on a Period. BBT Tracking Begins.

February 17, 2009 -- Sporadic Periods. Back to the Dr. I go.

February 28, 2009 -- 1st cycle on meds: Clomid.

March 29, 2009 -- 2nd cycle on meds: Clomid.

April 4, 2009 -- 1st visit to Reproductive Endocrinologist: Dr. Lynn Davis (SRM)

April 6, 2009 -- Hysterosonogram (to look at my uterus & fallopian tubes).

April 10, 2009 -- Follow-up Ultrasound to look at uterus

April 11, 2009 -- MRI to examine uterus. Septate uterus suspected.

May 10, 2009 -- Surgery on uterus.

June 1, 2009 -- 3rd cycle on meds: Clomid.

June 29, 2009 -- 4th cycle on meds: Clomid.

July 27, 2009 -- 5th cycle on meds: Letrozole and 1st round IUI.

August 23, 2009 -- 6th cycle on meds: Letrozole + Follistim and 2nd round IUI.

September 18, 2009 -- 7th cycle on meds: Letrozole + Follistim + Estrogen and 3rd round IUI.

October 8, 2009 -- Acupuncture Begins

October 14, 2009 -- 8th cycle on meds: Letrozole + Follistim + Estrogen and 4th round IUI.

December 8, 2009 -- Meet with new Reproductive Endocrinologist: Dr. Letterie (NCRS)

December 12, 2009 -- Monitor Natural Cycle

January 27, 2010 -- Begin IVF Suppression

February 25, 2010 -- Begin IVF Cycle

March 6, 2010 -- Egg Retrieval, 15 eggs

March 11, 2010 -- Day 5 Embryo Transfer, 1 Grade 3-4

March 20, 2010 -- Negative HCG Beta. IVF Cycle Failure.

The Next Day

I went to bed early last night with puffy eyes and an awful headache as the 5 hours straight of crying took a toll on my body. I am sad about our failure, but much of the sadness I feel is about our future. I read about people who undergo 3, 4, and even 7 attempts at IVF. Some with sucess, others without it. How far will we go to have a baby?

The Dr. posted some extra notes along with the beta test results late yesterday afternoon on the online patient portal about the state of my lining when it was last checked. On the day of egg retrieval, when it should have been at its highest (9-11 mm), mine was noted as "measurements range from 3.74 to 5.65 mm." The patient portal is typically updated real time with results and details, so I think the delay of information was very intentional as was brief answer of "looks good" the Dr. provided when we inquired post-surgery. Now, my first instinct is to be upset that she misled me with that response. But at the same time I respect what she was doing. She knew we were committed to doing the transfer, so there was no point in giving us bad news going into it. Positive thinking and hope is what we needed, and in that moment that is what she gave us.

That additional information does serve to provide us with a possible explanation of what went wrong. We'll know more when we sit down with our Dr. to do our cycle review which I hope to get scheduled this week. The scary thing for me is that it makes no sense why my lining would have gotten thinner (it measured 7mm earlier that week) and be so thin with an estrodiol level in the 4000s. Lots of estrogen was definitely present in my body, it is almost as if my body just doesn't know how to process it correctly. In all of my research, it seems like this complication maybe one that is difficult, and sometimes, impossible to fix. And, that reality is what has me deathly afraid.

In speaking with my sister again last night about this added information, while she admits that as an OBGYN this level of reproductive endocrinology is out of her league, she also recognizes that this problem with my lining, despite high estrogen levels is a difficult one. Even with the best embryos, without a welcoming uterus, a baby cannot survive. The conversation eventually drifted to our other options including surrogacy and adoption. Both are options I know are there. Both are options I really can't face right now.

I wish I had a crystal ball and someone could tell me either way, if I will one day be able to carry a baby. I even jokingly told the Husband last night I wanted to see a psychic (he thought I said psychiatrist, should I be offended?!) to get some answers. I would go through 10 IVF cycles and 4000 shots if I knew one day I would be successful. As fearful as I was about all of the shots or the surgery, it is the fear of the unknown that is the worst fear of all.

Day 52: Negative

At 1:00 pm on the nose, we got the call we'd been waiting for. It came earlier than we expected (we were told between 2-5 pm) so we were out on a walk enjoying Lake Washington and the sun. I stopped dead in my tracks on the trail when the phone rang and the familiar 425 number appeared on screen.

"This is blah blah from Northwest Reproductive. I wish I had better news...."

It was in that moment that my throat constricted, my eyes welled with tears and I said: "It's negative, isn't it?"

"Yes, yes. I am sorry to tell you, you are not pregnant."

I don't remember much more of the conversation. I do remember the tears and sobs that came as I hung up the phone. The Husband was standing next to me and could tell the news immediately. He gracefully put his arm around me and led me to a nearby bench where we sat and cried. I am not sure how long we were there, my guess is about 35-40 minutes. Not too many words were exchanged during that period. Just the occasional "I can't believe it" or "where did it go wrong?"

The first and only phone calls I made were to my mom and my sister. I could barely choke the words out, "It didn't work." They were so sad for us, as were all of our friends. It seems that everyone wanted this for us just as much as we did. Today, we were all collectively disappointed by the news.

It's funny. I think deep down I new it was negative. As much as I tried to remain positive over the past 10 days, something in my gut told me this wasn't it. I tried and tried to bury that feeling with lots and lots of positive thoughts. I'd remind myself that the odds were on our side. 65% chance of it working. I'd talk to the Bean (that is what we nicknamed our embryo) everyday and rub my belly, but somehow I knew the Bean wasn't there talking back. The fact that I was scared and not excited to test, was further proof of my doubt.

But regardless of this intuition, I still held out hope and the news still managed to hit me like a ton of bricks. I am devastated. I never thought it was possible to feel this much pain and disappointment. My mind continues to race with thoughts of what happened, what went wrong, what will happen next. My heart continues to grieve for what could have been. My eyes can't seem to stop with the tears.

But despite the pain and sorrow we feel today, I know that life will go on. I know that tomorrow will be a new day. I know that we will try again.

I know that some day I will be a mother.

Day 50: A Moment of Weakness

I stood in the shower tonight and had a moment of weakness thinking, "All I need is a home pregnancy tests and the answer would be mine!"

I went back and forth on the pros and cons of an early test while I stood there. As much as I want to know, I am SO SCARED about the results that I am deathly afraid of testing. I made up my mind before I got out that I've waited this long and another 48 hours for the "official" results wouldn't hurt me.

I must admit even after making that decision, I got out of the shower, dried off and checked under the bathroom cupboard to see if I had any extra pregnancy tests left from previous cycles. Thankfully I don't.

48 hours more. I can hardly wait!

Day 48: Waiting, Waiting, Waiting

I am naturally a very impatient person and this week-long wait is killing me!! My emotions fluctuate from feeling very hopeful and optimistic to feeling domed and disappointed. Tears come easy and my mind is constantly wandering to my belly and what may or may not be growing inside of me. The past few days have been an emotional roller coaster and Saturday cannot come soon enough.

I am excited to hear the results. I am also so very scared. I know that whatever news we hear our lives will be forever changed. This IVF process has changed me and I know the result will forever impact me as well.

I so want it to be real. For all of our hard work and sacrifice to pay off. For the good news to be ours to share. For it to finally be my turn.

Day 46: 2 Left

We found out yesterday that they were able to freeze 2 of our embryos. From the 15 eggs retrieved 1 week ago, in the end we netted out with 3 healthy embryos. One in my belly and now two safely in storage. While I hope, pray, beg, plea that we won't need those extra ones, it does make me feel a bit better that they're in safe keeping.

It is hard to believe that this time next week we'll know the outcome of this journey...T-6 days.

Day 44: Relax

With the transfer behind us, we can finally take a deep breath and try to relax. Today was the first day in quite some time that my skin had not been penetrated by a needle. All total, I calculate 40 shots over the past 17 days. I have the bruising, sore muscles and swelling as a reminder of what we've been through, but the end of the daily shots is the first step in returning to our 'normal' lives.

I stayed home from work today and focused as much energy as possible on making our embryo feel nice and welcomed in my belly. I was treated with a mid-day visit by a dear friend with lunch and support and I hope that our little embryo is feeling as loved and special as I did by her visit.

Although it often feels that the burden of this process has rested primarily on my shoulders and on my body, we couldn't have done it without the love and support a select group of dear friends and family members. Thank you everyone for the hugs, pep talks, special treats and love. We really couldn't have gotten through these past 44 days (or two years!) without all of you.

Our "sharps receptacle." Overflowing. Thank god we're done!

Big Day #2 - Transfer

Hello from the couch just a few hours post transfer. I got myself one of those lap desks so that I could efficiently lay down and work from home on my laptop. I am liking this set-up. Today was our transfer day and I am excited to tell you all about it!

I had a rough night last night as I witnessed my already fluid-filled belly expand and get larger and larger. At one point I saw the Husband's eyes bulge when I lifted my shirt and I knew that things were getting worse, not better. I was so scared that I was coming down with hyperstimulation and our transfer today would be cancelled. After a 5 am chat with my sister who is an OBGYN and a morning acupuncture appointment I was feeling more relaxed as they both put my mind at ease that what I was feeling was most likely a mild case since I was still free of any of the serious OHSS symptoms (difficulty breathing, nausea, vomiting, rapid weight gain, etc).

We walked in to our transfer appointment at 1 pm with a fully belly (from lunch), 2 very swollen and full ovaries and a VERY full bladder due to their request for 20 oz of liquid 1 hour before the appt. After both changing into hospital gear (gown for me, scrubs for him) we were set up in a recovery room. After what seemed like forever (remember the full belly!), the Dr. came in with our final embryology report. From the 8 we had on Tuesday, 5 embryos still remained. They had selected the absolute best embryo for our transfer which was considered a Grade 3-4. Being the perfectionist I am, I was bummed that we didn't have a 5 so I asked her why. The Dr. was quick to point out that she rarely sees a 5 and ours was a very good looking embryo. Here is a photo of our embryo. There are three distinct parts to a blastocyst - the two cell types and the fluid cavity. I've done my best here to mark up the two cell types that make our embryo so pretty.



As development of blastocysts progresses, the cells in each of the 2 components divide and the fluid cavity enlarges. With continued blastocyst development the embryo expands, the shell thins, and it hatches out of its shell. Blastocyst implantation into the lining of the uterus can then begin and at that point we're pregnant!!

So next up for me is a fair amount of rest, just giving my body the opportunity to focus as much energy as possible on making our little embryo feel nice and welcomed. We'll get a call tomorrow with the final report of our 4 remaining embryos to see how many we'll have left to freeze based on how they progress over the next 24 hours.

Thanks for everyone's love, support and well wishes. Fingers crossed!

Day 42: 8 still in it

We heard yesterday (Day 3) that our embryos were looking good and therefore we were pushed to a Day 5 transfer which will happen tomorrow. A Day 5 transfer is exactly what we wanted. We'll have even more information about the quality of the embryos 5 days after fertilization than we did at 3, allowing us to select the very best to put back.

Of the 10 eggs that fertilized, as of yesterday we were down to 8. 5 of them were considered a Grade 3 or higher (5 is the highest grade) and 2 were at a Grade 2. We'll know tomorrow when we go back in what their final grades are when we talk to the embryologist.

I am so nervous and scared. I can't wait!!!

Day 40: Worry Wart

Today was my first day back at work since the Egg Retrieval. Still in a fair amount of pain/discomfort, but I hear it is normal for this stage of the recovery. All day I couldn't help but think and worry about our 10 little embryos. I really hope they are doing well and progressing as they should. At one point I IM'd the Husband expressing my worries and he was quick to respond that they are in very good hands. Perhaps he is right, but I can't help but worry.

We'll know tomorrow morning how many embryos have survived the past few days and if we are set up for Day 3 (Tuesday) or a Day 5 (Thursday) transfer. Our goal would be a Day 5 (Blastocyst) transfer since we know by growing embryos to the blastocyst stage in the laboratory we can deliberately weed out the embryos that do not have the genetic potential for continued growth; therefore leaving us with better quality embryos for transfer.

But we realize it is out of our hands and we can only hope for the best. I'll post an update tomorrow.

Day 39: Decuplets

I am so happy to report that My eggs and the Husband's sperm got along swimmingly and we got a call this afternoon with the report of 10 fertilized eggs. This means that male and female genetic material (DNA) are contained in the 2 pronuclei seen in the zygote. I was so excited to hear news and started hugging the Husband claiming "we have 10 babies (decuplets)!" Technically, they aren't babies yet, but I can't help but be excited about our DNA now coexisting in 10 zygotes. Now all we need is our fertilized eggs (zygotes) to continue to progress the the next phases of development (zygotes --> embryos --> fetus --> baby!)

Overall I am feeling much better than I was yesterday. I am still on quite a few drugs which will taper off over the next week or so and the side effects of each along with the fluid in my ovaries make me quite uncomfortable, but I realize I am in the home stretch and am determined to power through it. Here are the meds I am on currently:

- Progestrone in oil shots 2x per day intramuscular (in the butt)
- Doxycycline 2x per day (to prevent infection from the retrieval surgery)
- Medrol 1x per day (steroid hormone is taken to suppress any inflammatory reaction that might occur between the embryo(s) and the endometrial lining.

And, here is a photo showing you what our 10 fertilized eggs should look like. Can you see the 2 pronuclei?

The Egg Retrieval

Just a quick update on today. Everything went well and they were able to retrieve 15 eggs! Each one of those eggs are now shacking up with 100,000 of Husband's sperm. I hope they get along.

We'll know by tomorrow afternoon how many were fertilized. I am excited to hear the news.

In the meantime, it is back to the couch for me.

Night.

Day 38: Big Day #1

Today is Big Day #1 - Egg Retrieval! We've been waiting for this day for quite sometime. 37 days to be exact. But in a lot of ways the entire 2 years we've been trying has led up to this day.

My blood work from yesterday morning showed a big jump in my estrodiol level. It is now at 4,500 (up from 2,500) the day before. Each mature follicle will produce ~150-300 units of Estradiol, so based on my current level we'd suspect anywhere from 15-30 eggs to be harvested today.

I am about 75% excited going into today's surgery and 25% scared. The scared % took over last night on my drive home from work. The weight of everything we've gone through and will go through all hit me at once and I began to sob...

Day 37: Fingers Crossed

I was back at the Dr. this morning for yet another round of blood work and an ultrasound. Follicles are looking good and estrodiol is now up to 2527. We got the call this afternoon to proceed with the trigger shot of HCG tonight and our egg retrieval surgery is scheduled for Saturday at 9:30. It will be 100% confirmed after a final round of blood work tomorrow morning.

The only bit of bad news from today's appointment was that my uterine lining was measuring just under 7, which is the same size it was yesterday. It should be growing ~1-2mm per day and with my estrodiol level so high the Dr. is slightly concerned at how my lining is progressing (he would have expected it to be at leat 8-9mm). The uterine lining is important in this whole IVF equation as embryos need to implant in the endometrium and an optimal lining is thick and rich with blood vessels providing nutrients to the embryo. I've had a problem with my lining in every cycle we've done for the past year so this isn't a complete surprise, I guess I was just hopeful it wouldn't be a problem given the drugs I'm on this round.

The biggest risk at this point is that the Dr. will advise us that the conditions aren't ideal for a transfer and we'll be given the option to freeze all of our embryos until my body's had time to create a better lining. Obviously this isn't ideal and I am quite bummed even thinking about this possibility. So I am determine to do what I can to improve things between today and Saturday.

I know that one of the things acupuncture can really help with is blood flow the the uterus which can improve the lining so I made an 'emergency' appt with my acupuncturist this afternoon. She tried a therapy with me called "Electroacupuncture" which is a form of acupuncture in which pairs of acupuncture needles are attached to a device that generates continuous electric pulses between them. So my quest for a baby reached a whole new level today as I laid on the table face down, with needles in my lower back and legs connected to wires and some type of electric machine that generated continuous electric pulses. It hurt a bit and was the strangest feeling. I laid there thinking: OMG this is crazy!!!

I'll go back tomorrow for another set of blood work with a follow-up appointment with the acupuncturist for another round of electroacupuncture. So tomorrow between 8-10 I'll be poked, prodded and electrocuted...all in our crazy pursuit of having a baby.

At the very least I'll be able to look back on this cycle and despite all of the bruising, bloating, crying, and pain, I'll know in my heart that I've gave it all I got.

Day 36: Getting Closer!

We were back at the Drs this morning for another ultrasound and blood draw. My right vein is getting some serious action these past few days and no matter how many times I get pricked, it is still so odd to see blood flowing out of my veins into vials. Estrodiol level is now up to 1528 and I currently have about 16 "big" follicles measuring 14 - 17 mm in size and then 8-10 smaller ones. They want to give the follicles one more day so I'll go back in tomorrow for another check. The nurse said she is 90% positive they'll 'trigger' me tomorrow, which will mean the egg retrieval surgery will most likely be scheduled for sometime on Saturday. Just a few more days, I can't believe it.

I got the sweetest care package today from my older sister. She also struggled with infertility, but was successful in a gonadotropins cycle last year and has a baby due in just 4 weeks. My care package contained magazines to keep me entertained during my recovery and lots of healthy snacks. But the most special gift was a little stuffed sperm. It was a good luck sperm one of her friends gave her during her cycles and she wanted to pass the luck along to me. The good luck charm worked for her, I can only hope it works for me as well!

Day 35: Slow & Steady

We're 6 days into the stimulation process and we had an appt with the Dr. again this morning to check my progress since Sunday. Estrodiol levels are up (as to be expected) at 1074. They also tested my LH (1.63) and Progesterone (.59) levels.

The Dr. spent a fair amount of time measuring each of the follicles to get a sense of development using the ultrasound. So far I have about 15-20 follicles total in development with the bulk of them at developing at a similar rate, which is exactly what he wants. He surprisingly wants to see me back again tomorrow for additional blood work and testing so the methodical monitoring continues. In the meantime, my instructions for tonight and tomorrow morning were to drop my meds dose down to 50 units. The trick here is slow and steady growth of the eggs.

I also had an acupuncture appointment tonight and my Chinese medicine diagnosis is also a good one. She said my energy has been really great over the past few weeks and my tongue and pulse were fantastic today! I'll see her once more before the egg retrieval surgery, then once between egg retrieval and embryo transfer and finally 2x on the day of the embryo transfer.

So I am thrilled to have good reports thus far from both Western and Eastern medicine. Yippee!