Monday, September 28, 2009

Great Expectations

When I read about someone embarking on IVF, the one thing that I'm always interested in is how did they get there? What happened in the months or years leading up to the moment that they decided to go through with this procedure? Our path to IVF was not diagnosis indicated, so maybe our story will help someone else grappling with the decision?

Without further ado, Niki and Joe's Not So Excellent Adventure.

July 29, 2008: Paragard (Copper/non-hormonal) IUD removed. We're told it can take up to three cycles for my period to self regulate.

August 8, 2008/Cycle #1: AF arrives on time. Apparently it takes my body only 10 days to self-regulate. Whoo-hoo this is going to be easy. Let's get busy (pun entirely intended).

September 6, 2008/Cycle #2

October 4, 2008/Cycle #3: You mean I didn't get pregnant in two months? Something must be wrong. (insert sarcasm here). Start looking into pregnancy resources. This is my first cycle charting.

October 31, 2008/Cycle #4: Got this charting thing down pat. Sex is timed perfectly. This is SO it. It has to be! I've fingered myself (aka checked cervical position) at 6 a.m. nearly every day! FAIL.

November 26, 2008/Cycle #5: Still charting. Holding on to shitty statistics like "60% of couples get pregnant in the first 6 months of TTC". Three of Joe's friends announce their pregnancies back to back. We've been together longer, married longer, trying longer. One even comes to our house and gives us unsolicited advice on "how to get pregnant". Really hoping this is it. I'm supposed to test on Christmas Day. This would be the best Christmas announcement. December 23 = BFN. I hide the pregnancy test in the garbage can at Joe's parent's house and cry in the shower.

December 23, 2008/Cycle #6: This is my first short cycle. AF comes more than a week early. I went 22 days with a 10 day LP. I call the gynecologist. Is this a LP defect? Dr. Google says it might be. Starting to panic. Nurse tells me they can squeeze me in for an appointment in February. I take it and breathe a sigh of relief.

January 14, 2009/Cycle #7: Chart is looking awesome right up until 12DPO. AF arrives right on time.

February 10, 2009/Cycle #8: I'm praying that this is it for us. Even Joe, who was a bit more detached from TTC, is starting to wonder what the hell is happening.

February 25, 2009: Meeting with gynecologist. I arrive to the appointment early armed with 6 months of fertility charts and several questions. The doctor runs over an hour late to my appointment. I finally get back to her office and she asks me why I'm there. Huh? What? Oh, um, well I had a 22 day cycle back in December and we've been trying to conceive for 7 cycles, this is #8 and, well, we're not pregnant yet, and I'm just getting worried.

Dr. yells at me. It can take up to a year to make a baby. I tell her I know this, but our timing is so good and something just doesn't feel right about what's happening. Dr. tells me it's my fault that I'm not getting pregnant. I am making my body too stressed out. I'm creating a hostile environment for pregnancy. She tells me that this is all my fault again. She tells me that I'm not pregnant again right now, she can tell by looking at me. I'm not pregnant and I'll never get pregnant. Type-A people don't get pregnant.

I'm fighting back tears. My voice steadies and I manage to squeak out how good our timing has been. How do I know about my timing? Oh, um, we chart. Did you bring the charts with you? Yes. Let me see them. No that's okay. No I want to see them. No really it's okay, it was stupid to bring them. Give me the charts.

No wonder you're not pregnant, look at this, look at all these things that you're tracking and monitoring. No one gets pregnant like this. You'll never get pregnant like this.

Thank you for your time. She hugs me at the door to the office and says that she didn't mean to upset me, but someone had to make me understand how crazy I am being.

I call Joe from the elevator, but I have nothing to say. There are no words.

March 5: I test early at 11DPO. Faint line. Or at least I think it's a line. I pee on 9 more internet cheapies. I see something weird on all of them. Joe doesn't see it. Girls from Getting Pregnant tell me that this is what their BFP's looked like at 9DPO. This is it.

I lose it in the shower. Thank you God for this moment. Thank you. I tell Joe that I think we're pregnant. He doesn't really think it's happening. I can't focus at work. This is it. Secretly I can't wait to tell the doctor that I'm pregnant, take that biotch!

March 6: I test again. No line this time. What is going on? Where's my line. Trying not to lose hope. But these look more and more like evaporation lines.

March 9: OMG my temps are still high at 15DPO. Still no line. I show my mom the tests from March 5, she thinks they look more gray than pink. But 75% of couples get pregnant within nine months; this has to be it for us. It has to. BFFN.

March 10, 2009/Cycle #9: After the events of the last 30 days, we decide to "take a cycle off". But are you ever really not trying? I call and make a new patient appointment with a new gynecologist.

March 21-23: Tons of EWCM. Figures. I'm not charting. I have no idea where I am in my cycle. I'm already regretting the decision to take the cycle off. Fuck.

April 7: new patient appointment at new GYN. She says that cycle 9 is a bit advanced, decides to start basic infertility testing. Writes us an Rx for CD3 bloodwork, CD12 ultrasound and an SA.

April 8, 2009/Cycle #10: Joe asks me to stop charting. Clearly it's not helping. I agree to stop taking my temperature, but ask to keep recording OPKs and CM. He says this will be okay. We decide to try having sex every day of the cycle; maybe we're just missing our window?

April 10: CD3 bloodwork completed. Everything comes back in normal ranges.

April 20: CD 12 ultrasound fell on a Sunday so they scheduled me for a CD 13 ultrasound on Monday. This because day 11 is too early and day 14 is too late. However, my day 13 ultrasound is cancelled because radiology tech went home sick. I'm irritated. I have to reschedule for the next cycle. More delays. IF is starting to put a strain on my marriage.

April 21: Joe drops off his sample to the urologist.

May 3, 2009/Cycle #11: after 25 days of straight sex we are both chafing and uncomfortable. Joe has turned into Sting. However, tantric sex is not on the agenda. We both want to cry. We decide to just have sex every day from day 7 through 17. Even this plan makes me want to cry. I really don't want to have sex with my husband ever again. Doctor orders an HSG.

May 6: Joe has to cancel his SA because of work. I lose my shit. This proves to be a breakthrough for us though. Now he's taking this seriously and now we're a team.

May 8: SA results appointment with urologist. Joe has a physical there too. His results are stellar.

May 14: CD 12 ultrasound. Several small follies and one dominant follie. Gynecologist says ovulation should occur in the next 24 hours. This is confirmed by OPK tests. Our timing has been excellent. If we are pregnant this cycle we will find out on Joe's mom's birthday. This will be a great birthday present.

May 22: I start acupuncture. I stop acupuncture.

May 31, 2009/Cycle #12: AF comes a week early. 23 day cycle, 11 day LP. Doctor says this is "normal". I don't feel "normal".

June 5: horrible, awful HSG. But everything is clear. New plan, we will do three rounds of Clomid, hCG, TI with gynecologist. If we're not pregnant by August we'll get an RE referral.

June 23, 2009/Cycle #13: first Clomid/hCG/TI cycle with gyn. She tells us that there's a 40% increase in pregnancies the two months after an HSG. Joe is hopeful. I am. Well. Nothing. I just am.

June 24: the pharmacies are OUT of hCG. Whaaaat? I have to drive to 10 pharmacies. Apparently the  manufacturer has the product on backorder. How can this be? In the end Wal-Mart comes through. OMG.

June 27-July 1: Clomid

Thursday July 2: CD 10 ultrasound. Radiology tech says she sees two mature follies, one at 18 mm and one at 21 mm. I may be able to trigger today.

My doctor is out of town for the holiday. One of her partners is supposed to review our u/s results with us. We're left in the waiting room with newborns and pregnant women for nearly 90 minutes. A nurse comes to tell us that the doctor is too busy to see us. Two women have gone into labor. I start to cry. Nurse doesn't understand why I'm crying. I tell her this is our first medicated cycle. She offers to trigger us and talk to the doctor to get our results.

Nope. He's too busy. He'll call us by the end of the day. She triggers us. We go back to work. Doctor never calls.

We don't know when to have sex, what the trigger does, how this all works. I ask the TTTC board what to do, they say have sex. We have sex every day through the weekend.

Monday July 6: My doctor calls us to review the ultrasound results. I don't return the call. It's too late for the information to be helpful. We feel cast off and un-taken care of. We decide we want to go straight to the RE if this cycle is a bust. Getting ignored for pregnant people is simply unacceptable.

July 10: Called RE and scheduled a new patient appointment, just in case.

July 17, 2009/Cycle #14: another break cycle. We're exhausted and are going on vacation this month so we can't do meds because of timing issues. I think we're ready for a break anyway.

July 23: first RE appointment. We're given lots of options.

We are told that I actually only produced one mature follicle on Clomid and that my lining was only .3 at time of trigger. A minimum of a .6 is needed for implantation. They shouldn't have triggered me. We are VERY happy that we left the GYN's office.

August 14, 2009/Cycle #15: We take cycle off to be monitored, let the RE see what my body can do on its own.

August 17: New CD3 bloodwork

August 20: SHG

August 25: CD11 and CD12 ultrasound. Unexplained diagnosis confirmed. We're not sure how to proceed from here.

August 31: IVF Orientation Class. After the class we think slowing down and starting with Letrozole is the best option for us. IVF just seems so overwhelming.

September 3: we find out our insurance counts everything in a treatment cycle against our $10K lifetime coverage limit. If this is really the case then we're going to start with IVF so that we don't run out of money. Being out of pocket for IVF is not an option right now. RE's office confirms this on September 9. I guess we're onto IVF #1. I take my first BCP.

September 10: we realize an upcoming vacation will prevent us from cycling for IVF this month. Another break cycle. I stop taking BCPs. I'll start taking BCP's for IVF #1 at the beginning of October.

October 3: On 2nd day of BCPs when we meet with the RE for the first time. He suggests we can take a less aggressive approach. Joe would like to scale back. I stop taking BCPs and start taking Letrozole (Femara) that night.

October 31 (Halloween): I start spotting during dinner. We have friends over, I can't even cry or tell Joe that our cycle is a bust. I hold it all in until everyone goes home and then I just fall apart.

November 2: CD2, Cycle 20. I call my NP to tell her we'd like to move forward with injectibles. She orders my meds I go in for baseline on November 3.

November 11: I am supposed to stim for 3 more days, but my e2 levels are off the charts and I have early signs of OHSS. I'm told to trigger. I would have had 5 follies. I don't really know what was what by the time I triggered. I should have known then that my cycle was done because my body was fried, but I held on to hope.

November 12: IUI

November 23: AF comes full force. The worst, heaviest AF ever. My cycle was 22 days long. I can't even hold it together. I call my NP and tell her that we are ready to move forward with IVF. She schedules my baseline appointment and orders my BCPs.

November 26: CD3/baseline day. We find out that I have over two dozen cysts all over my ovaries, a lovely gift left over from the injectibles and my soaring e2 levels. I'm put on BCPs and told to come back in three weeks to see if the cysts are gone. I leave the office crying. One more hurdle to overcome.

December 16: ultrasound shows that my cysts have healed. I start Lupron that night. IVF #1 is fully underway.

December 19: I stop BCPs and keep injecting Lupron.

December 24: clinic appointment shows that I am fully supressed and I am given the all clear to start stims on the 26th.

December 26: start Follistim injections, drop to half dose of Lupron. The shots aren't so bad. The black and blue marks, however, are awful.

December 30: first follie scan. I'm not happy with the result. I know it's early but I thought I would respond better.

January 2, 2010: second follie scan. I can't believe how slow I'm responding. I know it's quality over quantity, but I can't help but be disappointed.

January 3: hCG trigger

January 5: egg retrieval. I wake up to the awesome news that they retrieved 13 eggs. I don't remember much about this day other than hearing the number 13. I slept approximately 20 hours. You have to love anesthesia.

January 6: fertilization report call came in at 7:30 a.m. I love that the clinic called so early. I think I would have died waiting. 6 eggs were mature. 2 good, 2 fair and 2 poor. My 4 good/fair fertilized the other two haven't done anything yet, but they're leaving them in the incubator to see if the fertilize in the next 48 hours.

January 8: embryo transfer scheduled for 6:45 a.m. Transfer actually happens at 9 a.m. Of our 6 embryos all six fertilized through ICSI. One arrested by day three. Of the 5 that remained two of the embryos were from the "unfertilized drop" meaning they didn't fertilize in the time period under which they were observed. By 3DT these embryos were grade 4, 8-cells but they were too risky to transfer since they fertilized late. These two along with a lower quality grade 2, 4-celled embryo were held for observation for cryopreservation.

{ these are the two from the unfertilized drop } 

In the end we transferred 1 grade 3, 8-celled embryo and 1 grade 4, 8-celled embryo.

January 10: Of our three embryos that were being observed only the grade 2, 4-celled embryo made it to blast stage, but it was not strong enough to survive cryo. To this day my biggest regret is not transferring back this embryo when we had the chance.

January 14: Joe and I start to talk about all of the what ifs and then whats of our IVF cycle. We begin to prepare ourselves for a BFN and try to decide how we'll move on if the cycle fails. This is the first time that we discuss living life child-free.

January 17: unofficial BFP on HPT (used internet cheapies from and a FRER).

January 19: Beta #1 = 16. It needed to be 50 or higher. We're scheduled for a repeat beta in 48 hours; if the number doesn't double by then, my first pregnancy will be over. We pray that we have a late bloomer on our hands and are told to prepare to lose the baby.

January 21: Beta #2 = 42. This is an exciting climb, but we are not out of the woods yet.

January 23: Beta #3 = 84. Another slow, but low, appropriate rise. Our nurses are concerned because my beta seems to be rising very slowly, although it is still in a "normal range". They have asked us to wait 5 days before coming back again to give my body and the baby some time to play catch up. We are shooting for a level of at least 420 at our next beta. We are afraid to be excited, afraid to hope; but there is a little tiny piece of life inside of me fighting and so we give in to those feelings and try to let go of the fear.

Once we hit a beta of 1000 they will be able to see the baby (or babies) on ultrasound and give us a better idea of what's going on and if they baby is healthy and measuring appropriately.

January 28: beta #4 = 392. The rise is appropriate, but is very low for someone who is 5 weeks pregnant. They explain to us that the likelihood of this pregnancy being ectopic is very high. We are advised to come back in a week for an early ultrasound to detect the fetal pole and sac.

I proceed over the next week to have a five-day anxiety attack.

February 4, 2010: our first ultrasound confirms a blighted ovum. Because we never even made it to ultrasound our pregnancy doesn't even count as a pregnancy at our clinic. This is hurtful. We are struggling with what to do next. I was given a blood test for my hCG levels, and I have to go back in again in 48 hours. If my hCG doesn't drop on its own I will have to get a shot of methatrexate to terminate the pregnancy fully.

February 6: my beta - what is this? number 6? - reveals my hCG is dropping on its own. I look like I have track marks on my arms. I'm tired. So tired. I just want this cycle to be over. Everything in my world has changed and, yet, everything is exactly the same.

February 9: we meet with our RE for our what the fuck (as in what the fuck went wrong, what the fuck will you do differently next time to make sure this doesn't happen again). He really doesn't have any answers for us. I responded well to stims, Joe's sample was great. He was surprised we were able to get 13 eggs. So many of them were immature, but really they were only expecting to get 8 or 9 based on my follie checks, so the goal for the next cycle is to grow more follicles to maturity. There won't be any change to my meds. Now we just have to wait for me to be unpregnant and decide when to do this again.

February 16: after a lot of back and forth and bullshit with my RE (who wanted me to wait for my body to terminate the pregnancy on its own) I have my D&C. Eighty five days from the start of my cycle and my first IVF is over. It's all over.

I feel empty. Broken.

March 2: I went in for beta #7 for IVF #1. It was 14, which is ironic given that beta #1 was only 16 to begin with. I'm so ready to move on. If all had gone well, today I would be eleven weeks pregnant. I have beta #8 in two weeks. On the anniversary of my thirteenth week of no longer being pregnant. And I think these betas are a cruel twist of irony. And frankly, I am quite sad.

I take some time for myself, try to fix my body and fix my head. But really, I'm just waiting. Still stuck in limbo.

March 11: we get a consult for IVF #2 at another clinic and consider switching after several bad experiences with our current clinic.

March 16: beta #8 = 2. I'm officially not pregnant anymore. Hallelujah! I mean, if it's even right to celebrate such a thing.

March 18: I order meds for IVF #2. I decide to stick with my current RE after hearing the adjustments he was making to my protocol. A 2010 baby is still a possibility...I can't believe we're doing this again, but how could we not do this again? We book a last minute vacation to take time to heal from our loss, to make some necessary repairs to our marriage and to get ready to get on this roller coaster one more time.

March 31: I start cycling for IVF #2. This has to work. We're out of insurance money after this cycle and we've agreed that if this cycle doesn't work, it'll be time to move on to Plan B. We start talking about what exactly Plan B is and how aggressive we want to be for our last cycle.

April 4: Easter. Mass was really hard, I started crying just before communion. There were a lot of newborns and the sermon was about sacrifice and choosing paths in life and it was more than I could bear. This is the first time that I've been overwhelmed by our infertility in a public place. It caught me way off guard.

April 21: IVF #2 is kicking my ass. I'm an emotional basket case. And no, it's not from the 10IU of mood-unstabilizing hormones I'm injecting into my stomach daily. It's a combination of fear that this cycle won't work, fear that it will work and I'll lose the baby again, fear that I may never get to be a mommy and utter disbelief that I am here again. I keep hoping that the last few months were just a bad dream.

April 28: We have our first follicle check and see 7 follicles in the making. We're elated.

April 30: Today's follie check revealed 9 follicles. We were told to come back again in 24 hours to check my levels.

May 1: I have 9 or 10 mature follicles with another 5 or 6 that are smaller. We had hoped to stim for another day to let the little buggers catch up, but my progesterone has already started rising (a sign that my body is trying to take over this ship) and so we trigger later that night. I'm disappointed that we didn't capture 15 eggs before trigger, but I couldn't be happier with our "on-paper" yield.

May 3: We got 14 eggs. The embryologist told my mom and Joe that they were all perfect, a good size and looked amazing.  I think they pushed anesthesia a little too fast because I threw up in the parking lot, which actually made me feel A LOT better. I managed to sleep for the rest of the day.

May 4: Of the 14 eggs retrieved yesterday, 13 were mature and 12 fertilized. We requested a 5DT this cycle. Joe and I are over the moon. We have more than double the number of embryos that we had in IVF#1. I never expected to do this well.

May 6: three day embryo report reveals that all 12 of my embabies are still going strong! I cannot even believe this. I cannot even believe this. I burst into tears as soon as I found out. Maybe this really is our cycle? Please, let this be our cycle.

May 8: transfer day for IVF #2. We arrive at the clinic and find out that of our 12 embryos, two had already arrested and two were at the morula stage (which means they were about 12-18 hours behind in development and on their way to arresting). Four of them are early blastocysts which means that their cells are too cloistered to be graded. They will remain under observation to see if they are candidates for cryopreservation.

Another 4 had progressed far enough to be graded - one 3AC, one 1AB and two 2AA. We transfer the 1AB and the two 2AA's. We wait to find out if the 3AC is good enough to freeze (along with the others that are still being observed).

May 9: Mother's Day. I mean really. Seriously?

May 10: Snowbabies! We found out that of the 7 remaining embryos under observation TWO of them were graded high enough to be frozen. They were rated 2AB and 2BB. We're overjoyed. To think that we may never have to do another fresh cycle, well there are no words to express how that makes me feel.

May 11: This morning - 3dp5dt - I was trigger negative. I go away with Joe on a business trip so I don't have to spend the 2WW alone. Before heading to the airport I test again and get a faint line. Maybe I wasn't trigger negative after all?

May 12 - May 15: I test again every 24 hours. Line after line after line. All getting darker!

May 17: Beta #1 = 311!

May 19: Beta #2 = 764

June 4: 1st ultrasound. It's TWINS! Baby A and Baby B were both measuring exactly the same and were perfect for 6w, 4d. Baby A's heartbeat was 124 and Baby B's heartbeat was 118, both right on track for just under 7 weeks!

For more information on my pregnancy click here and here.

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