Living through uncertainty...

Nothing new to report today- I am settling into the strange reality known as the "two week wait" - a stretch of time that seems to go on forever. Whereas in the past I think I have vascillated between crazy excitement over the possibility of pregnancy and the sheer terror of a negative outcome, now I am in a different place. While I feel alot of hope that this will work, and I can't help but feel a little of that "Christmas Eve and I can't sleep or think of anything else" anticipation, I honestly am not scared of a negative pregnancy test. I know there is nothing to be scared of- I have been through it before, and know I will feel sad and disappointed. But, I will move forward as I have done before, and focus upon other parts of my life that have to be put on hold during this process. There is no empty space that I will struggle to fill- because over the past nine months, I have realized that I needed to create a meaningful life that is sustainable no matter what happens on the rollercoaster ride of infertility. I can't sit around and wait for another pregnancy, or a baby, to fill a void in my life. It's not healthy for me emotionally or spiritually. So the anticipation of waiting for the results on Wednesday is more like waiting to find out where I'll be going to college- it is a sense of wonder about what the next chapter will hold. It may hold a pregnancy, it may not. Each outcome brings a different set of problems, and a different set of opportunities. I've long since let go of the illusion that pregnancy or a baby will somehow fulfill my life completely- don't get me wrong, I know it will be WONDERFUL, and I also know it will be the hardest thing I have ever done.

So, I am eager to know a little more about what will come next for Jeff and I. No matter what happens, I know that I am incredibly fortunately, and I know that I will make the most of it. If I am not pregnant, there is much I want to do in the meantime. If I am pregnant, there will be a long journey of uncertainty ahead- but I think I am ready for it.

Now back to waiting.

Five maybe-baby-cicles

The embryologist just called to tell us that we were able to freeze FIVE beautiful blastocysts. This is really wonderful news, as it will give us two more cycles- for if this one doesn't work, or if it does and we want more without going through the IVF procedure. The other bonus is that it preserves my healthy, young, 30-year old eggs so I can take advantage of them later.

It's nice to have a back-up plan.

I feel good, though I have had the sniffles and worry with every sneeze that I am dislodging the embryos. I know it is irrational.

Emotionally, I am doing great- just happy with life in general. The fear I've felt in previous cycles is gone... and I am enjoying the ride.

Out of our hands and into my uterus

Well, we've passed the final hurdle in the IVF process. This morning we transferred two textbook perfect embryos. Both were ICSI'd (and Jeff seems OK with this). Each has 200+ cells and has differentiated into the parts that will become that placenta and the part that will become the fetus. What a change from their eight-cell statuses just two days ago! I have pictures of our embryos that I will post as soon as I have a chance to scan them at work. Very cool.

The transfer went very smoothly- no issues whatsoever. We'll know by tomorrow how many blasts we will be freezing- it will be at least four, and perhaps as many as six. This is the best possible outcome we could have hoped for, and I am incredibly grateful.

It's interesting to enter into this next phase, in which they say there is virtually nothing you can do to impact the outcome of the cycle. If those embryos are going to hatch and implant, they will do so within the next day or two. While they don't recommend that I run any marathons or do any bull-riding (and I have no intention of doing either, IVF or no IVF), it's pretty much out of my hands. I will continue to do my evening shots of progesterone in oil (my butt is already sore, but I know this drill well) and will drinks tons and tons of gatorade as I am still at risk of OHSS. But that's it.

And gosh, that is hard for me! There is something about the routine of shots, ultrasounds, and blooddraws that gives you a sense of control. You're always doing something. So it is very strange to shift gears and be able to do nothing. But then again, I had better get used to it now, if I am hoping to endure another nine or so months of this!

That said, I feel less stressed than I have in past cycles. We've been successful this cycle- more successful than I ever would have imagined. Obviously I want it to result in a pregnancy. But I also know that it will happen in its time, and that I cannot be the judge of that. If this isn't to be our time, there will be a reason. Yes, I will be disappointed and sad- but the sadness will be fleeting. And if I do get pregnant, it will be only the beginning of a very, very long journey. My bags are packed and I'm ready to go, so I'll be ready once the adventure begins.

"Your embryos will be driving by tomorrow"

The embryologists reports that seven of the nine embryos are thriving, and two are a little slower to develop. Having 100% of your embryos is pretty much unheard of, so this is great news. There's reason to hope that we will be able to transfer two and freeze a few for our future attempts. Evidently they look SO good that Dr. Couchman got nervous about screwing up the transfer of such beautiful embryos- and did a "trial run" so she'll be ready to go at 9 am. I am not worried. She's done three transfers with me before, and we've never had a problem. For any of you that are curious, the transfer procedure is very simple in comparison to the retrieval. Basically they thread a tiny tube through your cervix and deposit the embryos suspended in a few drops of fluid in your uterus. I once heard a metaphor that greatly alleviated my fears that they might "fall out"- evidently, it is like inserting a sesame seed into the middle of a peanut butter sandwich- it's not going anywhere.

On another note, I had a conversation with Dr. Brown, the head of the Maternal-Fetal medicine program at Duke, about whether it is advisable for us to transfer two blasts (as this would give us about a 25% chance of twins, theoretically, at least!)
He feels that this is the right decision, and the kinds of precautions we will take will be in place regardless of whether there is one or two. The only difference is that the restrictions on my lifestyle might be more stringent with twins. Given that I will probably not breathe, let alone do anything remotely risky, for nine months the next time I get pregnant, I'm not terribly worried about the difference between total bedrest and almost-total bedrest. It will be the challenge of my lifetime either way- but well worth it. So that will be a good problem to have one day. For now, I am just focusing on getting to tomorrow!

Unbelievable!

More good news this morning - ALL NINE of our "maybe-babies" are now (in the words of the embryologist) "beautiful, compacting, textbook perfect 8 cell embryos"! This is very surprising to me, as in past cycles, we have had only one 8-cell embryo on day 3. It makes me wonder if the lab and embryologist at Carolina Conceptions (Dr. Couchman's new clinic) is better than the one at Duke? Along those lines, I have to say that my experience at this new clinic has been nothing but wonderful. I have always loved my Dr., but now it seems that everyone who she works with is equally caring and sensitive. I am confident I made the right choice in making the move. Even if this cycle doesn't result in a pregnancy, I feel so much better psychologically than I have in the past- mainly because I feel as though I have an entire team pulling for me and determined to get me pregnant one way or the other. I have to remind myself of how incredibly, ridiculously fortunate I am to have all of this covered by my insurance as well. It helps me to maintain a balanced, healthy perspective- if it doesn't work this time, there will be other chances for us. There is no way I would be saying this if I knew that each attempt was costing us (gulp!) 12k. We all need to get out there and advocate for states to enact mandated fertility covereage, as they have in MA. Does it not seem ridiculous that most plans cover Viagra and not infertility treatment??

So why the big hoopla about making it to a five-day transfer? Here's a little blurb that explains the science behind it:

"The rational behind a blastocyst transfer is that an embryo which has failed to reach the blastocyst stage, would be unlikely to have resulted in a pregnancy. However, if it reaches the blastocyst stage it has about 50% chance of implanting. So the improved implantation rates following blastocyst transfer is due to selection of the best embryos."

With nine 8-cell embryos, I think the chances of us having two good-quality blasts to transfer on Tuesday are excellent, and we may even be able to freeze a few "maybe babies" for future attempts.

For now, I am doing my best to relax and tolerate all the uncomfortable bloating I am experiencing, which will most likely get worse before it gets better. The good news is that I have finally found a flavor of Gatorade that I can tolerate- lemonade. It's not bad. My guess is that I will be living on it for the next few weeks or so.

PS: The photo is of an 8-cell, compacting embryo - like ours!

Nine embies thriving!

Just got a call from Heather, the embryologist, and she gave me some very encouraging news! All nine embryos now have four cells and look "beautiful". She and Dr. Couchman feel confident that we will make it to a 5-day transfer. Heather will check them again tomorrow morning, so that if the next 24 hours is not as productive as the first, we can proceed with a 3-day transfer. I'm very hopeful, and plan to spend my weekend relaxing, as the effects of ovarian hyperstimulation seem to be kicking in... my belly is sore and distended. I'm drinking Gatorade like it's no ones' business, as this is evidently the best way to ward off OHSS. It all seems a small price to pay, honestly... and I am allowing myself to enjoy this hopeful stage of the process.

(P.S.- the photo is of a healthy, 4-celled embryo like ours!)

Successful swimmers

So the news was good yesterday! Of the 7 eggs that were fertilized "naturally" (in a test tube)- 5 were successfully fertilized. Of the 6 that were ICSI'd, 4 were successfully fertilized. So we have nine. The other really encouraging news is that the quality of the eggs themselves was "excellent". This has long been a concern of mine, perhaps for irrational reasons... but I do know that women with PCOS can experience diminished egg quality, even when they are theoretically "young and fertile" like me. On a humorous note, Jeff decided to reassert his belief that having natural selection determine which sperm is the winner would somehow produce superior children. We got a good laugh out of the thought that 10 years from now, when little Jeff Jr. or Elisabeth Jr. misbehaves or fails a math test, he will look at me and say "see? ICSI. I told you so!" We will let this little debate play itself out over the next few days, as we should know which embryos were produced using which technique. We'll put back the most healthy-looking embryos regardless of how they were created, of course. This little intellectual debate is all fine and good, but at the end of the day I'm not granting it enough weight to allow it to influence our chances of pregnancy!

Today we should get a call from the embryologist regarding whether we will do a 5-day (blastocyst) transfer or a 3-day. This question will be answered by how well the embryos are developing in the lab environment. If they seem to be thriving, we will give them an extra couple days. During this time they will develop into blastocysts- and being able to accomplish this bodes well for their viability. If they're not doing so well in the lab, they will be transferred into a more natural environment (my uterus) on day 3- when they should have between 6-8 cells. My first IVF pregnancy was a 3-day transfer- so I know this can work! The main reason that you want to go to five days is that it allows you to put fewer (theoretically higher quality) embryos back. If we do a day-5 transfer, I will put back two. I will have to take many precautions in a future pregnancy (cerclage, bedrest, high-risk monitoring) so whether there is one or two makes little difference. If I do a 3-day transfer, much will depend on the quality of the embryos. The first time, I put back three- 6, 7, and 8 cell embryos. If I have two perfect 8-celled embryos, I will put back two... and if the quality is a little less perfect, three.

So now I wait patiently from the call from the embryologist to let me know how the nine "maybe-babies" are doing 48 hours after fertilization. Hopefully most of them are developing!

Retrieval #3

So after all this time I have decided to start a blog. It's been two years since this journey began... why is it that I now want to to start putting my experiences out there, for no one and anyone to find? Perhaps it is because of the amnesia that seems to blur my memory as I try to recall all I have been through... the details of my previous IVF cycles, what it felt like to be pregnant, the incredible anxiety I felt during the first part of the journey. I'd like to be able to look back and remember what I was thinking and feeling- and honestly, I am happy to share my experiences with anyone who may care to read them, either because they know me (and therefore they care) or they have experienced infertility and loss (and may resonate with some of my experiences). Regardless, here goes.

Today was my egg retrieval. After weeks of IVF drugs, starting with birth control pills and progressing to Lupron (to keep me from ovulating), to Follistim (to make my follicles grow), and finally HCG (to trigger the final stages of egg maturation)- this part of the process was finally complete. After 28 or so needle sticks, the day of reckoning had finally arrived. It's funny to me to think about how scared I was to do that first injection. After all I have been through, I fear much bigger things, much more horrific pain at this point. Makes a needle stick seem downright enjoyable in comparison! The experience was a bit of a rollercoaster, as my estradiol levels seemed to start out low and then skyrocket, and as a result I have been walking a fine line between having a strong, healthy response and ending up in the hospital with ovarian hyperstimulation syndrome. Fortunately, I was able to proceed with the retrieval without having to "coast", or go for a few days without meds, which can have a negative impact on the eggs (though it didn't seem to have any kind of detrimental effect on my first IVF!)

So Jeff and I awoke this morning at 6:30 am and at 7 am we were off to Raleigh, specimen cup in hand. It still amazing how routine, how normal even the most personal and private acts become when you are treated for infertility! We arrived at the clinic and I changed into a gown, and got prepped for my IV. We decided if we had more than eight eggs, we would let half fertilize "naturally", and the other half would be ICSI'd. We did this for our first IVF cycle, and had good results, so it seemed worth trying once again.

That decided, I went into the retrieval room (husbands are not allowed in, and as Dr. Couchman said, "he wouldn't want to see this, anyway!") and was remarkably relaxed as I lay down and rested my legs in the stirrups. The last thing I remember is asking the nurse if she had started the medication, because I felt wonderfully woozy... and before I knew it, I woke up, unsure as to what was real and what was a dream. I had evidently "come to" immediately after they finished the 15-minute procedure- was in a wonderful mood (as seems to be the case when I come out from under anesthesia- scary that I know by now what I "usually" do in these cases) - and was told they had retrieved thirteen eggs. Intially, the superstitious side of me was unhappy with that number (silly, I know) but then I decided it was a "baker's dozen", and as such, was OK.

I rejoined Jeff and whispered gleefully "I feel like I am high!" (If only they would give me some of those drugs for the moments when the uncertainty and anxiety creep in...) If I remember correctly, Dr. Couchman told me my eggs looked "good". I should hope so- because I felt as though someone had kicked me in the crotch, and then in the stomach. I guess in the new clinic, where they put patients "out" during the retrieval, they feel much more free to search more "aggressively" for any eggs that might be hidden in your ovaries (as opposed to the way it was done at Duke, where they told me "won't it be fascinating to watch this procedure?" and then had to deal with all the flinching that resulted every time they poked the needle into unthinkable places... ouch...) Anyhow, they must have had quite an "egg hunt" with me today.

So, my eggs placed in the hands of the (hopefully highly capable) embryologist, we headed home, where I passed out for a few hours and then went to work. Yes, I know I could have stayed home, but I figured that I was going to be sore whether I was sitting on the couch or sitting at my desk, and as such, I might as well save my hard-won PTO hours for a more pleasant occasion (like my trip to Boston in early October!)

So now, the anxiety and uncertainty sets in. How many eggs will fertilize? Did we make the right choice about only using ICSI on half the eggs? Will at least two of our embryos make it to day 5? In the past we have done a day three transfer- and we won't be able to decide whether to take it those critical two extra days until day 3. I will be overjoyed if we have two embryos to transfer on day 5 - anything else will be icing on the cake. That said, a 3-day transfer had good results for us the first time, so that may not be a bad option either. Perhaps you can see how easy it would be to drive yourself absolutely nuts thinking about this!

What I can say is that, for now, it is nice to know that it is "out of my hands". For the next few days at least, all I can do is trust the professionals to take good care of those "maybe-babies". And even after I "re-gain custody" of those embryos- I know there is absolutely nothing I can do to influence the outcome of this cycle. It makes me realize how much of a miracle this whole process of creating life is. Whether you do it the "good ol' fashioned way" (I hear some people still do it that way...) or whether the miracle involves incredible technology and a team of doctors, nurses, and embryologists... at the end of the day, it is out of all of our hands, and the work of a force so much greater. And yes, it is nothing short of a miracle.

So, I wait and hope and try to have faith in this all-powerful life force. I do believe that Jeff and I will be parents one day. I also hope that I will not have to wait too much longer for that day to arrive. For now, I eagerly await the "fertilization report", and prepare myself for the next step, whatever that may be.