Post-IVF Follow Up & Next Steps

Well, we had our IVF follow up appointment a couple of days ago.  It was something that I was both looking forward to and not really interested in doing.  I joked with my husband that he could just go in my place and report back to me.  When it came time for the appointment my husband found himself double-booked and had to skip the appointment.  It was something he wanted to be there for and was quite apologetic about but I wasn't hurt by his absence.

The main thing I was looking forward to was learning the grades of our embryos but also learning how many they recommend to transfer back for a frozen transfer and what the protocol would be for the frozen egg transfer.

The thing I wasn't looking forward to: rehashing failure.  

I was pleasantly surprised by the appointment.  I was upbeat and positive going into the appointment and my RE wasn't too apologetic or emotional with me which is always what I prefer.  And we didn't rehash the past.  We focused on the future.  It was a huge relief.

We began the appointment talking about my great response to the medication and how pleased they were with the 17 eggs of which 11 where mature.  I expressed how pleased we were with those results as well and that the side effects throughout were very minimal.

I wanted to know how our embryos progressed when compared to someone without a history of recurrent miscarriage.  She told me that if it were someone else, without a history of loss and now infertility, she would have expected more embryos to have made it to freeze when beginning with 17 eggs.  This leads her to believe that it IS a quality issue that we are dealing with.

I wanted to know our embryo grades.  She began by saying that they recommend transferring both embryos.  She was hesitant to give me the actual grades, and in the end she didn't, but she did say that they were above average.  She sort of side skirted the grades by returning back to the subject of an elective single embryo transfer.  She is terrified to give us twins, that much is quite obvious.  So, in a way her fear of both of these embryos sticking and giving us twins assures me that whatever grade they are, they stand a good fighting chance. (BUT she did have that same fear about our two, day 3 embryos we transferred in the fresh cycle so who knows)

Twins.  Our doctor is far more concerned with us having twins than we are.  I understand her concerns (she should know, she has twins herself) but these are not OUR concerns.  We will be transferring both embryos at our FET.  We look at it like this:  1.  This is what the algorithm recommends, 2. Even if both stick that doesn't mean we will bring home twins - it doesn't even mean that we will bring home one, especially with our history of loss.  The goal is to bring home a baby but if we happen to bring home two we will be thrilled.  We understand that it will be more challenging than a single baby but we have nothing to compare it to (since we are childless) so it will just be our normal if both happen to make it home.  Would it be challenging, yes, but if it happens it is meant to be.

FET protocol.  Call on CD1.  Blood test on CD2.  Begin estrogen/estrace pills.  Ultrasound and blood work on CD14 to make sure my lining is good and that I haven't ovulated.  If all is well we would have our transfer 5-6 days later.  Medrol is taken before and after the transfer.  Progesterone will be taken after CD14 and until Beta Day.

So now we wait.  We wait on insurance approval and for CD1 to arrive.

Rainbow:  The follow up appointment went better than I expected.

Rainshower:  Today is CD23 with no signs of ovulation in sight.  I may be anovulatory again, maybe not, but I promised myself that I will let things happen naturally this time and resist the temptation to take progesterone to bring on an artificial period.  I have put my reproductive system through enough lately.  I just need to be patient.  Easier said than done.

Reflecting on a Failed IVF Cycle

Our first IVF cycle was a failure, but was it?  

Yes and no.  

No, I am not pregnant but, yes, we do have two frozen embryos for a frozen embryo transfer (or two depending on our Doctor's recommendation).  We have a follow up appointment on June 26 so I hope to know that information soon along with the protocol for a FET.

I am already at peace with our circumstance and am already moving forward.  My mother-in-law on the other hand is taking all of this very hard... Harder than us.  We knew the statistics.  We knew we had a 45% chance of success as opposed to the 20% chance in a medicated IUI.  We cautioned her to not get ahead of herself when she congratulated us on the transfer as if it meant we were automatically pregnant, but I don't think she was prepared for it not to work.

This makes me feel bad, of course.  It is moments like this that I can plainly see other peoples' desires and hopes for us.  It is times like this that true emotion peeks out of otherwise well-spoken and carefully-worded inquiries and responses from family members.  

Lesson learned: We will be keeping my sweet and well intended MIL in the dark about our frozen embryo transfer.  For her sake and ours:)   FYI the only people that knew what we were up to were our parents and select bosses.

I have been writing less here than I originally intended when we were cleared to go ahead with IVF.  Not for a lack of motivation, however.  Quite the opposite, in fact.  Going into IVF I decided to write everything in a journal.  

My IVF journal included things like: 

• Inspirational quotes 
• Goals, fears and setting expectations
• medical protocol
• Appointment timeline
• Lifestyle goals (diet, vitamins, eastern medicine)
• Medication (notes & calendar)
• Ultrasound & blood work results
• Egg retrieval results, fertilization report, etc.
• JOURNALING

Keeping this IVF journal was one of the best decisions I ever made.  I intended on using the journal as a way to keep everything in one place and a way to stay organized but, it quickly turned into something greater.  It was with me at all times and I just felt less overwhelmed and anxious having it to reference in my moments of confusion, worry and anxiety.  It helped calm me and put everything into perspective.  I thoroughly believe that keeping the journal was the single-most anxiety-diminishing exercise that I could have done for myself in the IVF cycle.

So in those moments that I probably would have hopped on this blog to write out some of my anxiety I found myself writing in the journal instead.  The physical act of writing also helped calm my nerves.  Here are the titles of my journal entries during the process:

• Roller Coaster of Feelings - a proclamation of how I intended on using the journal and that it would probably be written in most during those difficult times.
• PGD or No PGD? - I touched on this subject in a previous blog post here.
• Today My Heart Aches - it was one of those days that your heart just hurts and longs to have your baby in your arms.  Ever have that feeling?  It doesn't happen to me often but when it does I just ache for a baby... It's almost like being in love but not having that love in return... That's the best way I can think to describe it.
• Calm, Cool and Collected - an entry about being at peace with the IVF process and maintaining a calmness that to this day I am proud of (especially because I was calm until a few days before Beta Day-no small feat).  I was Zen, what can I say?  I do not think I will ever be able to fully explain why.
• Dreams - crazy dreams.  Vivid dreams are uncommon for me.  I had been having many vivid dreams.  I dreamt twice about lightning.  "To see lightning in your dream signifies sudden awareness, insight, spiritual revelation, truth and purification"
• Marathon Monday & Dreaming / Hoping for Ovulation - I had a little scare right before beginning Lupron.  I wasn't sure I ovulated which was a concern because I hadn't ovulated in the previous cycle.  It seems silly to think about how much I was worried at the time but it just goes to show you how this process can be all-consuming at times.
• Anovulating - UGH - more worry about having to delay our IVF cycle due to delayed ovulation or anovulation.  Good times.
• And so it begins - stimulation begins.  Nothing new here.  I've already done plenty of shots at this point so no biggie.
• Feeling the Burn - my ovaries are feeling like they are responding.  Nothing too crazy but I know my ovaries are there when they are normally the silent hero/villain depending on my mood.  This chart was helpful to me in seeing if I was on track based on my stimulation day.
  
  
  Source:   www.advancedfertility.com

• Too Busy to Journal - I am in an IVF whirlwind.  Ultrasounds and blood tests are frequent at this point and it is getting difficult to find the time to process my thoughts let alone find the time to write about them.
• Calendars - I copied my two month calendar which highlights the shear volume and frequency of appointments, etc.  It is crazy to see it all in one place like that.  It really puts things into perspective.  This is a big deal, a true 'life event'.
• 17 Eggs Woot Woot - egg retrieval day.  17 eggs!  It was surprisingly simple and pain free.  I was back at work the next day (at my desk job).  
• The Two Worst Medical Questions - reflecting on egg retrieval day.  The anesthesiologist ask the two most painful medical questions... "How many pregnancies have you had?" and "How many living children do you have?" M My painful answer is '3' and 'no living children'.  It's a punch in the gut right before egg retrieval.  It just stinks.
• Is this Real Life? - it almost doesn't feel real that we just had our egg retrieval.  It went so smoothly, and without side effects that it sort of feels like a dream.
• The Holy Grail of Charts During the Wait Before Testing - I found myself coming back to this chart frequently.  It was fun to think about our embryos/morulas/blastocyst's progress each day.  I enjoyed visualizing them burrowing into my uterine lining and implanting themselves.

 

 Source:   www.nyufertilitycenter.org

• I am Feeling Down Today - I was 12 DPO and feeling out.  It was a bad day.  I tested and it was negative.  I was mad at myself because I wanted to wait until 13 DPO, for no particular reason, but I caved a day early.  This phrase really summed up my general feeling:

 

Source:  www.healthshire.com

• A Little Bit of Optimism - I was clinging to the hope that I could still be pregnant but just not testing positive yet.  I found a chart on fertility friend that helped me find the optimism I needed that day.

 

• No Dice - Beta Day.  The official results were in.  A follow up appointment was scheduled.  I sense that the nurse was surprised that I didn't want to instantly hang up and cry when I requested to speak the the scheduler about setting up the follow up appointment.  I'm moving forward people.  There is no sense in dwelling on the negative results.  That doesn't accomplish much.  Instead I binged on bad food and skipped my pre-natals for a few days as I always do after a bad cycle.  Don't judge me.  We all have our thing, right?  Taking those stupid prenatal vitamins on the heels of a negative test is like adding insult to injury.  It is like they are taunting me and saying 'why do you even bother with us, you don't need this folic acid because you aren't pregnant'

At the end of all of this I still consider this cycle a success.  We have two frozen embryos... Two more chances at starting our family.  I will look back at this cycle with pride in our accomplishment and with a sense of peace that we did everything we could and did it without too much personal and physical sacrifice.

The only true side effect I had after all of the stimulation, retrieval and gooey medication after the transfer was some gas pains that at times became somewhat severe. But hey, as someone that has stomach ulcers, IBS and lactose intolerance it wasn't much different from an ordinary week.   More than you ever wanted to know I am sure.

Successful.  Truly successful in my book.

RIP to our two 8-cell embryos with slight fragmentation.  I cradled you as best as I could.

Rainshower: I did IVF and all I had to show for it was gas ;)

Rainbow: Seriously though, those two sweet frozen embryos are waiting on us.

IVF Results...

We had a 3day transfer.  The algorithm that the embryology lab uses indicated that we should transfer two, our Doctor suggested one.  We transferred two 3day embryos with slight fragmentation - we put our trust in the algorithm.  With that the wait began.

The wait was difficult but no moreso than a medicated IUI cycle.  I began to analyze little things here and there and analyzed the lack of symptoms as well.  I was quick to dismiss the ovarian twinges I was feeling because at this point in this medical marathon I KNOW that those twinges are just an indication of developing cysts.

We were fortunate enough to have two embryos to freeze...the grades of which are unknown at this time, unfortunately.

Beta Day arrived but not without me testing at home in advance.  Negative.  I like to know the results ahead of time.  The nurse confirmed my suspicion in record time on Beta Day.  Sigh.

I follow up appointment has been scheduled.  I am curious about a frozen embryo transfer schedule and protocol.

I am ok.

I really am.

The thing is, I wasn't letting myself get too excited. If it DID work, and I got pregnant, that didn't mean that everything was going to work out...  I could always have another miscarriage.  You never know.

It is sad though.  I haven't been pregnant since July 2012.  This whole escapade began in June 2011.  It has been three years.  Three LONG years.  

I wish I could say that I was able to still fill those years with wonderful memories, great trips and with good friends but that just isn't the case.  I have been through the ringer and it is written all over my face.  I have been forever changed.  There will always be a profound sadness associated with this time period in my life, regardless of the eventual outcome.

At this point I am a little all over the place with my thoughts and emotions.  Some days I am fine.  Others not so much.  There are so many things to consider and so much free time that I find my mind wandering into the 'what if' scenarios. 

What I do know is that my life feels incomplete.  There is a missing piece.  The big question though is "will a baby make me feel complete?"