A Letter to My Son as He Turns 2

 

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{One of my fav pics of the two of us // 5 months old}

To My Son on Your 2nd Birthday,

It doesn’t seem possible that the best day of Mommy and Daddy’s lives is that far behind us; it seems more impossible to encapsulate in words all that I feel as I watch you become a two-year-old right before my very eyes. But just like we do everyday for one another, I will try my very best.

I always say that from the very first moment I held you in my arms, I was so proud to be your momma. I would’ve never imagined having the chance to experience that same sensation every. single. day of your life. Do we do time outs and attitude changes? Do we do “No thank you’s” and “excuse yourself”? Of course, but yet still everyday when I put you to bed I’m so proud of the little boy you’re growing to be.

You’ve learned so much over the past year, from walking and talking, to counting and colors. What I’ve loved watching most though is your special spirit emerge and your unique personality shine through. You’re non-stop with the exception of your Nicky-Nicky (aka solid 2-2.5 hour nap).  Your face lights up when you see the ones you love most. When you’re uber excited about something, you scrunch your nose and put your hands under your chin which always makes my heart smile. Our days are mostly fun-filled and jam-packed with activities like library, music and your current fav, ball class with your BF Paulie. Yet, the best times are when I glance back at you in the car and I catch you staring at me as if to say “I adore you,” or we slow dance to country music in the living room. I especially enjoy when it’s bedtime and you say “Mommy stay.  Me lay rocking chair.” You never cease to amaze me with the things you remember, the way you connect with others, and how you’re always even-stephens. When you hold daddy’s hand, you hold mine & when you cuddle with me, you make sure to lean over to squeeze dada every once in awhile. My heart explodes when I hear you say “amen” during prayers and I love the way you wave to our church when we pass by.  I secretly love when someone talks about the pool and you say “Me cry mommy” because you don’t want to be away from me even for a short time. The way your laugh is contagious and how you understand our humor is beyond your years.

You’re a lover of trucks, tubbies and all-day snacking. You’re a giver of huggies, “I love ooo’s” and smirks before you do something fresh . You’re obsessed with Paw Patrol, Dora, reading Little Blue Truck, and playing outside with “me girls” down the street. You’re a creature of habit like daddy and a galavanter like me.  You can’t live without your wuby, hot dogs, lollipops and park trips. And your day isn’t complete unless you have a breakfast appetizer in bed watching your programs and daddy screaming “Not-so-fast”, “Hi-yah” and “one last time” as he shuts the lights for bed.

I can’t live without the sound of your voice calling my name, the touch of your hands on my cheeks, and the look you give me that tells me you know you’re so loved. You’re my day date and daddy’s mini-me. In all the time we spent waiting for you,  I couldn’t have envisioned a more perfect and precious son for us.  You, my child, are so special that every night after I kiss the “crown on your head”, I close your bedroom door and thank my lucky stars that I get to be your mommy.

May your soul always be this pure, your spirit this free, and may your heart always be this full.

Happy 2nd Birthday Baby Boy!

When IVF Is Your Best Route

I jumped a little ahead of myself last time with The Box on Your Doorstep post, but it was appropriate for a few of my gal pals at the time.  The majority of the e-mails and messages I receive, though, are along the lines of “I think were going to have to do IVF…,” “We’re having trouble getting pregnant.  What’s IVF like?” or “My doctor said IVF is our best route…”  But what does that actually mean?  I think I’ve  touched in previous posts primarily on the emotional facets of IVF and less on the physical.  So, I thought it was time, to take a step back and explain, at least from my experience, what IVF entails.

I can’t proceed without reiterating that everyone’s experience with IVF differs from protocol to outcomes.  Yet, I’m sure we’d all agree on one thing:  Regardless of whether you had no symptoms at all or you suffered from the list of them, the physical pain you endure is incomparable to the emotional suffering.  I’d be able to do an IVF cycle every single month for the rest of my life if I had to, if it weren’t for the associated roller coaster of high’s and low’s.  With that said, there is some solace in knowing what to expect and having someone to confide in who has been there before.

When IVF is your best route, or as in our case, your only route, the acronyms start flying at you: IVF, ICSI, HSG, HCG, FSH, ER, DPT, TWW, and my personal favorite, PUPO.  It’s all so much information to process and I feel as though, once you’re at the point, time finally seems to fly until the dreaded wait of course.   I, obviously, am not a doctor or nurse of any kind and was fortunate to have only undergone one IVF cycle.  Therefore, while I’d like to consider myself fairly knowledgable in this area, there is so much I continue to learn by being part of this community.  The following is a generic timeline for an IVF cycle that includes my specific protocol.

Ovarian Suppression  This is the initial step once the month of a cycle has been determined. Different clinics prefer different protocols, but typically the way in which ovarian suppression is achieved depends on your ovarian reserve, or the number of eggs you still have.  This is determined by Day Three blood work (day three of your period) which evaluates your baseline levels of Follicle Stimulating Hormone (FSH) and estradiol (E2).  There are several means of addressing this based on your baseline results.

Three years ago when I was undergoing IVF, I began by taking birth control pills (BCP) for the month before.  However this is less of a common practice now, unless they’re accompanied with an overlapping use of a GnRH agonist (most commonly, Lupron).  Regardless the purpose is to better regulate your hormone levels, while also minimizing the potential for cysts to develop.  To be completely honest, this is the phase of IVF I’m least familiar with.

Ovarian Stimulation  In infertility lingo, when we say we are beginning stims, this is the start of using hormones(s) which stimulate the ovaries to produce multiple follicles.  Each follicle is fluid-filled and houses an egg.  Ovarian Stimulation begins around day 3 of your menstrual cycle and can range for 8 to 12 days, depending on how you’re responding to the medications.  Common side effects include drowsiness, headaches, fever/chills, joint aches, injection site reactions.  Typically, monitoring begins around the fourth day of stims and occurs every other day, until you get closer to the point of trigger.  The purpose of these frequent visits, which include internal ultrasounds and blood work, is to determine how your body is reacting to the hormones.  Estrogen levels are assessed through the blood work and the follicle quantity and size are recorded.   It is anticipated that at 12-14 millimeters, the follicles will begin to grow at a rate of 2 millimeters per day. The larger the follicle, the closer it is to maturation.  Depending on your results, the medication protocol may be increased or decreased.  In many cases an Antagon is added to suppress premature ovulation.  This is usually administered during the latter half of the stimulation phase.   Once the follicles reach between 16-20 millimeters they are ready for the next step, retrieval.

 

I began taking Estradiol by mouth (0.5 mg once in am/once in pm) and two hormone injections daily around day 3 of my menstrual cycle (February 8, 2014).  My protocol included 150 units of Follistim (FSH) and 75 IU of Menopur (HMG) injections which I had my husband give me around 6 pm every evening.  He had already been injecting himself for almost two years, so I was lucky enough to have a skilled injector.  For this reason, I’m sure, I found the injections to be completely tolerable with only slight burning and minimal bleeding here and there.  My husband would squeeze the injection site (my lower abdomen, below my belly button) and inject on alternating sides.  I never needed to ice the area and had very little bruising.   We did add Ganirelix to the mix, but I can’t recall when and for how long.  I do know that I had Ganirelix leftover.

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I continued on these meds for 10 days before triggering.  Between 7 and 9 follicles were monitored and measured.  The greatest advice given by the nurses was quality over quantity.  I had read so many stories online of women with 20-30 follicles and wondered why my quantity was significantly less.  I’d go on to find out that many of these women hyper ovulated, which from what I’ve heard can be very painful.  Over-stmulation occurs when estradiol levels soar too high, too quickly.  Typically if a women suffers from Ovarian Hyper Stimulation Syndrome (OHSS), the transfer may be postponed to allow the ovaries and lining of the uterus time to get back to normal.

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HCG Trigger  Triggering refers a shot of human chorionic gonadotropin (HCG) which stimulates the eggs’ release.  Precise timing of triggering is imperative for successful egg retrieval, which occurs within 36 hours of the injection.  This time is crucial as it allows the eggs to go through the final maturation process; without this they’d be incapable to fertilize.

I took the trigger shot, Ovidrel, on February 18, 2014 at 10 pm in the evening.  Like the others, I didn’t experience any side effects.  At this point, the only way I could describe  how I felt was as if I was carrying a fanny pack of golf balls.

Egg Retrieval  For this procedure, you are given intravenous anesthesia because it is considered minimally invasive.  A needle is inserted into each ovary and using an ultrasound to guide them, the doctor is able to aspirate the fluid and egg from the follicle.  It is a fairly quick (20-45 minute) and painless procedure.

My egg retrieval was late morning on February 20, 2014, two days post-trigger.  It was my first time going under and I can only describe it as the best 15-20 minutes of sleep I’ve ever had.  Within no time, I remember waking up and being pushed to the recovery area.  I spent less than a half hour waiting for the anesthesia to wear off and the doctor came in to give us the number of eggs retrieved.  While the nurse had been monitoring between 7 and 9 follicles, 11 eggs were retrieved in total.  We were advised that we would receive a fertilization report the following day via e-mail.

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We also got the green light to begin those oh-so-lovely progesterone shots.  My husband injected me in the bum, alternating sides every time.  They were, by far, the most painful of all the shots, but of course you’ve probably heard by now how I had him stick me with the 18 gauge needle, so that may have traumatized me!

On a serious note, of all the days within my IVF cycle, this was the most stressful.  However, much of that was due to our circumstances.  My husband’s surgery was the morning of my egg retrieval, so you must remember I was going to have the eggs retrieved without knowing for certain if there’d be sperm to use or if the eggs would have to be frozen.  Again, it wasn’t the physicality of the procedure, it was the emotional duress that made that day the most difficult.  Fortunately, they spun the sample extracted during my husband’s surgery and were able to find viable sperm to perform ICSI (Intracytoplasmic Sperm Injection).

Egg Fertilization  The embryologist prepares to fertilize the eggs within hours of the retrieval.  Traditionally, a sperm sample is placed around each egg to allow for natural selection.  With ICSI, a single sperm is injected into each egg.  Fertilization rates with ICSI have been found to be slightly higher.  The following day, the embryologist will notify you with an embryology report that discusses how many eggs were mature enough to fertilize and out of those how many actually did.  The embryos remain incubated until day 3 or 5 depending on when the transfer will occur.

In our case, 6 out of the 11 eggs were mature enough for fertilization.  Out of those 6, using ICSI, 4 fertilized.  We received these results on a Friday, the day after retrieval, and were elated to have even gotten to that point.  The report indicated that we would hear from them again within 1-2 days.

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The next day, Saturday, I received a phone call while working with my husband.  The nurse relayed that all 4 embryos were still progressing; however it appeared that only 3 would be quality enough to transfer.  I had prepared myself for the more common day-5 transfer (at which point the embryos are considered blastocysts), so when she went on to say that we would be transferring the following day, day-3, I was discouraged to say the least.  The decision was made based on the number and quality of the embryos at that point and I was told that they’d best survive in the most natural setting.  Unfortunately, this did not put me at ease and I’d consider this the second most difficult day of our cycle.

Embryo Transfer  This procedure involves placing a flexible catheter  into your cervix to inject the embryos.  The number of embryos is decided prior to or the day of transfer and depends on various factors (e.g. patient’s age, number of previous cycles, quality of the embryos, etc.).  Post-transfer, recovery usually takes about thirty minutes before going home.  Every clinic’s recommendations vary, as you’ll read.  However, research suggests that strict bed-rest is counterproductive, but heavy exercise and intercourse should be avoided.

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Meeting with our doctor beforehand and making a final decision on the number of embryos to transfer was the most difficult part of the transfer.  Our circumstances are not common; nor is the recommendation of transferring three embryos.  However, based on the embryo quality and our openness to twins, the doctor assured us that transferring all three would not result in triplets.

We both dressed for the procedure and entered the surgical room on February 23, 2014 (three days post retrieval).  Within a few minutes, the embryologist knocked on the door and presented a catheter containing our three embabies.  She confirmed our last name and the number of embryos before passing it over to the doctor.  Within minutes, the catheter was inserted and we saw as our three embryos were transferred into the cervix.  It was one of the single-most surreal and magical moments of my life.

Recovery was again less than thirty minutes and I went home to let my embabies stick.  Pineapple core, warm socks, laughter and all for the days that followed.  I took full advantage of having meals made for me and laundry folded, but I did make sure to move around and engage in some activity.  I took an extra third day off, as I felt a cold coming on and since I worked with kids at the time, I did not want it to worsen.  Other than that, and a tug around my belly button here and there, I did not have any symptoms.  Given that early pregnancy symptoms and the onset of your period mimic one another, it’s often hard to differentiate.  Please refer to my TWW Survival Guide for enduring the longest 9-14 days (depending on transfer day and clinic) of your life.  Naturally, I continued Progesterone injections and went in for blood work once during this time.

Beta Day  If implantation occurs, it starts to release the pregnancy hormone, HCG into your bloodstream.  It’s imperative for the most accurate results to wait at least 9 days after a day-3 transfer and 7 days post day-5 transfer to ensure that the HCG trigger is out of your system.  Initial beta numbers can range from single to triple digits depending on length of time since transfer and when implantation occurred.  Regardless, the level should double every 48 hours for a singleton pregnancy and even faster for multiples.

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For us, Beta Day was March 10, 2014  and as it turns out was one of the most cherished days of our lives.  We both went for the blood test together; however I received the call that it was in fact positive with a beta of 816, fourteen days post day-3 transfer.  The second beta, a few days later was over 16,000.

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With such high numbers, we were able to finally breathe.  However, we were far from out of the clear.  Unfortunately, especially with IVF, it becomes hard for you to accept positive news and you remain guarded because you’ve encountered so much disappointment.  It wasn’t until we actually saw a heartbeat at 6 weeks and then got past the 9-10 week safety zone, that we truly acknowledge that we were an IVF first timer success.

As I re-read this post, it is certainly the most dry of my entries to date.    My hope, though, is that it brings some clarity to those who are approaching an IVF cycle or think that IVF might be in their future.  There are many common things about our IVF cycle and many unique parts too.  The fact that we were an IVF success the first time around places us in the minority.  Not a day goes by, where I don’t thank my lucky stars, that after at least 84 injections, over a dozen blood drawings, and more suppositories than I’d like to remember (and that’s just for our IVF cycle and doesn’t include my husband’s shots!), we finally had a child of our own.

The Box on Your Doorstep


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You’ve decided, one way or another, that IUI or IVF is your next step. You’ve had some bloodwork and monitoring and probably some procedures. You may have started acupuncture, meds, researching, playing out every scenario in your head. Everyone has a different “aha” moment during their journey, but I’m sure it’s safe to say when that box arrives on your doorstep you realize this is actually happening-shits getting real.

It can be an overwhelming moment when you open that box and sort through its contents. Your nurses may have muttered off your laundry list of meds and they were probably reviewed again with you when you went to place the order with the pharmacy.

Yet there’s nothing that can truly prepare you for the box itself. There’s needles-💉💉💉lots and lots of needles, an overabundance of medications you can barely pronounce; some that need refridgeration and others that need to be mixed. Gauges and mgs, PIO, and suppositories (if you’re so lucky 🙄) that look like they could last you a lifetime of cycles.

With the variety of baby-making concoctions, comes a myriad of emotions. You’re nervous and intimidated. Will you be able to handle the shots? Should you go stomach or thigh? What if you miss a pill or don’t use the right dosage? You’re angry and self-loathing perhaps. Why do I have to go through all this? Why is this happening to us? What could all these hormones do to my body? Above all, though, you’re excited and hopeful. This box signifies that you’re that much closer to holding your baby. It’s a reminder of how incredible you are to have gotten this far and it’s a filled with endless dreams and possibilities.

Just like you have every step of the way during this up-hill battle: Take it one step at a time. Check that you’ve received all that you were supposed to and check them off as you go. Sort the medications in a safe place and once you receive your protocol organize in a way that makes sense to you. For me, I wanted to make IVF pretty. So, I hit up my holy grail aka Target and bought some fancy shmancy hanging travel bag and put my meds in accordingly (except for the refrigerated ones of course-I actually had to label mine and my husbands because we both had Follistim). Do something that makes it yours-for me it was the aesthetically pleasing storage case. For others if may be to keep all of the syringes and empty bottles for a future pregnancy announcement. It’s one way to make a seemingly unconventional
way of making a baby your own.

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Infertility strips you of ever just being able to have intercourse on your fertile days and missing your period ~14 days later. I HATE that about infertility and I don’t use the H-word freely. I dislike that you don’t get the surprise of a BFP and that even when you are pregnant all of this makes you fearful that it could actually be true. I despise the fact that infertility makes you feel guilty for wanting a biological child or moreover for wanting another. Don’t let the infertility win.

Like Pooh said, “Promise me you’ll always remember.  You’re braver than you believe, and stronger than you seem and smarter than you think.”

Now go on.  Open that box on your doorstep like a mother 👊🏻😝!