Tag Archives: egg retrieval

Hello From the Other Side

Whoa I know! Who’s this girl posting twice in one week?! It’s just your standard new year overachieving which I’m sure will subside by mid-February ūüėĚ. Let’s be real-by way sooner than that! ¬†Truthfully, though, I’ve had a bit of a writer’s block the last few months. It’s been three years since we underwent IVF and thus even longer since we started our infertility journey. Sometimes being out of the fertility intervention game means that I’m not sure exactly what you need to hear at this moment that will resonate you. So any topic suggestions would be greatly appreciated please!

Pondering this got me to thinking that it might be interesting to read what your future holds, once you’ve beaten infertility, or are on the other side of it so to speak. Of course, just like every journey to parenthood is different, so too is the aftermath. I can only speak to what life after the birth of our IVF miracle has been to us. Much like the struggle itself, I’m sure the post-infertility-battle is pretty similar in terms of emotions and outlooks.
Here are 1ÔłŹ‚É£0ÔłŹ‚É£ things to know about being on the other side of infertility.

1ÔłŹ‚É£¬†People will still ask you when you’re having another, even if they know about your struggle TTC #1.

Its not something that I mind at all personally. ¬†I just find it kind of funny that immediately after you have #1 {which took a bigilllion days/months/years} people are already wondering when you’re gonna pop out #2 and they almost always remind you not to let too much time go in between kids. ¬†If only that were in our control right?!

When people unknowing of our situation ask if and when we’re having more , I usually just say “Hopefully if we can, but we have significant infertility issues.” ¬†I love when that turns into hearing their own personal infertility experience, which you’d be surprised how often it does!

Other times, I am sure you can guess what they say! ¬†“You never know. ¬†Sometimes people have to do IVF with their first and then they get pregnant on their own.” ¬†ūüôĄ Insert my thought ūüí≠: ¬†Yes, that can happen, but not for us and our issue. ¬†Moral of the story is people still say stupid shit when you’re on the other side and even when they know about your infertility.

2ÔłŹ‚É£¬†You will refer to your RE as the closest thing to God.

Because he or she is, right?! ¬†They got you pregnant, despite X, Y, and Z (fill in the blanks: PCOS, DOR, Endometriosis, MFI, Unexplained Infertility). ¬†Ironically our doctor is Dr. Gad Lavy of New England Fertility Institute (http://www.nefertility.com) so my husband always jokingly says, “In Gad, we trust.” ¬†Can I get an amen ūüôĆūüŹľūüôĆūüŹľūüôĆūüŹľ?

3ÔłŹ‚É£¬†You will want to help anybody that says they’re dealing with infertility.

Even if you overhear a complete stranger in front of you at Starbucks, you will feel inclined to tell them that you’re an infertility success story. ¬†You can’t help yourself because you remember all too well how stories with happy endings helped you keep the hope alive. ¬†You want to do that for someone else. ¬†And, those times, when you feel embarrassed, or don’t have the courage to speak up, or you were in a rush because you didn’t want your baby to fall asleep in the car before making it home, you’ll stew over it all day long.

Not only will you want to help them, but you’ll want to “fix” them too. ¬†You’ll spew off your doctors names and numbers, ask if they’ve underwent an HSG yet, and basically put your RE hat on because by now you’re an expert. ¬†Then you’ll give your email and contact info if they ever need anything because there’s¬†an unspoken bond between infertiles, even if you’re perfect strangers. ¬†No matter if you’re in the midst of it or you’ve overcome it, we stick together.

4ÔłŹ‚É£ Talking about your struggle with infertility is less emotional.

Before becoming a mom, it was really, really hard (borderline impossible) to utter the words pregnancy, baby, infertility… without tearing up. ¬†You’re just a constant ball of emotions that could unravel at anytime.

On the other side, it’s alot easier to talk about your battle, the ups and downs, and ins and outs of your struggle. ¬†It’s still a heated subject, but I can get through it tear-free¬†usually. ¬†Sometimes the happy tears flow.

5ÔłŹ‚É£¬†You can still instantaneously put yourself back in that place.

When you hear or read something someone’s saying about their trouble getting pregnant, you can immediately put yourself in their shoes. ¬†It’s like you’re ¬†flooded with all the feelings you felt when you were there. ¬†You can feel that same fall-to-your-knees despair you did the day you found out you were 1-in-8. ¬†That same lump -in-your throat nervousness will overcome you when you think back to waiting on results and Beta day. ¬†Pictures of BFN’s, waiting room selfies, and follicle monitoring ultrasounds will still get you every. single. time.

6ÔłŹ‚É£¬†Words still hurt and pregnancy announcements still sting.

Maybe it’s just me, but I’m pretty certain I’m not alone. ¬†Even after becoming a mom and having my turn, pregnancy announcements or hearing someone say they’re starting to try again still jabs me a little. ¬†I think it’s less to do with the other person because honestly I’m so happy for them. ¬†I think, just like the initial go-around, it’s more just having a little pity party for myself. ¬†Like, I wish it were that easy for us. ¬†I wish we could have an oops or just decide to try again and fall pregnant.

The thief of comparison still rears its ugly head too. ¬†For example, if someone posts that they’re pregnant again I can’t help but think to myself that they’re first is half of my son’s age. ¬†It usually involves some social media detective work and calculating, but I can’t help myself.

7ÔłŹ‚É£¬†You’re like rain man with the dates.

I barely can remember what I did two days ago or someone’s name that I run into shopping. ¬†Yet, I can, without hesitation, spew off every significant date of our journey.

October 14, 2014: received diagnosis of Azoospermia

February 20, 2014:  Egg Retrieval & TESE

February 23, 2014:  Transfer

March 10, 2014: Beta Day…

October 24, 2014: Birth of our baby boy

8ÔłŹ‚É£¬†You cherish every moment because you’re not sure you’ll ever get the chance again.

Don’t get me wrong, sleepless nights, teething, and tantrums can ware anyone down. ¬†Yet you recognize the pure blessing every waking (& sleeping) moment is that much more. ¬†Not only will you never get that moment in time back with your little miracle, but you don’t know if you’ll even get the opportunity to experience it with another baby. ¬†So, this helps to put things in perspective when you’re up to your ears in shit and spit-up. ¬†It also makes you spend more money because what if I never have another to put this romper on?! ¬†I gotta get it now before he’s too big for it. ūüíłūüíłūüíł

This too shall pass, but at the same time you wish you could put it in slow motion. ¬†Every milestone, achievement, glance at baby toes, and every time you go to pack away stuff they’ve outgrown is a moment you don’t take lightly.

The best advice I was given for my wedding day was to every once in awhile, take a step back to look around and take it all in (Thanks Jen ūüėė)! ¬†The same applies for mommyhood. ¬†Every once in a while, usually during the most ordinary day, I take a step back to savor these precious and all-too-fleeting moments.

9ÔłŹ‚É£¬†You will be able to reflect on your infertility journey in a much more meaningful way.

Similiar to numbers 3ÔłŹ‚É£-5ÔłŹ‚É£, being on the other side enables you to look back on your struggle. ¬†In some ways you see it exactly as you had experienced it and in other ways you see it thru a different lense. ¬†Dare I say it, could the wait have been what we needed? ¬†Could it had been a lesson we needed to learn? ¬†Was it all just God’s plan because he needed extra time creating our baby and molding us as parents?

I’m still not sure and flip-flop back and forth on my feelings. ¬†I do know for certain, though, that I was destined to use my struggle and success story to help others in the same situation.

1ÔłŹ‚É£0ÔłŹ‚É£¬†It’s so worth the wait.

Bottom line.

What I’ve learned most from being on the other side is that infertility changes you forever. ¬†Even after you’ve overcome it, it never escapes you.

 

 

 

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.

Lefty or Righty

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Pic via seltzergoods.com

With infertility sometimes you don’t know what direction you’re going in and/or you’re being pulled in a million different directions. You don’t know which way to turn, left or right.

Lately, I’ve been connecting with so many women on social media who are courageous enough to share their infertility. Sometimes reading these makes me feel guilty because so many journeys are longer and harder than ours. That’s when I had an “aha” moment about our particular story and began to look at it through a different lense.

Now stick with me, but I’m visualizing a successful pregnancy/IVF/IUI as the middle ground. To the left is the journey to get there and to the right is the point past the initial positive test result or completion of IVF or IUI.

For all of us, the IUI or IVF is relatively the same-a conglomerate of injections, bloodwork, procedures, monitoring, doctors appointments, and waiting. Some might get more side effects. Some might suffer from Ovarian Hyperstimulation Syndrome (OHHS). Your trigger shot or protocol may differ.  Yet, they all remotely resemble one another.

Our struggles, however, tend to vary greatly. Even if two women are suffering from Polycystic Ovarian Syndrome (PCOS) their journeys could look drastically different. Many of us infertility warriors struggle with infertility to the “left” or before we get to the point of IUI/IVF/conceiving some way; while others find their difficulty after, either with failed cycles, chemical pregnancies, miscarriages, etc.

In our case, obviously, the bulk of our infertility fight took place to the left. ¬†Us “lefties” might have to endure months, even years, of struggle to get to the point where IUI and IVF are even a possibility. ¬†For example, my husband needed to remain on medication for almost two years before IVF was in the cards and, even then [right up to his TESE procedure and my egg retrieval] we didn’t know if we’d make it to the point of having viable sperm for fertilization. ¬†Our extreme highs and extreme lows came before the initial BFP. ¬†The waiting and longing, tears and angst occurred prior to our IVF cycle. ¬† However the culmination of our struggle was the point in which our little Mikie “stuck” and , thanks be to God, stayed. ¬†The IVF and entire pregnancy were smooth sailing for us and as some might say, we were finally on the other side of infertility.

“Righties” have a different experience. ¬†They might get diagnosed with infertility and move forward with an IUI or IVF cycle within a couple of months. ¬†It all might seem like a blink of the eye, and before they know it they are Pregnant Until Proven Otherwise [PUPO]. ¬†That is, until the otherwise comes. ¬†Maybe the cycle failed. ¬†Maybe their beta confirms a positive pregnancy, but there’s no heartbeat at the 6 or 8-week ultrasound. ¬†Maybe this keeps happening time after time after time. ¬†Just like “lefties”, it’s not the injections and procedures that are the most painful for “righties”. It’s the roller coaster of emotions that’s associated with the ecstasy of hearing “You’re pregnant,” only to hear “I’m sorry for your loss.”

As a “lefty”, I cannot fathom the heartache that failed cycles and miscarriages must incur. ¬†It makes me feel so fortunate, and almost embarrassed in some respect, to ‘wallow’ in my struggle.

What I’m trying to get to is the realization that infertility is not a battle. ¬†Whatever your story is, first time success or multiple failed attempts, months or years, “lefty” or “righty” is really irregardless. ¬†Infertility is a struggle and the struggle is real.

While all of our circumstances and experiences differ, “lefties” and “righties” are still one in the same. ¬†We all cringe at the thought of hearing another pregnancy announcement. ¬†We all “trick” ourselves into believing we’re pregnant, even when it’s nearly impossible. ¬†We all yearn to rest a newborn on our chest and hear a little voice coo “Mama” for the first time. ¬†We all could write a book on trying to conceive and could pass a phlebotomist test with flying colors. ¬†We all cry and we all pick ourselves back up, with a little help along the way. ¬†We all have the same common goal: to carry, love, and raise a child of our own.