Tag Archives: Tww

To Teachers in the Waiting

I’ve been MIA guys because…well summer. Busy days trying to cram everything in before it’s over and late nights causing us all to crash hard…making it a feat to squeeze in a blog post. But for me, summer is always a harder time for dealing with infertility.

As some of you may or may not know, I am a speech-language pathologist (SLP). Before having my son, I worked as a school-based SLP which meant I was fortunate enough to have summers off. And while summer months can be a perfect time to re-charge I also found they afforded me a lot more free time to focus on my infertility. There were more free minutes to google. More opportunities to research and read. No alarm wake-ups meant I could peruse Pinterest all night for nursery ideas and baby stuff. It also meant that my mind had more space to go to those deeper darker places, especially as August rolled around.

Here we are, the first few days of August. Back-to-school Staples commercials and billboards of tax free back-to-school shopping already have our stomachs nervously filled with butterflies thinking of the imminent end to summer days. And for anyone who works in a school and is struggling to get pregnant, it also means the dreaded going back to see who has since become pregnant from last school year.

It may sound selfish or ill-natured, but I can assure it’s neither. Rather it’s a culmination of all this built up anticipation of getting pregnant over the summer when we could “just relax” or have extra time for monitoring and bloodwork. Most women who work in schools have been trying for awhile now. Originally the plan was to get pregnant with a spring baby as to not have to go back until summer when he or she was at least six months. Then it got revised to a summer baby and then to any time of the friggin year because I just want a baby NOW. And then here comes August and it hits us smack in the face when the whispering of pregnancy news echoes through the halls and the emergence of glowing faces and rounding bumps burns the sting a little more.

Even now, having overcome infertility and having not gone back to work/school, it’s as if my internal clock knows. Looking back Summer 2013 was the toughest point in my journey. I feel as if somehow my body, my brain, and my heart can’t forget that and all remind me around this time of year. Currently in a very different chapter of my life than then and in the very early stages of our journey to baby #2, some of those same emotions are surfacing. While these “bad infertility days” as I call them are very few in number and mild in nature they still remind me of where I was four years ago. It feels like yesterday and a lifetime ago all in one. It’s almost as if it’s subconscious; as if I’m not really sure if my eyes are welling up because of that, but what else could it be?

For that reason, I can’t help but think of my teacher friends still in waiting.  There’s a disappointment in going back with having nothing changed and yet an eagerness to get started as it feels as if you’re moving ahead at least.  And yet, all you feel is stuck.  It’s as if the rest of the world is moving forward and you’re trapped in the same space in time.  You’re no closer to having a baby than you were when you left for summer break.  Baby limbo is a hard place to be as seasons change and transitions occur.

In this season of change, I, myself am experiencing a huge transition as my son goes off to preschool.  While it will be an adjustment to say the least for us, I know it’s time and we are both ready for this next venture.  I’m grateful for our days spent over the course of the past almost three years. We’ve grown together.  We’ve learned together.  And I can’t help but get teary-eyed thinking about what have been thus far, the greatest days of my life.

With this, August is once again filled with the anxiousness and eagerness I’ve always known it to bring.  As difficult as it may be to start another school year, remember that like my son and your students, you’re resilient.  Not even infertility can keep you down.

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.

TWW Survival Guide

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I can only speak from my experience and what worked for us during the dreaded two week wait. Regardless of how you tackle it, I’m sure we can all agree, though, that it is an uphill battle. It starts off with the euphoria of knowing your embaby(s) are getting comfy cozy and gradually seems to go slower once you digest your last piece of pineapple core. The first week, thus, is bearable, but the second is intolerable. It’s in the second week that you start to symptom spot, that every ache, thought, motion is either a sign that this is your happy ending or you’re greatest fear: a BFN. The second week goes at a snail’s pace and typically involves an influx of pregnancy announcements and pregnancy test commercials that really test all the hormones raging inside of you.

My recommendation is first and foremost do what works for you and your significant other. Remain in that constant state of infertility: cautiously optimistic. Use these as a guideline, rather than an end all be all, because while I was one of the lucky ones I’m not sure how many TWW’s I would’ve been able to tolerate.

🔸 AVOID GOOGLE

Sounds as impossible as surviving the TWW, I know. However Google is like a woman in the TWW’s crack. It is so addicting and so easy to get caught up doing, but gets you nowhere. If you’ve made it to the TWW, then you’ve done all your research. You know what to anticipate. Searching for “specific symptoms 4dp5dt” will give you no concrete answer. All it will do is make your mind play all sorts of crazy tricks on you.

Go ahead, look up cute maternity dress websites and plan your entire baby shower through Pinterest. But please, my dear friend, do yourself a favor and avoid at all costs using Google to “predict” your outcome.

🔸 N O  T E S T I N G before B E T A

Again, a personal choice, but one I strongly recommend. My husband and I made a vow to one another that we would wait until we received our call on Beta Day. It wasn’t easy but I made sure that there weren’t any leftover tests lingering around the house and stuck it out.

From my perspective, testing before Beta can lead to two devastating outcomes. First, with a fresh transfer, your HCG from trigger can still be recognized on a pregnancy test if you test too early. This could give you a false sense of hope that you’re pregnant when it could’ve been the residual hormone in your system.

Second, you could test early and get that BFP that you’ve dreamed of. It could quite possibly be one of the greatest moments of your life all to come crumbling down on Beta day when your number comes back lower than the magic number. In this instance, you typically have to keep going for more bloodwork to see if the number changes. So basically the TWW becomes even longer and more devastating.

In my opinion, testing before Beta is a complete mind fuck. Just like googling, it’s a dominos effect. If you say you’re only going to test at day 8 and then the line is so faint, you’re anxious to test again at day 9, 10 and so on.

🔸 F I L L  Y O U R   S O C I A L
C A L E N D A R

You may have to swap the Pinot for Pellegrino, but make plans. Girls night outs, date nights, or even coffee outings to help give your mind a break are all welcome. They’re great for keeping you on track, maintaining your positivity and sustaining your sanity.

It may help to talk about what you’re going through or you may opt, especially when out with your significant other, to forgo discussing your infertility altogether. Either way it’s a time to feel like yourself, which is easy to lose when on this journey.

🔸 P U R G E or P R O J E C T

In less than 9 months you could potentially be nesting. Why not get a head start?! It’s true what they say-Clean house, clear mind.

It’s important mentally to rid yourself of some of this excess.  Doing so physically can be helpful too.  Reorganize those cabinets you’ve been meaning to for the last 7 months.  Or maybe you can start and actually complete that DIY project you’ve been meaning to tackle.  Either way, they’re both a wonderful strategy for making the time pass while being productive.

🔸 P R A Y

Cliche I know, but I’ve noticed the overwhelming amount of faithful ladies amongst us.  Regardless of how you pray or Who you pray to, prayer or meditation of some sort can be a source  of peace.  If not for yourself, do it for your little embryos that need you in a place of calmness.  It’s also a way to connect with yourself and your embaby(s).  In my experience, the majority of our TTC tribe use prayer as a way to cope with the pain and suffering of infertility.

🔸R E W A R D   Y O U R S E L F

At the point of the TWW, you have done everything possible to make this work. Maybe you’ve done acupuncture, changed your diet, or tried fertility herbs. Maybe you’ve eaten the pineapple core for 5 days or worn socks since transfer day, even if it’s 90 degrees out. Whatever it is you have done, you’ve done it to the best of your ability. Reward yourself for that-a handbag, a daytrip, a good book, a piece of jewelry (obvs my top pic 😝💎).

No matter the outcome this time around, remind yourself that you’ve done everything in your power to make this work.  Know this, honor this, applaud this.  You are a warrior and not everyone can say that.  More importantly, not every child can say that about his or her momma-but yours child-to-be can.