Struggles with Infertility

Being a parent is not something that everyone has as a goal in life. But once you decide that you want to be a parent, and you are unable to, your life can either unravel, or you can try to find meaning in your struggles. This blog is me trying to find meaning.

Saturday, August 5, 2017

The Importance of Being Honest

We are still in a holding pattern, which is why I've been slow with blog posts. My posts here always happen after I've given some good thought to what I'm going to say, and to be honest, I've not been giving a lot of thought to our fertility journey the last few months. However, we are coming up on a year since our 2016 IVF, and I've come to the unfortunate realization that I'm coming up on 40 (what?!).

Throughout this process we have had times where we are not on the same page. In fact, we are usually on different pages, if not completely different chapters. It's a re-occurring theme requiring some honest conversations to find ourselves somewhere in the middle. Generally our conversations relate to timing, though recently it's been focused on next steps. But the key is that we have those horribly painful honest conversations, and communicate our individual expectations and boundaries. I also want to point out that expectations and boundaries can change over time for each partner, which is why it's important to keep talking.

Another point I wanted to make was that sometimes it's ok to say you no longer want ownership over driving your fertility journey. Typically, in a heterosexual relationship, it's the woman's job to do the research, make the appointments, handle the finances, find the surrogate, and so on. That is a huge burden, especially over time, and especially when you also need to continue to work on being aligned. Sometimes you need to step back and say you need help. If you're both in this together, maybe sharing the workload is a reasonable approach in your relationship. Work together for your shared outcome: a baby. Of course, I recognize that every relationship is different, so do what works for you. But make sure it's a joint decision. You're in this together, for the long run.

Friday, March 10, 2017

The Tipping Point

At some point earlier this year, as I wrote '2017' as part of a date in my notebook, I realized that we have entered year ten of trying to conceive. It was a bit of a shock; we are in the double digits, can ascribe the term 'decade' to our journey now. To say it and think it, it seems like forever, but to experience it is different. It doesn't seem quite that long (I was also a teenager just a few years ago, I swear!).


I think I've mentioned before that our first recorded pregnancy was discovered as we were losing it. It was right around the time Derek was finishing Fire Training school, and we weren't yet prepared to be parents. Despite that, the hope and short term joy that had been triggered in that small span of time before it was a confirmed loss was enough to push us towards wanting to actually try.


You all know most of the story that follows. The years of heartbreak, sorrow, and grief. But what I wanted to write about was my tipping point. The point where I was finally ok with being a parent, or not. The point where I could talk about our sad journey without dissolving in to tears. Where I could talk about a life without kids, and be ok with it. I started reflecting on this after I had a conversation with a friend last week about our infertility and she said 'How do you talk about this without crying?' as she teared up on our behalf.


That tipping point for me came about two and a half years ago. It started as a question from our therapist (whom we've been with for almost a decade as well, and which I strongly recommend for anyone). She asked me if I would "be happy with just Derek for the rest of your life?" She was asking me what makes me whole. Would I be whole and happy only if we had children? Or could I be whole and happy if it was just Derek and I?


I spent some time reflecting on this, and ultimately came to the decision that yes, I could be happy if it was just the two of us. He makes me whole already. Kids would be a bonus. In fact, I've surprisingly started to swing in the other direction, where I am enjoying life child free, able to spend money on myself and be spontaneous. We're going to give it one last big push with donor eggs in 2018, but ultimately we're doing that so we make sure we have no regrets.


So now, when I tear up, it's when I talk about already being whole. I'll be ok if it's just us. Just us is also a great outcome.

Thursday, December 29, 2016

The Commonality of Infertility and Why IVF Should be Funded


According to Resolve, the United States National Infertility Association, one in eight couples have trouble getting pregnant or sustaining a pregnancy (infertility = inability to get pregnant < 1 year).  The World Health Organization estimates global infertility rates at one in four, based on 2004 and 2012 data (infertility = inability to get pregnant <2 years). Within those couples, approximately one third of infertility issues are associated with the female partner, one third with the male partner, and one third remain ‘unexplained’. Derek and I were originally unexplained, but more and more evidence is pointing towards egg quality issues, with potential immunological issues on my part as well.


Because we are open with our infertility issues, others are often open with us as well. In my immediate family, I have one sister who is infertile due to teenage cancer treatments (early menopause), one fertile sister with two children, and a sister in law who has Poly-Cystic Ovarian Syndrome and is in the midst of fertility treatments with her husband. In addition, my mother and father took >2 years to become pregnant with my youngest sister (secondary infertility), and my mother in law had a still birth between my husband and sister in law. I have a handful of current and past coworkers with IF, and multiple friends and acquaintances from past and present who have reached out to share their stories. Infertility is all around me, and I’m sure it’s all around each of you reading this, though you likely don’t realize it.


An aspect of infertility that is gaining attention in the media recently is funding of infertility treatments. In November 2015, the Ontario provincial government announced that it would fund one cycle of IVF for qualified patients (note that funding is not fulsome, some costs are still paid by the patient). Conversely, Quebec’s publicly funded IVF program – paying for up to three IVF’s – was cut to one, and changed to a tax credit program (patients pay for the procedure up front and receive tax credits from the province). IVF is not funded by the public health care system elsewhere in Canada.


In 2013, the Government of Alberta commissioned a study through the University of Alberta’s School of Public Health to better understand the true costs of IVF. Currently, IVF is unregulated and unfunded in Alberta. Patients pay for IVF, and as a result, are driven to transfer multiple embryos – more bang for your tens of thousands of bucks. Multiple embryo transfers result in high rates of multiple pregnancies – the costs of which are borne by the public health care system. High risk prenatal care, preterm births and associated NICU hospital stays for the babies, and longer term health care associated with premie baby births result in $82 million dollars of societal costs over 18 years. Implementing a funded, but restricted, policy for IVF with single embryo transfers would save these costs, in addition to protecting the health and safety of mothers and children.


Infertility is common – more common than you think – and equitable access to infertility treatment not only reduces the long term burden on our health care system, but also provides more hope to your sister, brother, cousins, friends and coworkers in becoming parents themselves. Talk about it more to understand the issue better, and help us get the message out in support of funding for infertility treatments. It not only benefits us IFer's, but also you as the taxpayer.

Wednesday, September 28, 2016

And Then There Were None

Over the last week, I've gone through multiple scenarios regarding our two little embryos in my head, going through the what if's. What if one is genetically normal? We would be scared we only had one, but hopeful that it was the golden embryo leading to the last, greatest chapter in our story. What if we had two? Even better, with our plan to do a single embryo transfer we get two chances at success, a little bit of insurance.

But the scenario I avoided thinking about was what if we had none. It was hard to think about, hard to talk about. We avoided verbalizing it for fear of negative thinking, of course this was going to work! We are doing everything right this time!

But, unfortunately, the scenario we couldn't stand to think about during the wait is what ultimately happened. Both embryos are genetically abnormal. Abnormal to the point that a live birth, if it got that far, would result in severe mental retardation and physical deformities.

I suppose the silver lining is that we might have some sort of answer after all these years. We produce really crappy embryos. We suspect it's my eggs, and Dr. Hudson confirmed that during our call. We briefly discussed the option of doing multiple IVF's in the hope that we might end up with a normal embryo, but that is so far outside of what I am willing to put myself and us through I immediately rejected it.

Onward, I suppose, to whatever the next step will be and we know we have some options. I have to come to terms with the fact that I will never pass on my genetic material - I think I'm ok with that, but it's still really shitty. Regardless, we'll be taking some time to think and refocus, and explore this new world we've found ourselves in.

Tuesday, September 20, 2016

And Then There Were Two

After a couple of days of agony, we got the call from the lab this morning that we have two blastocysts, graded at a 17+ and an 18 (of 20), on ice. They were able to biopsy both and we should have the results in a week or so.


It will be interesting to see the entire lab report on all embryos to understand the day-by-day. Yesterday, on day five, I answered a call from the clinic and it was Dr. Hudson himself. I instantly felt a knot in my stomach certain that the news would be bad and all embryos had arrested. But we still had four, although the news wasn't exactly what I wanted to hear. As of yesterday, we had one hatching blast graded 17+ that was suitable for biopsy and vitrification (freezing), but only one other early blast graded at a 16, and two morulas. A morula is typically what is seen on day four, so they were a day behind. Not necessarily bad news, but not great either. The plan was to see what made it to blast and freeze with no biopsy - the concern was that they were of such low quality that attempting a biopsy would damage them to the point that they'd arrest.


Ending up with two, and having them graded higher than I expected, is great news!


The PGS results will tell the final story however. At my age, according to the research, we have about a 50/50 chance of a genetically normal embryo. Since we have two, we're looking at around a 66% chance of at least one genetically normal embryo. I am so thankful we made it this far - hopefully we have something to work with and we can move to the next stressful step in the process!

Sunday, September 18, 2016

IVF #2 - Day Three Embryo Report and More

The day following the retrieval we decided to make our way back to Calgary early to give use some time to visit friends and family along the way. Long days of travel followed by evenings of visiting meant I had little time to provide an update. We arrived home last night and Derek's at work today, so I can sit down and write it all out.

After the retrieval, we ended up with seven mature eggs and three immature. We elected to use ICSI on all the mature eggs (we were originally going to do 50/50), and natural IVF on the immature ones to see what happens. The day after retrieval (day one), six of the seven mature eggs fertilized with ICSI had fertilized, and two of the three immature eggs matured overnight and fertilized with natural IVF. On day one we had eight! This was great news and a very good result.

Day two is the first day they can assign grades. VFC grades on a scale of 20, but really it's a scale of 15 - 20. A grade of 20 is perfect and very rare, where a 15 is very poor quality and generally is not transferred. On day two we had two grade 18's, three grade 17's, one 16 and one 15 - seven embryos still going, some better than others. The other piece however is that they were all 'fast cleaving' as most of them were six to seven cells. On day two they look for four cells; you'd think more is better, but growing too fast can lead to them using all their energy too early and petering out later on. It can also indicate chromosomal abnormalities. That said, some recent research has shown that fast cleaving embryos produce more robust blastocysts (day five embryos) if they make it to that stage.

By day three they look for six to nine cell embryos. Our day three embryos were a six cell grade 18, two grade 16+ embryos at five and eight cells, and a nine cell grade 15. We also had two grade 17's with six and seven cells, however they had not done much for about 24 hours so they may have arrested. The lab was going to let them keep going to see what happens.

Today, day four, is a critical day for embryo development and they don't disturb them. They "got a bath" yesterday (words of the lab director!) and went in the incubator, where they will stay until tomorrow. Our hope is that we have two or three blasts tomorrow to do PGD on. The more blasts we have the more likely we have at least one genetically normal embryo.


Keep those little embryos in your thoughts and will them to make it to day five!


Wednesday, September 14, 2016

IVF #2 - Retrieval Day

This'll be a fairly short update as there isn't a bunch to go over, and I'm still a bit loopy from the drugs and napping all day.


We arrived at the clinic at 7:30 this morning and were immediately shown to a room where we both changed in to more appropriate clothing - Derek in scrubs, me in a cotton nightgown. I climbed in to the bed and put the warm heating pad over my belly. Our nurse came in to go over a few things and provided me with Tylenol and Celebrex to keep my pain down all day, gravol for nausea, and Ativan to make sure I was relaxed going in. We waited for about 45 minutes for it all to take effect and during that time had a few visits from Dr. Hudson and the embryologist to go over the game plan. By 8:20, after emptying my bladder, we were lead to the retrieval room.


The nurse gave me a tiny bit of freezing in my wrist prior to inserting the IV. As the embryologist and Dr. H were getting prepped, she started loading me up with fentanyl and propofol. At this point things get really hazy and I don't remember much. I know Derek was in the room with us, and I did feel some minor pain. Dr. H had the nurse top me up with pain medication twice during the 10 minute procedure. Once done, I was carefully walked back to my recovery room for a nap. This is the point where Derek went and did his part, which I have no recollection of at all because I was still pretty drugged up.


We stayed in the recovery room for about an hour (according to Derek) where I napped on and off. I was finally able to wake up enough to get dressed and be escorted to the car. We stopped for a quick breakfast (no food prior to the procedure) and came back to the rental so I could nap some more - I was incredibly tired and still am 10 hours later! I crawled on to the couch and slept for about 2.5 or 3 hours, and laid around the rest of the afternoon.


In the end, we have ten eggs, seven of them mature. The embryologist is going to allow the three immature eggs develop overnight to see what happens. The seven mature eggs will have been ICSI'ed earlier this afternoon while the other three, if they mature, will be fertilized using natural IVF. We should get an update call from the embryologist some time tomorrow morning with how many survived the night.


The next five days are going to be very difficult - during our last IVF we started with 14 mature and ended with two that were transferred on day 3, two that made it to day five. My hope is that we have two or three for PGS testing, and at least one is normal. The wait continues....