Tin Man

A number of years ago, one of my sisters described me as the Tin Man. For most of my life, I've seemed stoic and unemotional to most of the world, when really I'm a frantic and frightening roller coaster of emotions on the inside. I usually cried alone unless the bottled up feelings exploded out in a mess of reactive and defensive emotions, like anger, coldness and anxiety, when really I was feeling hurt, jealous or neglected, but I couldn't process these difficult feelings. Years of this led to a resistance to showing vulnerability except to a certain few people. It also led to a number of related issues like eating disorders and addiction in my 20's. I've worked hard to better understand and work through my emotions so they don't continue to get the best of me, but being vulnerable is still difficult to overcome.

Experiencing infertility leaves you completely, unabashedly vulnerable. The easiest for me is the physical vulnerability - being at the mercy of doctors and nurses, often naked, usually with your most private areas being probed. It's the emotional vulnerability that hurts the most. We are very open about our infertility, and love it when people ask us questions to better understand. Sharing a sense of hope and positive future plans with others, and feeling the positive energy that generates from my friends and family, brings me a sense of joy and happiness. However the necessary sharing of bad news (and crying openly when doing so), and especially when asking for help, leaves me raw and exposed. My stomach churns, my heart is in my throat, and I struggle to make eye contact. I try to embrace it, to learn from it, because I know being vulnerable will make me a better person. But I struggle, which is what prompted this somewhat reflective blog post (which is interesting on further reflection, because I tend to write what I'm feeling rather than say it because I feel a sense of protection still).

We all struggle with this at some level, some more than others. My only point to this post is that whether your struggle with vulnerability is related to infertility or something completely different, it's ok. Be vulnerable. It makes you a better person on the other side.

I'll leave you with a Ted Talk on this subject that resonated with me - Brené Brown on The Power of Vulnerability:

A somewhat ambiguous long term plan

I’ve long equated infertility with the grieving process. You go through multiple phases of shock and disbelief, anger, bargaining, depression, and finally acceptance. Personally, I see myself progress through these phases at some level with each loss, each failed cycle, and at a higher level, with the issue of infertility itself. Over the years I’ve observed (always in hindsight) that my grief cycles have become shorter; I am not spending as much time grieving. I think that is because I have finally come to accept that we may not have children, and I am at last feeling ok with that.

But that’s not the end of the story. Years ago, when we first began this crappy journey, I reluctantly agreed to Derek’s timeline of ‘kids by 35’, or we move on. It took me years of painful reflection to agree to this, but I got there. I turned 35 this month, Derek is 35 next spring. Guess who had a change of heart? Derek isn’t done.

So we have decided to continue the pursuit of a child with a vague timeline. Knowing that I am now entering the age of rapidly declining fertility, we’ve decided to hit it with everything we’ve got in the hopes that we can bank a few good quality embryos for when we’re ready to try again. We had a consultation with Dr. Hudson at the Victoria Fertility Clinic last week and we are so relieved that he is on the same page as us. After a thorough review of our infertility history, he outlined his assumptions: inhospitable uterus likely due to immunological issues, and possible genetic issues with our embryos. We fully agree and are on board with the double pronged approach he’s suggesting.

Our first step is full blood panels for both of us, including karyotyping, to identify any easily discernible genetic conflicts between the two of us. Our second approach is Pre-implantation Genetic Screening (PGS). In part because we aren’t in a rush, we will be banking embryos through multiple IVF’s (three in a row) and performing PGS on the lot of them once we have them banked. After each egg retrieval, they will be fertilized, cultured to day three, and frozen. Once we’ve got a few in the freezer, we will thaw all of them, culture to day five, perform the embryo biopsy, and re-freeze while we wait for the results (the biopsy is sent to the U.S.). We will then (hopefully) have a good set of genetically normal embryos in the freezer.

If and when we are ready for a FET, I’ll be treated as an immune patient with a combination of heparin (a blood thinner), corticosteroids (to calm my immune system down), and intralipid therapy (down-regulates natural killer cells that attack a developing fetus). The hope is that the combination of a genetically normal embryo, plus aggressive immune system treatment, will allow me to carry a pregnancy to term.

We will be going in for our lab work in the coming weeks and have a follow up with Dr. Hudson at the end of November. Once we have an understanding of what we might be facing genetically, we will schedule our first IVF early in the New Year, with the hopes of finishing up all three cycles by next summer for PGS on the embryos. And then we decide on next steps…maybe. Stay tuned.

A little bit pregnant, but only for a minute

Last Monday, at 10 DPO, or four days past our transfer of two day six blastocysts, I got a clear but faint positive on an FRER. Thus, the frenzy began and I peed on everything (hide yo kids, hide yo wife!), multiple times a day. By Wednesday, 12 DPO, I had such a dark line I decided to call the fertility clinic and beg to go in for an early beta (seriously, they had me down to have my first beta July 1st - tomorrow!). The nurse agreed and I practically ran over to the nearest lab, hopes high, certain that this was it. I had never, ever had such a dark test so early. I mean, look at this:

12 DPO, not even first thing in the morning, this is around lunch time.

After a three hour wait the nurse called me with my beta. 12. 12! I was pregnant, but only a little bit. And holy cow do these FRER's detect low levels of hcg. Reassuring myself that a beta of 12 at 12 DPO was perfectly fine, I told the nurse I'd go in on Friday for my repeat.

Unfortunately, Wednesday seems to have been the peak. My tests on Thursday were slightly lighter. I rationalized this by telling myself that the dye in each FRER is different, it's a normal variation, tomorrow will be better.

Friday was lighter. And by Sunday morning, it was so light I called it negative. Loss number seven. I called the fertility clinic yesterday and let them know, and when they asked if we wanted to schedule a follow up with our fertility doctor, I said no. Really, what's the point.

But we are not done. We have plans, and those plans include moving to a new clinic (Victoria), running comprehensive immunology and genetic panels on both of us, and getting as many genetically normal embryos banked (frozen) over the next 12-18 months as possible. And then we decide if we give it another shot on our own (can we handle another loss?) or move to other options, like surrogacy. Either way, we haven't given up yet. Dum Spiro Spero.

Dum Spiro Spero

"While I breathe, I hope." That was what was written on the silver bracelet I was wearing today for my transfer, along with a really awesome pair of purple unicorn knee high socks. Through this journey I've developed many friendships with other women who also struggled to start their families. Despite most of them finding their way to motherhood over the years, they still support those of us in the trenches while we still pursue this dream. Thank you to those wonderful women - this picture is for you:

We arrived at the clinic at 11:20 am, me downing water to try and fill up my bladder, Derek belting out "We're gonna make a baby the expensive way" in a Scottish accent (don't ask). Standing in line to check in, the fire alarm started going off. Despite this, I was calm and confident, and when the alarm was shut off less than 10 minutes later, we were still on schedule.

My acupuncturist was already there waiting for us and we were lead in to a room with a reclining chair. We signed all the paperwork, only then being told that both of our frozen blasts had survived thaw and were in great condition. I relaxed with some needles in various places while my bladder quickly filled up and we waited for the call to go to the transfer room.

You can't see them, but I have needles everywhere, including my abdomen.

 At exactly noon, we were led to the transfer room and given this picture:

Our day six blasts were rated 5BB and 5BA. The clinic uses the Gardner grading system, so these were both "(5) Hatching out of the shell", several celled, loosely grouped, and one was forming a loose epithelium while the other was forming a cohesive layer. But the coolest part was when she showed them live on the screen before taking them up in the catheter. They were both very clearly hatching, and we were seeing it in real time. It was a bit emotional.

Despite issues I've had in the past with doctors getting through my cervix, my very overfull bladder seemed to straighten everything out and the RE got through with minimal cramping. Using ultrasound, they guided the catheter in, prepped the blastocysts, and did the transfer. The green cross over the white spot in this picture is where the blasts landed (the catheter is that white line below and to the left), which we watched in real time. Amazing.

After 10 minutes on the bed letting things settle I was able to go pee (longest pee I have EVER had in my life considering I didn't want to push it out too hard), then back to the recliner for another 20 minutes with the needles before we left at 1 pm. It's all over, after years of waiting. It's happened.

And now we wait. See you on the other side of the two week wait.

Checkmark. Transfer date is set!

My uterus has not failed me, nor have the twice daily doses of estrogen. Today my lining is at 10mm, and is trilaminar. A trilaminar endometrium is the ideal state for this phase of my cycle, and ensures a receptive environment for embryos. According to the research, "At the time of embryo transfer, it is favorable to have an endometrium of a thickness of between 7 and 14 mm with a triple-line configuration...".

So, transfer is scheduled for one week from today, June 18th. In preparation, I soon stop the five times a day Suprefact nasal spray, continue with twice a day estrogen, and start vaginal progesterone thrice daily, starting five days before transfer. 

During my meeting with the nurse today, I had her bring up the information about our blastocysts. We have a 5BB and 5BA. The '5' represents the type of embryo (blastocyst), the first letter represents the degree of fragmentation (A meaning little or no fragmentation, C meaning lots of fragmentation), and the second letter is the overall grade. We have one average blast and one above average blast. I asked about thaw success rates, and the nurse reassured me that success rates for blasts are the highest of all at the clinic, and it is very, very unlikely that we will lose one or both. Then she asked if we were ready for twins.

I know it's going to be a slow week to get to Thursday, but one of the longest waits I've ever experienced in my life is the time between transfer and pregnancy test. Thank goodness it's summer.

T-9 Days Until Ultrasound (but not the exciting kind, yet)

Here we are, day 18 of Suprefact, day five of Estrace (estrogen) and baby aspirin, day four of an antibiotic, nine days from an ultrasound to check my lining, and ~14 days from embryo transfer.

I'm almost in shock that it's actually here and finally happening. I keep expecting something to go awry, but so far, so good, and no historical issues with lining development to cause me to worry. Granted, I'm emotionally tired most days (though generally in a good mood, lucky for Derek), I've been having headaches, and oh man, the hot flashes, but despite those minor inconveniences, I'm feeling pretty good about all of this. The addition of Traditional Chinese Medicine (TCM), acupuncture, and a Qi Gong healing session over the weekend from Derek's lovely Aunt Shirley seem to be helping with the anxiety and worry. I feel good. I feel confident even! This might work!

Of course, it also might not work. There are still things that can go wrong (i.e. the whole embryo thaw process is one of those things that is unknown), but my overall positive outlook, and the fact that I'm pretty busy with life in general, override my minds ability to dwell too much.

Almost there. And hopefully 'there' is just the beginning of the journey.

Suprefact Side Effects, Ugh.

I am on day four of taking Suprefact nasally. Five times a day, every four hours starting early, early in the morning, I spray a dose of Suprefact up each nostril. The first couple of days I was still on vacation in the Okanagan area of B.C. riding my road bike with a group of team mates and I felt great. I had zero side effects the first few days despite having to spray gross stuff up my nose at the top of a hill climb on a stomach full of gels and bananas.

And then yesterday morning I woke up a few hours after taking my morning dose (and going back to sleep for a few hours) with some pretty severe stomach cramps. The memories of stomach pain associated with the Suprefact during my IVF came flooding back. I think what happens is the small amount of medication that does not get absorbed by my sinuses runs down the back of my throat and in to my stomach. It's probably especially bad when the stomach is empty, like it is first thing in the morning. Of course, to compound the fun, I started getting hot flashes as well (and I run pretty hot already).

We made the eight hour drive home yesterday with me cringing in the passenger seat every 20 minutes or so from a stabby cramp. I put off taking my next doses until the very last minute in fear the cramps would worsen, and made sure my stomach was full of absorbent foods each time. The cramps eased up by about midnight, and despite taking it again this morning on an empty stomach, I am not cramping today. I do still feel like a furnace though, so I'm thankful for the cooler weather here at home.

So here we go, first medication is started! I should start AF late next week or weekend and we add estrogen to the mix. I can't believe in less than a month I will be PUPO!

Here we go!

Eight days ago I called in to the clinic with cycle day one and on Monday we got the offer for FET. This time we were able to say yes. Here's the schedule:

May 15th - start Suprefact, which is a suppressant that prevents me from ovulating during the FET cycle. I also start taking daily low dose aspirin for possible clotting issues (more preventative than anything).
Around May 29th - start taking Estrace (estrodol). This starts to build up my uterine lining.
Around June 11th - ultrasound to check lining, blood work to check estrogen levels. If all looks good, I will start taking Prometrium (progesterone) for further uterine lining development and potential pregnancy support.
Sometime between June 16th and 19th, the transfer will happen.

I pulled out our big fertility file because although I know we have two totcicles, I couldn't recall what age and grade they were. We have two day six hatching blasts, average grade. Our hope is that these two embryos were the best of the lot (I had 17 eggs retrieved, 14 fertilize during the IVF in 2012 - only four made it past day three, two of which are these frozen ones) and are strong, as evidenced by having made it to day six and starting to hatch. There is a risk that one or both don't make it through thaw, but the success rate for thaw is around 90%, so we won't let that worry us too much.

Now here's the thing - Derek and I have agreed that there will be radio silence for a few weeks following the transfer. He is aware of this blog and how public I am with our fertility journey, and he's open about it as well, but we both want to (hopefully) enjoy the first few weeks of a successful pregnancy, or mourn a failure privately, before we let you all in on the results. Trust me, this will be as hard on me as it is on you, but I think it will be good for us to have something between just us, even if for a short time.

FET Non-Update

We're on the call list and will hopefully stay there. We got 'the call' this cycle (this past Monday); unfortunately we had to say no because the tentative transfer date was smack in the middle of a vacation we have planned in May. The nurse went to the effort of seeing if there could be any adjustments made to allow for it, but with ultrasounds and blood work requirements, it wasn't going to work.

So we said no, but have been reassured that we're at the top of the list now. This means that we are pretty much guaranteed a call next cycle. Looks like transfer will be in June!

Happy Easter everyone!

The FET Lottery

Over the years, I have come to find that patients at the Calgary Regional Fertility Clinic are really just numbers. There is no holistic or personalized care, and they only used standardized protocols with minimal, if any, deviation. I would guess that the reason for this is efficiency - with the rise in the number of couples and individuals (because there are single women out there who decide to use a donor to become mothers on their own), the clinic is becoming more busy, therefore standardization tends to move things through more quickly.

The unfortunate side effect is that there are hundreds (thousands?) of CRFC patients playing the waiting game each cycle. Here's how it works if you are waiting for a frozen embryo transfer (which is similar for IVF):

• Day one of your period you call in to the 'period hotline', leaving your name, chart number, and phone number.
• You spend about a week to ten days hoping that you get a call back. You make sure you have your phone by you at all times and answer all calls, leaving meetings, interrupting conversations, answering when you're in the bathroom taking care of business (I'm serious). You constantly check for messages. And sometimes they just never call.

Not getting the call sucks. You've looked at the calendar and calculated when your transfer might be (it's about 6 or 7 weeks between cycle day one and the FET transfer on the typical CRFC medicated protocol) and start to get excited. However, your hopes, once again, are crushed. And the waiting game continues on.

Last month I didn't get the call. In about a week, I will call in again, and wait to see if I win the FET lottery this time. I hate being a number.

Rollercoasters

When I last updated, I had just gone in for my LEEP after 10+ months of waiting for the appointment, causing a year long delay in our planned FET. LEEP day was a crappy day in itself and I was emotionally drained. I wanted off the rollercoaster. That didn't happen.

What happened next is that I called the fertility clinic to kick our file in to the active pile only to be told that I needed to do a Sonohysterogram (SHG). An SHG is essentially an ultrasound of the uterus that occurs while they are pumping a saline solution in to the uterine cavity and fallopian tubes. The purpose of it is to check for any abnormalities, such as fibroids, polyps or adhesions, which are contraindicated for pregnancy. I'm not sure if you recall, or have read that far back in my blog, but I have always had trouble with these tests because they can not seem to get a catheter through my cervix. Every HSG or SHG I've had done was performed under general anesthetic as part of a laparoscopy, primarily because of my cervix issues. So when I found out my SHG was scheduled for the morning of the day we were flying out for our vacation in Hawai'i, I was super pumped.

On January 7th, a month after my LEEP, and four hours before I departed for warmer weather, I went in for my SHG. The doctor was running late, which was a stress in itself, and of course she had problems getting the catheter in. All I could think was that I just wanted to get this over with so we could keep moving forward. After about 10 minutes, three tries, many whimpers and tears, and a doctor positioned in a sideways crouch on the floor, they were able to perform the SHG. And thankfully, everything looked normal. Checkmark.

The next step was waiting to make sure the borders of my LEEP were clean. I was told that if they were not clean, I would get a call to come in for a repeat LEEP in mid-January. Thankfully, while I was on the sunny beaches of Hawai'i, I did not get that call. My LEEP was successful. Checkmark.

I got home near the end of January, and my next big thing was getting the hardware out of my elbow on February 10th (installed following a bike crash I had last August that resulted in a broken elbow). However, before I could check that one off the list, I got a call from the fertility clinic. My doctor wanted a note from the Ob/Gyn that performed my LEEP saying I was good to proceed with FET. Getting notes such as these from an Ob/Gyn I've only met once is highly unlikely. So while I called and explained, begged and (seriously) cried to the nurse, I was unable to get anything out of the Ob/Gyn. Back on the rollercoaster. At this point, my anger at the ridiculous situation I was in caused me to almost give up. But thanks to the support I received from a few wonderful friends, I immediately picked myself up and continued to fight.

I was able to get copies of my LEEP report sent to my RE at the fertility clinic. So, despite being only about 30 hours post-op from getting all the pins and wire removed from my elbow, I went in to see my RE this afternoon determined to make her agree that we understand the risks and want to move forward. And I was successful. In fact, the appointment started with her saying she had reviewed the LEEP report already and was comfortable with going forward. Checkmark!

So, we are off that rollercoaster and on to another. We're good to go for March and are on the list for FET. Depending on when AF shows, and if the clinic has room for us, we may be looking at a mid- to late March transfer. Regardless, it feels so good to have some forward progress again, even if it's going to be filled with more ups and downs.