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.

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....

Tuesday, September 13, 2016

Dum Spiro Spero V2

Dum Spiro Spero
While I breathe, I hope



I've been wearing this bracelet since I left Calgary and tend to fiddle with it during my appointments at the fertility clinic. I'll be wearing it tomorrow during the retrieval as well. It was a gift from a group of amazing ladies during our FET last year. I just wanted to acknowledge them for their ongoing support.

Today was a total down day. No injections, no early appointments, just a late sleep followed by a pedicure (so my feet look nice in the stirrups), lunch, and wandering around the city. I'm trying not to get my hopes up for tomorrow (and the days to follow while we wait to see what makes it to day five), but I can't help but want to compare to last time: 17 eggs, 14 mature.

So, let's have some fun and start guessing - how many eggs, how many mature do you think based on the following:

IVF #1: Long Lupron (Gonal-F and Luveris, started 150 IU and 75 IU respectively, increased to 375 IU Gonal-F by day 7)
Baseline E2: 72 pmol/L
Injection day 7: E2 501; seven follies right, four left
Injection day 10: E2 3879; eight follies right (lead at 16 mm), five left
Injection day 12: E2 6665; eleven follies right (lead at 19 mm), five left
Trigger day 13
ER day 15: 17 eggs, 14 mature

IVF #2: Femera/Antagonist (Gonal-F and Luveris, 450 IU and 150 IU steady)
Baseline E2: 24 pmol/L
Injection day 8: E2 890; eight follies right, five left
Injection day 10: E2 2024; seven+ follies right, three+ left (plus a few stragglers)
Injection day 11: E2 5388; seven+ strong follies right (lead at 21 mm), five+ left
Trigger day 11


Monday, September 12, 2016

IVF #2 - Trigger Day

After eleven days of stims, tonight is my last injection - the HCG trigger shot. The purpose of this injection is to essentially force me to ovulate and allow the eggs to be collected from the follicles. The trigger is very time specific and taken 35 hours prior to retrieval - I take it tonight at 9:30 pm.


At the ultrasound this morning we counted eight follicles over 17 mm with the lead at 21. There are also a couple of stragglers in the 14 - 16 mm range that will catch up by retrieval Wednesday morning. My estrogen continues to rise quickly (similar to last time) and was 5388 pmol/L (~1500 pg/mL) this morning. All good news!


In other good news, we received an email from Genesis Genetics this morning (this is where we are having our genetic testing done) and the cost is about half what we expected at $2,600 CAD. This covers up to eight embryos over a nine month timeframe. So, if something happens (i.e. we send our embryos and none are genetically normal), and we decide to try another IVF, we are covered in this respect cost-wise if we do another cycle right away. It's good to have that peace of mind.


Next stop, egg retrieval! I show up at the clinic Wednesday morning at 7:30 am with everything but my legs crossed.



Sunday, September 11, 2016

IVF # 2 - Day Ten & we're almost there

This is an update from yesterday's ultrasound and blood work - for some reason the patient portal is not working for me so I had to get an update verbally during my appointment this morning.


Yesterday we had seven strong leaders on the right ovary, and three on the left, with the lead follicle at 17 mm. Estradiol was 2024 pmol/L (around 550 pg/mL in US units). For comparison, on day nine of IVF #1, we were at eight on the right, five on the left, with the lead follicle at 16 mm. My estradiol was at 3879 pmol/L.


I am on a Femara/Antagonist protocol, which suppresses estrogen in the early part of the stim cycle, so I'm not really surprised that my levels are slightly lower. The use of Femara (aka 'letrozole'), which is an aromatase inhibitor, acts to block the conversion of androgens to estrogens in the body. This results in less free estrogen in the blood stream. The benefit of Femara as part of the Antagonist protocol, and the subsequent reduction of estrogen, is that it makes my follicles more receptive to FSH, which is part of what makes the eggs grow. You can read a bit more here.


We went in for another ultrasound and blood work this morning with instructions to return again tomorrow. I will likely be stimming for one more night (tonight) and then trigger tomorrow night, for egg retrieval on Wednesday.


I think side effects are kicking in to high gear because I feel slightly nauseous all day, with a pretty serious aversion to coffee and espresso drinks of all things. Anyone who knows me knows this is serious! Luckily, it isn't so bad that I can't be out and about enjoying the beautiful weather all day, and we've had a lovely time touring Victoria with Derek's mom and aunt for the last four days.


Almost go time!

Friday, September 9, 2016

IVF #2 - Day Eight of Stims / First Ultrasound

This post is a day late because I spent most of the day yesterday in bed with food poisoning (thanks Salmon Wellington). Luckily, before it hit me too hard, we were able to make it to the clinic by 7:30 am for blood work and my first ultrasound. It looks like we're on track and things look similar to IVF number one, which resulted in 14 mature eggs. Here's my follicle report:




We are looking for follicles close to 17 mm for trigger. The more that are close to that number at trigger, the better. In some cases, they'll let me go an extra day or so, resulting in follicles upwards of 20 mm, to allow slightly smaller ones to catch up.


During our first IVF my right ovary looked much better than my left as well, however during retrieval they found a handful of hidden ones (my left ovary itself likes to hide). I'm hoping for the same result this time as well. Estradiol yesterday was 890 pmol/L, which is right where I need to be.


Next ultrasound and blood work is tomorrow morning.

Sunday, September 4, 2016

IVF #2 - Day Four of Stims

I had forgotten how much nerve it takes to stab yourself in the abdomen with a needle. I started stims four days ago, and as I stood over the sink with my first of three daily injections, I almost started crying when I realized that I ACTUALLY had to put this needle in my stomach. Tears in my eyes, I looked at Derek sitting on the edge of the bathtub watching me, planted my feet, and jabbed it in. And it stung going in, but wasn't so horrible that it stopped me from preparing and taking shots two and three.

Now I've got my routine and I'm done in 20 minutes flat. 150 IU of Luveris (two 75 IU vials with multiple prep steps) and 450 IU Gonal-F. I'm also taking 7.5 mg Femera mid-morning (pills), and steroids in the evening (also pills). In a couple of days, I add a new injection mid-morning to prevent me from ovulating too early. I've added all of these reminders to my phone and check often to make sure I'm not missing anything. Good thing I'm organized by nature and enjoy routine!

When I was contemplating what I would write in this blog post as an update earlier today, I was reflecting on the fact that I've had very few symptoms so far. My abdomen is tender for sure, and I haven't been sleeping well (this is normal for me, so not sure if it's a symptom or not), but otherwise it's still early, so no major bloating. Then, this afternoon, I started getting irritable. And then, about an hour ago, I had a cry. For no reason. Yup, side effects are starting. Now the fun really starts!