Gestational Surrogacy

In one of my last posts, we had outlined an ambiguous long term plan involving multiple IVF's, genetic screening of the embryos, FET's and immune system suppression protocols in the hopes that I would be successful in carrying a baby to term. After some very long and heart wrenching discussions, we landed on pursuing the use of a gestational surrogate - a surrogate would (hopefully) eliminate the unknown that is my body, and the genetic screening and use of 'normal' embryos would at least give some sense of security in that respect. We are not totally eliminating my carrying a pregnancy myself, but it's no longer our focus.

We started our search last December and I slowly entered the new world of Canadian surrogacy via Facebook groups and websites offering matching services. What we've come to discover is that this is not going to be easy. There are limited surrogates publicly offering their services in Canada via matching services or informal online groups, and while surrogacy in our country is legally 'altruistic' (you pay for actual losses, but nothing more), fee-for-service money certainly changes hands in many cases. This brings ethics in to the equation. Is it ok to skirt the law in order to secure a surrogate who expects payment for the 'service' she is providing, and is that changing the ethical implications of surrogates in Canada? If most surrogates now expect payment, and you can afford to pay it, do you still wait until you find a legal surrogate, or do you skip the line?

For now, we are sticking to our sense of ethics and the law in Canada and continuing to search for a surrogate that meets our needs and is aligned with the ethical intent of surrogacy in Canada.

I would like to highlight here that I have had multiple offers of surrogacy in the past and declined because we were not ready to pursue it. I also know that I will have friends and family that read this that may be interested in being our gestational surrogate, so to minimize the risk of uncomfortable conversations, here is a list of non-negotiables (for now):

• Must be healthy - this means healthy weight, non-smoker, no heavy drinking, no drugs (including prescription medication)
• Located in Alberta or British Columbia (preferably near Vancouver or Victoria)
• At least one successful, uncomplicated pregnancy and birth
• If there is a spouse/partner, they must be fully on board
• Available for gestational surrogacy late 2016 and in to 2017

I'd also remind you to read my previous guest post on what surrogacy means for the surrogate: Guest Post: What it means to offer to be a surrogate

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.