One Step Forward, Two Steps Back

The next week was a long, difficult week for us.  We tried to process the idea of loosing something I’d always taken for granted- having a baby.  I was home from work.  This was both a blessing and a curse.

As time moved forward, and the longer I had been away from work, the more anxious I got about returning back. I was still very depressed, tired, achy, and wanted to sleep the day away.  On the other hand, getting back to work would keep my mind occupied.  Plus, I love my job.  I kept telling myself I’d go back tomorrow.

Then the evening would hit and I would be so anxious my mind would be racing in circles.  My job took my full concentration.  What would happen if I went back and made a mistake?  What if I missed something?  There were potential negative consequences for others if I made an error.  This thinking was enough to push me back into my cave of loneliness and I’d crawl back into bed for yet another day.

Days became a week, then two.  I needed to go back.  My calendar was fairly light for the next week ahead so thought it might be a good time to ease back in.  I promised myself that Monday would be my first day.

Monday came, I made it to work, and nothing terrible happened.  Tuesday followed, and I was back into the swing of things.  Focusing on other issues made our problems fade into the background… at least during my working hours.  Evenings I’d return home and feel lost at what to do next.

We had our WTF appointment at the end of the week.  Dan and I talked daily about what questions we had, what we needed to understand, and what we had decided- we were done with trying.  Our evenings turned into mini-counseling sessions.  Dan and I would try to talk through everything focusing on what was next.  (Ok, I talked through everything.  Dan did a lot of nodding.)  One thing we knew was that we couldn’t just jump into something else, we had to mend ourselves from this process first.  Throughout the week we talked about next steps.  We had decided to look into surrogacy as our next step, but the clinic didn’t know that yet.  What would they say about our new plan?

The night before our appointment it occurred to me- I needed to completely change my way of thinking.  Instead of focusing on ‘getting pregnant’, I know had to focus on ‘making a family’.  At one time, those meant the same thing.  However, now, I knew they were two very separate things.  Getting pregnant was only one solution.  Changing this mindset would take some time, but thinking about things this way made me feel like there was some light at the end of the tunnel. 

This wasn’t the end, this was just the end of trying ourselves.  More importantly, this was about the be the beginning of a whole different story.  Our story.

WTF Appointment Day:

Dan and I pulled into the clinic and gave each other the ‘we can do this’ smile.  We held hands and walked through the door.  This past year and half may have beat us down, but we made it through.  One thing was for certain, our marriage had never been stronger.  If we could make it through this, we could make it through almost anything.

We sat down with our RE and he said he was sorry about our disappointing news.  He then started into how he was going to change our protocol for the next round in hopes that it would take significantly less time to get my body to produce follicles (eggs).  I kept trying to jump in but he continued on and on about different medications we could try to help etc.  Finally, I stopped him.  I asked him to back up.

Why didn’t it work?  What went wrong?  Was it me?  Was it the embryos? He simply shook his head.  Science had come so far, and the doctors and scientists knew so much about everything before you actually put the embryos inside me.  Once they were inside, we just had no idea what went wrong.  There was no medical answers.  It could be my body rejecting the embryos, it could be something wrong with the embryos, or it could be simply bad luck.

Then I just came out and said it.  We were done.  We simply couldn’t do it anymore.  It took an entire year straight to do only 4 cycles (when most people would get to do 12).  The emotional, physical, and financial toll was just too heavy.  If the doctor didn’t have any reason why it wasn’t working, then what would change if we did it again?  My body was simply revolting at the idea of carrying a child.  No matter what we did, my body seemed to protest it.

I then told him about Jen’s offer of surrogacy and said that we were interested in exploring this option further.

He just shook his head.  What kind of surrogacy he asked?  We were thinking about Jen being a gestational carrier.  This meant that it would be my eggs, Dan’s sperm, and her uterus.  The child would have no DNA connection to Jen, we would ‘simply’ be using her body as an oven.

He took a deep breath and shook his head again.  This was not a simple process he explained- had we looked into it?  Did we know what it entailed?  And if we wanted to do it, we would still be required to make eggs again which was one of the most difficult parts last time.  He explained that while our clinic was one that would work with surrogates, that all of the docs would have to agree that Dan and I made good candidates.  This was not a simple hurdle and was not decided on lightly.  In order for the clinic doctors (the 5 of them) to approve us for moving forward with surrogacy, they would basically be saying they felt there was virtually no chance of us being successful by ourselves.  He wasn’t sure if we met that criteria yet…

I was stunned.  I had thought that we had figured out the perfect option to move forward with.  We had someone who was willing to investigate the process further.  We were with a clinic that would work with gestational carriers, and fertility treatments were simply not working for us.  And now the doc was all but saying no?  I was crushed. 

I asked him if he felt that Dan and I could conceive.  He said that there was no medical evidence at this time telling him that we could not.  I asked then if there was therefore medical evidence that we could?  He looked at us thoughtfully… and slowly said no.

He said, “In a perfect world, we wouldn’t have to worry about the costs associated with these treatments.  If we were in Holland or even Quebec, these services would be covered by the government and we would like to do three fresh transfers.  Once a couple has done three fresh transfers and was not successful, it was at that time that the clinic would say that we were unable to conceive.”  We had done one fresh transfer, and two frozen transfers plus an attempt at the less invasive IUI.  Not exactly his formula above, but it also wasn’t like we hadn’t given it our all.

The doc sat there in silence for a minute then said, “I know that your situation is very unique.  We have had issues at every step of the way and we know that you are not a typical infertile couple.  Let me think about this a little more and I will take it to my team to discuss.  We will discuss if we feel you are appropriate candidates for surrogacy and get back to you.”

Defeated, I nodded.  We shook his hand and left the clinic.  I finally thought that we had an opportunity to move forward… and now we were in exactly the same place we were a year and a half ago (only thousands and thousands of dollars poorer).

When we were going to get a break?  It appeared my ideology about this being the beginning of a new story for us meant nothing.  This looked like it was simply going to be the end.

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Drafted to the Big Leagues… IVF

* Foreward…

 

I’ve been procrastinating and delaying writing this part of the year.  This is the part of our journey where things got tough.  Real tough.   Hormones, emotional hell, physical agony and an empty wallet would be the short version… Here is the longer one.

 

 

 

We have just been switched to IVF and our heads are spinning.  We have been talking about IVF as our next route, but had no clue we would be making these decisions now.

 

We signed the consents and had another brief overview with the nurse about other changes.  I was now given another medication call orgalutron- another needle to give myself in the evening.  This is used to prevent immature ovulation in women being stimulated in fertility treatments.  There is no use growing these amazing follicles if we can’t do an egg retrieval to catch them all!

 

Now our goals had shifted- we now wanted as many follicles as possible while maintaining a safe level of estrogen.  The clinic gave me a couple days off from monitoring and I was to come back on CD 36.

 

My body felts like I was falling apart.  I had been trying to go to work and keep up, but at this point, I could barely walk due to the pain in my abdomen.  Additionally, I now had the shakes and was sweating like you’ve never seen.  Between my hot flashes, track marks on my arms from blood work, and trembling hands, it was getting harder and harder to convince people I’m not an addict coming off a high.  My boobs and abdomen were so swollen that one would actually think I’d be pregnant and in my third trimester.  Anything that touched me below my neck and above the knees felt like a knife stabbing me.  I tried to tolerate the physical symptoms as best as possible, but at this point, I was breaking down.  I eventually gave up and called work to let them know that I was going to need some time off.

 

CD 36: The most painful transvaginal ultrasound and blood work.  Ever.

 

I step into the clinical room to receive my results and now understand why I am so ill.  I now have 29 follicles growing in my ovaries.  Twenty-nine.  Now keep in mind, a normal person grows one, maximum two follicles, once a month. 

 

To perhaps put this in better perspective, a normal and healthy ovary is about the size of a Greek olive.  Both of my ovaries now are approximately the size of large grapefruits.  They also don’t really have any room to move so one has migrated up and under my ribcage, and the other is squishing everything else in there.

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Right Ovarian Follicles- Black circles are follicles

 

 

After seeing the ultrasounds, we decided to wait for my blood work before making any decisions.  The reports came back around noon and they gave me a call.  My estrogen had sky rocketed, and was so high that the clinic was worried about Ovarian Hyper Stimulation Syndrome (OHSS).  More about this later, but what this meant was that we couldn’t wait any longer, we had to move ahead with the egg retrieval. 

 

This wasn’t an optimal time as even though I now had 29 follicles, many of them were under 18 mm so were not big enough to have a mature egg.  This didn’t matter, waiting and continuing treatment was not an option.  Plus, we have about 15-16 follicles within the size range that we want- still a great result!

 

By this time, Dan had officially given notice to his old employer and was full speed ahead doing the last minute preparations for opening our Pita Pit.  Construction was underway and he was able to be home and help me as needed.  The better news was that I had now (finally!) convinced Dan to list our home on the real estate market and shop for a new one.  We decided to move closer to friends and family, so we had picked a smaller rural town close by.  I had found my dream house, and even though it was a tad over our budget, my negotiation skills prevailed and we had a 30 day closing!  (As if we weren’t busy enough….)

 

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Our Soon-to-be Pita Pit

 

 

After we received our results from the blood work that afternoon, Dan drove back to the clinic to purchase a trigger shot for me to take.  The goal this time was not to trigger ovulation, but instead, to trigger the eggs to mature.  When he came home, I gave myself the trigger needle.  Tomorrow was the big day- egg retrieval!

 

Egg Retrieval

 

I woke up the next morning and we got ready to go into the clinic for our egg retrieval.  The clinic had given me a prescription for an anti-anxiety medication to take the morning of.  I took the pill and tried to concentrate on the bigger picture and end result- a baby!

 

We got to the clinic and Dan handed the clinic a fresh sperm sample.  As soon as the eggs were out, the lab would be fertilizing the eggs to make embryos.

 

They had me get dressed into a hospital gown and took us to the back where the procedures happen.  The RN started an IV and gave me special medication that I required to assist me due to my bleeding disorder.  This made me start to get very nauseous… trying my best not to puke, the nurse came over and added in some gravol to the IV.  These meds, plus the anti-anxiety meds, had me pretty darn calm.  I waited until it was our turn to go in- no big deal.  I can do this.

 

Another nurse arrived who was scrubbed in and ready to go.  They lead us to the room and I got onto the table and put my feet in the leg holders.  I was now lying down with my legs spread and in the air.  Dan was sitting beside me holding my hand. 

 

As the RE arrived ready to begin the procedure, the RN started to add medication to my IV.  Different clinics do this different ways, however instead of knocking you out, our clinic chooses to do something called conscious sedation.  The purpose of this is to give you a combination of medication to help you relax (a sedative) and to help block pain (an anesthetic).  The goal is to be semi-awake but not to be able to feel the majority of the procedure.

 

The RN started to give me the medications.  They continued to ask me questions and then said they were ready to start.  This isn’t a pretty procedure- basically they are shoving a transvaginal ultrasound in with a suction needle on it.  They push the needle through and into your ovaries.  The needle then sucks out the contents of each of your follicles (eggs).

 

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Egg Retrieval Diagram

 

 

As the RE started to insert the ultrasound probe I was in incredible pain- they hadn’t even started yet, however due my physical symptoms, everything hurt.  I asked them to stop and to give me more medication.  They did.

 

They went to start again… and again I’m in excruciating pain.  Dan is squeezing my hand as I try to calm myself down and stop from crying.  I request more medication.  The RE nods and the RN gives me more.  We start again…

 

This time I try to grin and bear it.  It hurts… no, it is terrible.  I’m not able to stand it and am now extremely upset and sobbing loudly.  The RN then informs the RE that they have given me the maximum amount of the medications allowed in a non-hospital setting.  They cannot give me any more medication.

 

The RE says that we can stop due to the pain.  I ask what that really means- does that mean we aren’t going to go through with it?  She says we don’t have another choice.  Due to the timing of the trigger injection, the eggs are ready now.  If we wait, they will ovulate and be over mature.  It was now or never.

 

I looked at Dan… he looked more scared than I did.  He was handling this amazingly considering the state I was in.  I looked at him and said, let’s just do it.  The RE explained that it would be very painful, and she understood if I wanted to stop.  They could not explain why the medications were not taking any effect on me.

 

Here we go again…  Dan was now standing and holding my arm, half supporting me, half trying to keep me still as I sobbed and moaned through the procedure.  They called another lab tech into the room to assist to hold my other side.  The RN was trying to encourage me through it as the RE sucked everything that was viable from my right ovary.  I have never experienced pain like that before.

 

They then went for my left ovary.  The RE stopped and explained that she was unable to reach it as it was shoved way up under my ribs due to its excessive size.  She tried a couple more times, however she couldn’t get it.  They checked to see if they were able to access it from my abdomen with a bigger needle, however the pathway was blocked by bowel and intestine.  They could not safely access my left ovary to get the eggs out.  She just shook her head and apologized.

 

After the most painful 30 minutes of my life, they could only do half of the job.  My body had yet again failed me.

 

I don’t really remember most of the rest of the day.  I believe Dan took me home and got me into bed.

 

Fertilization

 

We received the report.  They were able to extract 8 eggs from my right ovary.  Out of the 8 extracted, 6 were mature.  The clinic went ahead and fertilized those eggs.  Due to the small number, we decided to go with a method called ICSI.  I don’t even know what that stands for (and I’m too lazy to google it!), but basically instead of just putting Dan’s sperm with the eggs and crossing our fingers, we fertilize the eggs with a bit more science.  The lab picked out good healthy sperm from the sample and held the egg still.  They then injected one sperm into each egg in hopes that they all would take.

 

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ICSI

 

 

We got the call the day after the retrieval that all 6 of our eggs had fertilized and were now growing in the incubator!  The disappointment of the retrieval day was behind us, and we were now focusing on our 6 growing embryos.  We continued to get an updated report each day to find out how the embryos were growing.  Just because your eggs fertilized does not mean they will grow.  Ours were good quality so we had high hopes, however nothing is guaranteed.  We finally had a spot of luck on our side and all six embryos made it through three days of growing. 

 

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Embryo Development Diagram

 

 

In the meantime, I was now done with injections, but was giving myself progesterone suppositories three time daily.  The purpose of the progesterone was to keep my uterine lining in good shape and prepare my body to accept an embryo- and hopefully attach!

 

I was under the impression that once they took these eggs out of my body, I would be feeling much better.  However, the opposite was true.  I was now full fledge into ovarian hyper stimulation.  My stomach had distended (I literally looked 9 months pregnant), I was throwing up and having classic OHSS symptoms.  I actually got so sick that Dan had to get me into the car and get me back to the clinic to be seen.  They reviewed everything and said that I had moderate to severe OHSS.  My estrogen was over 25x higher than an average woman.  The good news was that I did not have any free fluid in my abdomen.  This symptom of OHSS is life threatening, not to mention, they would have to cancel my transfer.  Part of the problem was that my left ovary never released the substantial amount of follicles. 

 

I continued being very ill for three days.  Dan took good care of me and was feeling like a human again by day three post egg retrieval.  The clinic reviewed my symptoms and approved me to continue with the embryo transfer.

 

As a side note, we had received possession of our new home.  However, because the first one had not sold yet, we didn’t have to rush and move.  I spent the 3 days between the retrieval and transfer lying on a sunbathing chair in my kitchen wrapped in bedding.  My family assisted us each day in moving some items over.  My Mom actually unpacked my whole kitchen as I laid in the chair pointing.

 

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Our new house on moving day- still no sod or paved driveway! But couldn’t be happier.

 

 

Transfer Day- June 4, 2013

 

After all the hi-tech science that has happened to get us here, the actual transfer was fairly uneventful. They guide a catheter into my uterus using an abdominal ultrasound.  Once the ultrasound is in the exact position, the RE injects the embryos in the top 1/3 of my uterus.

 

The crazy part is that she is actually injecting two small babies into my belly!  Depending on your philosophical thinking of course, but for me, life begins at conception… so here is a picture of the ultrasound they gave us when leaving.  The bright white spot near the top centre (inside the darker circle which is my uterus) is the two embryos that were transferred.  This was the first ultrasound of our pregnancy!  I took a pic and sent it to my family and close friends!

 

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Our embryos after transfer!!

 

 

I went home, relaxed in bed for another day, then went back to work.  Technically I was now pregnant.  However, the bigger question was would it last?  All that these little guys had to do was snuggle their way into my uterine lining.  Two embryos meant a very good chance of two babies…

 

Let the wait begin.