IVF Cycle #1: An Embryo Transfer and a Funeral

Sunday morning I woke up early and could not sleep. I kept thinking about my grandpa and decided that I really wanted to write his obituary. Ideas and phrases kept popping into my head and I kept grabbing my phone off of my night stand to type little notes. Before I knew it I had written an entire obituary for him in the notepad app on my phone. At 7:00 am I texted my mom to ask if I could write it. I thought for sure she would be up-she never slept in. An hour later I had not heard from her so I confessed that I had actually already written it so I really hoped they would use it. She texted back saying that my grandma would love for me to do it. I called later that day and got information to fill in some blanks and then sent it to my dad to edit.

The rest of my Sunday was spent preparing for our embryo transfer in the morning. After the transfer I would be on bed rest/limited activity for three days. I had been recording movies on our DVR for weeks and also had "A Game of Thrones" to finish reading. I went to the store and bought fruits and veggies for smoothies and salads. I cut up a pineapple and put daily portions into zip lock bags so for breakfast I could just add a bag of pineapple, a banana, some orange juice, a scoop of yogurt and a handful of frozen strawberries to the blender to make a quick smoothie. I mixed lettuce, tomatoes and cucumber slices together and divided it into meal sized portions in zip lock bags, so for lunch I could take a bag of salad and top it with some steak or chicken strips (also prepared and in the fridge) and dressing for lunch. I figured I would leave dinners up to Ryan, since he would be home each night by that time. I made sure laundry was done and the house was clean so that I could truly relax for those three days.

By Monday morning I felt completely ready! We went to the doctor's office first thing in the morning to have our first little embryo put into my uterus. It sounds so cold and scientific, but really IVF is such a miraculous thing. I am so glad we have so many developments in modern medicine so that something like this can be an option! The doctor had me take some Valium to help me relax, then had us sign some papers and explained what was going to happen. Then we discussed the embryos. It used to be that more embryos meant a better chance of a pregnancy but our doctor said that current research shows an increase in twins when you transfer two embryos, but not necessarily pregnancy. With my age and good health he recommended one, but said it was up to us. We had though it over quite a bit (and I had looked up lots of information online) and decided to just transfer one embryo. Not all of our embryos had made it; we had eight embryos left and not all of those eight had reached the blastocyst stage they needed to before they could be frozen. They would transfer the best one of the eight embryos that day and freeze the other seven as they were ready. They even gave us a picture of two of our embryos to take home (which I still think is so cool! How many people get a picture of their baby at this early stage in development?!)

I keep this picture on my fridge.

The embryo transfer was a really neat thing to experience. As always, they had me laying down half naked and covered by a sheet. I was laying on a foam triangle shaped pillow to elevate my pelvic area. Ryan was sitting next to my head to my left. One of the nurses put jelly on my stomach for the ultrasound. On the wall behind the doctor they had a TV. The embryologist came in and had us verify that the name on a vial was mine then the he went into a room connected to ours and Dr. Moore told us to watch on the screen. He explained everything while we watched a little dot on a white screen grow larger as the microscope zoomed in until it looked just like the embryo in the picture. Then the embryologist zoomed out and we watched as a clear plastic tube appeared and sucked up the embryo. We could see the tiny little embryo move into the tube. Then the embryologist came back in holding the small catheter tube and handed it to the doctor. He inserted it into me and they watched on via ultrasound to make sure they got it in the right place then as they release the embryo a small white streak appeared. The embryo itself is too small to see on the ultrasound-the white streak was from the fluid that contained the embryo. After that the embryologist took the catheter back into the attached lab and put it under the microscope again. We watched on the screen as he zoomed in just to make sure the embryo had not gotten stuck in the tube. All was good and we were done!

Our ultrasound: notice the little white streak in the circle.

Dr. Moore said that for the next three days I should take it easy and limit my activity. He said I did not have to stay in bed all the time-we could go to dinner or a movie-but to try and stay off my feet as much as I could. I asked what he thought of me attending my grandpa's funeral. The viewing was being held Wednesday night and the funeral Thursday morning. I explained that it would mean packing and traveling since the funeral was in Idaho Falls. I really liked how my doctor handled this. He basically gave me permission to go, but then asked how I felt about it. I told him that I was worried about the stress of going on a trip, the emotional stress of seeing my mom and grandma cry and the physical standing and walking at the viewing and cemetery after the funeral. I explained that I felt like I had closure and really I wanted to be there for my family (who had told me to stay home) more than anything. I was actually pretty lucky: I got to say goodbye to my grandpa and make sure that my last meeting with him was meaningful. That is so much better closure and brings much more peace than a funeral could. After everything I had to say, he said that it would probably be a good idea for me to stay home, but to do what I felt I needed to do. I just appreciated the sensitive way he handled a tough question: he gave me his recommendation, but also made me feel like I should do what I thought was best.

They had me lay there for thirty minutes (I came prepared with a book) then a nurse came in and told me I could get dressed. I stood up and the Valium really hit me! I felt so dizzy and light that I couldn't help but giggle. Ryan had to help me get dressed then the nurse wheeled me down to the car in a wheelchair. I fell asleep before we were on the freeway and didn't wake up until we pulled into the driveway. I was starving so I went inside and had all the stuff out to make myself a salad before Ryan was even in the house. That was when I realized that I had forgotten to prep cheese...I pulled the one-pound block of cheese out of the fridge and grabbed a big knife. Ryan stopped me and told me that putting my body weight into a block of cheese was not bed rest and walked me downstairs and then fixed up my salad himself and brought it down to me-complete with tiny cubes of cheese sprinkled on top and the bottle of dressing on the side. I ate and then let the Valium take over again and I fell back asleep until I had to wake up for my progesterone shot. Ryan would have to give me these shots until my tenth week of pregnancy if we got a positive result! The shot was so much easier than I thought it would be. It was a pretty big needle and the shot had to go in my hip muscle (above my but cheek). We had the nurse draw circles on my back after egg retrieval so he would know where to aim. It did no hurt like I thought it would (yet...)

Later that day I cut my grandpa's obituary down to fit in the required word count and emailed it to my aunt so they could get it to the funeral home. It was printed in the the Idaho Falls Post Register on Wednesday that week (read it here: William Lynn Yorgesen Obituary). I don't really remember much about what I did during my three days of bed rest (but bed rest is not a very exciting way to spend your days). On the first day I went through all of my pictures and emailed some of the best ones of my grandpa to my aunt for a slide show they put together. I did not go to the funeral, but felt like I still was able to contribute. The funeral home would also provide a recording of the service so I knew that I would get to hear it all later. My mom told me that she knew my grandpa would've wanted me to do everything possible to bring a baby into the world and so she too thought that I should stay home. That made me feel better. Looking back now I have a little bit of regret because it would not have made a difference in the outcome if we had gone or not, but at the time I did not know that and we just did what we felt was best.

At this point I was still drinking a ton of Gatorade every day and it was really starting to make me feel sick-my stomach hurt all the time. On top of that I was nauseous off and on all the time-especially when I was hungry-likely from the HCG in my system from the Pregnyl shot. I still felt very bloated for a few days and was getting heartburn so bad that I couldn't sleep. Finally I decided that I could not take the Gatorade any more. I think all the sugar in it was irritating my stomach. I switched to coconut water and pedialyte to replace the electrolytes and broth for the sodium (I emailed the doctor for approval). After one day on the new fluids my stomach felt so much better. Two days later something magical happened: I lost two pounds and an inch and a half in one day! That meant everything was leveling out and I was probably no longer at risk for Ovarian Hyper Stimulation Syndrome. (I kept track of my weight, stomach circumference and fluid intake and output for another couple days just to be safe though.) I was finally starting to feel normal again...but normal was not necessarily what I was hoping for.

Later that week we found out we had lost another embryo, but we still ended up with six frozen ones. That meant we still had six more chances to try again, which is quite a few-more than a lot of couples come out with-so we still felt blessed. They scheduled our blood test to find out whether or not I was pregnant for March 8. For those who have experienced the "two-week-wait" you know that it feels like the longest two weeks of your life! I was fortunate enough that I only had to wait twelve days, but it was still a very long twelve days. The hardest part was knowing that according to the traditional pregnancy calendar I was technically already three weeks pregnant.

A Bittersweet Week

On Monday, February 17, we went in for our screening ultrasound. I was so miserable from all the medications! My stomach felt full and bloated all the time to the point it hurt (not horribly, just enough that I felt uncomfortable all the time). I was walking around so slow and taking small steps to keep from moving or working my stomach too much.

In the ultrasound they would count how many eggs I had and see how many of those were mature. We were crossing our fingers for a lot of eggs-the more eggs we had the more embryos we would end up with. We expected that by the end we would end up with half of the eggs becoming fertilized and maturing to 5-day embryos. The more embryos we got the more chances we would have to become pregnant and still have some left for baby #2 in a few years (as we will likely have to do IVF every time to get pregnant. There is no telling for sure until we get to that point though.)

I couldn't help but smile as the doctor read off more and more measurements of eggs! I looked at Ryan and could tell he was excited too. As it turned out we had FIFTEEN eggs! That was such good news! Only 10 of the eggs were mature enough, so the doctor ordered a blood test to check my estrogen level and they told me to come back the next day for another screening (I would go in every day for ultrasounds until they thought I was ready). They figured that by Wednesday the rest of the eggs would be mature enough to schedule the egg retrieval.

A few hours later we got a phone call from one of the nurses. My estrogen level was at 3800. At 4000 I would be at risk for severe Ovarian Hyperstimulation Syndrome (OHSS). My increased estrogen levels were a result of how hard my ovaries were working to produce extra eggs. Normal women's estrogen levels fluctuate, but usually stay under 400. OHSS causes the ovaries to become enlarged, which is why I was feeling so bloated. If OHSS gets severe, excess fluid can leak out into the abdominal cavity and require a doctor to drain it (using a large needle) or ovarian cysts can burst requiring surgery. To prevent this, I was told to take it easy and drink 64 ounces of Gatorade a day. Gatorade for the electrolytes and the sodium: I needed to stay hydrated, but it was also important for my body to absorb any excess fluid. I also had to weigh myself and measure the circumference of my stomach every morning and track how many times a day I peed. If I had a decrease in frequency of urination, a weight gain of 2 pounds or more in a day, abdominal swelling, chest pain, shortness of breath or swelling in one of my legs, I was supposed to see a doctor immediately.

We did get one bit of good news: one whole day with NO SHOTS! Ryan had to give me a shot of Pregnyl (HCG) that night (our first hip muscle shot), but I did not have to have any injections on Tuesday (I just had to take an antibiotic before bed). Wednesday morning we would go in for the egg retrieval! I couldn't believe we were finally so close to doing this!

During all of this my grandpa was very ill. He had cancer in his liver and kidneys, but they were not sure where it started or just how bad it was (it all came on very suddenly). On Tuesday they transported him down from Idaho Falls to the VA hospital here in Salt Lake. I went to see him for a few hours on Tuesday afternoon before my mediation class (I just completed a conflict resolution graduate certificate program at the University of Utah).

My mom, grandma, aunt and cousin were there. The room was big for a hospital room and dimly lit. It was strangely quiet, strange because I come from a family of talkers. My grandpa looked so small in that hospital bed-he was so skinny that when I hugged him I could feel his shoulder bones. He was so pale and so weak that he could not even sit up. Even his voice was so soft and quiet that you could barely hear him when he talked. I talked to my grandma quite a bit and just remember wondering how she was so calm; she seemed so strong to me in that moment. My grandpa drifted in and out of sleep while I was there and I was so scared it would be the last time I would see him. I didn't want to leave him-I was late for my class that night. I told some friends where I had been and everyone kept asking if I was okay. I remember feeling so peaceful through this whole experience. I accepted that I might lose my grandpa and was not as upset as I thought I would be. I thought about him a lot and worried about my grandma, but deep down I just had a feeling that no matter what happened everything would be okay. 

On Wednesday morning we went in for the egg retrieval. I was excited, but also nervous-this was an entirely new experience and I was not sure exactly what to expect. The procedure was done under conscious sedation so I don't remember much of anything after the nurse put my IV in and walked me into a room with a weird chair. I remember we talked to the doctor for a minute then I woke up in a recovery room feeling high and so happy! Ryan was next to me and seemed happy too...he told me they had gotten EIGHTEEN eggs! That was even more than we expected! Our embryo transfer was scheduled for Monday.

I slept the whole way home and for a couple hours after. Then we got some bad news. My grandpa was too sick for treatment. Rather than a few months, like they had previously estimated, they said he had hours to days left to live and that it would be best for him to go home where he could die comfortably. They had already contacted hospice to get a hospital bed set up in his house and he would be transported home by ambulance in the morning. Ryan and I knew we had to go see him. We picked up my sister and her husband and two daughters on the way there. My mom, grandma, aunt and cousin were there again when we arrived at the hospital and my youngest sister showed up shortly after we arrived. I told my grandpa all about the egg retrieval and that in 5 days we might be pregnant. He told me how happy he was for us and how proud he was of me for everything I had done. He was so quiet that you could hardly hear him unless you were real close. He kept telling me he just had to kick this thing and I told him to get well soon. He kept telling all of us that he loved us and just laid there watching so much of his family gathered around him talking (he was missing two daughters and more young grandkids back home). He held me close a little longer when I hugged him to leave. He kissed my cheek and told me he loved me and I told him I loved him too. I know he knew he was going to die, but he didn't want to upset any of us, so we all played along and said "see you later" instead of "goodbye."

Friday the embryologist called and told us that of our 15 eggs, all had fertilized and we had TWELVE good embryos! But our good news was followed by more bad: Saturday night, just days before our embryo transfer, my grandpa passed away. His wife and daughters were there with him at home, so as sad as it was, I can't think of a better way to go. He died just a few minutes after my grandma sat next to him, held his hand and told him that she would be fine. They have the kind of lasting love that I hope Ryan and I can grow and nurture over our years together too. I cried in bed that night and in the shower the next morning. Partly because I was sad about my grandpa and partly because I was worried about how my mom and grandma were doing! I still felt strangely at peace though. I know he is in a better place and not in pain anymore. But I am sure going to miss him greeting me with a big smile and a hug the next time I go visit my grandma. I can still hear his laugh...I hope I never forget that. He was such a happy, kind man. I had this image in my mind of my grandpa sitting under a tree with a child that I knew was mine; I kept thinking that grandpa was in heaven preparing a sweet spirit to come into our family. Monday was our embryo transfer and two weeks later we would find out whether or not it worked. It felt so strange to think that one soul might have left our family just as another was coming into it.

IVF Cycle #1: The Shots

We called the IVF nurses at UCRM (Utah Center for Reproductive Medicine) in December 2013 to get on the schedule for our first IVF cycle. We had hoped to get started as close to the beginning of the new year as possible. There are a whole team of doctors at UCRM and each week one is assigned to do the IVF procedures (egg retrievals and transfers). After discussing it and thinking about it for a few days Ryan and I decided that we wanted Dr. Moore to do the embryo transfer (the part where they put the embryo inside me). This meant our embryo transfer would be set for the week of February 24th 2014. They sent me a calendar as well as a schedule for medication doses. I would remain on birth control pills and then start medications for the cycle on January 26.

My Calendar for IVF cycle #1: it hung on the fridge all month to keep me on track!

In January, Ryan surprised me with a trip to Disney World...one last vacation as a twosome (we have had a few "last" vacations before baby, but I think this one really was it!)  My big box of drugs arrived in the mail two days before we left. I would start my first injection in Florida, so I ended up having to take one of my medications (Lupron) on vacation with us (as it turns out traveling with needles in your carry-on is no big deal...I did not even have to open my bag or show anyone my prescription). 

All the hormones and medications for egg retrieval and embryo transfer

The first day was the hardest of all the shots. I had watched all the instructional videos and knew exactly what to do, but still decided to follow along with the video for the first shot, just to be sure. Needles have never really bothered me much and I've never been particularly squeamish about getting shots, but giving myself a shot totally FREAKED ME OUT. I sat there pinching the skin on my stomach, syringe loaded and needle posed ready to go, for about five minutes. It reminded me of being a child on the diving board at swimming lessons: standing there looking down at the water and counting to three over and over in my head but being too scared to take the plunge. I stared at that needle saying "one, two, three...go." Then nothing. So I'd start over. After I finally did it, couldn't believe it had taken me so long; the needle was so small and sharp that it slid right into the skin, just like butter. So easy! Although it did take a few days to get used to it enough that I could get it done and over with in seconds.

For the first couple weeks, Lupron was the only medication I was on. I took my last birth control pill on Saturday, February 1 then had what I hoped would be my last period in at least 9 months. On Monday, February 10, I reduced my Lupron dose and I started the Follicle Stimulating Hormones (basically hormones to make my ovaries overproduce). Lupron made me all too comfortable with the shots. I had some slight skin irritation at the injection site for about 30 minutes after for the first few days, but then I guess my body got used to it and I had no side effects. The next two injections were not so kind. There were two: Gonal-F and Repronex. The Gonal-F was a pen type injector, so preparing was different: I twisted a needle on, turned a dial to my dose, removed the needle cap, stuck the needle into my tummy skin and pushed the button until it stopped clicking (there was some math involved in this one too: I had 4 pens with different amounts of medication in each to last for the 8-11 days I would take it, so I had to plan daily doses just right). The medication went in just fine, but left some bruising after a day or so. The Repronex was awful! I had to mix fluid from one vial into a second vial that contained a powder, then change the needle on the syringe and administer the shot. This shot HURT! The medication stung going in and after left a big red welt that turned to a bruise after about 3 days. I tried icing the area first and mixing the liquid and powder before I did anything else so it had time to sit and really dissolve for sure...nothing really worked (though the ice did help some). I had so many tender areas on my stomach that I started running out of places to give myself shots without having overlapping welts and bruises. Altogether I gave myself 47 shots in my stomach in just over 3 weeks!

My stomach on day 8 of FSH injections

 
In the meantime, Ryan had started taking Doxycycline, an antibiotic to make sure his semen would be free of any kind of infection or bacteria when he did his duty on egg retrieval day. This was the ONLY medication he had to take (lucky man!) The hardest part for him was remembering to take it twice a day. Which brings me to my next point: all these injections had to be given at the same time every day. This meant I had to plan things around my injection time (10:00 am).  It starts to feel like it controls your life a little! I have never had to rely on any medication for anything before, so it was weird to have to stop what I was doing when the alarm on my phone went off and go take my shots. With three different ones to prepare and administer (and all that practice I was getting doing it every day), it took about 15 minutes. Luckily my mornings are pretty open so it wasn't too disruptive, but there were a few times where it was a little inconvenient (still, totally worth it if I get a baby out of this in the end!)


The closer I got to egg retrieval, the worse the side effects got. Not only was my stomach sore and bruised on the surface, but I was super bloated-so bad that most of my jeans were too tight to button up, so I spent the week before and week after egg retrieval in yoga pants or pajama bottoms. Those who know me, know I don't typically leave the house without being dressed, complete with jewelry and my hair and makeup done, so pajamas are not usually daily wear. I was so bloated and my stomach was so tender that the thought of wearing anything around my waist made me want to cry. I wanted to cry sometimes anyway...don't know if that was a side effect or just the stress of it-the process of IVF felt like it had taken over my life! My ovaries were so full (and enlarged) by the end of the first week of stimulants that when my bladder was full it hurt. My boobs were also very tender and my nipples hurt, so I spent about a week wearing my sports bra (yes, I only own one) every day, and even sometimes at night to keep my boobs from moving.

I might have looked like I just came from the gym, but I was not allowed to exercise or do anything more than "brisk walking." I also could not take anything but Tylenol for pain and was to avoid all alcohol, tobacco and caffeine (besides the pain medication part it was easy since I had quit smoking and drinking caffeine a couple years before and did not drink alcohol much to begin with). Tylenol was not very effective for the bloating pain I was feeling. I spent a lot of time just laying around the house...it felt best when my stomach had room to stretch and I didn't move too much. <Side note: the frozen embryo transfer cycle I am in the midst of now is a PIECE OF CAKE compared to the egg retrieval process of a fresh transfer! Lupron and estrogen (pills) are all I have to take in preparation...so I feel pretty normal right now!>

The next step would be the screening ultrasound to see how many eggs I had and how mature they were, then would come the egg retrieval. AND more injections...with bigger needles and in places I couldn't reach, which meant Ryan got to give them!

The Loneliness of Being Childless

Infertility is a very lonely experience. I imagine being childless in general can be an isolating experience, but I think it is different when you are childless not by choice, but due to infertility. I often feel isolated from other women because I want what they have (or can could have if they wanted) and they don't understand how I feel. I don't blame them for their lack of understanding...nobody can truly understand what infertility feels like unless they've been through it themselves. I even feel disconnected from friends who experienced infertility before getting their miracle babies because they've experienced pregnancy and now have a child of their own while I have never even been pregnant. Their stories inspire me and give me hope, but they don’t make me feel any less lonely. Stories of successful pregnancies have kept me going and are part of the reason I decided to go public with my own personal struggles. The loneliest I have ever felt was when I was trying to keep our infertility troubles a secret between ourselves and close family. Putting my private life out in the public eye was such a hard thing to do, but it has also been a very rewarding action: I have found support in people I never would have imagined could relate to me.

Still, I feel like I don’t really fit in anywhere. Nearly all of my friends have children. I have two types of friends: the single parents and the married mothers. I don’t get invited to do adult things with the single parent friends because they are really kind of like a club and you have to be raising a kid on your own to join. I don’t get invited to do things with the single parents or married mothers when it is something with their kids because I don’t have a kid to bring. My husband and I occasionally go out with the married mothers and their husbands if they can get a sitter, but usually if they have a sitter they want to go out on a date by themselves. My husband and I even find ourselves wishing we had more childless couples to invite out on a moment’s notice to do things with us (we have one I can think of), but most of our friends need advance notice to get a babysitter.

The events we do get invited to are usually family oriented ones: barbecues, football parties and holiday gatherings. Even in those situations I find myself feeling alone in a crowd of mothers talking about the cute things their kids did last week, how hard potty training is, the picky eating habits of their four year old, the huge mess their house is because of the kids, how they never have any time to themselves or how busy their schedule is because of carpools and soccer practice. I don’t usually have much to contribute to the conversation because I don’t have any of those experiences-in fact I spend A LOT of time by myself, my schedule is very planned and organized (I have to TRY to fill all of my time and stay busy), I spend several hours cooking nearly every night and my house is always clean. (Don't get me wrong...I enjoy cooking and do like having a clean house, but I'd give it all up for children of our own!
  
I hate hearing people complain about their kids and hate it more when they tell me how lucky I am to have so much freedom because I would trade them places in a heartbeat. I wish my life was more chaotic and noisy. I want to clean up after children and change diapers and watch Disney all the time and have bedtime routines and read stories and drive kids to practices and watch recitals and games. I want to know what it feels like to be the one person in the world a child wants more than anyone else. I want to cuddle them when they are sick or sleepy and rock them to sleep when they are scared and tickle them just to hear them laugh. Ryan may not say it out loud very often, but if you've ever watched him interact with our nieces and nephews you would know that he wants to be a dad as much as I want to be a mom (and he'll be such a good dad!)

I also want to be asked about our journey...if you're curious where we are in the IVF process or how things are going for us, just ask. When friends ask us about our journey it makes us feel loved, supported and less alone-let us know that you have our backs! The disappointments are easier to face when we know we have a support system to catch us, think of us and pray for us.

The Procedures:

A Sonohysterogram...

In August 2013, we went to the doctor because I was having some pain and irregular bleeding in between periods. Sometimes I would have light bleeding for as much as a week between periods and my periods were lasting longer than normal. My doctor decided it would be best to check and make sure everything was okay with a Sonohysterogram.

A sonohysterogram is basically a procedure where the doctor does a transvaginal ultrasound while fluid is injected into the uterus through a catheter to help give a better view of the uterine lining and any abnormalities. The pain of this is similar to the HSG I had undergone previously, and the endometrial biopsy I had done earlier this week. It is a pain that feels almost dull and sharp at the same time. The worst part is that it is not like stubbing your toe where it hurts really bad for a minute then the pain gradually dissipates, this is a pain that is constant and does not get better until the doctor is finished seeing what he needs to see. On the pain scale, the endometrial biopsy wins first place (although the pain is not as constant as the other two), with the HSG coming in second and Sonohysterogram coming in close at third most painful. They all feel similar, are miserably painful and I never want to have any of them done again!

During that first Sonohysterogram (yes I had to have another one, but that is a story for another day) I just kept telling myself to relax, but I couldn't help but tense up! So I tried to take slow deep breaths-despite the strong urge to hold my breath. It lasted for five or ten minutes, I am not really sure. That might not sound like long, but it feels like FOREVER when you're in constant pain waiting for it to end. I don't know how to describe it in one word, but it was definitely more than just uncomfortable. It is a pain I have never experienced through any common injury. Don't let me scare you-it is bearable-it is just a unique pain. The closest common experience I can think of is menstrual cramps, but it hurts so much worse! And to top it off you are left with the pain of cramps and sometimes a little spotting for several hours after.

The sonohysterogram gave us our first bad results: the doctor found a polyp. A polyp is kind of like a mole inside the uterus. Polyps commonly cause miscarriages, so I had to have it removed before we could do our first IVF cycle. It was also likely the cause for my irregular bleeding. I was glad they knew what was wrong, but still felt like nothing was going our way.

The doctor said since I had still had 3 months of Norethindrone in my future, there was no rush to get the polyp removed. We had a vacation coming up (trip to Houston for an NFL game in September-Ryan is the Texans #1 fan), so we decided to put the surgery off for a while so I would not be recovering on vacation. It was around this time that we decided to wait on IVF for a little longer. The way things were going, we were going to be completing our cycle in the end of December. We decided we may as well wait until after the new year to get started, just in case a senate bill that would provide a tax credit for infertility treatments passed in 2014 (read about the bill here). IVF is so expensive and we thought if there was even a small chance of getting some of that money back (especially since our insurance had a $7500 maternity deductible we had to look forward to paying), it was worth waiting another month.

...and a Hysteroscopy 

I ended up scheduling my Hysteroscopy to have the polyp removed for November 4. My mom took me in for it (Ryan was in Houston with my brother-in-law at a football game…don’t worry, I got even later!) A Hysteroscopy is an easy out-patient procedure. The worst part was that I could not eat or drink anything after midnight and my procedure was not scheduled until 3:30 pm! Once I got there, they asked for a urine sample (standard procedure to make sure I wasn't pregnant before going under anesthesia). I asked the nurse if he was kidding-I hadn't had a drop to drink in 15 hours! He wasn't. They always say they only need a few drops, well that is all they got!

Once I got into the room I changed into a gown and the nurses got me all settled in with warm blankets (my favorite thing about being in a hospital) and started my IV. Then my doctor and another who would assist him came in to talk to me about the procedure. I lied and told them Ryan was out of town on business (you can guess how I was feeling about his trip at this moment!) Before I knew it the anesthesiologist went to work, I fell asleep and next thing I knew I was waking up in the recovery room with my mom sitting next to me. What they did, is they use a small viewing device to see the inside of my uterus and then just snipped the polyp off. Quick and easy…I think I was out for less than an hour, but the anesthesia left that whole day a little cloudy. They go in vaginally so there was no incision to heal, just the spot inside where they cut off the polyp.

From there we picked up my prescription (pain medication) at the pharmacy downstairs and my mom took me to pick up dinner at Zupas and then home. She was so great to have there! What girl doesn’t want her mommy when she feels under the weather? We ate our dinner (and had some dessert) while we watched a movie (or two? I can't remember...) then she helped me get into bed and she went home. I do remember she offered to spend the night, but I insisted she go home so she could wake up and go to work in the morning at her normal time. I ended up getting by just fine on my own… I watched lots of movies, took my pain pills and slept off and on all of the next day, then Ryan got home that night.

Really the recovery process was easier than I expected. Since they did not go in through my stomach, there was no muscle tissue that had to heal: I had some spotting and felt really crampy for a few days. It was an easier recovery than the laparoscopy (which left two small incisions) I’d had several years before…after that I could not even sit up without a little push!

At my check up a few weeks later the doctor showed me pictures of the inside of my uterus and told me everything was normal and good (including the polyp which was benign). As we had with everything before this, we just considered this procedure another step on the path to pregnancy. We had to think of each delay as a step towards progress in order to stay hopeful-and sane really. We just had the holidays and then we would be starting IVF!

The TESTS!!!

Before we even got to start the cycle, we had to take SO MANY TESTS! After knowing about all of them I think I would be a nervous wreck if I got pregnant without being tested for everything to make sure I was healthy and my body was ready! By the time we had our IVF Consultation, I had already done one small part: the blood test (well the first one). With that blood test they were able to get my values for my:

• Anti-Mullerian Hormone: gives them an idea of my egg supply, or ovarian reserve.
• Thyroid Stimulating Hormone: indicates thyroid function
• Prolactin: which can inhibit the hormones that trigger ovulation. It is also the hormone responsible for producing breast milk, which is why most women don't ovulate as long as they are breastfeeding

All of my results had been normal, which was good news. We ended up having plenty of time to get all the rest of the tests done, because after discussing my case with the other doctors at a weekly meeting where they all get together to discuss their patients, Dr. Moore called and told me he thought it would be best for me to go on a hormone called Norethindrone for three months to help treat my endometriosis before we did IVF. <Just a side note: I think the weekly meeting the doctors have together gives patients a huge advantage-even if I only work directly with one doctor, I have a whole team of them working together on my plan of care.> I'm pretty sure I had already started on birth control pills by this time in preparation for our first IVF cycle. Every time I ovulated, my endometriosis would worsen (because of the thickening on the uterine lining.) Birth control pills prevent ovulation; Norethindrone helps prevent the growth of the uterine lining during menstruation. Both of these together would help thin my uterine lining to prepare me for the IVF cycle and hopefully keep my endometriosis from worsening. We were pretty disappointed that we were going to have to wait an extra three months to start. That would push our first cycle back to November.

The next test I was sent in for was another blood test for them to find out my blood type, test for antibodies in my blood (RBC Antibody Screen) and check to make sure my rubella antibodies were still effective. Remember that MMR vaccine you got as a kid? Rubella is the "R" part and a disease that can cause serious birth defects if mothers contract the disease while pregnant. As it turned out my rubella antibodies were low, meaning my immunity to the disease was wearing off, so I did have to get a booster shot. Everything else was all normal and good.

Next it was Ryan's turn: the sperm test. This was the only thing Ryan had to do in the testing process. He gave a sample (I am sure you know how that works) and they tested the sperm to make sure they were strong enough to penetrate my eggs by putting some of them in with hamster eggs and leaving them overnight to see what happens. This part still makes us giggle a little...Ryan was going to make little hamster babies (not really, but you can't tell me that's not the first thought that came to your mind too!) They also did a general count and assessment to see how many were shaped normally and moved well. The penetration test came back 10/10, his count was on the high end of normal and most of the little swimmers had normal shaped heads, one tail and were able to swim straight, so all in all GOOD NEWS!

The last test was a genetic test where they test for over 100 genetic disorders and diseases (see them all here). The test would see if I had the recessive gene for any of the disorders (things like cystic fibrosis and spinal muscular athrophy). If I had tested positive for any of them, then Ryan would have done the test as well. If we both had the recessive genes for any of the disorders then that would mean there was a 25% chance that a baby would have that disorder and they could then take extra precautions to prevent and extra testing to catch and treat (the ones that could benefit from treatment) them in the baby early. For this test I had to spit into a tube-I had to FILL the tube with spit-first thing in the morning before eating or drinking anything. Then I packaged it up with what they provided and sent it to a lab that does genetic testing (Counsyl). It was a weird experience! But the test results were negative, meaning I did not have the recessive genes for any of the disorders, so Ryan did not have to be tested.

Even though we had been delayed for three months, we were still trying to look on the bright side: this would give us more time to come up with all of the money so we would hopefully not have to take out a loan and it would ultimately up our chances of success with IVF, so we had to think of it as a good thing!

Our Initial IVF Consultation

In order to really go over In Vitro Fertilization (IVF) in detail, Dr. Moore had us come in for an IVF consultation a week after our first appointment (July 2013). With my endometriosis diagnosis he estimated that the live birth rate for a fresh IVF cycle (embryo transfer after egg retrieval) would be about 65%. He explained the process beginning to end, including the shots, risks, cost and finally the tests.

The Process and Hormones

I would first contact the nurses to get on the schedule for a transfer week. They would send me a calendar that outlined everything I needed to do. I would start with 6 weeks of continuous birth control pills (active pills only-I would skip the placebo pills and start a new pack). Sounds crazy right? I was surprised that the first step to getting pregnant was to take pills that prevent pregnancy! But the birth control pills quiet everything down which enables the doctors to control my cycle in order to time everything just right.

From there it would be a matter of adding in other medications one at a time...Lupron injections for two weeks, then add in the Follicle Stimulating Hormone (FSH) injections ending with Pregnyl, an HCG (Human Chorionic Gonadotropin) shot 36 hours before the egg retrieval. In the meantime Ryan would have to take antibiotics, just to make sure he wouldn't have any bad bacteria in his semen sample the day of the egg retrieval. (I will get into more detail about each medication/hormone and the side effects I experienced later when I talk about my experience with the egg retrieval and embryo transfer.)

The egg retrieval date would depend on the size of the follicles containing the immature eggs. All of these hormones would trigger my body to release multiple eggs rather than just one like the body does during a normal ovulation. They would have me come in for an ultrasound to check on them every day (starting on a certain date) until all of the eggs were mature enough to collect them. The egg retrieval would be done under sedation. They would use a small catheter guided by ultrasound to basically suck the eggs out (again...I'll go into more detail when I write about my experience with the process.)

After egg retrieval I would start taking antibiotics (a pill-yay!) and progesterone injections. Then we would just wait to see how many eggs fertilize and develop into embryos. On the fifth day of growth they would transfer one or two of the 5-day embryos (blastocysts) into my uterus. We would wait two weeks then come in for a pregnancy test. The doctor estimated that they would get anywhere from 10-20 eggs, with 8-18 fertilizing. Overall he estimated we would end up with anywhere from 3-8 embryos in the end. It all sounded so perfectly planned and simple really. All I had to do is follow directions and the doctors would take care of the rest.

The Risks

• Risk of multiples (which is what EVERYONE thinks when they hear IVF!): 
• If they transferred two embryos then our risk of a twin pregnancy would be 50% and the live birth rate 37% (it is not uncommon to lose one twin before delivery-usually very early in the pregnancy.)
• If they transferred just one embryo the risk of twins would only be up to 11% (slightly higher than the risk of a naturally occurring twin pregnancy, which is just over 3%.)
• Our risk of having triplets or more would be less than 1%.
• I would have a 2 fold increased risk of the baby being Small for Gestational Age (SGA), Preterm Labor and Gestational Hypertension. For this reason IVF pregnancies are considered HIGH RISK pregnancies.
• Birth defects: 2-4% (same incidence as a naturally occurring pregnancy)
• Ovarian Hyper Stimulation Syndrome (OHSS): 1-2%
• Ectopic Pregnancy: 1-2%
• Everything else (bleeding, infection, human error, etc.): 1-2%

 

The Cost

The cost of our first IVF cycle, which would be fresh embryo transfer, without ICSI (Intracytoplasmic Sperm Injection) would be $8900 (ICSI is a process where they inject the sperm into the egg when the sperm cannot penetrate the egg on its own...we did not need that, but if we had it would have cost an extra $1200). Medications were not included in the cost and would be an extra $2000-$3000. Because Utah is not a state with a mandate requiring coverage for infertility treatment, none of these costs would be covered by insurance, even this consultation that cost $165. (Fortunately my doctor was able to put endometriosis instead of infertility as my reason for the rest of my visits so they could all be covered.) Each frozen embryo transfer would be $2720 with under $500 in medications. To cryopreserve (freeze) our extra embryos it would be $1000 with a storage fee of $435 for each year after the first one.

By the time Ryan and I made this appointment, we had already done a significant amount of research about the costs and options. Like many infertility clinics, UCRM also has a money back guarantee program. We went in for this appointment with our minds made up that we wanted to do the guarantee program. The doctor explained that with the money back guarantee program they place you in one of three tiers based on history and age. We would have to transfer two embryos on the first try and if it didn't take we would do one frozen embryo transfer. If that did not take either, then we would be refunded about 80% of the cost (which still would not include medications). If we got pregnant on the first or second try (and that pregnancy resulted in a live birth past a certain week) then we would not get any money back. <After talking to the manager (who I actually went to high school with) later that week we found out that it would cost $17,900 to do the guarantee program. They had some finance options he gave us information on and emailed us all the terms. We still wanted to do it. We thought it was our best bet because if it didn't work we would get back enough of our money to try a few more frozen embryo transfers.>

The Tests 

The tests were an interesting part...there were so many different ones that I think that could be an entry all on its own! Here is a list for now, but I will go into more detail (including definitions) about all of them and my (and Ryan's) results later.

• Anti-Mullerian Hormone
• Thyroid Stimulating Hormone
• Prolactin Levels
• Blood Type
• RBC Antibody Screen
• Rubella Antibody Screen
• Counsyl Genetic Screening
• Sperm Assessment
• Sperm Penetration Test
• Ultrasound (more specifically, a sonohysterogram)

These would all need to be done before we even started the IVF process! It seemed overwhelming, but we still left this appointment feeling SO hopeful and excited! Talking about the babies we would have someday finally seemed like a more realistic conversation than what we would do with all the money if we won the lottery. We couldn't wait to tell our families about the new path we were about to take.
 

This appointment happened on July 16, 2013...we went through so much more before we even got to our first IVF cycle in February 2014! Keep checking back to find out about the tests, the procedures, the emotions and the medications and side effects!