Negative

I got the beta results on Wednesday (7.27.16): negative, as suspected. My HCG level was <1. I wasn't surprised to hear the news. The nurse did have some good news. The PGS results for our last (nonconcurrent embryo) came back and the embryo (grade AA) is normal. I will speak to the doctor on 8.10.16 to discuss our next steps. I think he will want to go ahead with another FET of the last embryo before moving forward with another cycle.

I start teaching at the end of August, so the next time I will have the required time off (for an FET cycle) will be in December during Winter Break--although the clinic shuts down during the holidays, so this will also be an obstacle. Another STIM cycle would have to wait until next May...this is what makes things so hard. The failed transfer is devastating, but it's even harder having to wait so long until we can try again. I worry about timing and the clock ticking, and getting through a semester (or two) of teaching. 

The day I got the news, I felt okay...and was happy to hear the news about the normal embryo...but in the days following, and especially this weekend, I have gotten more depressed. It is hard to get out of bed, to eat, to take showers. I don't want to do anything. I have 4 classes to prep for this upcoming semester, plus a textbook chapter to write, and I do not have the energy or ability to do so. I feel like I'm dying.

Did I mention that my best friend had her (first) baby the day after I found out? Of course I am happy for her, but I have to tell you I have had to unfollow so many people on social media this week. It seems like everyone is posting pictures of their baby bumps, showers, baby rooms, kids, etc. (I also decided to unfollow people who have been posting election-related stuff that I disagree with...because, really, who needs that?) 

I did come across this article about HGTV's Flip or Flop couple, Tarek and Christina El Moussa. It turns out that after they found out about Tarek's thyroid cancer, they were told they should not try to get pregnant for 6 months to a year, so they decided to sperm-bank and do IVF. It took them 3 tries and 2 doctors, but they got pregnant with their baby boy, Brayden James. I have had the pleasure of speaking to Christina a few years ago, and I reached out to her again and got a sweet message back from her last night. It is nice knowing that others have gone through this, and that it took them several attempts.

There are actually a number of celebrities who suffer from (or have suffered from) infertility and/or have gone through IVF. It is somewhat encouraging to know you're not alone in this. Something that Jennifer Aniston wrote recently in a letter really stood out to me: "We are complete with or without a mate, with or without a child. We get to decide for ourselves what is beautiful when it comes to our bodies. That decision is ours and ours alone."

Preparing for the Worst

I hate these things! (And they are so expensive!)

My beta is tomorrow morning at 10:30am and I am preparing for the worst.

 I ended up taking HPTs on Days 6, 8, 9, 10, and 12. All negative. I started getting worried on Day 8, and the rest of my hope disseminated with each test I took. It was like letting air out of a balloon. HPTs are the devil.

I have to say that perusing message boards at this time was not helpful, especially when other women, who had transfers on or around the same day as me, were starting to see faint positive lines on their tests. I would say probably 90% of the messages I read of people with successful betas had seen positive lines by Days 5-9 or were those who never did HPTs at home. I had pretty much succumbed to defeat until I spoke to my friend Anna online last night. She started the IVF process a month ahead of me (and did a fresh transfer) and is now at the beginning of her 2nd trimester with a baby girl. She told me she did not get a positive until the morning of her beta (Day 14). That did give me a faint glimmer of hope, but the cheap dollar store HPT I took today (Day 12) was clearly negative, so that quickly went out the door.

Part of me is still praying for a miracle, but I know I should not get my hopes up or count on anything positive coming out of tomorrow. I'm dreading the phone call tomorrow afternoon because I know it will be the last nail in the coffin. And let me tell you, each of the negatives on these tests killed me a little bit. You build up so much anxiety and hope to see the faintest of lines because maybe, just maybe today your body has made enough HCG to detect, and even just a faint line is enough to give you some sort of relief...and of course, that positive line would of course provide that relief...but no line means the exact opposite of relief. It's devastation. It's getting the wind knocked out of you. It's having your heart wrenched out of your chest. It's your world crashing down. It's the worst stomachache in the world. It's absolutely the worst feeling in the world, and nobody else could ever possibly understand it unless they've been in your exact shoes. 

I just devoted 4 months (and my entire summer vacation) to this, the countless injections, the hormones, the pain, the dietary restrictions, the physical restrictions, the mental anguish, the loss, the mourning, the money, putting all my eggs (literally) into 1 basket...and to watch it succumb to nothing.

My biggest frustration is we have to start all over again. We only had the 1 normal embryo (and 1 that is currently being re-tested)...so unless the last embryo is normal, we will have to go through STIMS once again, and then more testing, and then another FET...and the next time I will have 4 months to devote to this is next summer, a year from now. Right now I do not know how I can possibly get through teaching another 2 semesters before we can try again. This does not even seem feasible to me. I do not have the energy, strength, or capability to even think about prepping 4 classes which start in less than a month. 

One thing I've learned from this FET cycle is that HPTs are a bad idea. I do not recommend them to anyone. The best case scenario is that you see a positive at some point and your joy comes sooner than your beta. The worst case scenario is that your hope is crushed a little bit each time you test, and then crushed completely on beta day. I think that having it crushed just one time would be so much better than 6 times. I can't promise I wouldn't do them again next time, but I do know I wish I hadn't done them this time.

The beta is in 10.5 hours. Praying for the best; preparing for the worst.

The Transfer

I had my transfer yesterday! My mom and I left the house at around 9:30am, and got to the clinic a little early. I went in for my pre-FET acupuncture appointment at 10:45am. The acupuncture points were a little different than last time. They were on different parts of my limbs and included my inner wrists. After my appointment, my mom and I went to lunch at Panera before I had to empty my bladder and start drinking 20 oz. of water. By this time, I had not gotten a call in the morning saying anything went wrong with the embryo thaw, so I breathed a sigh of relief, assuming that the embryo thawed without complications.

Drinking the 20 oz. of water was no problem, but right before I was called back for my appointment (around 1:45pm) I started feeling the fullness in my bladder. Then my mom and I sat in the room waiting for awhile and it kept getting worse and worse. I should explain that I already have a teeny tiny bladder to begin with...20 oz. of water is a ridiculously large amount of liquid for my little bladder to hold! Before the doctor game in, I absolutely couldn't hold it any longer so I scrambled to put my shorts back on and ran out the door into the nurses about to come into the room! They told me I could relieve myself for a (very fast) count to 10. I counted to 5 and (surprisingly) was able to stop mid-stream. 

Our little embryo! The embryologist gave us the cutest little
card framing a photo of the little nugget!

I went back into the room and they came in to start the transfer. I'll be completely honest. The fullness in my bladder was so incredibly uncomfortable that I don't remember much of the procedure, except that the catheter going into the cervix felt like nothing compared to the U/S tech pressing the wand on my abdomen. The doctor tried to distract me by asking me about my students, and I tried to answer him as best as I can. He showed me my embryo on the screen before the procedure, and then I got to watch as the catheter was threaded through my cervix into the uterus, and then as the embryo was released! There was a clip on the monitor that they replayed several times so I was able to record it on my phone.

After the procedure (which probably didn't take more than 15 minutes total), the doctor told me to stay lying down for 5 minutes, during which a nurse would come in with discharge instructions. I was just about to get up to go to the bathroom (because I couldn't hold it any longer) when the nurse came in...so I (begrudgingly) listened to her as she gave me the instructions. (I told my mom to listen closely since I wouldn't be able to pay much attention!)

After I was finished, I went to my post-FET acupuncture appointment. The points were similar to the first time, except the acupuncturist did not put them in my abdomen and concentrated the heat lamp on my feet (instead of abdomen). After my appointment, I was headed toward the bathroom and almost tripped on my feet. I didn't trip/fall, but just kind of stumbled a little and landed on my left foot harder than I would have liked. Of course I started freaking out because I was worried I dislodged the embryo or moved it or something. In the car on the drive home, I frantically called the office in a panic until a nurse finally got back to me and said the doctor said I would be fine. After we got home, I spent the rest of the afternoon/evening in bed and lounging on the couch. 

Today I took it pretty easy too. I started getting some abdominal cramps during the late afternoon that started on the left side. I took a nap to sleep it off, and when I woke up the cramps had radiated toward the right side as well. I called the on-call nurse who said cramping is normal. She did say I could take Tylenol (not Advil) although it may not help much with cramping. It did seem to help a little though. Then after I ate dinner, I got heartburn. I spoke to another nurse (the one who did my first at-home IM injection for me) and she said I could take TUMS, Pepcid of Zantac as needed and that sometimes cramps and heartburn could be early signs of pregnancy! I don't want to get my hopes up, but that makes me feel a little better.

FET Schedule

I just got off the phone with my nurse. My FET is scheduled for 1:45pm, but I need to check in at 1:15pm. 75 minutes prior to the FET, I need to empty my bladder and then drink 20 oz. of water (12:30pm-12:45pm). They prefer you have a full bladder during the transfer so that they have better visualization during the abdominal ultrasound to help the doctor know where best to implant the embryo.

I am planning on going in for my pre-FET acupuncture appointment at 10:45am (45-minute appt.), then go to lunch with my mom, drink my water, then check in for my FET appt. After the procedure, I will go back and do my post-FET acupuncture appointment, then go home and rest.

The nurse recommends I take it easy for the 2-3 days after the transfer, with no heavy lifting, and light aerobics only (walking, yoga, swimming). I am to continue my del Estrogen and Progesterone injections until the first blood pregnancy test (2 weeks later).

I am getting super nervous/anxious, especially since we are still waiting on the embryology lab to re-biopsy the non-concurrent embryo (they are taking their sweet time!)...in the mean time, I am doing a whole lot of meditating and praying to get me through today and tomorrow!

FET Schedule for Thursday, 7/14/16:

• 10:45am – 1^st Acupuncture Appt.
• 12:30pm – Empty bladder, then drink 20 oz. of water before 12:45pm
• 1:15pm – Check in (4^th floor) for FET Appt. (Bring photo ID)
• 1:45pm – FET procedure
• ~2:30pm – 2^nd Acupuncture Appt. (exact time TBD)

After Transfer:

• Take it easy for 2-3 days; no heavy lifting, light aerobics only (walking, yoga, swimming)
• Continue injections until first blood pregnancy test

PGS Results

Last Friday (6/17/16) the nurse called me with the PGS results (a week sooner than expected). The news was not great. Out of the 4 blasts biopsied, only 1 was normal. Two were abnormal (1 missing chromosome 2, 1 missing chromosome 17), and the 4th was non-concurrent (inconclusive without further biopsy/testing). To make matters worse, my doctor wasn't able to discuss things until today (5 days later), so there was a lot of anxiety and replaying different scenarios in my mind all weekend long.

I finally spoke to the doctor today and we discussed moving forward with a FET of the normal blast, and the possibility of re-testing the non-concurrent one either now or later on. He said with where we are now (with PGS testing concluding a normal blast), there is a 65% chance of pregnancy, 10% chance of miscarriage, and 58% chance of live birth. Without the PGS, the birth rate would go down to 50%. He said that my attrition rates have been pretty average so far, (although 1 normal out of 3 would be slightly below average; 2 out of 4 would be average).

Part of me is excited to move forward. I am happy that we even get to move forward, but of course my mind starts thinking that if this doesn't work, and the 4th embryo is also abnormal, I'll have to start another cycle...and if I start another cycle, when could that possibly be because I don't have another long break from work until December. I also can't help but think that not having any extra (normal) embryos means there's no chance of a second baby...which is silly because at this point, I should only be focusing on having even one baby--which I would be thrilled, overjoyed, elated, and so blessed to have!

Today will be my last day of birth control, and I have a baseline BW and U/S appointment tomorrow morning at 7:45am. I'm scheduled to start Del Estrogen injections (intramuscularly!) tomorrow evening. We have decided to hire a nurse to come to the house to teach us how to do the first intramuscular (IM) injection. I am thinking my mom will be the one to give me those! Not looking forward to that...

Day 7

Yesterday was Day 7. In the morning, I received an email from my nurse stating that the remaining embryos did not make any changes overnight and the culture was terminated. :( The total number of embryos that we biopsied and froze for PGS was 4. I am disappointed with the number we ended up with. I had planned for attrition, but did not expect it to be so quick! I was hoping for at least 5 or 6 blasts, but given that we only had 2 on Day 5, I am thankful for the 2 more we got on Day 6. My nurse also told me that she has moved to a different position within the clinic and I will be working with a new nurse.

I am supposed to start birth control again tomorrow, Friday, 6.10.16, and will take it for 18 days. The PGS biopsies are supposed to go out by tomorrow and the results should come back within 2 weeks. At that time we will discuss the date for the embryo transfer. 

The 4 frozen embryos are graded AA, which is great. Although clinics often grade their embryos differently, an AA grade generally means that the inner cell mass quality is good (many cells, tightly packed) and that the trophectoderm quality is also good (many cells, forming a cohesive layer). They didn't give me a grade for the expansion (usually a number from 1-6).

Everyone always talks about the 2 week wait (2ww) for after implantation, but for me, the 2ww starts with waiting for PGS results!

Day 6 after ER

I received phone calls from the nurse on Days 1-2, and today, Day 5. The ER counts as Day 0, and we left knowing they had retrieved a total of 19 eggs. On Day 1, the nurse called to tell me that of the 19 eggs retrieved, 17 were mature, and 11 had fertilized successfully. On Day 2, we found out that of the 11 embryos, we had 2 x 2-cells, 3 x 3-cells, 4 x 4-cells, and 2 x 5-cells. Days 3-4 fell on the weekend, and the lab likes to allow the embryos to develop undisturbed during those 2 days. Monday was Day 5, which is the day most embryos become blastocysts. Traditionally, embryos were transferred to the uterus on the 2nd or 3rd day of development after IVF because they were only able to sustain growth for 2-3 days in a lab setting. Advances in medicine have allowed them to survive longer than this, after 5 days of growth, in which the cells should have divided many times, with those surviving to this stage likely being stronger and healthier. Basically, a blastocyst is an embryo that has developed for 5-7 days after fertilization, and has 2 distinct cell types and a central cavity filled with fluid (Advanced Fertility, 2016).

On Day 5 (Monday), the nurse called to tell me that 2 of the embryos had reached blastocyst and were biopsied and frozen. (We are doing PGS, so the biopsy will be sent to the lab and the embryos will be frozen until we are ready to transfer.) She told me that there were 3 embryos at the early blastocyst stage, and that the remaining embryos were as follows: 1 x 3-cells, 4 x 6-cells, and 1 x 7-cells. She said that they were going to check again tomorrow to see if any of the early blasts had reached full blast stage and also to check on the progress of the remaining 6. To be honest, this news hit me pretty hard. I was expecting the numbers to go down every day, but I hadn't expected to go from 11 to 2. I immediately started worrying and bracing myself for a failed cycle. What's worse is that David had to leave yesterday so I got the news right as we were eating lunch together, before heading to the airport. :(

Today was Day 6, and I was incredibly nervous when I answered the phone. The nurse told me that 2 more had made it to blastocyst and they were able to biopsy and freeze them. I immediately felt better, knowing we now have 4 embryos that made it. We still have 3 more compacted morula, that are not quite blastocysts yet. When they are compacted, the cells and cell borders are becoming fuzzy as the embryo "compacts" or melts together. This is basically the stage right before blastocyst. So I am praying hard for those compacted embryos to grow tonight and make it to the blastocyst stage tomorrow. Tomorrow is Day 7, the last day they will be allowed to grow to. After this, the embryos that haven't reached blastocyst will be discarded. The remaining 4 embryos are as follows: 1 x 3-cells, 2 x 6-cells, and 1 x 7-cells. Most likely these will not make it to blastocyst by tomorrow (Day 7), but I am praying for a miracle.

As silly as it sounds, throughout these 6 days, I have gotten attached to these 11 embryos. The night of Day 2, after the nurse told us 11 had fertilized successfully, I started praying hard for each of those 11 embryos. It was amazing to me to know that conception had occurred, that this had actually happened, and these could be our future babies. Knowing that some of the embryos won't make it makes me a little sad. I have been rooting for them and praying for them and and thinking about them, and it's upsetting to think about them being discarded. I know that this happens naturally in our bodies, and that the reason they are discarded is because they would not survive beyond this, but part of me can't help but be a little sad and grieve for them.

On a happier note, I weighed myself this morning and I am back down to my original weight (before starting stims), so at least the bloating is going down.