Not-So-Oral Estrace

Last time I spoke to the doctor, he had mentioned that my lining (at the last FET) was about 8.6mm (they aim for over 8) but that he would consider adding in an Estrace suppository this time around. I asked the nurse about this, and the doctor agreed that I could add in the vaginal Estrace. I was expecting her to call in a new script, but (unlike Progesterone), there is no "official Estrace suppository" and you just take the exact same pill vaginally! That's right...you stick that little blue pill up there.

I started this last night and am hoping it will help to increase my lining this time. It is a bizarre thing to do, but I spoke to two nurses about it (and read a few online message boards). I highly recommend wearing a pantyliner!

All in all, even with the extra steps of taking 2 pills (orally and vaginally) 2 times a day, it is much better to take the pills than to do the injections. You only have to do the injection once every few days, but there's so much involved with the injection (time of night, numbing, drawing up medication, switching needles, injecting, heating pad, etc.)...not to mention that I can't give it to myself since it's very hard to reach back there. The pills allow me to be much more independent, but just require that I have 2 alarms set every day.

I was looking at my calendar and I can't believe the transfer is only about 2 weeks away. I am not looking forward to the actual transfer (with the full bladder) and I am certainly not looking forward to the 2-week wait! Hopefully, it won't be as dreadful this time around. I am telling myself now that I will not do any at-home pregnancy tests this time. I am hoping I can exercise enough self-control.

Here We Go Again...

After our negative pregnancy test (7/28/16) and then stopping the Estrogen and Progesterone injections, I got my menses relatively quickly (8/3/16)...but I kept waiting and waiting for it to come again so we could start birth control to prepare for our next FET, and it just wouldn't come. After nearly 60 days, I had the nurse order a no menses panel which included: STAT Estrogen (E2), Progesterone (P4), and HCG (Quantitative) blood tests...so I drove 3 hours to the closest fertility clinic that could fit me in (on 9/23/16)...only to find out later that day that my menses "was on its way" and the doctor felt I should wait instead of inducing. It did end up coming a few days later (on 9/27/16). I was finally able to get my official protocol for our FET (scheduled for 11/10/16).

I started birth control on 10/1/16 and took my last pill on 10/15/16. Two days later, I drove another 3 hours to get my bloodwork done at an outside lab and then went to (yet another) fertility clinic for my baseline ultrasound. Long story short, I found out later that afternoon that the lab I went to did not/was not able to STAT one of my tests, so my nurse/doctor never got the results and didn't call me to tell me if I should begin my Estrogen. I was incredibly frustrated with this situation, as I had only made my appointment with this particular lab after calling first to find out if same-day results were available, and what the price was. (It was significantly cheaper than having it done at the fertility clinic.) Things turned out ok in the end (after multiple calls to the lab as well as the answering service and on-call nurse at my clinic). I started oral Estrace that evening (10/17/16). 

There is currently a nationwide shortage of injectable Estrogen so the doctor switched me to oral Estrace (2mg tablets 2x/day). My next appointment (bloodwork and u/s lining check) are scheduled for 11/5/16. I do have to say that oral Estrace (though I have to take it twice a day, 12 hours apart) is a lot easier than having to do IM injections, since I have to have someone do those injections for me. When/if I start Progesterone after my lining check, I will have to begin daily injections of those. 

My plan for the FET is to fly to my parents' house that Wednesday (11/9/16), do the transfer on 11/10/16, then fly back here on Monday, 11/14/16. I'm hoping that resting for ~3 to 4 days will be enough before I have to go back to work. I am not getting my hopes up for this transfer, specifically because the embryo had to be biopsied twice (thawed and frozen twice), which decreases the chances a little bit...but of course part of me is still hoping (and praying) it will work. I did end up finding an acupuncturist here in town that specializes in fertility, and my first appointment was last Friday (10/14/16). I will go to her another three times and will also do appointments at the place connected to my clinic before and after the transfer.

Trying to manage everything with outside clinics (3 hours away) and my home clinic (which is 3 hours ahead of us) while teaching full-time, has been somewhat of a nightmare. Not only do I have an extra busy semester this fall, but I also made the (crazy?) decision to take on a supplemental position with the business school, which requires an additional 8 hours/week of my time. I have been working 10-11 hour days, 6 days a week...and it's been exhausting. David and I were able to escape to Disneyland two weeks ago for a much needed 4-night, 5-day getaway, and an absolute blast. :)

The second time around, I am hoping my emotions will be less up and down. I am hoping that now that I know what to expect, I will be able to relax more and that I will be able to bounce back more quickly from any disappointment. I am determined that one of these six cycles will eventually work...

This. Is. The. Worst.

The TWW is THE WORST. Throughout this entire process--the countless injections, the numerous visits to the doctor, all the ultrasounds, the daily blood draws, the violating ultrasounds, the bloating and headaches--this is the worst!

I am currently 5dp5dt (5 days post 5-day [embryo] transfer) and I still have 8 days until my beta pregnancy test (7.27.16). I seriously don't know how I will last that long. I have 2 boxes of FRER Pregnancy Tests sitting on the kitchen table, but I am hoping I will somehow make it to the beta without opening them! Perusing all the online forums, so many women begin POAS (peeing on a stick) starting on day 5, although many of them get a negative at such an early stage. I don't know if I have it in me to do it and get a disappointing result. More seem to get (very) faint lines starting on days 7-9. Day 9 (for me) is this Saturday (7.23.16), which is only a day after I should be expecting Aunt Flo, and only 4 days before the beta, so I keep telling myself if I can wait that long, I can wait a few days more. Who knows. I'm literally taking things a day at a time...an hour at a time?

I cannot even begin to describe how ridiculously difficult these first 5 days has been. Right after the transfer, you start noticing, feeling, and being aware of the tiniest things you (and your body) are doing. Am I peeing too hard? Am I putting too much weight in each step as I walk? Should I drink/eat that? Did I stretch myself too much when I was: putting on my seat belt, reaching for the remote, grabbing my phone, petting the dog, using the microwave, tying my shoe, washing my hair, laughing, breathing, sleeping...every movement, every gesture, every thought, you are worried about jeopardizing the implantation of the embryo(s). You're just certain that that one decision you made (drinking something too cold, laughing too hard, putting on your shirt, reaching for that towel, eating that piece of chocolate) has jeopardized the embryo in some way/shape form! It's a nightmare.

IM injection sites: Honestly, the bruising
and pain is nothing compared to the TWW!

Don't even get me started on the hormones! At this stage, I'm taking nightly injections of Progesterone as well as injections of Del Estrogen every 3 nights. (Del Estrogen is an injectable form of estrogen that is given to help thicken the endometrial lining. Progesterone is produced by the ovary after ovulation, and is given to support embryo implantation.) So here you are naturally worrying about the implantation that is supposed to occur over this 2-week period, and your hormones are completely out of wack. Don't forget that if God forbid, you aren't pregnant, then that means you're about to start your period, so you're possibly PMSing...and if you are pregnant, you have all those hormonal changes/imbalances going on too. I was watching an old episode of 16 and Pregnant yesterday where Farrah gave birth, and as soon as the baby was born and the doctor said "Happy Birthday," I burst into tears. 

Every day, night, hour, I am feeling different symptoms that could mean implantation or could mean miscarriage or could mean my period is coming. And unfortunately, after an FET, with all these different things going on, and especially because of the hormone injections, could mean absolutely anything. Also, the Progesterone could prevent a period from coming, so even if you aren't pregnant, and you should be getting your period, you might not, because of the Progesterone.

Normally I can take my mind off things by going to the gym for a couple hours or taking the dog for a walk, but both of these things are a no-no. I can't do my normal stress-reducing workouts and it's too hot during the day to take the dog out (plus he pulls on the leash)...so I am stuck at home watching TV, trying not to eat too much, and constantly perusing message boards (which I need to stop doing).

July 27 cannot come soon enough!

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

Preparing for FET

I got back from my short visit home on Friday. Unfortunately, my connecting flight got canceled, so I had to kiss my checked suitcase goodbye as I tried to find another flight. Luckily, I found one that would get me home around the same time, but it meant that my Early Bird Check-In status was gone. Luckily, I found a window seat (next to a couple) on my first flight, and since I was riding in the same plane to my 2nd destination, I was able to switch seats after we landed, and I got a first row seat with extra leg room. As I suspected, my bag was lost, but I got it back the next morning after my lining check.

Speaking of my lining check (yesterday, Saturday, 7.9.16), I was super nervous in the days leading up to it. I made the mistake of perusing message boards online (which can be good or bad), and came across a post where a woman's FET was canceled because she had ovulated. I immediately started panicking because I had no idea that your FET cycle could be canceled due to something like that. Of course, I was worried because I had some ovulation-like discharge, so I brought out my trusty ovulation predictor kits (OPK)...which I thought I was done with forever! I went to my lining check appointment yesterday morning, and the sonographer said my uterine lining looked great (8.6mm vs. 3.4mm at baseline), so I just had to wait for the nurse's phone call with my blood work results. She called later in the afternoon and told me everything looked great, that I had not ovulated, and that I would start nightly Progesterone in Oil injections (1 cc) in the evening. Everything seems to be a go for my FET scheduled for Thursday, 7.14.16.

I am trying to get as many sessions in at the gym as I can, because I won't be working out for awhile after the transfer. I'm also still planning on doing acupuncture sessions before and after the FET. I've even stocked up on walnuts and Brazil nuts, and plan to get a pineapple for the week after. Eating those things may be an old wive's tale, but I'm willing to do anything to up the chances of a pregnancy!

Acupuncture

Figuring out flights and travel plans has been so stressful. When we originally started planning everything, we thought I'd be done with the transfer by now. Here we are, and my (original) flight home is scheduled for tomorrow, and my transfer is not until 7.14.16! I have decided I will go home for a week, and then come back for my next lining check (on 7.9.16). Unfortunately, this means I will be missing a good friend's wedding. :(

I will come back, do the lining check, and then the transfer 5 days later. After that, I begin the two week wait (2ww) for my first pregnancy test (7.26.16). Last night while lying in bed (not sleeping), I started thinking about things I could do to help with the transfer. I read different things about eating pineapple core, walnuts, Brazil nuts, and doing acupuncture. I had completely forgotten about acupuncture, but there seem to be a lot of people who have done it during their cycles. I reached out to a couple local clinics and got a call back from the clinic that happens to be in the same building as my IVF clinic. They offered a package with a consultation/treatment, plus treatments pre- and post-transfer. I was able to schedule the consult for today (right after a much-needed massage). 

The massage I had (although shorter than expected) was just what I needed--I fell asleep on the table as soon as I flipped onto my stomach! After that, I drove to the acupuncture clinic and met with the acupuncturist. She spent some time going over my intake paperwork, asking me questions about my health and our fertility procedures, and then she brought me to the room where we got started. I don't know exactly how many needles she used, but I know she put some in my scalp, forehead, hands, abdomen, and feet. After that, she covered my eyes with a mask, and told me to rest for 30 minutes. Again, I fell asleep! I didn't even realize that the needles were still in my extremities until I moved my hand. 

While I don't typically practice holistic medicine (except for chiropractic), and I don't know how that acupuncture will really help with the FET, I do know that after the procedure, I felt extremely relaxed. That in itself, I feel, could help improve the chances of implantation since it's so important for you to be rested and relaxed. Some studies have shown that "when used in conduction with Western fertility treatments, acupuncture increases conception rates by 26%" (Pacific College of Oriental Medicine, 2015). While I don't know how true that is, "in fairness...acupuncture is not harmful and most of those so treated swear by it. For the nay-sayers, what can be said with certainty is that at the very least acupuncture has a 'feel good' aspect to it and in most, evokes a psychological benefit that should not be discounted" (Sher Fertility, 2016). My thoughts are that although there may not be much scientific proof of acupuncture increasing implantation rates, it's not going to hurt anything, so if you can afford it, why not give it a shot? I plan to go in for (same day) procedures before and after the transfer.

Right now, I'm all packed and ready to head back home for a week. The only thing I have to worry about while there is giving myself two IM injections. Other than that, I plan to RELAX!

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...