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!

First IM Injection

I had my baseline appointment on 6.23.16. It was similar to the other monitoring appointments during Stims. First, I had my blood drawn and then I had an U/S--except the U/S was to check my uterine lining instead of my follicles. My uterine lining was at 3.4mm.

I had a nurse come to give me my first Del Estrogen injection so she could show my parents how to give an intramuscular (IM) shot (in my rear). I was incredibly nervous given the size of the needles and the location (going in a muscle), but when she looked at the needle gauge and sized me up, she thought because of my BMI, I would be better using a smaller gauge (and shorter!) needle. (Thank God!) I iced the area for approximately 5 minutes while she went over the protocol of drawing up the medication and then she showed my parents how and where to give the injection. The actual injection was pretty painless (I assume because of the icing). I am really glad we hired her to come show us. She was so nice and understanding, and it turns out that not only does she work at our clinic as well, but she had two IVF babies from them that are now 8 and 12 years old! She got pregnant on the first cycle with each of them. It felt good to finally meet someone who went through what I am going through and has two actual beautiful children to show for it. It was so encouraging.

Yesterday, the nurse called to discuss the FET with me. Due to my doctor's schedule, we will be doing the FET on Thursday, 6.14.16 (instead of 6.12.16). This means that I will have my next moderating appointment (to check uterine lining) on 7.9.16. They want to do three pregnancy tests on 7.26.16, 7.28.16, and 8.1.16. Then they want to do two ultrasounds on 8.8.16 and 8.21.16. It's so hard to think that far in advance, and if we will even get to that point. 

Right now I am stressing out about plane tickets to fly back home so I can actually spend some time at home this summer before flying back here to get ready for the FET...then I have to fly back after all the pregnancy tests and ultrasounds. This entire process will have taken the majority of the summer (~15 weeks/3 months)!

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.