Negative

The pregnancy test came back negative today. I am really disappointed with the results but also feel that we have tried every possible path to success, there isn't everything else we could do. We have decided to take a break from the intervention and get back to basics, I want to take some time getting in shape and getting back to my hobbies like tennis, pottery and travel. We have been trying to get pregnant for 3 years and the last year has been intensely focused on various interventions-acupuncture, IUI and IVF. I have been poked and prodded enough to last me for awhile. I will continue to blog but will take a hiatus. Thanks for everyone's support and concern.

What a day!

Today was the day of the transfer for the single embryo that fertilized. I was at the acupuncturist at 8AM where I was given a series points on my abdomen, that were then attached to the teeniest electrodes I have ever seen. She also put other points on my head, ears, hands, legs and feet. The abdomen electrodes were for stimulating those points and bringing blood to my uterus. I left there to go straight to the hospital with a full bladder. We were brought right in but had to wait for the doctors for 15 minutes and then they started the procedure, where they got me set up and get the embryo from the embryologist. I will spare the gory details but it wasn't a good experience at all. My full bladder was mostly to blame, but a few other discomforts emerged. Luckily I know how to tough these situations out and didn't pass out or call the doctors any bad names.

The transfer was successful and the embryo was called 'very good' by the embryologist, photo below. The doctor was also positive about the quality of the embryo and stated that it had begun compacting, which is a sign of progress that our previous embryos hadn’t showed. I hadn’t heard the term ‘compacting’ before, so since I was assigned to bed-rest all day, it was the perfect time to research it. Essentially it's when the 8 cells break down to transform into a single large cell. If you look at the photo from our first transfer in April, you will see that the 8 cells are still perfectly formed with distinct edges and it has not started compacting. If you are interested in seeing the development of an embryo, this site has a great image timeline to show. http://www.ivf1.com/lab-embryo-culture

They gave us a photo of the transfer and the image below shows the embryo placed, it kinda tough to see, but it's a small,white dot in the middle. After we left the hospital with my delightfully empty bladder, we headed straight back to do another accupunture session. It was a great relief after the stress of the invasive medical procedure and really relaxed me. I came right home and have been glued to either bed or the sofa diligently working on my bed-rest assignment. I look forward to getting back to the world tomorrow, hopefully a changed woman!

The Embryo

The Placement in the Uterus (little white dot in the middle)

And then there was one

Of the five eggs retrieved, only four were mature and only one fertilized. This news was a real blow, since we would hope that all of the drugs would help develop more eggs and that those eggs would fertilize. If the embryo makes it through Thursday, they will transfer it. I have scheduled acupuncture before and after the transfer. Keep your fingers crossed!

Nothing says holiday weekend like IVF treatments

This weekend is traditionally the summer opener for me and kicks off the fun of the season. This year was a little different in that the weekend was book-ended by IVF appointments. We had to stick around on Saturday to do a final check-in where 6 mature eggs were id'd with a couple of smaller follicles seen. We departed directly afterwards for the Lake and enjoyed our time until we came back at 6:00 AM today for a 8:30 AM appointment for the retrieval. Overall it went fine, but it took the nurses 3X in 3 places to get the IV in and the sedation was only somewhat effective during the procedure, so I was alert during the process. 5 eggs were retrieved, which is good but 6 or 7 would have been better.

I didn't get the call about the fertilization success, but I should find out tomorrow. I feel a lot more sore and groggy than the first time having a retrieval, but I took it easy today and hope tomorrow I will feel back to normal. If the doctors decide to do a 3 day transfer, then that will happen on Thursday. Then I have to wait 10 days for a pregnancy test, which would be 6/13. It would be a great birthday present!

Getting poked

So today I had my shot in the morning, a session of acupuncture where she inserted needles at 16 points on my body and then had to give myself my shots tonight. Needless to say I have learned the resilience of my skin to getting poked by sharp objects and I am becoming fairly desensitized.

My accupuncture session this morning was really good, it has been over a year since I have been able to go, so it was a great feeling to be back. I am working with a new practitioner and she told me that overall my body seemed very balanced, in spite of all the activity happening in my body. The points she did today were pretty easy except for my right ankle/calf area that didn't really hurt, but was very sensitive and easily tweaked. She explained at the end of the session it was connected to the spleen that is very close to the uterus and probably feeling some sensitivity due to the fertility activity.

I go back tomorrow for an ultrasound and blood work to determine when my retrieval will be scheduled, probably on Monday. I'll post another update once I learn more. Happy Holiday weekend to everyone!

Timing

I had another ultrasound and bloodwork this morning and everything looks good. I have 5 follicles ranging from 12-16mm, which they are happy about. I have to go back for another ultrasound/bloodwork on Saturday and they think my retrieval will be on Monday, Labor Day. This puts a kink in our weekend plans of going on a family vacation from Friday to Monday, but hopefully we'll be there on Saturday and can stay through part of Monday. 

I spoke with the doctor yesterday and we talked about transferring two embryos. She feels confident that this is right number, since I asked her about transferring three and she immediately said that she would be prefer two. Given my preference for one baby, transferring three can be  risky. 

Progress

The eggs are growing and I am beginning to feel a little uncomfortable. I had an ultrasound this AM and the nurse left me a voicemail with the information to start Ganarelyx tomorrow, which slows down the ovulation process, while continuing to take the other two drugs that help the eggs grow. I have to go back for an ultrasound on Thursday morning, hopefully I will have more information then about how many eggs and when the retrieval will happen. In the mean time I have a pelvic adjustment tomorrow with the Chiropractor and an acupuncture session on Friday morning. 

Round 2

Round 2 of IVF is in effect. I started taking the fertility drugs last Thursday including Gonal-F (which I took last time) and a new drug Menapure. So shots again every night at 9PM. The Gonal-F is really easy but the Menapure requires mixing and also burns when injected, but overall not too bad.

I go to the doctor for check-in tomorrow morning to see how the eggs are developing. They hope the Menapure will increase my number of eggs, so we will find out later this week. They plan on the egg retrieval being sometime between this Friday 5/28 and Monday 5/31, conveniently when I will be on a family vacation in Michigan. After the retrieval they will fertilize the eggs immediately and they monitor them. They will transfer them back in on Day 3 or Day 5, depending on the development status. Pregnancy test will 10 days after the transfer. 

I also plan on doing acupuncture treatments and chiropractic adjustments which are supposed to be really helpful. I will update the blog daily for the next few weeks. xoxo 

Negative

Got the results today from the nurse and I am not pregnant. I am very disappointed, but we will try again. I will give updates on the next round of IVF soon. Trying to stay positive but hard knowing it will take at least two more months. 

Now what?

So we did the embryo transfer this morning and the next step is a pregnancy test on 4/21/10, next Wednesday.

It was a difficult decision to decide how many embryos to transfer, since we initially decided to transfer two when planning the IVF process, but we recently changed our minds and had just a single embryo transfered this morning. There are several factors that played into our final decision, but we have had a good experience with the IVF process (very few side effects from the drugs and success in getting a good number of eggs) and research indicated that success for women 35 and younger (me for a few more months!) is pretty high at 47%. We have the opportunity to try again if this round doesn't work, which gave us some comfort. So we decided why risk a high risk pregnancy the first time, when there is a strong possibility that even this embryo could split?

My comfort level was higher in not getting pregnant vs. thinking about having a multiple birth pregnancy that could be triplets or quads. The down side to transferring only one embryo is a lower success rate. We also have two embryos left that didn't get transfered. They will continue to cultivate and they will check on them in two days. If they are still thriving, they will call us and we can freeze them if we need them for the future.

This quandary is the high price to pay for the high-tech world of baby-making. Ultimately we want to have healthy, happy babies: one baby, twins or even more if that happened. But multiples can come at a high price: physically to the babies and mother and also financially for the family. This has been the most difficult part of the entire process for us, really trying to make sense of it. Natural pregnancies don't come with this decision process but twins and even triplets are a happy, unexpected surprise. We are hoping for our happy surprise next Wednesday!

Transfer Day

We did the embryo transfer today and I think it went really well. The process is fascinating! The doctors use the abdominal ultrasound to see the catheter inserted into your cervix and then they transfer the embryo which is encased in an air bubble and they can see it when it gets into the uterus.

The Embryo Transfered- 8 Cells

The Ultrasound Photo with the Embryo.

The middle of the photo is my uterus and the tiny white dot at the top in the middle is the embryo.

SO AMAZING!!!!

3 embryos forming!

I just got the call from the IVF lab. They fertilized 3 mature eggs and they all took! 95% of fertilized eggs make it to embryo once successfully fertilized, so they will have two good ones to put in on Sunday! Every step I have convinced myself that it will not be successful and that there will be a problem, only to be surprised and find out it did work. I hope this trend continues!

Now we need to determine what to do with any leftover embryos, but we have a little time to figure it out.

4 eggs Retrieved

I went for the retrieval this morning and they got 4 eggs. The procedure was pretty straight forward and luckily they put you out, so you don't feel anything either. The worst part was getting an IV in my hand, since I hate getting IV's and that feeling. My doctor was happy with the procedure and my the overall follicle development, but wished there had been more than 4 eggs retrieved. She was hopeful some would get fertilized and will continue to grow. Statistically, half of all eggs retrieved make it into embryos.

If the eggs fertilize and continue to grow, they plan on doing the transfer on Sunday, Day 3 of the embryos. This is a very easy procedure done by inserting a thin catheter into your uterus and sending the embryos on their way. If there are two embryos to insert, they will put two in. Let's hope that two embryos make it and can get transferred.

The embryologist will call us tomorrow with an update on the status.

I am home recuperating since they put you out and consider it an out patient procedure. My ovary still feels very heavy and painful, but I am trying to ignore it. I feel relieved that this part is over but now getting nervous about the next couple of days, since the eggs could not respond. Thankfully some friends are coming to visit for the weekend and I will have a great distraction.

Retrieval scheduled for Thursday

I went for a check-in this AM and the follicle retrieval is scheduled for 10:30 AM on Thursday. She told me I currently have 8 follicles and that is a good number. Once they are retrieved the eggs will be extracted and fertilized. They will call us on Thursday afternoon to tell us how many eggs they fertilized and they are currenting scheduling the implantation for Sunday.

Monday Update

I went for a check-in this morning for an ultrasound and bloodwork. The nurse called back and let me know that my estrogen has increased nicely to 1071 and that I now have 7 follicles: 1 at 10mm, 2 at 13mm, 1 at 14mm, 1 at 16mm and 2 at 17mm. They want me to come back tomorrow morning for another check-in. Hopefully I'll find out when they will do the retrivel!

Sharing this blog

Please feel free to share this site with anyone that you think would be interested. Infertility is a very difficult process, especially since there are many unknowns and little public knowledge about it. I know from my experience it can be very lonely, but there are many people going through it, so you just have to find them and talk to them. I have also started being much more open with my family and friends since they want to support us, but don't understand or have any experience with it. Hence the creation of this blog and having more frank conversations with people.

I'm still trying to figure out how to talk to neighbors, co-workers and acquaintances about it. I saw my long-time neighbor yesterday while walking the dog and stopped to chat for a bit (spring is here so everyone has to catch up from over the long,cold winter!) He told me they just had a baby in February and that she arrived a bit early, but everyone is now doing great. We talked about the difficulties of apartment living with kids and he explained they would probably rent their place to move into a bigger house. I said we were also trying to start our family and may do the same with our apartment. He then went to tell me how I should send G out partying more and that's how they got pregnant. I explained that we have been trying for awhile, so it might take more than a good drunken night for G to make that happen. He wished me luck and told me to research some "pills" his sister took and now has a beautiful baby. It made me think of Jack and the Bean Stalk, how I wish there was magic pills to give us a baby! But I then realized that I should think of all my lovely shots like magic serums and maybe that would lighten the process. We'll see!

IVF Info

There is a ton of information about IVF on the internet both from a sales and marketing angle, as well as, chat rooms and posting boards. I have exhausted the sales/marketing sites, since they all say about the same thing and limit myself to 15 minutes per day on the chat rooms/posting boards since it can be really overwhelming.

I personally think that Wikipedia has an excellent entry about IVF, but from a British perspective, so the word spelling is a bit different. Here is the whole entry.

Here is the IVF overview section that gives the step-by-step information about the IVF process:

Ovarian stimulation
Treatment cycles are typically started on the third day of menstruation and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists that are started prior or at the time of stimulation or GnRH antagonists that are used just during the last days of stimulation; both agents block the natural surge of luteinising hormone (LH) and allow the physician to initiate the ovulation process by using medication, usually injectable human chorionic gonadotropins.

Egg retrieval
When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. This agent, which acts as an analogue of luteinising hormone, would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anaesthesia.

Fertilisation
In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use. The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.
In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.

Culture and selection
Laboratories have developed grading methods to judge oocyte and embryo quality. Typically, embryos that have reached the 6–8 cell stage are transferred three days after retrieval. In many Canadian, American and Australian programmes, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.In Europe, transfers after 2 days are common. Preimplantation Genetic Diagnosis (PGD) procedures may be performed prior to transfer. Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter.[3] Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage. Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.

Embryo transfer
Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimise the risk of pregnancies carrying multiples. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

4 identified and 1 added

4 ID'd- I had the first ultrasound yesterday at 8AM to look at the egg follicles and they also did blood work to look at my hormone levels. They called me yesterday afternoon to tell me there are 4 good follicles ranging from 12-15 mm identified and that my hormone were a really good level. I was a little concerned about the quantity of follicles and that it was too low, since I have heard as many as 20 follicles developed and I thought more was better. The nurse assured me that 4 follicles are fine, since it's common for large quantity of follicles to have low quality egg. So now we need to hope that the 4 follicles that are developing have eggs inside that are good and high quality to get removed safely sometime next week.

1 added- Since my follicles have grown to over 14 mm, I was started on a new medication Ganirelix, which helps from the egg from being prematurely released. This is in a pre-mixed, preloaded syringe with a short needle and I take it in the morning, so pretty easy. I am still doing nightly shots of Gonal-f that help push follicle growth.

I go back for an ultrasound and blood work tomorrow morning, they will hopefully tell me when they will do the retrieval of the follicles. The retrieval process requires for me to be sedated to twilight (similar to a root canal) where they go into vaginally with a small needle and aspirate the follicles to remove. The eggs are then immediately handed to an embryologist, who take and fertilize with a fresh sample.

I will add some more resources about IVF and the specific next steps so you can learn more.

Supplies

Day 5 and Year 3

Today is my fifth day on IVF drugs and the third year of trying to have a baby. It's been a long road that will hopefully just be a jaunt in the bigger scheme of things, but one that has opened my eyes to the trials and tribulations that life brings. This blog will be a place I periodically update my family and friends on the progress of the fertility process.

Day 5: I have to give myself shots every evening of a drug called Gonal-f. This comes after being on birth control for 21 days. The birth control essentially cleared out my ovary (FYI-I lost my left ovary to a large cyst in 2006) and the Gonal-f pumps up the the egg creation to hopefully make 10+ follicles that the doctors will remove sometime during April 7-April 12, depending on their development progress. I have begun to feel bloated and slightly uncomfortable, but overall okay. Because the extreme hormones in the drugs, my ovary will grow to over 5X-10X it's normal size. Because of this my body will create a buffer and send lots of fluids to help protect it, hence the bloating. There is emphasis from doctors on keeping up with fluids, since this process can make your body dehydrated since so much fluid is going to my abdomen. We go tomorrow for our first ultrasound to see how many follicles are growing and how big they are.

Year 3: It's difficult to write about this perspective. I got pregnant in July 2007 and miscarried in Sept 2007, without any pregnancies since. Knowing I can get pregnant is a good thing, but it's such a mysterious process that has alluded G and I since then. We see life flourishing all around us and sometimes it feels as if our lives are on pause, watching new life pass us by. I have stopped setting benchmarks and envisioning myself pregnant at certain upcoming events and gave up the goal of having a baby by the time I'm 35, since that day is a just a couple of months away.

I have surrendered to the process and the reality, we will be okay if we are child-free. Going through this process has made the relationship and bond between G and I so much stronger. Our mutual care and respect for one another has exceeded anything I have ever had before, and that has been a true gift. We really hope that IVF works for us but I also understand the reality that it may not. I appreciate the kind, positive words that people give but unfortunately no one knows what the future holds and I am okay with that.

Yielding Life

YIELD verb 
 to give up or surrender 

YIELD noun 
 the act of yielding or producing

This blog is about my life and trying to have a baby. I am in new territory that I thought I would never go, but trying to embrace being here and see my path forward.