IVF
This post is all about our experience with IVF… I will try to keep it to the highlights, because it was a long process. I’ll also pepper in a few songs - I made an IVF playlist throughout the process to keep things fun.
The beginning: When we decided to switch from IUIs and pursue IVF, I had to undergo one final test - the mock embryo transfer - to make sure the real embryo transfer would go well. In my case, this meant waiting one more cycle before beginning treatment, because they only do the test at a certain point in your cycle. By this point, we had received a sample IVF calendar from our nurse, and taken a class at our fertility clinic to learn how to administer the various shots.
When we got our IVF calendar from our nurse… I cried - mostly out of sheer exhaustion looking out at what was in front of us. The calendar for one cycle stretches over a month, and that’s after you have been on birth control for a full month. One of the hardest things for me was what seemed like an endless expanse of time stretching out ahead of us with no certainty on how it would all turn out.
Shots…shots shots shots shots shots: Now to the part that most people think of when they think of IVF…. the SHOTS. I follow @hilariouslyinfertile on Instagram (her posts got me laughing at some very low points) and as she puts it “I knew there were stomach shots and ass shots… and that was it.” Accurate. There are also suppositories, oral pills, etc. But back to the shots. Once you finish a full cycle of birth control pills you begin what’s called the “stimulation” phase of an IVF cycle - aka shots to stimulate your ovaries to develop several eggs at once. We had to take a class on how to administer the shots, which was very useful because in addition to my husband sticking me with needles daily, we also had to mix some of the shots ourselves. Some drugs arrived in powder form and you had to combine the powder with a saline solution (keeping all of this sterile) and sort out how many vials of powder you needed for that day’s dosing. It was a lot to keep track of. Plus, the timing of everything was fairly regimented - so we had to dip out of evening commitments or just make sure we could be close to home to do the shots on time. In order to make this all suck less - we celebrated each shot by playing LMFAO “Shots” afterwards. It helped lift the mood for sure but I will never listen to that song the same again!
Monitoring: Before beginning the cycle and starting a few days into the shots, I headed into the clinic for monitoring appointments (bloodwork and ultrasound) so they could measure my hormone levels and see how many follicles were developing. In my case, one of my ovaries began to develop ALOT of follicles very quickly. So, while most people go in for their first monitoring appointment and then come back a few days later, my doctor changed up my drug regimen (lowered the doses) and started me on daily monitoring after that first visit. A few visits later I started another daily shot meant to stop my body from ovulating on its own. So essentially I was taking two shots to stimulate my ovaries to grow many follicles and another to stop my body from releasing them until they were good and ready (aka most likely to produce mature eggs).
What it felt like: Luckily my husband did a pretty good job of not causing me to bruise, so outwardly I just looked a bit like a bloated pincushion with tiny bruises around the injection sites (on either side of my belly button). On the inside, my ovaries felt enormous and heavy, which started out with a dull ache in my low back and by the end it hurt to lay in any position, it hurt to drive because I felt every single pothole (and the state of our city streets did not help) so mostly I just wanted to be a blob on the couch in stretchy pants… laying on a heating pad.
The retrieval: Fast forward through several monitoring appointments checking the size of my follicles and hormone levels and I was finally given the go ahead to take the trigger shot and prepare for my egg retrieval. Because I had so many follicles, I had to take a trigger shot less likely to cause ovarian hyper stimulation syndrome (OHSS). It meant that I took the shot (at an extremely precise time, according to when my retrieval was scheduled) one evening and then went in for another monitoring appointment the following morning to ensure that my body had properly responded to the shot. That evening you take antibiotics to minimize the risk of infection following the retrieval, and the following day is the retrieval. Mine was scheduled for early (early) morning - we had to arrive at the clinic at around 6am to begin the prep. This meant leaving our house at 5am, and, something he will share in his own special guest post later, my husband procuring his sample at 4am. And finally, it was time to get the eggs out! You are put under general anesthesia for the procedure, but its pretty quick. I remember meeting the doctor, a few nurses, and the embryologist and then waking up back in the triage area. I wasn’t in any pain afterwards but took the rest of the day off to rest.
Recovery: Despite not being in pain it took me 3-4 weeks to feel fully back to normal after my retrieval. For much of that time I didn’t exercise (you’re restricted in the beginning to avoid ovarian torsion). I mostly focused on lots of walks (the inspiration for the next song…). In order to prevent OHSS, the other risky post-retrieval complication, they recommend a high salt, high protein diet. I hadn’t felt like eating much leading up to the retrieval because I was so uncomfortable - I lived on green smoothies with protein and Nuun electrolyte tablets. However, the evening of the retrieval we celebrated by going to ShakeShack and eating alllll the salt and protein in a burger and fries. It was amazing.
What next? They retrieved 29 eggs that morning. That’s a lot. The optimal amount (I’ve heard) is somewhere in the 12-15 range. Too many and its not likely each egg has enough energy/size to sustain an embryo and too few and by the sheer odds of the embryo development process you may not have any embryos make it to 5 days. All of that said, we found out the morning of the retrieval how many eggs had been retrieved and we were positively giddy. Surely this meant we’d never be doing another retrieval again - we must have enough good eggs in there to develop some embryos.
29…25…19…3, our 3. Over the course of the next 5-6 days, you get periodic calls from a nurse reading the results from the embryology lab. They track the embryos at each stage of development, and it is expected that 50% or more won’t survive each stage. For us, the progression went like this: 29 retrieved, 25 were mature eggs. Of those 25, 19 fertilized normally. At this point, we were on a total high. We were sure that this meant we’d end up with at least 8-9 embryos, and of those, maybe half to two-thirds would be genetically normal (we had decided to have the embryos genetically tested before freezing them). By the header on this section, you can see what a roller coaster ride we were in for. Of the 19 that fertilized normally, we found out in a series of calls from nurses over the next few days, only 3 made it to the blastocyst stage - the stage at which they will freeze the embryos. They tried re-fertilizing some of the ones that didn’t take originally, and watched 7 additional embryos up to day 7 to see if they would make it beyond the cellular level, but in the end were only able to freeze 3.
At this point I was oscillating between sending all of my strength and love to those three embryo babies… our babies, as we think of them… to feeling completely deflated and mourning the loss of the remaining 22 that hadn’t made it past fertilization. Even now, months removed from these moments, tears are welling up again just reliving that feeling. Believe me, I know how incredibly lucky we were to have even one embryo make it to the blastocyst stage, let alone 3. But I still also felt an incredible sense of loss.
The next few months… We participated in a research study with our clinic so instead of a “fresh” IVF cycle we did a frozen cycle. We were planning on a frozen cycle anyways because we knew we wanted to have the embryos genetically tested. Whether or not to test is a very individual decision, but I felt pretty strongly that I wanted to minimize the number of times my body had to endure rounds of drugs. Testing the embryos gives you an idea of whether or not they will result in viable pregnancies, as most miscarriages in the first trimester occur because of a genetic abnormality in the embryo.
The study we participated in involved one final test - a test to determine the optimal time to implant an embryo - which, for me, also represented a way to minimize the chance of multiple failed IVF cycles. However, it came with a cost - a (very) extended timeline. For us, the timeline looked something like this: birth control for a month, stimulation/retrieval cycle, birth control for another month, “mock” cycle where the additional test was done, and finally the transfer cycle.
The transfer: This post is pretty fact-heavy, but throughout the months of treatment the emotional roller coaster was real. We learned of four more friends who were pregnant, and I missed a bachelorette party and went to two baby showers. I felt rage like I never have before (apparently normal, but very strange), and also intense sadness - I spent a lot of time feeling sad. I am grateful for friends who reached out, listened, and asked how I was doing. I am grateful for my accupuncturist for helping to smooth out some of the emotional roller coaster, and my therapist for validating every single feeling I was experiencing. I explain all of this because by the time we made it to the transfer, I had finally arrived at a feeling of peace and ease. It took me the four months from the start of our treatment to the transfer to feel open to whatever happened.
So… what happened? Well. In short… it worked! Those are the first words I said to my husband when I called to tell him the news, so that is how I will leave it here. Through tears, I kept saying “It worked! It worked!” We found out of our little miracle baby via a voicemail left by our nurse, and some days I replay that message, knowing that I am (as of the writing of this post) 24 weeks pregnant, and still can’t believe it.
I plan to continue posting on the blog about our experience beyond fertility treatments, because I’ve really enjoyed sharing this process, and it has been my experience that pregnancy feels different after infertility. That said, I know there are other couples whose journey is still being lived. I hope that I can continue to share in a way that doesn’t minimize or forget the pain and loneliness of that experience, but instead in a way that offers hope.
