As a way to observe National Infertility Week, I have decided to share our story of infertility in hopes it may help at least one person. This story is extremely personal to me and has taken tremendous effort to live through and now write about. I understand firsthand how taboo the topic of infertility can be. Please keep in mind how vulnerable I am making myself when reading and commenting.
I shared the first part of our story, the birth of our daughter, here. She was conceived naturally without any issues. The next step was trying to get a diagnosis for our infertility and I shared that here. Then we tried 3 unsuccessful IUIs in part 3 of our story here. Our next step was to try IVF.
IVF is often a 2 month process. The first month they need to do more tests. This includes blood work of the man to ensure there are no STDs or any other diseases. It also includes a hysteroscopy of the woman in which they inspect your uterine cavity through endoscopy (video). That way they can ensure there are no fibroids, polyps, or anything else that could impede an embryo from implanting into the uterus. With your next cycle, you either begin ovarian suppression medication (a few weeks of birth control pills or other medication like Lupron) or go right into stimulation medication to stimulate the growth of multiple follicles. Sometimes ovarian suppression medication is done for scheduling purposes to help time out the cycle, other times it is done to help increase the amount of follicles. Ovarian stimulation is done through subcutaneous injection (stomach shots) over the period of about 2 weeks. Typically a woman is on 2 stimulation medications at a time and then needs to add in a medication to keep her from ovulating the last 4-6 days of the stimulation cycle. The doses of medication are changed based on monitoring, blood work, and follicle size. Monitoring appointment Then there is a trigger shot given to cause final maturation of the eggs and an egg retrieval surgery is done before the eggs are actually ovulated. The eggs are then in the care of a lab, fertilized (hopefully) and watched to see if embryos grow. If everything looks good, implantation is done 3 days or 5 days after egg retrieval surgery. Otherwise, the embryos may be frozen and implanted during a later cycle (also called Frozen Embryo Transfer or FET). A typically IVF cycle begins at $10,000 not including prior blood work or hysteroscopy. Other costs can make that go up like Intracytoplasmic sperm injection (ICSI when the sperm is picked and then injected into the egg for fertilization). Medication is also a significant cost in addition to that, typically starting at around $5,000 a cycle and climbing from there.
In October of 2016, I had my hysteroscopy with normal results. My husband did his blood work (normal again). We completed the stack of paperwork associated with it all (even needing notarization on a couple of the documents). I began a few weeks of birth control mid October my last day was on October 25. I then started stimulation injections October 29. They had me on what is called the antagonist protocol. I was on low dose HSG and Follistim to stimulate follicle growth. I also had acupuncture about once a week during the process. Towards the end of the cycle, I also added in Ganirelix once a day (at a very specific time) to suppress ovulation until as many follicles as possible were at a good size (and hopefully had eggs inside of them). Just to give you an idea, I had 5 monitoring appointments during my IVF cycle. My trigger shot was the night of Tuesday November 8 and then egg retrieval surgery was November 10. I found out that day they had gotten 9 eggs. The next day I would find out the fertilization results. We opted for ICSI because of the borderline low morphology issue we had with the sperm. When I got the call the next morning I was literally shaking. Of the 9 eggs they retrieved, 8 were mature enough to attempt fertilizing. 6 had been fertilized. Even with ICSI, not all the eggs can be fertilized. The clinic thought that was enough embryos to try for a Day 5 implantation so they scheduled the implantation November 15. After that phone call I sat down and bawled with relief. All those shots and all that time and effort and we had a chance! I was thrilled they were trying for a Day 5 implantation, too since I had read about the difference in success rates.
There is a difference between a Day 3 and Day 5 implantation. Day 5 implantations are often more successful because there are more cells to grade the quality of the embryo by and they have developed into a blastocyst stage which not all embryos can do. Then the doctor can pick the best looking or strongest ones to implant. A better graded embryo means they have a better chance of implanting. However, the lab is not an ideal place for embryos to grow so many stop developing before Day 5. So if there are not many embryos, the clinic may opt to try a Day 3 transfer because the uterus is an ideal environment for them to develop and hopefully implant. Otherwise there might not be any embryos left on Day 5 if they wait. Many times only 50% of embryos make it to Day 5.
In the meantime, before implantation I had to start progesterone in oil injections, wearing estrogen patches, and continuing low dose aspirin. These are intramuscular injections done in your back hip area with a much longer (1.5 inch needle) right into the muscle. Ouch! Give me a stomach shot any day! My husband had to do these for me each night because it is at such a hard angle. These continue until your beta test 9 days after your implantation to check the HCG levels in your blood. Anything above 5 is considered to be a pregnancy, but they want it to be much higher than that because a higher number often means the pregnancy has a greater likelihood of viability.
The morning of November 15 I went for a run to help with the nerves and because I knew I’d be on bed rest for the remainder of the day. I got a call from the clinic about 1 mile from home. The lab was recommending that I cancel the appointment and try for an FET next month. There were still 3 embryos alive, but they were all a little slow developing. Typically they want the embryos to be at a blastocyst stage, but we had 1 early blastocyst, 1 compacting morula, and 1 morula (the development of an embryo goes zygote, 2 cell, 4 cell, 8 cell, morula, compacting morula, blastocyst). That decreased the chance any of them would take so they wanted to give them another day to grow and then try and freeze them. After asking some questions, I found out that they would only freeze blastocyst stage and our embryos might not all make it to that stage by tomorrow. And not all embryos make it through freezing and thawing. Panic began to set in that there was a very real chance we might have no embryos to show for everything we went through. I asked to speak to the doctor and sprinted home to talk to my husband. The doctor said she felt comfortable transferring the early blastocyst and morula, but she’d like to see if the compacting morula could develop further and freeze. So we proceeded with our transfer that day. By the time we had arrived at the clinic, the embryos had advanced a stage to an early blastocyst and a blastocyst. I took comfort in that.
I also had acupuncture to help relax and help the embryos implant after the procedure. My first beta appointment was ironically Thanksgiving morning. A few days after the transfer, we found out our last embryo didn’t make it to freeze. So if this didn’t work, I would have to go through the entire stimulation and egg retrieval process all over again.
The Tuesday before Thanksgiving I had enough courage to try an at home pregnancy test. I had been feeling implantation pains and other symptoms and wanted to know. By some miracle, there were 2 beautiful pink lines! I was still feeling cautious though. I remember just a few months before we had a light positive and it was a chemical pregnancy. We had our appointment on our way out of town for Thanksgiving. They said they would call with the results around noon. It was the longest few hours of my life. They finally called and said my results were 23. It was low, but that isn’t always bad. They said my progesterone was low too and so they increased the amount of my daily progesterone in oil injection from 1cc to 1.5cc. Progesterone helps the fetus grow and develop until the placenta takes over. I tried to stay calm until my next beta. What matters is the HCG doubling rate and how the number goes up. I was to come in again on Monday. Results on Monday were 99 so the HCG in my blood was doubling about every 48 hours which is considered to be average. I was to come in again on Thursday. This time results were in the high 300s. It started low, but seemed to be doubling. I was told to be cautiously optimistic. I scheduled my first ultrasound on Thursday December 8. These are all numbers and dates I don’t think I will forget for a long time. I remember sitting in the waiting room and shaking. Trying to be hopeful, but scared out of my mind that this wouldn’t end well. The doctor got tied up with an egg retrieval procedure and we spent another 30 minutes of anxious waiting in the exam room. As soon as the ultrasound image came on the screen, I knew. You see, I had made the mistake of doing some reading about low HCG and what could happen. Even about the possibility of success. It was all pretty bleak. I saw the ultrasound before the doctor was able to move the probe away, and I knew. There was only a lonely, empty sac. No baby. I started crying before she could even open her mouth to tell us. With sympathy, she told us I had a blighted ovum. It is a common cause for miscarriage in the first trimester and happens when there is a chromosomal issue with the embryo. The embryo attaches to the uterine wall, a pregnancy sac begins to develop, but the fetus does not. She instructed me to stop progesterone injections and I would probably miscarry on my own within a week. Once I had another cycle, I was to go in for a baseline for blood work and make sure my HCG levels were back to normal.
We stayed in the room for a while grieving and trying to process. We had gone through so much and come so far and then it was all taken away. And then I had to wait until my body miscarried, the exact opposite of what I wanted it to do. It makes you feel like a ticking time bomb. My body and heart felt at odds with each other. Two days later on December 10, I woke up not feeling well. A few hours later I started to miscarry. It was the worse experience of my life. It wasn’t nearly as painful as childbirth, but the depressing emotions that came with it all I can’t even begin to describe. It feels like light contractions, and I had them all day Saturday. And then as it passes through, you have to unfortunately see it all. It lasted for about a week. I know this, if I ever have a miscarriage again, I will beg the doctor for a D and C so I don’t have to go through that again. I felt like I couldn’t fully grieve until it was all over.
I’ve learned a miscarriage is something you always carry with you. I will always have that sadness with me in my heart. I think about that baby every day. I call her Lily. We wanted her so much and I never had the chance to hold her in my arms and tell her how much she was loved. So I try to hold Claire extra tight and give her extra hugs and kisses, it is even more important to me now that she knows how much she is loved, unconditionally. So if you have a child or children, give them an extra kiss and hug because they are special miracles. Some day I will share with Claire that she has a very special guardian angel watching over her in heaven.
I plan to continue the final part of our story next week with my last post on our story what has been going on since our loss in December until now. I also eventually want to do a Q & A post on infertility. Many of my friends and family had no idea process of getting pregnant and how many ways it can go wrong, possible diagnoses, different treatments (it’s not just IVF), and what happens during it all. If you have any questions about anything related to infertility or what you can do if you know someone going through it, please comment or email me at laura.bambrick [at] gmail [dot] com. I’m happy to answer anything privately, too. Just make sure to tell me in the email.
