Written February 18 - Day 1 Post Transfer
We have kept this under wraps as best as we could. We wanted to be able to still have some element of surprise of a pregnancy announcement for our family and close friends. When you share a transfer date, you are also sharing that pregnancy test results can be expected in ~9 days.
It is a hard balance for me to maintain. Sharing our journey has been so incredibly cathartic. I also firmly believe in sharing to lessen the stigma, or the silence that surrounds infertility. I want to encourage those new to the journey. I want to educate those who are new or those who will never have to face this themselves. I have said it before and I will say it again. Navigating infertility sucks. Really bad. Also, when there is grief involved, I have a very hard time going about my life acting as if nothing is wrong. If you were diagnosed with cancer or lost a dear loved one, you would not be expected to grieve alone in silence. Anyone who knows me knows I proudly wear my heart on my sleeve - these days though that heart is sometimes missing a piece or two.
Admittedly, at this point, I have a hard time empathizing with those who only needed a round or two of fertility treatment. Those for whom everything "worked" the way it was supposed to. Those who only needed one egg retrieval and got all the good embryos they needed from that one retrieval. Those who did not have to fight tooth and nail for every single embryo they made. Those who were far younger than I at the start, and had time on their side. Yet, I remind myself regularly that they, too, had a battle. They, too, would 100% say that infertility sucks. They experienced sleepless nights, tears upon tears upon tears, shots, scans, blood draws, the fear of the unknown. We are just extra special in that we get to do all of that to the nth degree. Over and over again.
In my last blog post, we were in the middle of stims for our sixth retrieval. I hesitate to say "last" because God only knows what the road ahead looks like for us. That cycle started off a little more "chill" but ended up bringing just as big of a roller coaster as the previous cycle. My estradiol levels ended up over 8500 which is insane. We retrieved 28 eggs. We were immediately upset as our 27 eggs from the round before yielded us nothing. Of those 28, 24 fertilized. Two of those made it to blastocyst stage (embryo), and one of those was genetically normal. So, across our last two rounds, we had 55 eggs retrieved, 45 of which fertilized. That gave us one embryo. One. Our July round with 12 eggs retrieved gave us two embryos. Crap. Shoot.
We finally made it to that magical four though. The magical number that means nothing in this world, except it was a number we decided we wanted. Four embryos. Four chances at making our family. Due to our extreme difficulty in making those embryos, we did not want to take any chances when it came to transfers. We elected to do a mock transfer cycle with a uterine biopsy instead of moving straight to a transfer. The mock cycle is usually not done until someone has had two failed transfers, but we do not have the luxury of "trying things out" with two of our embryos. The biopsy was supposed to be December 23 but did not happen until January 19. Why? Because once again, we were on the wrong side of the statistics. Nothing comes easy for us. The estradiol pills I was on for four weeks apparently didn't register with my body. It took four weeks to realize that. We switched to estrogen patches and intramuscular injections and that did the trick of getting my endometrial lining to grow the way it needed to. A good lining is needed to provide a good home for a transferred embryo.
The mock cycle consists of taking all the drugs and same schedule you would for a real transfer, but instead you take a biopsy of the uterine/endometrial lining on the day you would have transferred. We ended up taking three biopsies to do three kinds of testing. I feared the biopsy day due to horror stories of others. You get to take advil one hour before. Whohoo. And you are completely awake while they go in and take three chunks of the inside of your uterus. It is insane to me the procedures women are subjected to without pain medicine/anesthesia. Thankfully, for me, the process was not that painful.
More painful for me are the PIO (progesterone in oil) shots that you begin roughly five days before transfer. These are also intramuscular and given in the hip. Every day. My estradiol injections are 0.3ml every other day with a 23g 1.5" needle (that is a huge needle by the way). The estradiol ended up not being that bad at all. The PIO is a whole other story. I have to use 1 or 2ml of the drug, depending on the formula. Mine is mixed in ethyl oleate to be thinner since the dose is so high. The "regular" formula is sesame oil which is thicker, but usually okay for people in a lower dose. Three days into the PIO injections, I could barely walk. I was in so much pain that I got nauseated every time I moved around. My niece, Kate, is premed and working at a pediatricians office. Every time she sees me draw up 2ml, she just stares in amazement and says "that is SO much." For the mock cycle, I only had to do five days of PIO. It only took a day or two for the pain to subside after I stopped, thankfully. I told everyone I had COVID ass. If anyone had COVID arm after their vaccine, just imagine that in your hips, every day. I will say I seem to be special here in that others generally do not seem to have quite as much pain as I do with these. One more time we are on the "special" side of the stats.
As we agonized over the time lost as we were spinning our wheels trying to get my lining to grow, I kept hoping that somehow or another, we would know it was time well spent. Thankfully, we found out via the testing that I would need one more day of progesterone for my transfer to best support implantation. The rest of the testing came back clear which is good because had any of it showed any issues, we would have lost more time.
After the mock transfer, we were heading into our real transfer cycle. I was slightly excited and completely terrified. This time, my lining grew in the two weeks in which it was supposed to grow. I'm still on the thin side, but the new combo of drugs is definitely what I needed. I had my last lining check on February 10 and Dr. Vaughn said we were good to with my transfer. I could not stop crying once that happened. I could not believe it - and a good part of me was afraid to believe it. The time was coming - a culmination of everything we had been through for the past 14 months. It is odd to want something so bad and be so terrified of it at the same time. I had to get bloodwork done that afternoon and the girl who drew my blood told me she and her twin sister were IVF babies. I found sweet comfort in that.
Based on the embryo selected and the results from our mock transfer, we knew I would be on PIO for 7 days before the transfer. We have decided to not find out the sex of our embryos thus far, but did send specific instructions to the embryologist on which embryo to pick. If there are two of each, they were to pick the best quality. If there were three/one, then pick the best of the three. And obviously if they were all the same sex, just pick the best quality. I put in bold letters in the email "do not tell us which scenario exists" because we did not want to have any insight into what was what.
Fast forward to yesterday. Transfer day. Or, rather, let's go to Wednesday, February 16. I felt terrible. I have generally felt pretty bad through the last few months. Everything hurts, especially my butt. I yelp when I walk up the 12 stairs to get out of our house. Sitting and standing are awful. I was at least somewhat reassured on my Fertility Rally (support group) call Wednesday night. I told them I should be excited but I was so tired and felt so bad I was having a hard time feeling much of anything. Several girls chimed in that the progesterone and estrogen make them feel awful as well. Yea?
Yesterday morning I woke up feeling better. I was excited for the day. I bought a used Old Navy pineapple shirt online (yup) to wear, told Danny to wear his best pineapple shirt, and even curled my hair (pineapples are a symbol of good luck in the fertility world). We were supposed to arrive at the surgery center at 11:15 for a 12:15 transfer. Boy is the later morning mood around there completely different than what we were used to with our 5am arrival for our egg retrievals. The waiting room was full, people were chatty, and there was a general air of happiness. The best part is I was able to eat the candy in the awesome candy bowl! (When I'm there for egg retrieval surgery, I obviously can't eat it before and always grab some on the way out, but it isn't nearly as exciting when you feel like poo post op.) I generally knew what to expect once we were called back. My biggest worry was how awful it was going to be to keep the full bladder I was required to have during the transfer. I drink a ton of water, and pee all the time. I still drank my ton of water and wasn't allowed to use the restroom until after the transfer.
My other, real, biggest worry was an unspoken one. One that I knew could happen, but only happens 5-10% of the time. That worry was that an embryo would not survive a thaw. If that happens, it is just gone. Just like that, one of our four precious chances would be gone. I even had a dream something along those lines happened a few night earlier this week. I do not recall the exact details, but it ended with Dr. Vaughn taking me all over some hospital trying to help me. Danny and I were taken to our room and given paperwork to fill out. I was still happy and excited...but had to pee. I was pretty mad the nurse would not even let me pee a little if I promised to drink my whole water bottle afterward. The embryologist came in next with the picture of our embryo. What was supposed to be incredibly emotional for happy reasons was indeed incredibly emotional - but for all the wrong reasons. She let us know they had to thaw two embryos because the first one did not make it. I immediately burst into tears. How? Why us? Is this really happening? I rarely ask these questions as I know there are no answers, but man I sure wish I knew. My heart ripped apart and the day immediately turned into living one of my biggest fears. Danny was great and wanted to focus on the embryo we were transferring. He kept reminding me we have a great chance with that one. But all I could think about is that if this transfer doesn't work, we are down to two chances left. Two. We want more than one kid and each chance we have is so, so precious. If the transfer failed, that also means we were relying on trying to get something from our two lowest quality embryos. It can happen, and does all the time, but it is so discouraging.
I cried through most of the rest of the process. I did not say a word once we were walked back to the operating room where they do the transfer. I just laid there as they got everything setup and quietly watched the embryo on the big TV. The whole thing probably took ten minutes or less. When it was time to get up and walk back to our room, Dr. Vaughn literally held me as we walked all the way back. I was devastated and he knew it. When we got back to the room, he just hugged me as I cried and cried and cried. Then he hugged me again. I did not think about it much until later, but it is crazy that my dream ended with him helping me in some sort of hopeful way, and our visit ended with him being a literal shoulder to cry on.
I went to acupuncture afterward and did all I could to relay what had happened while holding in the tears. Once she left the room, the tears flowed once again and I eventually feel asleep for a few minutes. We headed to McDonald's after that because eating McDonald's french fries after a transfer is also supposed to be good luck. Too bad I was too upset to really enjoy them. I was supposed to take it easy the rest of the day but was not able to sleep. My hips/lower back hurt too bad from the PIO to be able to get comfortable. Kelly (my bff) called at some point later in the day as we had not yet talked for my birthday. I could not answer because I knew I could not talk to her without crying. She, of course, had no idea we had transferred. I decided to at least text her what had happened and told her not to tell anyone. The downside of not telling anyone is that you do not have anyone to grieve with or to provide comfort when shit hits the fan. At some point later in the afternoon, I went to find the two pictures Danny had dutifully brought home for safe-keeping. One was our embryo, and the other was the ultrasound when they transferred the embryo. I grabbed a small pink flamingo photo album we received as a wedding gift but had yet to fill, and put the pictures in the first two slots. I put the album under my pillow and slept with it there. I guess I will leave it there at least until we get our results...hopefully longer.
Now we set off on what is known as the "TWW" or the two week wait. For IVF though, it is really nine days. And for us, it will be eight. Next Friday, I will do my first "beta." Beta is the name for the level of HCG in your blood. The first beta generally needs to be 50 or higher. I'm unsure about ours since we are testing a day early due to the weekend, and perhaps due to our embryo being already hatched when it was transferred (it was transferred a day later than most unhatched embryos). You continue to test your HCG to ensure your levels are appropriately rising. I believe you generally test again two days after your first, at which time the number needs to have at least doubled. Since we are testing first on a Friday, I do not know if our second will be on a Sunday or Monday. And, of course, if the HCG level is 0 (below 5 actually), we are not pregnant and there will be no further testing.
We have a busy few days coming up which is nice. I am not allowed to exercise during this wait. I thought that would bother me, but I feel so bad and my hips hurt so bad, I am so far welcoming the time off. I am able to walk, stretch, and do light yoga. I am hoping to get a good bit of vitamin D while taking the dogs on lots of walks next week. Today, we are heading to Fredericksburg to spend the night with our good friends. They do not know we transferred and so far I am not planning to tell them, but we will see how that goes.
Written February 24 - Day 7 Post Transfer
I really thought I would write every day during this wait. I thought I would take the dogs on long walks and thought I would play the piano a bit. Not much of that happened. I do not know where time went. I pretty much decided in the last few days that today would be the day I tested at home. Danny and I both agreed we would test at home before the blood test as we did not want someone else telling us if we were pregnant or not via a phone call. Regardless of the result of the home pregnancy test(s), I still have to do the blood test on Friday, Day 8 as HCG levels could possibly be too low for a home test to detect, but that is unlikely.
I found out yesterday that one of the girls in my fertility support group who transferred a few days before me tested on Day 7 and had a positive test and the had a positive blood test on Day 9. Several of us transferred right around the same time, and of course I hope we all had great news.
Danny woke up at 5 this morning to run and told me "Russia invaded Ukraine" on his way out the door. Hmmm - that was not quite the positive vibe I was looking for heading into this first test. I waited until he got home from his run to test. I wrapped the test in toilet paper and put a timer on for three minutes to make sure we had the final result, and that we would get to see it together for the first time. I set my phone to video what would hopefully be one of the best (if not the best) moments in our life. I told Danny I was scared to look and he uncovered the test. I immediately saw that it was negative. I cannot say I was absolutely devastated because I think we both expected failure. Nothing comes easy for us in this journey - why would this be any different?
It is only 9:15am right now so I am still processing. And in all honesty, still holding out some shred of hope that I am one of the really rare cases where my HCG just is not high enough to register on a home test right now, but could show up on tomorrow's blood test. I wish that hope was not there at this point as I do not feel that it is going to do me any good. It is just delaying any certainty for 24 hours.
I do not know what is next. I do know that we have a ski trip planned in March that is probably going to mess up the possibility of going straight into the next transfer. I did not expect anything less when we planned this trip a few months ago. I hoped at best I was too sick from being pregnant to ski. Well, I guess I get to ski now. Yea. I would much rather be puking on the couch because I am pregnant than trying to ski while I feel like total crap from the hormones. If I happen to be on PIO at that point, I am not sure I will be able to ski anyway because the pain in my hips might be too great to do any of the bending/squatting skiing requires. Yea.
Written February 25 - Day 8 Post Transfer - "Beta Day"
I woke up pretty early this morning, unable to go back to sleep. My plan was to get to the lab before 7 to get the bloodwork taken care of and get the results ASAP to get on with my life. The limbo of not being 100% sure sucks. I took one more at home test to make sure nothing showed up - out of that one last shred of hope. Of course it was as negative as yesterday's was. Do not ask me how many times I went back to look at yesterday's test to make sure I could not see the faintest of a positive line.
I told the lady drawing my blood that I have squirrelly veins and that they usually do better with a smaller needle. I love when they somehow think they know better. I have lost count of the number of blood draws I have had - six retrieval and two transfer rounds of IVF come with a lot of that. Anyway, I don't know what she did but it was incredibly painful and produced no blood. She said we would move to the other arm. I was about to crack. It is insulting enough to have to get bloodwork to confirm what we already know to be the truth, but then to have it be painful and more than one try was almost too much for me this morning. I held back tears as she got the other side to work and I got out of there. I cried a good part of the way home. I decided I was going back to bed instead of to work. I'm so incredibly tired. I need rest - a kind of rest I fear will never come.
I finally got the phone call at 11am confirming our blood results. I know it pained my nurse to have to make that call - I do not envy that job. She is checking with Dr. Vaughn re: next steps. We have shared the news with our families. It is honestly much easier to share this way with our network vs individual phone calls or texts as those generally come with questions. I rarely have any answers, especially right now.
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Daine and Karina Branham