IVF #3 – a conclusion of sorts

Monday, May 29 was a Memorial Day.  C and I returned to NYC that evening.  The week ahead was sure to be rough – we were putting our cat to sleep that week and I was going to get the final word from the doctor that my HGC level had indeed, like the month previous, fallen.

I had one more HPT test left in my medicine cabinet in the apartment.  When I told C that I might as well use it up – he said, “why do you keep torturing yourself”.  He was right but an HPT in my hands is like a pipe full of crack to a crack addict.  I peed on it.  Quickly the line second line indicating pregnancy became very, very dark.  What in the hell as going on here!?  Neither C nor I could believe our eyes.  Could it be?  Once again our hopes were raised.  I was kicking myself – what about all that wine and the sleeping pill!  

My hopes were quickly dashed the following morning when my period began.  I went to the RE’s office around 8am, gave blood and waited for their phone call.  It finally came at 1pm – my husband was also on the line.  I had stopped taking phone calls from the doctor at work.  C and I decided that he should learn the news first and then inform me.  I heard the voice of the nurse..and stopped her in her tracks.  “I’ve started my period, so I know what you are going to say” I informed her.  “Well, that isn’t your period – your levels went up to 51”.  I couldn’t believe it.  

I quickly learned that a level of 51 at 15dpo was certainly within range for normal betas but it became clear that this was on the low side of normal.  Only 60% (or something like that) of pregnancies with a beta such as mine went on to become normal pregnancies.  Certainly this would be a singleton pregnancy – twins would probably be a much higher level…but every two days they checked my levels and every 48 hours my beta doubled.  I was given three  IVIG transfusions -there was a theory that my immune system was causing early miscarriages and this would help calm it down.  I was also placed on blood thinners for the remainder of my pregnancy.  One shot of lovenox and one shot of progesterone until week 12.  

When my beta level reached 5000 they stopped testing me every other day and I went in for a sonogram to check for a heartbeat.  I remember I was due to attend an offsite work presentation and had to arrive late.  When I walked in they were already in progress….everyone turned, looked and me and cheered when I told them there was one strong heartbeat place in the right spot in my uterus.  When I told C the news he said, “but what happened to the other ones??”.  That made me laugh – for the first time “be thankful for what you have” became something I could not only understand but live by!

During one of my many visits to the RE for a sonogram and bloodwork I passed a short woman wearing huge black sunglasses.  Instantly I knew who she was…and so do you.  I can’t ethically post her identity here but let’s just say she is a huge star married to a very famous actor.  A few days later while giving more blood I saw her husband (my childhood crush) enter the “wank room” as my husband calls it.  A number of weeks later I saw them both pass me while giving blood – clearly they had come for a conversation after a failed cycle.   She was around 40/41 (approximately) at the time and to my knowledge has never been pregnant again.  At that moment it occurred to me that infertility can happen to anyone to everyone – money certainly helps buy more cycles but can’t make your ovaries work or make that embryo a healthy one or solve implantation failure.  

I certainly digressed…the weeks went on and on – and nervously we waited for magical #12.  We had chosen the most conservative doctor in Manhattan (by ALL accounts) and she did a wonderful job of worrying about me and testing me – so much that I felt that I could finally relax.  We had our nuchal scan (where they measure the back of the neck to check for aneuploidy) at week 11 and all looked fine.  The blood work came back normal…but my doctor was urging me to have an amnio at 18 weeks.  She told us horror story after horror story about women who had great first and second trimester results delivering downs and trisomy babies.  But I couldn’t do it.  I’d come so far and was just not willing to take the 1 in 300 risk of miscarriage that might be the result of an amnio.  When I spoke to the radiologist he told me that results like mine had never – in his 20 plus years of experience – resulted in anything other than a normal child, my decision was made.  My doctor wasn’t pleased but I didn’t care.  I couldn’t take the risk.

In my 20th week they discovered that I had placenta previa – being on blood thinners and having your placenta cover your cervix was not a good combination.  I was put on modified bed rest and allowed to get up four hours a week (which I used stupidly used to go to work!).  On December 7, when I was 31 weeks pregnant, C lost his job – on December 8 my doctor, during a routine examination, found that I had dilated to 1 centimeter, my cervix had shortened considerably and I was contracting fairly regularly.  I was put in the hospital for four days on a magnesium sulfate drip.  That was the most miserable drug I’ve ever been given – it made you feel like you had a horrible case of the flu and every muscle in my body was weak and ached.  I was only allowed to get up once a day to use the toilet.  They gave me steroid shots to help develop the baby’s lungs should it arrive early.  On day 4 I had stabilized, was no longer contracting and  allowed to go home.  I stayed on the couch and in bed for a month and half.  I ventured out for a small walk at 35 weeks and had a massive contraction which sent me hobbling back to the apartment in pain with a very angry husband…and an even angrier OB on the telephone.  When she asked me why I went for a walk I told her the truth – I was bored.  “well the NICU is very exciting” she told me, referring to the Neonatal intensive care unit…my doula called and told me that I should have a small glass of whiskey to stop the contractions.  She urged me not to tell my doctor…and I didn’t.

At 38 weeks I was induced because of my blood clotting problem.  But first, to prove my child had well developed lungs, they made me do an amnio – which I did without hesitation.  I was feeling miserable and wanted desperately not to be pregnant anymore….

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IVF #3 – Part One

In early May 2006 I began my 3rd try at IVF. To say that I was not optimistic is a very great understatement. In fact, I had completely lost hope. What we thought would be a quick means to an end turned out to be a living nightmare. Suddenly we had to confront not only the fact that we had really serious fertility problems but the idea that this might not work for us – EVER. I doubt many of you remember me going through this – because I basically went into a cave and shut everyone out. My wost fears were coming true. You see, I’ve only really and truly wanted two things in my life – one was to be married to my husband and the other was to have his children. Getting that man to the altar was exhausting enough – but IVF was threatening to do me in for good.

I started the cycle reluctantly – I had already made an appointment with a new RE at Cornell and was tempted to wait out the month and give my body a break but C urged me on. I’d been reading a lot about PGD and it seemed from what I read that the process might be damaging our embryos. This time I decided that I wanted to do a blastocyst cycle. Typically an embryo is transferred back to the woman’s uterus on day 3 of its little life. A blastocycst transfer takes place on day 5 when the embryo has divided into hundreds of cells. The theory behind transferring on day 5 is that most abnormal embryos will not reach the blastocyst stage. Transferring a blastocyst gives you a much greater chance of pregnancy. Most doctors will not transfer more than 2 grade A blastocysts for fear of multiples.

On May 15, 2006 10 eggs were retrieved. C and I had a running argument about ICSI. He didn’t think we needed it. He was convinced that his sperm was just fine and that 3K extra to spend on the embryologist hand picking and force fertilizing the eggs was a huge waste of money. He convinced our RE to give him an egg or two that would be placed in a dish with his sperm to fertilize naturally. When I found out that they had retrieved 10 eggs I agreed to give him 2 eggs for his experiment. The remaining 8 were all ICSI’ed and of those 7 fertilized. The two eggs involved in Chris’s experiment did not fertilize which is something we still don’t like to talk about to this day.

On Saturday May 20th 4 grade A blastocysts were placed in my uterus. I returned to our home upstate in Pawling, NY that afternoon. Most of my friends from high school were visiting that weekend and I remember not being allowed to walk up stairs or lift anything lighter than a glass of water.

The days following were long and boring. I was anxious and negative. The doctor had told me that the blastocyst would implant sometime between Saturday and Tuesday. On Monday I went to the acupuncturist – a lovely Chinese man name Dr. Wan Yu. He felt my pulse and told me that he was encouraged by its strength but he was certain that nothing had implanted yet. On Wednesday I had another appointment with him. “I’m sorry, nothing has implanted yet” he told me. I was concerned. “Let me try something”…in went the needles into my ears. About an hour later I began cramping. On Thursday evening I broke down and bought some First Response Early Result pregnancy tests. The result was negative. I told C and he was a bit deflated. “We’ll try again next month”…. I went to bed that night with a heavy heart.

The next morning I decided to try just one more test before I went to work. The result was negative, as expected. I called C to tell him that the cycle was officially over. As we were talking I glanced at the test and saw a very faint line. So faint that I thought perhaps my mind was playing tricks on me. “Don’t get your hopes up, honey”, C advised.

I quickly got dressed, grabbed the pregnancy test and got in a taxi to go to work. When I boss showed up I pulled him aside and showed him the test. “Yep, you’re pregnant” he told me. My friend Cheryl sat there shaking her head at me…”I can’t believe you just pulled out something you peed on and showed it to Rob”.

Finally I’d found a small glimmer of hope….but as you will soon find out, it didn’t last very long.

IVF #2

In late March we began our second IVF. Protocol stayed the same. I responded exactly the same way. 8 eggs retrieved, 7 fertilized with ICSI.

This time I had little patience. My mind had been spinning for weeks with horrible thoughts of never having my own child. My head hurt from the lupron, my ovaries became heavy and enlarged…and the money flew right out of our bank account. All of these things made me a downright miserable person to be around….

My mood improved when I received the results …there were three normals. I was happy…and relieved. I could produce normal embryos after all! There was still hope! Two boys and one girl were waiting in a dish and two days later they all went back to mama. I was hopeful but one extremely bad experience seemed to weigh over me. I couldn’t shake the feeling of impending doom.

A few days later…my in laws arrived. Don’t get me wrong, I love my in-laws. C and I have spent much time with them before we were engaged traveling to all manner of sunny spots, drinking margaritas and having wonderful chats over dinner. My mother in law is the kind of mother that most of us wish we had. She loves her children in a way that is so different than any American mother – she is kind and accepting and even when she doesn’t approve she holds her tongue and manages to keep a smile on her face. My father in law…well….he is the king of inappropriate comments. I normally don’t mind his biting comments – because, as many of you know, I can give it right back…. but this was too fragile of a time for me. There was too much at stake. If he said the wrong thing with me on lupron – all hell would break loose. They were there with us when I received the news – I was pregnant…but my beta HCG level was 4. Basically anything under 5 is negative but, as my doctor said, embryos have to start somewhere. Two days later it had disappeared and I was devastated. I quickly booked another IVF to start straight away and scheduled an appointment at Cornell (the mother of all infertility clinics) in case the cycle failed. By this time I had lost faith in my RE and in my own body. I remember planting sunflower seeds at our new house upstate and when they failed to grow, I sobbed. My father in law – he tried to console me, I suppose by saying “you have a new home, you have C as your husband – look around you at this beautiful home – why do you want to be miserable?”. That made me so angry – I stormed out of the house, skidded the truck out of the driveway and sped off to buy a book entitled, “how to deal with difficult people”. We got over it and he apologized but I’m fairly sure that he still doesn’t understand why I was so offended and upset at his comment. I can deal with him telling me I have a fat ass (which he does!) but telling me to be happy at the most unhappy time of my life? That I couldn’t do.

IVF #1

We started our IVF cycle at the beginning of March. My husband (I think we’ll call him C just to keep his identity off the internet) was still reluctant and felt that we hadn’t tried long enough naturally to be taking such actions. When we sat down with the doctor he told us that we had impaired fertility based on the morphology (shape) of my husband’s sperm. Most men have around 14% normal forms – my husband had 5%. When we spoke to a urologist he explained that this could easily have been the result of too many hot baths…(and boy does C like to marinate in his own dirty water). In sum, our RE told us that we would probably be able to conceive but the timeline was more likely to be 2 years trying naturally – not 2 months.

I went ahead with the cycle despite the fact that C was in the Middle East on business and not fully on-board with the decision. He was about 80% there….but I had to pull the trigger and start the cycle. There were some disagreements but in the end we both agreed that if we wanted to have a second child, time was of the essence. We signed up for PGD in addition to the IVF cycle. PGD stands for Pre Implantation Genetic Diagnosis – on day three of the embryo’s life a single cell is taken out and examined. They check for 9 of the most common abnormalities and if both chromosomes are found to be present the embryo is deemed normal. This process adds a whopping 7 thousand dollars to an already hefty 17,000 dollar cycle fee -but we wanted to get it right the first time. Many people use PGD for gender selection – and so, we decided to put back all the boy embryos and freeze the girls for another cycle. As I write this I want to go back in time and slap my face as hard as I can.

In our minds this would be a one shot deal – certainly if nothing was really wrong with either of us this would work on the first try!

Thus the cycle began. C gave me nightly injections of Follistim and Menopur in the muscle and I gave myself shots of lupron in the am. Follistim and Menopur tell the ovaries to produce follicles – lupron shuts down your system so that you do not ovulate before the doctor has had a chance to extract the growing follicles. My ovaries responded well – it looked like I had approximately 15 follicles and was told to trigger (you take one shot intramuscularly at exactly 34 hours prior to retrieval of the eggs). For us this occurred at approximately 1:25am. on a Saturday morning. On Monday am they retrieved 8 eggs and 7 fertilized with ICSI. ICSI is a process whereby a single sperm is selected and introduced into the egg…it is an efficient way of getting the egg to fertilize and thank God we used it or nothing would have fertilized at all.

On day 3 the embryologist began the biopsy to determine the health of our embryos. At approximately 3pm that afternoon the doctor called to tell me that we had five boy embryos and 2 girl embryos..and that each and every one of them was abnormal. Down syndrome, trisomy, polyploidy, Turner syndrome the words just kept coming….I remember hearing him but not being able to really understand. He repeated that there had been a catastrophic result with our embryos and that there would be no transfer. I felt like I was underwater. I called C and could barely get the words out. I went into my boss’s office and cried. C came to get me at work. I was so upset I couldn’t breathe.

Later that night we called the doctor again. He told me that I was taking this way too hard and that he had seen this happen to other women. “How many times in your career have you seen someone at the age of 37 have absolutely no normals” and he said, “a handful”. The internet told similar stories – one well known doctor wrote that women with all abnormal cycles were almost guaranteed to produce this same result over and over again. This doctor recommended going straight to donor egg. I was devastated. The thought that I might never have my own biological child sent me into a tailspin for a few days. I emerged ready to tackle the problem. I spoke at great length with my RE and he said that after talking to the embryologist their recommendation was that I do another cycle with PGD and if we received the same result, we would begin talking about using a donor egg.

During the next 30 days I earned my google MD. I read every article, every paper on the subject of aneuploidy, PGD, IVF outcomes…and then I remembered early in March before the cycle started. C’s best man Dave had visited from the UK. His kids were very ill at the time with high fevers. One week later during the beginning of my cycle I caught this virus. I had a fever above 101 for over 3 days. The internet told me that this fever could have damaged my eggs and created the result. I wouldn’t know until the next cycle – but I clung to that hope like you cannot imagine.

These were the darkest days I’ve ever known…. it would be a full 30 days before I would know if I’d ever potentially be able to have a biological child of my own.