IVF Post-Mortem and FET Prep

Super-Secret Post
Concerning end of cycle 38 and beginning of cycle 39 (November, 2014)

Uh…. Hi. Welcome back. Again, I’ve had to reconstruct a lot of details in the present to fill in the sparse notes I have from back in November.

The debrief for our IVF cycle had two sides to it. On the one hand, our appointment was so soon afterwards that we wasted no time at all before starting a frozen embryo transfer (FET) cycle. Since I was on a medicated protocol, I needed an injection at Day -7, and the day we met with the doctor was Day -7. The cycle “between” treatment cycles wasn’t even a wasted cycle as a result. We would be squeezing in the transfer before Christmas. Yay! Something working out for once!

The other side of the coin was that the doctor told us the cause of our embryo die off… which I promptly filed in the back of my head since I was too busy being so happy about the timing having worked out!

We figured we were statistically guaranteed one embryo would make it through thawing given that we had two and they each had a 90% shot at survival.

I miscounted and thought we had exactly enough time for a frozen embryo transfer before the Christmas break with our pregnancy test likely falling on Christmas Eve. We were sent home with no instructions except to call on Day 1 of a new cycle.

Then my period didn’t come and didn’t come. I had some symptoms like my chemical pregnancies and the clinic wanted to check what was going on, so in I went for bloodwork. I was terrified because, before the shot on Day -7, we asked the doctor if it would be counterindicated if we were pregnant, and she said yes. When I got my blood drawn to check for a pregnancy, the on-call doctor said that if I were pregnant at that point, it would be too late to worry about anything.

The test was negative of course. It was a bit neat that they could tell my period would be along soon. It did focus my attention on how I really can’t read my own symptoms anymore, from a combination of lack of data to the fact that we keep screwing with my biology so I can’t even use old data sets anymore.

It came the next day, 4 days late. I called it in but after 3pm on a Saturday so didn’t get a call back until the next morning — at 8:05am on a Sunday, waking us up.

“Do you have your schedule?” the nurse asked. My work schedule? “Uh, I don’t really have a schedule.” “I mean the schedule we gave you.” “… I didn’t get any schedule from you. Any paperwork at all.” “Oh I see… The doctor gave you a shot last time. Ok. Can you get some paper and a pen?” “Sure. … Ok ready with paper and a pen.” “Ok so you know the medication you have at home?” “No. I don’t have any medication with me.” “….. Oh. Ok. We need you to get to the clinic right away. Has your husband learned how to do the intramuscular injections yet?” “No.” “Ok. Please come in this morning.”

A rushed shower, breakfast, and bus trip later we picked up the schedule and the medication but didn’t have an appointment to learn the IM shots for another couple weeks. And because of the delay of my period starting late, the schedule was shifted so that the follow-up blood test would land while we were out of province visiting family at Christmas.

Later that day I had a major breakdown unlike anything I’ve ever experienced before. I wonder now if the four day delay in starting my estrogen supplements was to blame, but I ceased being able to function, and decided I would go to the hospital in the morning if I wasn’t better. I woke up feeling like myself the next day.

[Later I learned that suicidal thoughts are indeed a reported side effect of Lupron. I need to let my doctor know in case someone cares to track these kinds of things.]

Mostly the full impact of our last result from the doctor had settled in in my mind. My eggs, previously uninspected and only evaluated through inference, were found wanting.

The working theory is that the act of stimulation and creation of so many mature follicles spread quality too thinly across a high quantity. If that’s true, then stimulating my ovaries far less (say, to prepare 2 eggs) may have better outcomes for egg quality and therefore embryo quality.

In short, when I asked the doctor if we knew enough now to reevaluate the practicality of aiming for four children, she said that I will likely need to do a round of IVF for every pregnancy.

The fact that IVF won’t act as a way to stock up on embryos has changed our entire outlook. We no longer have our parachute plan of action; we don’t have a guarantee; there’s no drastic measure I can take that will be enough for sure. If we average one baby per IVF attempt, we’ll also spend way more money than we anticipated and I’ll have to put myself through way more… and now that I’d been through an IVF cycle I knew just how much more.

Our dreams of having four children are now foolish fancy.

It had taken awhile to sink in because it had been delivered along with the good news that we’d be able to squeeze in the first FET before Christmas (which now wasn’t quite true either).

Once I’d started to internalize that, and the hopes of being able to work get to the same outcome we always wanted even with this detour were dashed, the familiar self-pity and unfairness sunk in along with it. The knowledge that others are getting pregnant by accident, or neglecting children, while loving families are left unfinished because of bad luck… I’ve never experienced anything else like it.

But for now, we had two frozen embryos to try first.

IVF #1 (October 2014)

Super-Secret Post
Concerning month 37 (approx. October 2014)

tl;dr is at the end (if your instinct is “too long, didn’t read”, there’s a summary)

(more…)

IVF Prep

Super-Secret Post
Concerning month 36 (approx. September, 2014)

The protocol we were put on didn’t require any ramp up of medication in the cycle preceding IVF so we could go straight to IVF. But my hubby should visit his grandmothers every chance he gets and there’s a wedding in his hometown next cycle, so we’re taking a short break (and a leisurely pace to get all the paperwork and information sessions out of the way) before we jump in.

(more…)

Ottawa Testing and Results, Continued

Super-Secret Post
Concerning month 35 (approx. August, 2014)

There were a few crossed wires when I went in for further diagnosis, but it went OK anyway.

First, I was experiencing my regular anxiety over determining if I was really on day one or not before calling.

Also I didn’t know how much to drink beforehand (the booking confirmation email said “not empty bladder” but the assistant had said “full bladder”) and when I called for clarification I got the line “Oh it is in your welcome package.” Uuuuuugh since I am coming from another clinic I am a weird special case so somehow I skipped receiving the welcome package but still ended up punted back to the beginning of the process and was now trying to navigate it package-less.

Then I was missing a requisition for my bloodwork (which it turned out I had never received).

And finally I did a terrible thing by not noticing for a good ten seconds and two sentences that I wasn’t speaking to the same receptionist I had been speaking to 3 minutes earlier (they’d switched out while I ran upstairs for the req form) aaaaaand since they were of similar-looking ethnicity this seemed extra rude and callous. But I did start to realize that the person wasn’t wearing glasses or the same outfit and started to say “Wait a second…” just before she said “Yeah you weren’t talking to me; what can I do for you?” Then when the other receptionist came back and I realized an additional reason for my mixup, I made sure to apologize profusely.

But somehow despite all these things going wrong, the kinds of things that usually drive me crazy, I was walking on air when I left.

First, the ultrasound technician actually had a sense of humour, unlike those in Kitchener who I couldn’t get a smile from. When she asked how I was doing (in a mindless “How’s it going?” pleasantries way) I replied “Well the good news is that my bladder is full…” while obviously in discomfort. “And how are you?” “Well *I* was allowed to pee this morning so *I’m* ok.” Then she tried to give me better guidelines about how to make my bladder full enough but not bursting for the scans for an IVF cycle, and asked after who it was who told me “full bladder” so they could be corrected.

After the scans she asked if I was indeed blogging this (as my tshirt proclaimed “I’m Blogging This”) and I told her a bit about the blog.

The literature I did have about the test mentioned that the ultrasound technician would not discuss my scans nor interpret the images for me, which sounded completely reasonable. But not only did she count maturing follicles out loud, but also chatted away about what she was seeing.

The biggest reason I was walking on air? My mature-follicle count was nearly double the last one, matching my AMH number which had implied I have tonnes of eggs left. So there’s that to work with.

A week after that, we sat down with the doctor to talk specifics. Things looked good for them to medicate me minimally (which is easier on the pocketbook too) with no need for a ramp up cycle.

Too bad we’d already booked a trip in September and would need to skip that cycle anyway. Although this was a really good thing since my husband got to visit his grandmothers and we had a final chance for a big unpacking and organizing push (mostly it was only decorations still packed) and a housewarming party.

I did leave a little confused that they would need to stimulate me and then be worried about over-stimulating me. It’s just scary since the number of large follicles that would cause the doctor concern for hyperstimulation syndrome was “30-35” and that’s what I was already maturing.

The next steps were consent signing, an online education course, and an in-person injections tutorial. With six weeks to do this instead of just two, we were hoping for a less-stressful ramp up, but the anticipation may have been worse.

The Ottawa Test Results…. Part A

Super-Secret Post
Originally composed during month 34

Ok — so we only needed this one test result from the Ottawa clinic. Or so we thought.

The doctor’s tone immediately after pleasantries was such that I thought for sure my AMH number was terrible. She had some stuttering and false starts and looked generally like she was going to deliver bad news. (“So… we measured your AMH… and…. well…”).

And in a way it was bad news — the number was high but that didn’t match my low number of maturing follicles from the Waterloo testing. To figure out what was going on, she said she wanted “to do the testing I would usually do if you were coming to me in the beginning.”

(more…)

The Ottawa Consultation

Super-Secret Post
Concerning May, June, and July 2014

I am catching up to the point where I have to pay attention to when I post these such that I keep the 3 month delay I originally intended. I knew that a couple of posts covering longer stretches of time would help catch up and that’s why things were overly-delayed for awhile.

For a short period of time, we were under the impression that the time we forfeited in fertility progress was well-worth it: I’d finish a time-sensitive diploma requirement, we’d get ourselves moved to Ottawa, and we’d be able to hit the ground running at the Ottawa clinic. After all, I had just completed massive amounts of testing in Waterloo and had been an hour from starting IVF when we found out I was pregnant.

(more…)

Break for My Work Placement and Our Second Move

Super-Secret Post
Pertaining to February through May, 2014

I know how complaining about delays must look. Here I am, with other things I’m prioritizing above treatment (like deciding to do a work placement instead of IVF), and moving cities twice in a year which obviously sets us back.

It’s something that you can’t understand unless you’ve been there, and even then it’s a lot about personal coping. And for me, it’s a lot about working with incomplete information and making the best decisions possible which end up being predicated on incorrect assumptions.

(more…)

Gravida 2, Para 0

Super-Secret Post
Pertaining to Month 27 (which wasn’t over yet)

More terrible news, this time far less expected.

When last we left off, we were waiting for my next cycle to start so we could dive into the world of IVF.

(more…)

Waterloo Counseling

Super-Secret Post
Pertaining to Month 27

As promised, here separately is the account of our private couple’s pre-treatment counseling session. (more…)

Waterloo Testing

Super-Secret Post
Pertaining to Month 27 and 28

The testing in Waterloo was very different than in Vancouver. With all the appointments scheduled for me at the beginning of a cycle and performed at one location, it painted an extremely detailed picture of one cycle instead of piecing together data from different points of different cycles from different specialists at appointments I had to secure for myself.

Much detail follows. (more…)