And so it begins . . .

After 4 appointments in 2 days we are finally ready to start IVF with my next cycle. We had to meet with a counsellor to talk about IVF and infertility and our communication and coping with having infertility, failed IUIs, and how we will work through the IVF cycle. That was followed by an hour long introductory video to IVF. The video was pretty much useless and I could have done a better job on it. I can’t decide which part of the video annoyed me more – the fact that the narrator kept mis-pronouncing progesterone, the fact that they were trying to be all dramatic with cryopreservation and just showed them taking the lid off a liquid nitrogen tank, or the fact that they made the vagina look super weird in their cartoons. They also used scare tactics to dissuade you from transferring 2 embryos without providing any statistics to show if these increased risks were actually statistically significant. The only thing I did learn was that pre-implantation genetic screening is offered at our clinic, but only for couple with multiple miscarriages, multiple failed implantations, or known carriers of genetic diseases.  On the second day of appointments we met with one of the doctors to sign the consent forms, which involved such fun discussions as what should be done with the embryos if either one of us (or both) die, or if we divorce. I had a mock transfer done, which was pretty similar to an IUI, although I had a lot of cramping and nausea in the afternoon after that. Finally, we met with a nurse to get my IVF protocol and do the injection training. I think my husband was kind of overwhelmed by having to measure the medications, mix medications, and the whole injection process, but it was all very similar to injecting mice so it was no big deal to me.

There was a little bit of panic about if I’d actually be able to start with my next cycle because they want me to come in on CD2 for a blood pregnancy test, but I’ll likely be out of town for work on that cycle day so they are letting me do a home pregnancy test and call in with the results.

IVF Cycle Plan

CD1 – call to report CD1

CD2 – take a home pregnancy test and call with results. Wait for call from nurses about when to start birth control pills.

Take birth control until May 5 then have a withdrawal bleed.

CD1 withdrawal bleed – call to report and schedule monitoring

CD3 – Ultrasound and blood work. If everything looks good will start stimulation drugs (225IU Gonal-F, 75IU Luveris)

8-13 days of stims with monitoring ultrasounds and bloodwork every few days

As follies get close to being ready, start taking Cetrotide to prevent ovulation.

HCG trigger shot 36 hours before egg retrieval

Egg retrieval predicted for the week of May 21 (Happy Birthday to me :S). Eggs fertilized using ICIS

Transfer on day 3-5 depending on how embryos are growing. Start progesterone suppositories after egg retrieval. I will push for 400mg prometrium like I took during my IUI cycles because I know that that amount should stop the bleeding.

Pregnancy test 13-15 days after transfer. They don’t recommend testing before the blood test but I think I will test that morning so I can be prepared when they call with the results.

Test Results

We had our $50, 5 minute phone consult on Friday and it was not good :(

The semen analysis results indicated that the male factor infertility is worse now. The test didn’t look at morphology, which was our only male issue on the last semen analysis from a year ago. This tested looked at count, motility and ability of the sperm to swim around to find an egg. While motility was still great, there was a dramatic drop in count. This means that there are not enough sperm getting to the fallopian tubes to try to fertilize an egg, so there is pretty much no chance of natural pregnancy occurring and that IVF + ICSI will be our only option for pregnancy. This result was a bit confusing for us because count was great on the last semen analysis and for all 3 IUIs we did last year. It could just be a fluke result, or something could be going on that has impacted the sperm production. We could do a repeat semen analysis or other testing to try to figure out what’s going on, but this could just add more time and cost more money and not change our treatment plan or success rates, so we are going ahead with the plan to freeze a semen sample and do IVF + ICSI.

My test results were a little confusing. Everything came back in the normal range, but my AMH, which is a measure of ovarian reserve and potential response to the fertility drugs came back on the low side of normal. The RE mentioned that my AMH is closer to what he would expect for a woman that is 38 not one that is 30, which could mean nothing or could mean I am at risk for having diminished ovarian reserve. I didn’t ask for my FSH so I don’t know if it’s on the high side of normal, which would be another indicator of low ovarian reserve, and have not had an antral follicle count down, which is why we don’t know if my lower AMH means anything. Nevertheless, it’s not great because it means that I’m less likely to get a lot of eggs produced. The RE said that a normal response to the fertility drugs would be 5-14 eggs retrieved, but that they would expect me to be on the lower side so maybe 5-8 or 10 eggs, and that I would likely need to take higher doses of the drugs to get these eggs. The fewer eggs, the fewer embryos. In a “typical” IVF cycle it is expected that ¾ of the eggs will fertilize and about 1/3 of those will make it to 3-5 days and be suitable for transfer. Now, ICSI should ensure that all eggs are fertilized, but if we get 5 eggs we are likely looking at 1-2 embryos produced.

This low anticipated result now changes our plan. Ideally, we want to have 3 children, but really more than 1 would be great. When we were expecting a 10-15 egg result we should be able to get 3-4 embryos from 1 retrieval cycle, so unless the first 2-3 didn’t take then we wouldn’t need to do another retrieval cycle. Now that we are looking at 1-2 embryos that changes things, especially based on the AMH and semen analysis results. Now the plan is to “bank” at least 4 embryos so we should hopefully have enough healthy embryos to have 2 kids. We talked a little about doing this because then my eggs would be 30/31 instead of 33+ if I got pregnant from the first round and had to do another retrieval later. Now, we are concerned that my ovarian reserve is dropping or the amount of healthy sperm is dropping so we went to get a bunch of embryos now in case something happens and we don’t have that option in the future.

Testing Completed

We have now completed all of our repeat testing for the new RE. My husband’s testing was pretty straightforward. He was able to get an appointment to do the swim-up semen analysis a week after our appointment, and then he did his blood work right after. Since I have to wait for specific cycle days it took a little longer. Since I was right around ovulation when we had our appointment with the RE I did my 7 days post ovulation test and STI/immunity panel first. I was supposed to go in CD20-22, so 6-8 days post ovulation. Of course, that just happened to fall completely on a long weekend. I thought it would be fine because there is a lab my by house that I could go to that was supposed to be open. Turns out the RE needs to update their information because that lab is not even open on weekends. I also had an optometrist appointment on the Saturday morning so I needed to wait until almost noon before I could go to the lab. I had my husband franctically calling all the labs on the list from the RE with weekend hours to find one that would be open past noon that day. Luckily, there was one that was open. The only one that was open past noon. That clinic was also supposed to be opened Sunday morning but not holiday Monday, but I didn’t want to risk it so I headed straight to the lab after my optometrist appointment. I did not want to have to wait another full cycle to be able to get my progesterone tested.

I hate parking lots and just parking my car in general, and the parking lot at this lab was so narrow and tight, so that sucked. The lab was at a walk-in clinic and it was packed with people. There were 10 people ahead of me at the lab and one older man said he had been waiting for over an hour at that point. In addition, doctors from the clinic were sending people with “urgent” labs that got to jump the line. I really wanted to spend the Saturday of my long weekend hanging around a walk-in clinic. Luckily, a few people ahead of me had disappeared so I got in after about 45 minutes. The lab tech confirmed what cycle day I was on and said I really got screwed with this testing.

My second set of testing was a huge hormone panel done on CD2-4. Of course, this cycle I had a hard time determining when the new cycle started because my bleeding had picked up making it hard to distinguish what was my normal luteal phase bleeding and what was actually menses, so I had to rely on my temps and secondary signs like cramps and my luteal symptoms going away. Luckily, this fell on a Thursday-Saturday so first thing Friday morning I went to the lab by my house. Of course, since nothing can be easy, I wasn’t sure if it was open because I couldn’t find consistent lab hours online. Seriously, it ranged from not open on Fridays, to open at 7:45, 8, 9, 10, so I decided I’d go at 8:30 and if it wasn’t open I’d go to the same one from the weekend. Turns out it opened at 8 so I could have gone earlier and not been late for work, but it wasn’t too bad. There were 8 people ahead of me but I got in in about 30 minutes. I had so much blood taken. The good thing was that AMH was free here (it would have cost $150 in our old province).

Now it’s just waiting. I called the RE and if I want an in-person appointment to get all the results and next steps then we have to wait until May 2. That really upset me so I asked about a phone consult because it’s really just is everything okay for IVF? And do we need ICSI or not? And was able to get a phone consult for March 17 . . . but, we have to pay $50 for this. I’m so over waiting, so I took the phone consult.

Appointment Update

We met with the new fertility doctor about a week ago. My husband and I liked him and he actually trained our old fertility doctor so that makes me more confident in him because she was amazing. He reviewed all of our tests results and he doesn’t seem concerned about my bleeding or the low sperm morphology and said that he’d really consider us to be dealing with unexplained infertility. I’m a little sceptical of that. I know that sperm morphology is sort of hit or miss on if it actually impacts fertility depending on severity and if it impacts functionality of the sperm, but I have a hard time believing that dysfunctional bleeding as severe as mine is not impacting our ability to get pregnant – it’s been 26 failed cycles, so something isn’t working properly. Similar to the old doctor he suspects that my bleeding is either caused by a weak ovulation or a lack of or miscommunication between my ovaries and my uterus, which fits in with why the clomid and progesterone made the bleeding stop.

The doctor didn’t push us right to IVF and said that we could do more medicated IUIs if we wanted, but since we did have 3 failed IUIs he wasn’t sure if any more would actually result in a pregnancy. We did make it clear that we had been planning on moving to IVF when I got the job offer to move so he said that we could start prepping for IVF.

Since it has been so long since we’ve done treatments, we do need to repeat some of the testing and do a few additional tests for IVF. It’s pretty easy for my husband – he just needs the STI panel repeated because there is some sort of health regulation that you have to have the tests done within a year of starting IVF. They also want to do a functional semen analysis to help determine if we need ICSI or not. I didn’t really want to do it, but my husband thought it was a good idea, and he was able to get in within a week of our appointment, so he did it. All of his testing is now done. I have to also repeat the STI panel as well as my immunity testing for hepatitis B, rubella and chickenpox, which I had done yesterday. I also need to repeat my hormone panels, including have my AMH (anti Mullerian hormone, a marker of ovarian reserve) so the doctor has an updated idea of my hormone levels to better plan my cycle medications. I need to have a mock transfer so they know exactly how to place an embryo in my uterus. I did my 7 days post-ovulation progesterone draw yesterday and am now waiting for cycle day 3 for the rest of my hormone bloodwork to be done. Once all this is done we will be able to get on the IVF cycle list, which seems to be a 2-3 month wait to start. I can take femara (an ovulation inducing drug that is supposed to have less side effects than clomid) and progesterone with timed intercourse while we are waiting for IVF if we want to give that a try. I think we will just because it will give us something to do while waiting.

“It took me 4 months to get pregnant, so I totally understand what you’re going through”

I have a friend that is also TTC. She is currently on her fourth month trying and recently found out that her sister is pregnant because the condom broke once. She was telling me how much it sucks to see someone get pregnant accidently when she is trying to get pregnant, which I can empathize with. It sucks when you don’t get pregnant right away. It sucks even more when you’ve had a couple failed cycles and then find out someone is having an unplanned or accidental pregnancy. It doesn’t matter where you are in your journey, it just sucks. However, my friend followed this up with how she totally understands what I’m going through with infertility because it’s taking her “so long” to get pregnant.

Just, no.

It takes the average healthy couple 6-12 months to conceive, so at 4 months you’re barely a third of the way to average. Let me reiterate, it sucks when you’re ready for a baby and it isn’t happening right away, and you may be wondering if something is wrong, but it in no way compares to sitting in your doctor’s office and hearing them diagnose you with infertility, with finding out that you have practically no change to conceive naturally, to face spending tens of thousands of dollars on treatments with no guarantee that they’ll work, with having to consider using a sperm or egg donor, or a surrogate, to give up on ever having children because the only options available are beyond your means whether financial or emotional. You can’t understand that until you’ve been in that doctor’s office, you’ve had tubes and dye shoved into your uterus, your husband has visited “that room” at the doctor’s office, you’ve taken medications that have turned you into an unrecognizable person, you’ve sobbed on your bathroom floor because after spending $1000 and having a head ache and cramps and widely varying emotions for the past 2 weeks you’re still not pregnant.

Even as someone struggling through infertility, I can’t truly understand what my infertility family members are going through, because our journeys are so different. Some are doing IUI after IUI because IVF is out of reach financially or not compatible with their beliefs. Some have no problem getting pregnant but always miscarry and are afraid of another positive test because they fear another loss. Some get pregnant from treatment but miscarry. Some need surgery and recovery before they have a chance of a successful pregnancy. Some need a sperm or egg donor. Some have exhausted all their options and have chosen to be child free not by choice while others are pursuing fostering and adoption. Some book an appointment to see an RE and then cancel because they got pregnant with no treatments. Some try a treatment and it works. Some have completely normal test results but still can’t get pregnant.

My journey has been one of mostly waiting . . . waiting for my problems to go away naturally, waiting for tests, waiting for an OBGYN appointment, waiting for an appointment with RE #1, waiting until we’ve moved, waiting for an appointment with RE#2. In 18 months I’ve spent 11 months waiting and I’ve got 7 more to go before my next appointment. By the time my appointment rolls around we’ll have been TTC for 2 years. You can’t understand what that feels like when you’re on month 4, and you’re minimizing my struggle, my pain by even suggesting it.