IVF Update: Why TF We're Still Not Pregnant + Starting Round 2
Despite some hiccups over the past year, life is good right now. There are so many things I have to be grateful for. I’m living with my husband again in California (being away from him for long periods is not my fave), I’m in great health, I’m back at CrossFit (more on this in another post), I just got my Level 2 with CrossFit and I'm about to start coaching again (YAY!), we have a new fertility doctor in San Francisco, and we are excited about what’s to come!
If you read the previous blogs about our IVF journey, you know that our first cycle was unsuccessful. In that cycle, we only had one embryo test genetically normal, so when it didn’t take in the transfer, we were back at square one. We were kind of in this weird limbo of what do we do now? Is it even worth trying again? We wanted some answers about why it didn’t work and what our options were moving forward.
We scheduled a video call back in July with our doctor, Dr. Hasty, back in Georgia to review our case and get recommendations for next steps. During that call, our doctor was EXTREMELY optimistic about trying again. She told us that we are still considered unexplained infertility, even though there is a chance that my egg quality is playing a factor. However, the only way to know if egg quality is, indeed, the issue is to do another egg retrieval. By doing another egg retrieval, taking some supplements, and tweaking some of the meds in my stimulation protocol (the injections prior to egg retrieval), we still have a really good chance of producing multiple normal embryos.
Our big question was: WHY were we unsuccessful? Especially after feeling we had done everything right, we wanted to know if anything had come up that could have prevented us from getting a positive pregnancy test. Our embryo had been perfect, so we knew it wasn’t that. Her response was that we had just had bad luck. We were right about everything being executed perfectly. All of my bloodwork was totally normal, my uterine lining had looked perfect going into transfer, the transfer had looked great, we had done the test to ensure that my body was receiving the correct dosage of progesterone leading into transfer, and ultimately, there had been no reason to assume that it wouldn’t work. We just ended up being in that 30-35% category that it just doesn’t work out for. And honestly, that sucks. Sometimes I find myself wishing that there was an issue so we could correct it and move on. Instead, I’m left in this constant state of wondering, could it be this, could it be that? Or is it really just shit luck? Who knows?
Throughout this whole process people have told me that they are impressed with how positive I’ve remained despite some pretty shitty circumstances at times. But, believe me, I do get frustrated. It sucks not having all the answers. I have my frustrations and I get angry about the situation from time to to time, but the bottom line is that the situation probably isn’t going to just magically correct itself, and having a bad attitude accomplishes nothing in pursuit of our ultimate goal. On occasion, I have my moment of being down in the dumps or pissed the fuck off, but I never let it consume me, or last longer than a moment. Instead, I turn it around and I think, “ok, what can we do next?” So that’s what we were looking for on the call with my doctor.
Some of the suggestions that she made were to start taking CoQ10 and another supplement called Ovasitol. Both of these supplements promote healthy egg quality. She also mentioned possibly adding in growth hormone injections during the stim phase. Growth hormone is typically used in older patients during IVF, but it may make a difference if my egg quality is an issue. She also had some suggestions about changing some of my meds to higher dosages. Another change she thought might help would be to extend my stimulation phase an additional day before administering the trigger shot to allow my eggs to mature just a bit more. In my first round, we did 8 days of stim medication, triggered on the 9th day, and went in for retrieval on day 11. They were able to pull 22 eggs in my retrieval, but only 12 of them were mature enough to fertilize. Extending my medications an additional day could help us to draw out a few more mature eggs. All of these changes made it feel like giving it another go could give us a different outcome.
Part of me is totally nervous to do all of this again and end up with the same result. Maybe my body just doesn’t want to make a human. But the thing is, if I didn’t try one last time, I would always wonder what could have been, so we have to do it. Shawn and I discussed it at length, and we ultimately decided that we had to try one more time.
When we left Georgia, I immediately started googling fertility doctors in the San Francisco area. There is a CCRM in San Francisco which my previous facility (ACRM) is affiliated with, so I started looking into them off the bat. I actually scheduled an appointment for a consultation there the first week we were in town. Then, I talked to my friend Melanie back in Houston who has been through two successful IVF cycles now and currently works for the facility that she did her treatment with. She referred me to Doctor Kaser at Reproductive Medicine Associates (RMA). RMA, like CCRM, has great labs, high success rates, and are leaders in the field of IVF research. Dr. Kaser’s bio online blew me away, and I just had this gut reaction that pulled me toward making an appointment with him, even when I found out I wouldn’t be able to meet with him until mid-August. This pull was so strong that I called CCRM the next day and canceled my appointment with them.
I’m so glad I did, because I felt completely validated when I sat down with Dr. Kaser for our consultation.
Dr. Kaser was super warm and welcoming to both Shawn and I. He had read up on our case and seemed to know a lot about what we’d been through and what changes could be made with another cycle. He agreed with many of the suggested changes that Dr. Hasty had put in our cycle notes, and had some fresh ideas of his own. After chatting for a while, we started to put together a tentative plan.
He agreed that I should continue to take the Ovasitol and CoQ10 supplements going into the next cycle, and suggested that Shawn get back on a Men’s reproductive health supplement as well. We would wait until my next period started (in early September), at which point we would be ready to get started with the stim cycle. In his plan, I wouldn’t need to spend the first two weeks taking birth control (thank GOD!). Instead, I would come in on day two or three of my cycle for my baseline ultrasound and bloodwork, and then I would get started with my injections. He wanted to tweak and increase my dosages on some of the stim meds, and he decided to add in a small dosage of growth hormone this time. We will also (likely) be extending the injections an additional day from before, meaning we will continue injections through day 9 or 10 before triggering this time. Again, the point of triggering later in the cycle would be to (hopefully) end up with a larger number of mature eggs. Obviously, all of this is dependent on how things are progressing through my monitoring appointments.
Another change that he is planning to make is to have Shawn come in twice to give a sperm sample, and choose to use the better of the two. That means he’ll go in the day before the retrieval, as well as the day of retrieval for that. Last time we used a sample that was frozen the month before retrieval since Shawn was working out of town at the time.
Once the eggs are retrieved, they will be fertilized using a technique called PICSI. PICSI, like ICSI (which we used in the initial cycle) is essentially assisted fertilization where a single sperm is injected via tiny needle into the cytoplasm of the egg. In PICSI, however, the best sperm possible is chosen by selecting those that bind to a fluid that surrounds an egg. This is determined by placing the sperm into a dish containing the fluid. Those that stick to the dish are the ones chosen to use in the fertilization process.
With all of these changes, we are hoping that we can get more mature eggs coming out of egg retrieval, leading to a high fertilization rate, and more embryos making it to the blastocyst phase. Once we get there, we’ll do the genetic testing again (PGS testing) to check for genetic abnormalities where the end goal is that we get multiple normal embryos to take to the transfer phase. We will still only transfer one embryo, since we will be using the PGS testing, but if we have multiple normal embryos, it gives us multiple chances for transfer to succeed.
All-in-all, we left the meeting feeling extremely hopeful and excited to try again. The best part of our plan is that the timeline is SUPER condensed compared to my last one. I started my first stim cycle on April 2nd, first transfer was on July 1st, and we got our negative beta on July 11. That’s over 3 full months to complete that cycle. This time, we are starting stims the first week of September, I’ll have my retrieval next week, transfer by early to mid October, and (hopefully) a positive beta towards the end of October. Less than two months. That would be a dream. Although I’ve learned to not be glued to any particular timetable throughout this whole process, it’s definitely encouraging to hear that it could all happen quicker this time around.
Oddly enough, my body decided to surprise me with a period on September 2nd, which ended up being about a week early. I immediately ordered my meds from the pharmacy which were sent out for same day delivery. Then, the next day, I went in for my baseline ultrasound and bloodwork which determined I was ready for my stim cycle, and I was to begin injections that night.
Recall that the first time I did these injections, I was living with my mom, who is a nurse, and knows what the fuck she’s doing when it comes to medication. My medical knowledge is zero. I mean, look at all that shit that I have to deal with, and tell me it's not a little overwhelming. I’m also super high stress about getting everything done perfectly with the measuring, and putting everything in the right place, and doing it exactly like the injection training video shows, and so on. Shawn was losing his mind with me. So the first night of injections was a shit show. Honestly though, there are literally 400 syringes, needles, vials, swabs, all this shit I do NOT deal with, on my kitchen counter, and I have to figure out how to measure out the diluent, then inject it into the powder medication vial, and swirl it so it all dissolves, and draw it up, but not too much, and also not too little. IT’S A LOT. Let’s also mention that all of this shit cost us a small fortune and if I waste any of it I feel like I’m just flushing hundred dollar bills down the toilet. No biggie…BUT, I am proud to say that I gave myself all three shots that first night, basically pain free, even though it took like a damn hour. WHO CARES?! I felt like a boss bitch.
Since the first night, I handed off the mixing duties to Shawn so I don’t have to stress so much through that whole process. Once he preps them, I inject them in my stomach. It’s like a well oiled machine. Sort of…we’re getting better. By night 10, you might as well hand us our medical degrees. KIDDING.
We are currently 5 nights deep into meds, tonight will be the sixth, and we are thinking we’re going for about nine to ten total nights before we trigger, and then we'll get set up for egg retrieval two days after that. I've had two monitoring appointments so far, and I'll have a third tomorrow, which should give us a better idea of when my egg retrieval will happen. I will also, most likely, start going into the office a little more frequently after tomorrow, to continue to monitor my follicles, so we can pinpoint the best time to trigger and prepare for egg retrieval surgery.
Overall, I’m feeling pretty normal, aside from being a bit bloated, and finding myself feeling a little more fatigued by the end of the day. I am still exercising, with some restrictions. I’m keeping my heart rate under control, by monitoring it on my watch. I am currently avoiding high intensity exercises, weights are lighter than usual, I’m avoiding twisting movements, going upside down, high impact movements like jumping and running, and anything that puts strain on my lower abdomen. Yesterday morning, I demoed a few rope climbs for one of the morning classes, and afterwards I felt some pressure/cramping in my lower abs, so I know moving forward, that I need to cut those out for a little bit. Basically, I'm just listening to my body. Most importantly, I am happy to be going to the gym and to continue moving in some way.
So that’s where we are! Enjoying life, relaxing, staying as stress-free as possible, and looking forward to getting some high quality embryos! I’m planning to be a lot more transparent during the cycle this time around since I’ve learned a lot, know (for the most part) what to expect, and feel like my story can possibly help someone else who might go through this one day. Stories that I have read help bring me hope and strength, and if I can bring that to someone else, that’s pretty freaking cool. To all of you reading that are experiencing fertility struggles, I am sending you all the positive vibes, strength, and love. I know exactly how hard it is to want something so badly and be let down again and again. I find comfort in knowing there is a path, and we’ll find our way through it eventually.
Forever thankful for the support I’ve received from all of you. Thanks again for reading about our journey! There’s plenty more to come.