Our Fertility Journey: IVF Part 2
If you missed either of the first two posts this week, catch up with the beginning of the story here, and the first part of IVF here.
I had made it through the stimulation and retrieval phase of IVF, and was ready to find out how many embryos we had. One of the cool things about genetic testing is that you get to find out the genders of your embryos. We were excited to get that information and (hopefully) get to choose which gender to implant.
Side note on the genetic testing, it is NOT cheap. It’s a large added cost on top of your already expensive stimulation phase. That alone made it a difficult decision as to whether or not we would choose to do it. What they are doing with this test is looking at the genetic makeup of the embryo by examining its chromosomal break down. A normal embryo would have 23 chromosomes from the male and 23 from the female. If it has any less or any more than that, it would be considered abnormal, and would more than likely result in a failure to implant or a miscarriage if that embryo was selected for transfer. Keep in mind, also, that any given embryo can, initially, look perfectly healthy under the microscope, but can still come up on genetic testing as abnormal. This testing is also not required. Obviously, if you don’t do it, you won’t have the information on what gender is going in, but you wouldn’t with a normal pregnancy either, so that part of the process is personal preference. I had also done some research that had shown that genetic testing wasn’t recommended as often in patients under the age of 35, because women at this age have a significantly lower chance of producing genetically abnormal eggs. Egg quality tends to begin dropping off around the age of 35, so it is typically recommended after that. However, since Shawn and I were still unexplained infertility patients, our doctor wanted us to put our embryos through the testing, just in case. Because of her recommendation, and our desire to rule out any possible reasons as to why we still weren’t pregnant, we chose to do it.
After waiting the first week after the egg retrieval, we got a call from the lab to update us on the growth of our embryos. The embryologist informed me that out of the 12 embryos that fertilized after day one, six made it to day three, and by day six, only three embryos had grown to the blastocyst phase. Those three had been biopsied and sent off to Denver for the PGS testing.
It hit me that we only had three left. I was instantly shocked. Only three? Only three out of twenty-two eggs that they had originally taken. That seemed to me like a huge drop off. I asked him if that was normal, and he said that it’s a bit lower than they would like to see, but that the three that were left all looked perfectly viable under the microscope. I had done some research and it is typically somewhere between 30-60% of the embryos that make it to blastocyst. We were under even the low end of that range. That was our first big blow. I definitely wasn’t feeling great about that call, but I was trying to remain positive about the three we still had. They would, more than likely, all come back from genetic testing as normal, and we would still get to choose our embryo. Plus, three is better than one, and definitely better than zero, so we still had good odds of this thing working out for us.
The next two weeks were essentially torture. They dragged by. Although I started my period during this time, paid our dues for the transfer (remember this is separate from all the original fees you pay for the stimulation/retrieval phase), scheduled my transfer for June 10th, and received my protocol, there wasn’t a lot going on. My protocol had me taking birth control pills for a full two weeks before I started my appointments and drugs. My advice during these wait periods is to fill your time with as many activities as possible. I made a couple lake trips, made other appointments outside of fertility stuff, set up dinners and get togethers with friends and family, etc. For me it was all about trying to distract my mind from dwelling on the what ifs.
One thing I was required to do before going into the drug protocol, was to have a saline infusion sonohysterogram. They schedule this for somewhere between day 8 and 12 of your cycle. During this test, they insert a catheter through the cervix, and fill the uterus with a saline solution to allow the doctor to check the lining for any polyps, cysts, or fibroids. Any of these things can cause problems with implantation, and would need to be surgically removed before continuing on with the transfer. Recovery, and restarting the protocol would cause at least a month delay on the transfer schedule. The procedure itself is definitely uncomfortable, but I am always comparing things to the time I had my IUD placed in my early twenties, and that shit hurt like fuck. This was not that. It definitely isn’t fun, and I wouldn’t choose to do it on the regs, but it was necessary, and the pain only lasts for a few seconds. Plus, I’m a bad bitch that just made it through 23 injections and a surgery the month before, so I can do any fucking thing I put my mind to. Remember in this post I talked about my polyp removal surgery back in June of 2020. The surgery itself wasn’t too bad, but the thought of having to do that again, this time causing a delay my transfer was just not what I wanted at that point. I was praying that everything looked fine and that we could continue on as planned. This test, thank God, has same day results. Luckily, everything looked good and I was cleared for my next steps.
On May 20th, I finally received a call from my doctor to let me know about the results from the PGS testing. She let us know that the results showed that only one of our embryos was normal. The other two were each missing a chromosome, and were, therefore, not viable. We were down to a single embryo. My heart literally sank. How did that happen. We had started this whole thing with twenty-two eggs and only ONE was normal. How could this even be? Our doctor told us this is very rare in patients my age and could absolutely be the cause of our infertility, but the only way to know for sure if my egg quality was the problem would be to do another egg retrieval. It’s possible that it could have just been a bad batch of eggs. My stomach was in my throat and I just had this feeling that it makes absolutely no sense because of my age, but also some sort of sense, because we had been trying for so long and we still weren’t pregnant; if my eggs are shit, then maybe that’s why.
Dr. Hasty told us we had three options at that point. Option A would be to continue on as planned, do the transfer on June 10th, and hope for the best. My immediate reaction was yes. This is the option for me. I’m starting to go nuts. It’s been too long. The waiting is awful. I just want to do this thing, and if it doesn’t work, it doesn’t work. Option B was to do a second egg retrieval and try to bank as many embryos as we could. My immediate reaction to this was abso-fucking-lutely not, no thank you, do not pass go, do not collect any more eggs. Not doing it. Option C was to do a test called an ERA, an Endometrial Receptivity Analysis. Another fucking test. More fucking time. During this procedure, they take a biopsy of your uterine lining to check to make sure your uterus is receptive to implantation. It would tell us if we needed to increase, decrease or keep the same my dosage of progesterone leading into transfer. Essentially, it would delay my transfer for about a month, and we would do a mock cycle, or a trial run of the drug protocol leading into transfer. On my original transfer date of June 10, we would, instead, do the ERA procedure. She told us that she highly recommended we do the test, since we were down to a single embryo, and this would give us the best chance of the embryo sticking. If it didn’t stick, and we needed the extra day of progesterone, we would be kicking ourselves down the road. Since we only had one chance of making this work, it really was our best option. Fuck.
We went with option C. With one precious embryo remaining, we had to cover every single base we could to give ourselves the best odds of getting pregnant this time. The next day, I went in for my baseline appointment, as scheduled, to start my mock cycle. They did my ultrasound and bloodwork, and determined I was ready to start my estrogen pills the next day. For the next week I took estrogen pills twice a day, then increased to three times a day following that. I had a mid-cycle ultrasound and bloodwork on June 3rd, and was cleared to begin my progesterone injections on June 5th. On the morning of June 5th, I got my first taste of the dreaded progesterone in oil injections or PIO shots. They are a whole different beast compared to the stim shots. First off, they are intramuscular injections, as opposed to the subcutaneous injections we did before, so you get them in the booty/hip area, rather than the stomach. That means you basically need someone to give them to you. Secondly, the needle is GINORMOUS. I mean, that shit is going in DEEP. Third, the progesterone is an oil based medication, so the consistency is THICK.
Here is my advice on these bad boys, and my basic approach to them every morning. Warm up the vial of medication by rolling it for a minute or so between your hands, or wrap the vial inside a heating pad for a minute or two. Find a buddy, your husband or partner, or, in my case, my Mom. Clean the vial, and prepare the medication inside the syringe. Switch to the injection needle- no one wants to be poked in the butt with a giant, dull needle. Lay down on your stomach and shift your weight to the side that isn’t about to get hit. Have your injection buddy clean the site that they are going to inject. Make sure they know that it’s supposed to be the upper corner, because when they poke too far to the center it hurts like FUCK. Look the other way. Have them stick it in like a dart: fast and straight. They need to pull back the plunger, just slightly, to make sure they don’t draw blood. If they do, they need to pull the needle out, replace it with a new needle, and start again. This literally never happened to me, and I have now received twenty-two progesterone injections. If there’s no blood, they need to SLOWLY (over the course of 5 seconds or so) inject the medication into your butt. When the syringe is empty, they gotta pull that shit out quick and straight. Have them grab a gauze pad and massage that sucker for a minute or two (this helps with pain, as well as helping the medication spread through the muscle). Then, you’re done! Mostly.
After that, I would immediately pop up off the couch or bed and do 10 squats and 10 lunges. Then, I would lay on top of a heating pad for about 20 minutes. It helps with the pain. Speaking of the pain, ok, look, I know what muscle soreness is like in your butt. I’ve got a lot of workout experience under my belt. I’ve trained super hard in the past, and I love a good lower body day. I am no stranger to waking up the day after a tough leg day and not being able to sit comfortably on the toilet. But RIDDLE ME THIS. How in the FUCK do people that have never felt that before deal with that. Do they stay in bed all day everyday? I shit you not, some of those first few shots would feel like I had done 200 lunges with NONE of the benefits. It’s bullshit. I also know, as a trainer and as an athlete, that it feels better to move around, to get some blood flow to that area. Anyways, here’s what it feels like: imagine walking behind a grumpy horse that suddenly gets spooked and kicks you square in the ass cheek. You are probably going to have a massive, deep bruise from the hoof, and you’re going to walk funny for SEVERAL days. That’s what it feels like. It’s CRAZY. I have good news: you get used to it. Those first few days were ROUGH. The second time around (after the mock cycle), though, was much easier. Also, you’ll have to continue these daily shots throughout the first several weeks of your pregnancy, as well, so your body is bound to adapt at some point. Fuck. The things we have to do.
What got me through the shots those first few days? This guy ^^. Ok, so I had made it through the six days of PIO shots, plus the three weeks of estrogen pills, and I had finally made it to the ERA procedure day. I was a little nervous, because I couldn’t find much online about what to expect, because it’s a relatively new test, and all I knew was that they wanted me to take 800mg of ibuprofen an hour before the procedure. That means it’s going to hurt, right? Correct. I am telling you, I didn’t think I was going to make it through that thing. I thought I was going to have to tell them to forget it. It really wasn’t all that long of a procedure, but I swear I felt like they were jabbing the fuck out of my cervix over and over and over again. I was legit gasping for breath trying to get through it. Apparently, the catheter that they use for the biopsy tool is larger than the ones they had used in other procedures…I don’t know, it was fucking miserable, and I was SO mad that no one told me what I was getting myself into. I mean, I still would have done it, but it would have been nice to know what I was about to have to endure, so I could mentally prepare. That procedure is the fucking worst, and I wish it on no one, but if you need to do it, do it. I’ve heard stories about people needing the extra day of progesterone shots, and it made the difference in an embryo sticking or not. Just know that its going to suck a whole fucking lot. And I feel like someone should be there to tell people that, since everyone seemed to keep me in the damn dark.
They had re-scheduled my transfer for July 1st, and after the ERA I was looking at the timeline (three weeks), and started to get a little nervous. The results from the ERA take two weeks to come back, and my mock cycle had actually been closer to five weeks in length, so I was wondering how we would turn it around that quick. I called my nurse on the way home from the clinic, and she told me that the timeline was, indeed, quite tight. She said that in order to keep the July 1st transfer date, we were relying on the third party to get back to us with the results exactly on time or early, because if we didn’t get them in time, we could miss the window to add the extra day of progesterone if I needed it. Great. So the other option was to move my transfer date back to July 15th, and then we would have plenty of time to prepare.
I wasn’t willing to push it. Understand that by this point I had spent the past month waiting through a mock cycle to get here. Not to mention all the other waiting I had been faced with up to this point. Waiting is the fucking devil. It's, honestly, the worst part of IVF. I'll do a thousand more injections, but just don't make me wait anymore. Plus, I had just taken all those drugs just to find out if I was ready for the transfer, not even to get the actual transfer. So at that point, I was willing to risk it. Even if it did add a little bit of extra stress. So I took a deep breath, buckled up, and made the decision to move forward with the July 1st transfer date. Here we fucking go...
Next step, EMBRYO TRANSFER.