Category Archives: In-vitro fertilization

Reflections of the Way Things Used to Be

Last year this time, I was in New York with a fresh needle wound from the first shot of my in-vitro fertilization cycle. I was trying to be thankful for a wonderful husband, a promising job that fit my talents and general happiness with life despite the ache of not yet being pregnant and having to endure IVF at all. That was a difficult balance. It was even worse to battle such inner turmoil while wearing the permanent smile-face of holidays with in-laws who didn’t know or necessarily understand anything about me or anything I might be feeling. Empathy from outside of the infertility circle is hard to come by even after the explanations of why and how.

But. I. Survived.

And I came out with a story to tell happily ending with a real live Rufus and Reefus, born exactly three months, two weeks and three days ago. Even as I listen to them sleep in their cribs (for only the third freaking day ever FINALLY), it’s unbelievable that they actually exist way beyond a couple groups of dividing cells, a collection of heartbeats captured in a whirlwind doctor’s visit or even the invisible sources of discomfort in the late hours of labor. Ready or not (with emphasis on the NOT), they’re here.

Their presence means:

– I’m up at 5:43 a.m., having just nursed the boy for the third time this hour with him now wanting to play. (Grrr, boy, go to sleep!)

– I contemplate daily cutting my hair to a low fade to avoid looking a hot mess. (My stylist’s feelings will be so hurt.)

– I haven’t slept more than four hours at a time since a week before I delivered. (I’m done with the “I’m tired” complaints of my childless friends, BTW.)

– I ate Thanksgiving dinner with a baby on my lap, having cooked a minimal spread with another on my hip.

– I’m incredibly isolated from the civilized world most days and evenings and often lonely because of my husband’s work hours.

– This is life as I now know it with no end in sight.

Yet this year, even with all of that, I’m not superficially thankful with a veneer over the potentially heavy burdens of new motherhood. Instead, I’m overwhelmingly humble for the greatest gifts since salvation and welcoming of the collective discomforts that my babies bring. I can’t say I don’t complain — I do because, well, this crap is hard — but the comfort of this new family is greater than the discomfort of feeling it would never happen. This is true every day all day with baby giggles, smiles and developmental skills that put icing on the cake (which I can eat worry-free with the calorie burning of nursing). And I’m nothing but thankful for that. I’m also thankful for the smallest hope that led me to this point, the prayers of the people around me, those who remain to share in our children’s lives and to God, who made it all possible.

Recognizing that things didn’t have to work out in my favor has made every day with the twins a day of thanksgiving, regardless of what the calendar says. To those whose struggle continues, try to know that my heart is with you. Happy Thanksgiving (give or take four or five days. Sue me; I’ve got twins).

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It is no secret what God can do …

We're breaking out the sparkling grape bubbly with wine glasses from past tastings at Williamsburg Winery, where it all began for the Mr. and I.

Because we spent all of 2011 praying and fasted twice for 21 days at a time in hopes of a baby, I’d be remiss for not actually saying that the lines we saw nearly two weeks ago showed I’m officially knocked up, preggers (even though the Mr. hates that word), with child, expecting, in the family way, or finally, pregnant.

No, I’m not beyond the first trimester, but I’ve told a close and close-casual handful of people what I know to be true based on a four-week ultrasound (way too early — the nurse’s fault, not mine) and the double-line positive pregnancy test. Further, the way I’ve felt the last several days serves as additional evidence, but I didn’t count it as definitive given all the “symptoms” prior to in-vitro fertilization that were likely imagined.

The early morning “chest cymbals” were a clue. But now I’m beyond tired especially after I find something I feel like eating. This is no -itis; this is it. (For you “Karate Kid II” fans: “This no tournament; this for real.”)

It’s official: I’m pregnant. Feel free to applaud while I close my eyes — just for a second.

Conventional wisdom and practice says to keep early pregnancy a secret at least until you’re through the first three months. I don’t think it ever occurred to me to be that clandestine about it. I mean, we’ve been trying, it’s been a struggle, I’ve enlisted support from anyone who could offer it. I’ve had people earnestly praying for us. They — I’d — want to know that God answered and what that answer was.

It would just be rude to go silent; though, I’m sure some imagined that as the reason for my most recent lulls. Nope; I was just tired. That, and I had to call a few people first. (Actually, I didn’t want people from my hometown startling my matriarchal aunt with the news when I hadn’t talked to her since before Thanksgiving.) But outside of that, I’ve been operating, breathing, sleeping (and passing gas) as a pregnant woman. As you can tell, I’m even using the p-word. (Pregnant, pregnant, pregnant. Per-regggg-nant!)

Even as I say that — and know it — fears remain that this could end at any moment. Not only does that quiet paranoia have me avoiding all fish, caffeine even chocolate, cold cuts and mushrooms (though I’ve forgotten why about the mushrooms); it also has me claiming every minute of the mini-me in the making. So even if it’s for a shorter time than I expect, I feel confident in saying that if God can do what He’s done at this point having made it so, He’ll do it again. Thus, I don’t feel compelled to hide my pregnancy until it’s “safe.”

Also, in not knowing the future — for example, what tomorrow’s latest ultrasound will bring beyond the awaited fetal heartbeat — I decided to claim every victory in this quest to have my own children. Thus, as the song says, “It is no secret what God can do” nor what He has done.

Sparkling grape juice for everybody!

Double, double toil and trouble …

Despite good news, I'm still wary of the other shoe dropping. And given my reaction to a series of poop storms, I should also be watching for houses.

With infertility, silence sometimes means the worst has the happened. Fortunately, that isn’t the case, but as it always happens with every two-week wait and the optimism of each cycle, struggling to conceive means waiting for the other shoe to stomp all over your baby-building parade.

Under the invisible dangling shoe that has kept me quiet for the past few days, my human chorionic gonadotropin (hcg) levels doubled and then some, according to my latest blood test. Sunday, it was 148. Tuesday, it hit 552. It took a grueling hour to find that out.

I’d stepped away from my desk to pray with the rest of the company for the family of a recently deceased coworker, and the nurse called. A little shaken from the solemn office gathering and nervous about the call, I locked myself out of my voice mail. While waiting for the systems guy to reset my password, I tried calling the doctor’s office back. Every transfer to a live person went something like this:

“Name?” My name. S-P-E-L-L-E-D O-U-T. “Date of birth?” My birthdate and year. “Who’s your doctor?” My doctor. Then silence. “Let me transfer you to the IVF nurse.”

This was all too reminiscent of my low-ovarian reserve diagnosis. No one would tell me what the number was for my anti-mullerian hormone (AMH) test. I’d ask, and then they’d refer me to someone else. Essentially, this test can help determine the number of quality eggs a person has as well as determine gauge what the response might be to in-vitro fertilization. My test results suggested that my ovarian fertility potential hovered in the low- to very-low category. My doctor mentioned the use of donor eggs very early in this infertility process. I feared he was right and coped with the possibility by ignoring him.

That’s why is so unbelievable to me that, according to today’s doctor visit, he actually used what my husband called “the p word.” Here I was thinking the Mr. was being vulgar; instead he was marveling that the doctor kept casually referring to me being pregnant. I’d had moments of wanting to jump around like Doc Brown in “Back to the Future,” yelling, “It worked; 1.21 gigowatts!” but that still seemed a little premature. Short of that temptation, I’ve held out on using the p word and instead described my blood test results in strictly clinical terms.

Today, the Mr. and I had a brief moment of acceptance of a positive outcome. Then life kicked in and my focus returned to the poop storm spinning over work and now where we live. The latter is a horrific mess that would turn anybody into a Scrooge, or in my case, the B. on a Broomstick. That’s the bad news. The good news, in addition to the news I have yet to accept, is that trouble don’t last always. Praise God, it still will be a merry Christmas and a maybe even a very special one.

Meanwhile, I’ll be on the lookout for falling shoes — and houses.

 

Alas, poor embryos. I knew them …

My quest for motherhood is like looking for red Skittles, i.e., good-quality eggs, in a bag of many colors. They're there; we just have to find them.

With the number of steps involved in the in-vitro process, I was bound to forget at least one. This would be the call from the andrologist on the status of the remaining five embryos.

I first Googled the phone number as I always do with unprogrammed calls and saw that it came from the hospital’s lab, my hospital. Neither the Mr. nor I could figure out why they were calling. Then, the message on “the status of your embryos” freaked me out even further. I figured it’d be about cost or storage options or how long we thought we wait before tapping into the frozen reserve. I called back immediately to find that neither assumption was true.

It was about the status of our embryos.

Retrospectively, it felt like what would happen in the hospital when a nurse would call family members about their loved ones. They never say, “Mrs. K died.” Instead, they talk about the status of Mrs. K’s condition and how the family should come in. If you’ve ever experienced the activity surrounding someone’s else death in a hospital bed, you can always tell what you’re in for just based on the cryptic language used when they call you. But this was no nurse; the woman is an andrologist. She was compassionately matter-of-fact but obviously not a patient-care practitioner. I don’t hold that against her. I appreciated the information and her willingness to repeat it until I was sure I understood.

Essentially, there are no longer five embryos. Before the transfer, there were seven. The best two of those — the ones dividing evenly with proper cell shape and most likely to implant — were transferred last week, three days after fertilization.

Three more simply didn’t reach the blastocyst stage, meaning they “failed to progress” to Day 5. (Blastocysts are more likely to survive the freezing and thawing process for a another transfer than “younger” embryos.) Another embryo became a blastocyst but then began dividing unevenly and soon “arrested” as well. These are the types of fertilized eggs that never would’ve implanted in the first place. Yet, it’s still feels a little bit a little bit depressing that they didn’t make it and that there aren’t more additional mini-me possibilities.

Yet there is room for rejoicing because one survived to the cyropreservation (freezing) stage and is expected to be there when we need it. Also, in perspective, the loss of three embryos makes sense. Embryo survival is closely linked to egg quality, and my unexplained infertility is blamed on a diminished ovarian reserve. That means that of all the eggs I have, I only have a few that are of good quality. The majority of them probably aren’t as likely to undergo fertilization and endure a full term. The in-vitro route makes the existence of those eggs more apparent.

Imagine it this way: you have a bag of Skittles, and only the red ones count. You could blindly stick your hand in the bag for one at a time, hoping for a red one. However, the more efficient way would be to grab a handful and pick out the red ones while avoiding the rest, which would likely be the majority of the bag. In-vitro fertilization is my efficient handful into motherhood.

The quest feels a little more daunting right about now with just one backup, but I’m trying not to let it shake me. I will not buy a home pregnancy test to try to get an early result. I will not obsess about any twinges or odd feelings. I’m just gon’ ride it out and pray for two more days.

Send in the Embryos

This is a copy of the screen-grab image from the ultrasound at the moment of the embryo transfer.

It wasn’t on purpose, but I’ve been silent for a few days reveling in Thursday’s embryo transfer. It was nothing short of fascinating. It felt sacred and holy, an unexpectedly spiritual few minutes.

And that’s in spite of the intimate experience with an unfamiliar but funny doctor and his clueless intern. Bless her heart, I knew she bordered on inept because of preoccupation with the internal ultrasound probe that wasn’t part of this particular procedure. As instructed, I showed up with a full bladder. That meant an external ultrasound, but she’d missed the memo. (And sadly, she’d worked at the same hospital I had in the exact same position but on a different floor. I knew she should’ve known better.) When the doctor kindly corrected her, she pretended her gooped-up probe didn’t exist. To be nice, so did I. I even took shallow breaths so she wouldn’t lose her place with the external probe on my abdomen. I can’t take full credit for my behavior, though. My super-nice Mr. sat on a stool to my right, and his influence mellows me. Also, I didn’t have the benefit of the privacy sheet normally granted with exposure of the goods, and it’s hard to be critical with your hoo-hah on display. Fortunately, my monkey socks provided a nice diversion until the show started.

Just prior to the procedure, Dr. Funny Man passed the Mr. a good luck greeting card from the entire RE office. “Beautiful,” he said, “a family photo.” It was an image of the two embryos set aside for the transfer. And yeah, they were the most beautiful set of eight- and nine-cell embryos that ever existed. OK, it sounds weird, but the idea that these little babies could turn into real babies was just amazing to me. I think I’ve stared at that photo every day and several times a day since. I made it portable by taking a picture with my phone, and I look at that even more.

That picture might have been all I needed to see, but my excitement — while trying not to breathe too much for the Dr. Bailey intern reject — grew when the doctor pointed out everything on the screen. Amid the plumbing was his needle aimed at the ideal place. “Do you see me? Are you ready? Are you sure?” He yelled something to invisible people through talking through a hole in the wall and told us, “Bombs away. One, two. There they are.”

Two small somethings on the screen came through the needle and just sat tucked away right where they were placed. I cried a little staring at the movement I saw. I couldn’t look at the Mr. because it would’ve become a full-on Oprah ugly cry. And even though I felt it, crying just seemed a bit premature. I was fully aware, though, that whatever life that would come from this process would spring from something greater than a few doctors practicing medicine.

Regardless of the criticism surrounding infertility treatments, what I saw represented the presence of God in all things, including in what has been called “gravely evil.” Science only takes us so far; the rest really is up to God. And there ain’t nothin’ evil about that. Jerks.

Not the Octomama

ABC used to have a show called “Dinosaurs.” The youngest animal of this family referred to its father and, well, everyone else as “Not the Mama!” With that and seven fertilized eggs, a.k.a. embryos, ripe for implanting, let me say this once and for all as nice as I can muster:

Remember this "Dinosaurs" baby whose phrase was "Not the mama?" Let's take it a step further: not the octomama. I'll smile to be polite, but your octojoke really isn't funny.

I am not and will not be the freakin’ Octomama — not in a box, with a fox or eating lox. And no, I’m not even the septomama. Say it with me: Not. The. Octomama. Repeat as many times as needed to realize that any “jokes” related to Nadya Suleman aren’t funny and probably won’t be for anyone who has to undergo fertility treatments.

Weeks ago, The Mr. and I had a very detailed conversation together and with the hospital-provided therapist (a requirement for the in-vitro fertilization process at my particular facility) before arriving at the decision to implant two embryos at one time. So, even though we have been blessed with a singing group, a small basketball team or a volleyball team plus one, no doctor in his or her right mind would implant all seven. Here’s why:

  • Implanting more than the recommended number according to a potential mother’s age is like Russian roulette, not only with the chances of a live birth, but with the mother’s life. More babies, more problems (read: complications).
  • The greater the number of embryos in utero, the greater the likelihood that one or more of them might have to take one for the team. (I offer my apologies for attempting to soften the blow of reality.) Essentially, too many kids in the tub might force parents toward the decision of which ones stay and which ones have to be aborted to prevent the death of all. That’s real talk.
  • If multiples make it through pregnancy, the existence of many increases the risk of premature delivery. That’s days, or even, months in somebody’s NICU. It’s like a car accident. It’s one thing if it happens; if it occurs because your own recklessness, then it’s dumb.

We decided on two because, like most couples, we feared the risk of transferring one and having an unsuccessful cycle. We were adequately informed concerning single-embryo transfer, or SET, an industry-wide recommendation that all it takes is one, but we opted to roll this dice anyway. Aside from that, I really would love to have twins. Boys or girls, one of each, or a set of kittens with my nose and his eyes — any combination would make me happy.

As for the remaining five, we’ll literally have them on ice in case the first two don’t make it. (They’ll be frozen.) Should that happen, we’ll start again with two more. Or if we’re successful right out the gate, our frozen reserves will remain until it’s time for more children. Beyond the family size we choose, we’ll donate the rest to another couple who isn’t as fortunate as we’ve been to get to this point.