Fertility Specialist - IVF
One year after the loss of our twins
After being unable to get pregnant for the following year, we went to a fertility specialist in October 2019. We reviewed our history including being pregnant with twins, miscarrying one, then finding out the surviving baby had trisomy 13. The doctor asked us a few questions, asked us if we had any, then said they would start our “evaluation cycle” to monitor my hormone levels, conduct a few tests, and then decide on a plan moving forward.
The evaluation cycle started in November 2019. This consisted of a LOT of ultrasounds and bloodwork (including HSG test where dye gets injected through your fallopian tubes, and SHG where saline is injected into your uterus). I also had bloodwork for SEMA4 which screens to see if we are carriers of any possible genetic variants that could affect our future children. Due to insurance not approving one of the tests in time, I had to wait until December, so my evaluation cycle lasted 2 months instead of one.
After our testing was complete, we met with the doctor for a consultation to review the results and put a plan of action in place. This happened early January. We were told that there was nothing major wrong, but likely something small that the tests were not picking up. After 3 years of trying unsuccessfully, the doctor recommended IUI or IVF. As it was presented to us, IUI was less invasive but had only a 20% chance of success. IVF was more involved, but had an 80-85% success rate. The usual decision would be to start with a few months of IUI then if that didn’t work, we’d move on to IVF, but we talked with our doctor and with each other and decided to jump right in to IVF.
This was a personal decision that we thought over and prayed about as a couple. When you’ve been struggling to get pregnant and have dealt with the emotional heartbreak that comes every month (for years), it begins to take its toll. The doctor recommended taking in to account the emotional aspect when making the decision because it can affect your mental health.
I couldn’t bear the thought of getting my hopes up for IUI and having them dashed three months in a row, then needing to go through the IVF procedure after all that. The doctor’s office suggested that we request approval for IVF from our insurance, because if we didn’t get that approval, then we’d be doing IUI and wouldn’t have a decision to make. IVF was approved. Due to the nature of Dave’s job and the fact that he was looking for a new one and could lose the phenomenal insurance we currently had, we decided to proceed with IVF while we had the great coverage that we did.
What to expect: Fertility Specialist
IVF: Retrieval
We made this decision to embark on the IVF journey in January 2020. The doctor's office was great and started the process of getting the medications I would need approved by insurance and ordered by the pharmacy. It was not an easy process, so be warned it’ll take time and patience to get everything sorted.
In February, my cycle started and we prepared for the retrieval procedure. I went in for bloodwork and an ultrasound and got a tutorial on how to administer injections. I was put on pills to stop my body from naturally starting the ovulation process, then I started two injections every night as well as one pill morning and night. Dr. Dave gave me my shots :)
We repeated this routine for 4 days, and then added another injection each night. By the time things were looking good and ready for retrieval, I had gone through 13 days of shots (usually it’s about 8-10 days). I had my HCG “trigger” shot and then 36 hours later went in for the procedure.
It was a Saturday morning 8am procedure. The procedure itself was apparently about 10 minutes. I remember waking up feeling very tired. I think they let me sleep for about an hour as I hadn't been sleeping well since the shots started.
We had been assuming we would do a fresh transfer, and the nurse had ordered the medication we’d need, but the doctor recommended frozen since it would allow my body to regulate between the retrieval and the transfer. We were slightly disappointed by this because we’d been waiting to get pregnant for 3 years and were under the impression that doing IVF was not a two+ month ordeal. It’s true, every month feels like a year once you get to a certain point in your fertility journey!
However, the reasoning was sound and made sense to us. For those of you reading this and thinking about fresh vs. frozen, I encourage you to tell yourself it’s worth waiting until your body is in a good place to house your embryo and not rushing into a fresh transfer. It can be difficult to make logical decisions in such an emotional process. Now we had to wait for my body to reset and start a new “cycle” in order to embark on the IVF transfer procedure.
Big bag ‘o meds for a big lot of shots!
IVF: Transfer Cycle
When I went in to the doctor’s to start my cycle, I was told that there were two options - a natural cycle (unpredictable, but less medications) and a medicated cycle (more predictable but more medications). The doctor's office decided to put me on the medicated cycle and told me to return in about two weeks for a follow up and that my "transfer" would happen about 10 days after that. It was crazy to me that they could tell me the exact date 4 weeks in advance!
I started the medications and made sure I had everything I needed in stock. Now if you remember what took place in March 2020, it will not be a surprise to find out that my cycle got cancelled before I could get to my second appointment, as I got a call from the doctor's office saying that the American Medical Association was recommending no IVF during this time due to the coronavirus. No retrievals or transfers. This meant I would not get a transfer in April and would have to wait until we got the green light.
In the grand scheme of things, this was not a big deal. But in the moment, when you have been waiting years, an unknown “pause” on anything happening was discouraging. I was yet again back in waiting (with an unforeseeable end in sight). I tried to tell myself that it was for the best, and that I'd be at risk if I were pregnant during this time. I wished we had done a fresh transfer so that things were settled prior to covid. My journey to parenthood took another turn.
Thankfully, about a month later I received an email saying that the fertility clinic was working on a plan to return to work in May. Later on in the email, it said to reach out if we wanted to discuss our needs. I sent an email to the nurse and mentioned that I was at the beginning of my cycle and was wondering if I’d be able to start up a transfer cycle even though it was short notice. I went in the next morning for bloodwork and an ultrasound and was told that my transfer date would be May 19th. It still amazes me how they can schedule it like that!
The transfer cycle consisted of 4 weeks of monitoring and medications (pills, injections, and pessaries). It required a lot less monitoring than the retrieval which was a relief.
IVF: Transfer Day!
Tuesday May 19th, 2020
We walked into the doctor’s office and were greeted by our favorite receptionist, Deborah. She’s a friendly woman with a dry, quick-witted sense of humor who initiates conversation and remembers the details you share. After we went for our checkup back in early January, she asked how our New Year’s was and how we celebrated. We confessed that we were nerds who stayed home and worked on a puzzle (our annual tradition), and she made us feel like we were cool. She always has something uplifting to say and manages to make us smile. Today was no different. “Mr. and Mrs. Puzzle! Good morning. Ready to add another piece to the puzzle today?”
We had 8 embryos that met the criteria for freezing. The one that looked the healthiest (we shall call “Em”) was selected for today’s transfer. We were given a photo of something that resembled a blob, and said “awww” as we looked at what could turn in to our first child. We prayed. We took our first “family photo”. We had positive thoughts. We smiled. We laughed. There was hope in the waiting.
The big moment had arrived. I was instructed to undress from the waist down (which was actually quite modest in comparison to the egg retrieval procedure), put a gown on, use the bathroom, then enter the sterile room. Correct patient? Check. Located the uterus? Check. Correct embryo? Check. Embryo inserted? Check. Time: 12:02pm.
I was conscious the whole time, which was again very different from the retrieval procedure, and Dave got to watch the embryo get transferred. I shimmied over from the operating bed to another one and got rolled along to the “recovery room”, where we sat and waited for about a half hour and then got up and headed home. It’s a very bizarre feeling walking around knowing this tiny little embryo is inside of you and needs to attach to your uterus lining in order to survive!
IVF: Two week wait
There is a lot of literature out there about the two week wait. It can be difficult to focus on other things when you know there’s an embryo trying to attach to your uterine lining that could turn into a little human, but it’s worth keeping busy and pressing on without getting caught up in the wait.
I took 4 days off work to relax and my parents came to hang out which was a great distraction (they had no idea they were being used as a distraction). I think it’s a great time to eat healthy, get as much sleep as your body needs, and then proceed with life as normal. Returning to work and keeping busy were super helpful to me as the time passed quickly. Our fridge has never been so full of fruit and veggies!
IVF: Pregnant!
June 2nd, 2020 was the big day: HCG Test. I went in for bloodwork early that morning. At 9:55am, we got the call that the pregnancy test came back positive, and my blood levels looked great! They said to follow up in a week for more bloodwork. June 9th slowly rolled around and HCG levels were still looking great. The next week was more bloodwork and an ultrasound, which the nurse described as a “diamond ring” the way it looked. The following week we saw the heartbeat on the ultrasound monitor which was a reassurance to us that things were looking good. I was 8 weeks going strong.
They say once you’ve heard the heartbeat at 8 weeks, risk of miscarriage is only about 3%. We thought at 10 weeks we were at the edge of the woods, almost out, and looking forward to the future.
On July 7th in the doctor’s office, there was no heartbeat. Sadly, this is the second time I’ve experienced the hope-crushing silence in the ultrasound room. Today what was in my uterus looked small and lifeless. After joking that I was “graduating” out of the IVF clinic and on to my regular OB-GYN, the nurses were speechless. It was as if they were waiting for me to acknowledge the bad news. When I finally said, well this doesn’t look good, they agreed. They apologized, and said that it was nothing I did to cause this, and it was just something extremely sad.
I got dressed and met with the doctor in a private room. He went on to explain that this was likely a genetic issue, because everything else looked great. He recommended a D&C procedure which would mean they could perform a genetic analysis to hopefully get more answers as to why the pregnancy didn’t stick. My procedure was set for the next morning at 11:30am.
Thank God for faith, hope, and love. The thought of going through this experience without faith, without hope, or without love is horrifying to me. I know that I have a loving Father who cares for me, and that even when things come crashing down, and it seems as though “He” let me down, He didn’t. He will comfort me, lift me up, and give me a place to rest. I will draw closer to Him in my times of struggle, because I know He will get me through.
A friend asked how they could be praying for me today. I was stumped. Reason being, I felt incredible grace in this experience. I have peace, I have seen glimpses of joy throughout the day, I have hope for the future. I have friends and family there for me however I may need them. I am able to say that I trust God. Yes it hurts, I’m sad, my dreams have become a bit of a nightmare, but I have to trust that this experience will make me stronger, and I have to use it for good in some way.
My prayer is for healing, for God to be glorified, for this experience to provide me with the opportunity to help someone else, and for the next time I get pregnant, that I would stay pregnant. This is why I decided to write my thoughts and experiences down, in hopes that someone will feel encouraged, understood, or comforted.
IVF: Miscarriage
This is the first entry where I have just stared at the blinking line that appears as the computer screen waits for your fingers to type. I have many thoughts, but no idea where to begin.
After being 10 weeks pregnant and having seen a strong heartbeat at 8 weeks, I was resting in the data: 98% chance of successful full term pregnancy. Turns out that I was in the 2%. My first pregnancy, I had been cautious of not getting fully excited until the 2nd trimester, but this time around, I was excited from the time I saw the strong heartbeat.
I have had 10 days to process through the loss of what would have been my little girl. This second pregnancy was different from the first. I let myself get excited. I talked about the future like it was happening. We made plans for house projects to complete surrounding the baby’s arrival. A friend sent me a onesie.
When I was sitting in that ultrasound room looking at the lifeless image on the screen, I did think to myself, how could I let myself get so excited? But upon further reflection, I’m glad I got excited. It made the pregnancy experience more enjoyable. I did not spend so much time worrying, or thinking “what if it doesn’t work out”. I had hope, trust, and faith.
I still have hope, trust and faith, but my hope is not in an embryo making it out alive. My hope is in God’s truth, His promises, and His love. He has good plans for me. He lets me go through suffering so that I can grow stronger. I have been able to grow closer to God, and have been reminded that there is so much more to life than my journey to get pregnant.
So, for those of you anxious pregnant ladies, I encourage you to enjoy being pregnant, not to worry about what could be wrong, and to embrace the hope. Even if it ends sadly, at least you have a positive experience to reflect on instead of months of anxiety or fear.
IVF: D&C number three
I hadn’t slept much the night before my last ultrasound (the one that revealed no heartbeat), and I barely slept the night before the D&C. We went to the doctor’s office at 11am for an 11:30am procedure. We went through the usual COVID temperature checks (thankfully neither of us had a temperature) and were touched by the receptionist and nurses in the clinic who exhibited an attitude of mourning on our behalf. Everyone we interacted with knew why we were there, and we were not kept in the communal waiting area more than 30 seconds as they took us to a smaller individual waiting room.
We met with the nurse who explained the post-procedure instructions, and the doctor who explained the procedure and future directions (he wanted to perform an analysis to see if there were genetic issues that caused the baby’s heartbeat to stop). The anesthesiologist was the same woman who did our retrieval procedure. She mentioned how she had been through IVF and had a D&C as well, but that she now has multiple children, which was very reassuring for us to hear. She said it’s great that I’m 31 as that age gives me plenty of time.
I had my heat pad, my couch, and my pup to get me through. I’m truly thankful for Winston and his timing in our lives. He’s seen me through 2 miscarriages, 3 D&Cs, and lots of ups and downs.
He’s a wise pup who knows how to comfort me.
IVF: Genetic Testing
We spent quite a while back in January discussing whether we should perform genetic testing on our future embryos. It is a very expensive procedure that was not covered by insurance. We also wondered how ethical it was to test our potential future children for genetic abnormalities. We were told that the trisomy issues were so rare and coincidental that future pregnancies should be “normal”, so we refrained from the testing.
However, in July 2020, after our second pregnancy loss due to a genetic abnormality, we decided to proceed with genetic testing on our seven remaining embryos in hopes that it would help us for the future. After what felt like years, but was actually only 2 months, the embryos were thawed and tested on 9/18/20, and we received results on 9/25/20.
Four embryos were considered healthy, and three had abnormalities (a mixture of extra chromosomes, missing ones, and mosaic issues). This means of our 8 embryos, 4 of them had genetic issues.
These results brought us a sense of relief because we realized that without the testing, there was the potential for us to go through 3 more failed pregnancies. We also felt validated in moving forward with the testing. While we are aware that nothing is guaranteed, we are hopeful that genetic issues will not cause miscarriage in future.
