4

PUPO… Pregnant Until Proven Otherwise

We made it. On Tuesday we transferred two perfect looking embryos. I’ve been on bed rest since then and I’ve been reflecting on the last month.

The last I checked in I had my endometrial scratch and baseline. The day afterwards, I stopped birth control and got to start my favorite medication again… Lupron. ¬†Lupron is a subcutaneous injection which suppresses the pituitary gland to decrease the chance of ovulation.

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The medication I previously thought was the worst

 

Like last time, I somehow ended up with all kinds of bizarre side effects. Exhaustion, headaches, nausea, weight, hot flashes, night sweats, insomnia, and nightmares. I started on 10 units and was able to decrease it to 5 units near the end of the cycle. After I got my period (hopefully the last one for ten months!) I started the process to build a nice fluffy home for my embryos.

 

During IVF, the focus is the ovaries, and getting as many healthy eggs as possible without over stimulation. Success rates are slightly higher for a frozen transfer (FET) than a fresh transfer (transferring the same cycle as an egg retrieval before eggs are frozen) because for an FET the focus is 100% on the uterus and thickening the uterine lining.

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Every month, the uterus builds up a lining. If pregnancy is not achieved, the body sheds that lining during the menstrual period of a cycle to build a new one. Menstruation is triggered by a drop in the hormone progesterone that is produced by the corpus luteum, where the egg is released in the ovary. Either progesterone production is picked up by the growing embryo after implantation, or a period is triggered.

Once my next cycle started, I began a few medications to help build up that lining. The first was estrogen patches.

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These are applied and left on for several days. They bothered me at first and I was worried that they would come off, but I don’t even notice them anymore. I wear four patches, and each patch is designed to release 0.1 mg of estrogen per day. The next is estradiol valerate – my first intramuscular injection.

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This entire process has become overwhelming, so I’m at the point where I don’t take medications out of the box until I need them. It was the night before starting this one, so I pulled it out of the box. And I saw the needles for drawing up the medication, which is fine, I’ve used those for menopur. But then the¬†other needle was just as long… wait… this was an intramuscular injection?!?

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Well, I can’t give those myself, and I had been dreading them. I thought I had a few weeks to prepare myself for it. But it was starting tomorrow. Luckily I have an amazing neighbor who is more family than neighbor, and she happens to give amazing shots (tequila or medication, depends on the day). I called her when she got off of her shift at the hospital and she talked me off the ledge and gave me my first IM shot. It wasn’t as bad as I was expecting.

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It’s a big freaking needle….

Like the other medication, this was estrogen to help build up my uterine lining. Fun fact time… did you know that very few species menstruate? It seems the list of animals that menstruate is quite short: humans, apes, monkeys, bats and elephant shrews. What do these seemingly disparate animals have in common?

It all comes down to how much control the mother animal has over her own womb. In a paper published in 2011, it was pointed out by Deena Emera and her colleagues of Yale University that in menstruating animals, the transformation of the womb wall is entirely controlled by the mother, using the hormone progesterone. Embryos can only implant in the womb wall if it is thick and has specialized large cells, so this means the female is effectively controlling whether or not she can get pregnant. This ability is called “spontaneous decidualization”.

In most other mammals, these changes to the womb are triggered by signals from the embryo. In effect, the womb lining thickens in response to pregnancy.

If only we had effective control over getting pregnant. I’m going to try and will it to see if it sticks. Anyways, back to the FET.

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The week prior to the transfer (8 days before and 6 days before) I had ultrasounds and bloodwork to check my hormone levels and my uterine lining thickness. The office looks for a thickness 6 days before of 7cm, and I was at 10cm! That meant we were on schedule to move forward. I could hardly believe that we had actually gotten to this point.

Five days before transfer I started the progesterone injections. This was to signal to my body that I had “ovulated” and that it should be on the lookout for an embryo to implant. The progesterone oil injections are the devil. It’s 2 mL of liquid, and thick as all hell. The shot itself isn’t actually horrible. It’s afterwards. I’ve just accepted that I’m going to have pain for the next (hopefully) 12 weeks.

My tips for the injection:

  • Warm up the site prior to injection, I heat up a rice bag and put heat on whichever side I’m doing that day while I prep the injection
  • Heat the oil first, I wrap it with the rice bag while I prep the injection site
  • Completely lift leg off the floor and twist so that the muscle is expanded
  • Vigorously rub injection site for 3 minutes.. it hurts at the time but it’s worth it
  • Heat for 15 minutes afterwards

Apparently I am one of those lucky people who happens to have more pain with them… just another check in the box of side effects for me. It will be worth it if we end up pregnant! I will continue this injection every day until the pregnancy test or through the first trimester.

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For transfer day I had no dietary restrictions and was to arrive at noon. Of course I showed up in my transfer leggings and socks!

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We both went back and got changed. I had to remove my bottoms (able to leave on my shirt) and put on a gown. Taylor got a full set of scrubs and hat. The nurse came in and took my vitals and doc came and talked to us. He even brought us a picture of one of our embryos!

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First family picture!

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This is a photo of one of the embryos, but we transferred two. In the picture you can see that the walls are starting to break down and there’s a lot of activity. This is how the internal organs begin to form. Before transfer, the embryos were thawed and given a bath (their first bath!). They’re bathed in a “sticky” solution to help with implantation. Prior to transfer, the embryologist uses a laser to begin to remove the embryo wall to assist with “hatching” and increase our chances of implantation.

I was given my feel good pill – AKA Valium – and I’m absolutely convinced that valium should be given for all fertility appointments because it really helped with my anxiety. When they were ready for us we both walked back. The procedure itself was very quick and easy… we were able to watch on the screen as our embryos were transferred into my uterus! They wheeled me back to the room and let me empty my bladder… thank goodness. You have to have a full bladder for the procedure and once again somehow I had underestimated how much it would take to fill my bladder.

We had to wait about a half hour but then we were out of there! Just in time to get Chick-fil-a and get home before Tropical Storm Cindy hit.

And now we wait. We have a 60-70% of a pregnancy, and a 30% chance overall that we will have twins. Fingers crossed…. until then I am PUPO – pregnant until proven otherwise!

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4

Drowning in the Sea of Infertility

Everyone has good days and bad days. Everyone has ups and downs. It’s obvious when a friend or someone you’re close to is in a down, right? A successful, upbeat woman couldn’t possibly be depressed, could she? I wish it were that simple. I wish things were easy. I wish that when someone asked if I were okay, or what’s wrong, that I had an answer. Any answer, other than “I’m fine”.

Infertility feels like being in the ocean. It feels like you’re floating, being rocked by forces far beyond your control, praying that you have the will to keep treading water for just a little bit longer. There are periods in the journey where the sea is calm. It doesn’t go away, it is just a bit more at bay. You have time to stop, look at the sky, enjoy the breeze. But there is no way to truly prepare for the waves and storms that will do their best to drown you with vigor.

It’s much easier to recognize when you’re in a peak or trough.

The trough – the water is shallow. You can keep standing. Yes… you know there are waves on either side of you. But it’s okay. You can handle this. You go on with your life with an annoyance, that damn water keeps lapping at your ankles. But it’s manageable.. until it isn’t anymore. It’s like the frog in boiling water. If you take a frog and put it in a pot of water and slowly increase the temperature, the frog will keep increasing it’s body temperature and will not recognize that it is being boiled alive. When you’re in a trough you don’t realize that the water is rising until all of a sudden you’re treading water.

The other extreme is the peak of the wave. These are the bad days. These are the days that the waves knock you off of your feet and there is no other description other than you feel as if you’re drowning. You would give anything to just be able to breathe for more than a second at a time. It’s simply exhausting, treading water, but for how long? That depends. It depends on where you are in your journey. For me, most of the peaks are for a day at a time… today, I’m at a peak. But for some people these can last days, weeks, or even months at a time. And sometimes the waves just keep crashing.

The most dangerous times are the between times. In the between times everyone thinks you’re okay. Often in the between times even you think you’re okay. You go to work and are able to perform well. You go to functions with friends and family and are able to have fun and laugh like everything is okay. But when you get home and the world stops running at top speed everything just stops. Your mind stops, your body stops, and you just feel… empty. You get home and you can’t do anything. You want to, but you just can’t. You stop sleeping. You feel anxious about things that you typically wouldn’t feel anxious about. You feel insecure, especially with the people closest to you. But to everyone else… you’re okay.

Depression is as common in cases of infertility as it is in patients with cancer, HIV, and AIDs. High functioning depression, the “between times” slowly drown you, like the boiling frog.

So how do you not be the frog?

Talk to your friends and family. Tell them when you have bad days. As hard as it is, don’t try to cover it up. And if you aren’t completely open with your journey, find a group that you can relate to. I am very fortunate to have a group of online ladies that I can vent to. I would be lost without them. You may need to seek the help of a therapist or a doctor for help with depression. There is absolutely nothing wrong with seeking help.

Find something to blow off steam. For me, this is going to the gym. Even today I was able to go and work off frustrations. What makes you feel more like you? Go for a walk, go to the park, paint, read, take a bath, do what you need to do to make you feel like YOU again.

Be honest with yourself. This is something that I personally struggle with. Am I okay? Of course I am. I’m tough. I don’t need anyone. But.. I do. And I am truly blessed to have people that care about me. I have an incredible support system. It’s completely acceptable to admit when you aren’t okay. It is okay to not be okay, and sometimes the hardest part it admitting it. And that’s okay, okay?

Whatever you do, don’t lose the spark that makes you… you. It is easier to lose it than you think. Be open to that voice outside your head reminding you to stay positive when the one within feels lost.

A smooth sea never made a skilled sailor, and you must have hope we will make it to that island.

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