3

On the Road to Embryo Transfer

Has it really been a month since my last post? I could be cliche and say time flies when you’re having fun, but honestly the past month has been dragging by. I just haven’t been able to bring myself to write lately, but since we are officially on the schedule for our frozen embryo transfer it is time.

I was disappointed when our fresh transfer was canceled, but I know it was for the best. My estrogen levels were too high and I was too high risk for OHSS (ovarian hyper stimulation syndrome). That doesn’t make it easier, as I’m not a fan of change… to say the least. Dr. Dunaway did reassure me that their statistics are very good for FETs (frozen embryo transfers). 37 of the past 42 have been successful.

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So what have we been up to on the fertility journey this last month? To start, I’ve been on birth control for five weeks, today was my last pill. I’ve explained why many IVF/FET protocols include birth control in the beginning in previous posts, but it basically allows your hormones to start at a baseline and gives the team as much control as possible.

I have the opportunity to experience LUPRON again… my favorite.

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Lupron stops estrogen production. Makes it tank. Out of no where… BOOM.. I’m a 26 year old experiencing menopause symptoms. I can’t sleep, I have hot flashes, headaches, and I’m all around miserable. To be fair, I already eat dinner 430pm and go to bed by 9. They should just go ahead and give me that senior discount.  I will say that as hard as it is to get out of bed at 430am, I do feel immensely better after going to the gym. I had stopped going for my entire retrieval cycle but I’m going to try and keep it up this time.

On Tuesday I had my baseline ultrasound aka a morning date with the dildo cam, along with bloodwork. On the ultrasound they were able to confirm that I had no cysts, but still have some hemorrhaging leftover from the retrieval, but since my ovaries have done their jobs, that won’t hold us back for the FET. Blood work also checked out, so that means we’ve checked the next box.

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The following day I went back to the Fertility Institute for my 21st appointment – the endometrial scratch. Fertility clinics only started offering endometrial scratching recently. Research is still ongoing. But it’s already one of the more accepted add-on treatments. Compared to the evidence on fashionable extras like embryo glue and intralipids, endometrial scratching has more kudos.

Best described as being similar to a smear test, an endometrial scratch involves a quick scrape of your womb lining at a certain point in your cycle by inserting a catheter into the uterus through the cervix. The promising research suggests it could improve embryo implantation, especially if you’ve had failed IVF attempts before.

How does it work? Well, endometrial scratching seems to provoke a reaction within the inner lining of the womb. Hormones and chemicals are released to help the lining repair itself. A genetic trigger response to an endometrial scratch may give the implantation ‘green light’. In essence, the temporary injury seems to make the endometrium more receptive to an embryo. That means a better chance of a pregnancy and a live birth.

Early studies into endometrial scratching have brought intriguing results, gaining the attention of infertility experts. A 2012 study found that having an endometrial scratch was 70% more likely to result in pregnancy in women with unexplained recurrent implantation failure. And researchers in 2015 concluded that endometrial scratching was more likely to improve the birth rate for women with two or more previous IVF failures. It is in the standard FET protocol for Dr. Dunaway.

Basically, he goes all Freddy Krueger up in that joint.

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It’s lovely. And by lovely of course I meaning I NEVER WANT TO DO IT AGAIN. The scratch itself wasn’t that bad. You’re instructed to go in with a full bladder. Well, I underestimated the amount of time it would take for my bladder to fill, so by the time I got there it was really full.

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After getting undressed from the waist down, again, the procedure was conducted via ultrasound. But not the way I was used to. Nope, she threw that jelly on my abdomen and I had the pleasure of staring at my empty uterus. I had imagined the first time I had that ultrasound that we would be looking at our baby. Thanks for that.

Anyways, he prepped the cervix with iodine, which felt like a regular pap smear. Then came the catheter. Which would have been fine, except my uterus had two bends in it (maybe partially because I was about to pee myself… and on doc I suppose). He had to twist the catheter multiple times while it was inserted, took it out to bend it, and tried again. This happened not once, twice, but THREE times before he got to where he needed to be. I was seeing stars it hurt so badly. Thank goodness for the 1000mg of tylenol and 1000mg of ibuprofen I had popped.. after that the scratch felt like nothing.

So now… we wait. I’ll wait for hopefully my last period to come (hopefully I can tell, I’m still bleeding from the scratch and spotting from the lupron) and then I start estrogen patches and a new injection.

It is impossible to give an exact date, but I think our FET will be around June 20th. We will be transferring two embryos, with a 60-70% chance of pregnancy and 30% chance of that pregnancy being twins. If this cycle is successful, the due date would be March 7th.

Sending you all love and baby dust!

Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485
IVF Consult: $100
IVF Workup #1: $350
IVF Workup #2: $205
Infectious Disease Testing: $92
IVF Payment #1: $7,600
IVF Medications: $1,344
IVF Workup Balance: $196
IVF Payment #2: $7,600 (IVF payments covered by Sarah’s Laughter giveaway)
Anesthesia: $550
FET Medications: $1,500
Endometrial Scratch: $110

TOTAL: $22,464

 

 

3

Expect the Unexpected

This roller coaster ride feels like a real world version of Big Brother. Every week we get the phone call from Jackie, the IVF nurse (ie Julie.. for my fellow BB junkies..), it seems like a new twist. Since we first decided to go the IVF route in January, the plan has been to do IVF in May.

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On Thursday, Jackie called and asked “do you want to move your cycle up to April? We can start you on birth control tonight.” And I froze. I was speechless. I called Taylor before giving the yes, and then we were on our way.

But the plan… the plan was May. If you know me personally, you know that I am a type A, planning, regimented kind of person who gets thrown off if the plan changes, or something big happens. Even if the change is good. So while I have the “Yay! We get to move up IVF and try for a baby sooner!”, at the same time I’m thinking “Holy crap this was NOT what I was planning”.

So I had a little breakdown. It was almost a year ago exactly that we found out that we had a 1 in 200,000 chance of conceiving naturally, and all of those feelings resurfaced after our plan was set in motion.

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But… I feel better now. Today is day four of birth control, and I’m not going to lie, I’m not feeling great on it. It’s been a while since I was on the birth control pill, and I think it’s throwing me off emotionally. I know that as we’re about to start this (only 11 days until stims) I’m bound to feel a little emotional, but I feel SO down. Antisocial. it’s like there’s a huge weight sitting on top of me that I can’t quite get off. But it’s fine. I’m sure this will be the least of my hormonal issues we start the cycle. My boss, who I’ve been open with about everything, joked that I should put a whiteboard on my office door and indicate my mood with a smiley face or a frowning face to warn people what they’re walking into. Thanks, boss! Though it’s not a bad idea since my usual face makes it hard to tell what kind of mood I’m in….

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But why birth control? It does seem counterintuitive, doesn’t it? First, it may help to understand how the egg development process works. Don’t get intimidated by this picture.

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The natural egg production cycle

During natural conception, several eggs begin to grow in both ovaries at the beginning of a cycle. Each egg grows inside of a structure called a “follicle”. Even in my ultrasounds now, I have many of these “resting follicles”, which is a good thing for us doing egg retrieval! A follicle basically looks like a small blister, about 3 to 4 mm in size, nestled on the surface of the ovary, containing follicular fluid and a tiny cell the size of a small grain of sand, which is the “oocyte”, or egg. The egg is to the follicle as a seed is to a fruit.

As a result of natural hormones (the body stimulates the ovary with a hormone called follicle stimulating hormone (FSH)), only one follicle is selected for ovulation and the rest are reabsorbed by the ovaries. The selected follicle grows to be about 20 mm in diameter, or about the size of a large grape, before rupturing and releasing the ovum (the fully developed oocyte). The ovum is swept into the fallopian tube and has roughly 24 hours to be fertilized.

There are three main reasons that most IVF protocols start with birth control.

  1. It gives the ovaries a little time to rest before they are stimulated. Let’s stick with the grape comparison. In a normal cycle, you have one grape on one ovary. For egg retrieval, I could have 10-15 “grapes” on each ovary.
  2. It allows the doctor to control the timing. There is only one embryologist and one RE at our clinic, so this allows them to control each cycle so that there are no conflicts in scheduling, and each woman can have her retrieval at precisely the right time.
  3. Birth control is shown to help reduce ovarian cysts. A cyst is a naturally occurring fluid filled sac on the ovary. With a freaking grape farm growing on each ovary, there is no leftover room for cysts.

 

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Ovarian cyst

Last Friday we both had our pre-IVF blood work and signed consent forms. Next Thursday, I will have a sonohysterogram. Sonohysterography is a special kind of ultrasound exam. Fluid is put into the uterus through the cervix using a thin plastic tube, and sound waves are then used to create images of the lining of the uterus. The fluid helps show more detail than when ultrasound is used alone. This will allow doc to check for any abnormalities since we are planning on doing a fresh transfer (unfrozen embryos, 5 days after retrieval).

But just for a second, can we talk about hope? Even now… I know there is a good chance that this will work. BUT… I don’t want to be too hopeful. There’s still a decent chance that it won’t work. Even still…. I can’t help thinking what if it does.

If it does…. and I stay on the projected schedule (I probably won’t ..things always change), our retrieval/conception day would be April 3. That means that the due date would be on Christmas. I cannot imagine a better Christmas gift. It’s impossible to not have those thoughts. But we’ve had these thoughts before, these hopeful thoughts, and we have been crushed each time.

But still … We have hope.

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Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485
IVF Consult: $100
IVF Workup #1: $350
IVF Workup #2: $205

TOTAL: $3,276