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Alina Avery

A Beauty and Lifestyle Blog

Month: September 2018

Final Fertility Update – Our FET

September 29, 2018 by Alina Avery Leave a Comment

After our first IVF cycle failed, we met with our Reproductive Endocrinologist to follow up on how the cycle went and what our next steps were.

We were very much on the same page, we were happy with how our cycle went right up until the negative pregnancy test. My response to the medication, egg retrieval, fertilization and maturation of the embryos was all pretty much textbook. We feel very lucky to have had such a positive experience. It was obviously going to be emotional and difficult and the fact that we weren’t one of the lucky unicorns who find success after their first cycle was upsetting, but not world ending. We did have 6 more frozen embryos and nothing about the cycle raised any red flags that indicated we would need to change treatments or do more testing.

So the next step for us would be an FET, a frozen embryo transfer. Compared to the stim cycle, this would be a walk in the park. There were two options for us, a “natural” cycle, or a medicated one. During a natural cycle, you’re monitored similar to how you are for a stim cycle to pinpoint your natural ovulation. Then 5 days later, a 5-day old embryo is thawed and transferred when your uterus is receptive. The pros here: little to no medication. The cons: lots of visits to the lab for monitoring, less control over timing. Since I prefer more control and less poking (blood draws) and prodding (internal ultrasounds), I opted for a medicated transfer. What that meant was that at the start of my next cycle, I would start taking oral estrogen pills as well as using estrogen patches to both suppress my natural ovulation and begin to build a uterine lining. After two weeks of that, I would go into the lab for a lining check where they would do just one blood draw and ultrasound in order to make sure the estrogen had done its job. They were looking for low progesterone, meaning I hadn’t spontaneously ovulated, and high estrogen. I believe for the uterine lining, they were looking for something over 8mm and mine was 9.5mm, so all signs pointed towards go. And that’s when I started the most tedious point in the process: Progesterone In Oil injections, or PIO.

PIO is an intramuscular shot. Meaning that instead of a tiny, short little subcutaneous needle into your belly like the stim injections, it’s a massive long 1.5 inch needle that goes into your bottom. I needed to do one injection every day around the same time every day. It’s nearly impossible to do yourself and after daily injections, even after switching sides, your butt gets bruised and sore.

The progesterone injections are intended to simulate ovulation. It changes the quality of the uterine lining to be sticky and holds it in place so that the embryo can implant in it. In a natural cycle, progesterone is produced by the follicle left behind on the ovary once the egg is released. Since I wasn’t actually releasing an egg this cycle, I had to supplement my progesterone. So after 5 days of progesterone injections, we went in for the FET.

It was very similar to the process for a fresh transfer. I needed to have a full bladder again, but this time I overdid it and was told I could try to partially relieve myself so I wasn’t in pain. I had to do that at least twice and still when the ultrasound tech came in the first thing she said was “whoa, good job with that bladder!” Matt commented that he could see a lot more definition on the ultrasound screen looking at my uterus this time. It was pretty clear to see the outline of the organ, the lining, and where the little embryo ended up. After the transfer, they gave us a photo again, told us to come back in two weeks for a pregnancy test, and to continue the progesterone injections and estrogen pills and patches.

I had a minor freak out a few days later when we got about 6-8 inches of snow. Matt injured his back at the gym, so digging the car out was up to me. I thought maybe I’d over done it shoveling snow, even though I hadn’t gotten out of breath and was careful not to lift any too heavy shovel loads. I was a bit paranoid that I’d managed to dislodge our precious embryo. Some incessant googling calmed me down though.

Two days after that, we boarded a flight to London. Remember when I said the PIO shots had to be done around the same time every day? Well we’d started doing the shots around 9pm eastern time, which meant that 1. we had to do a shot at the airport and 2. we’d be doing the shots at 2am while we were in London. The shot at the airport was difficult for me. The only private place we found to do it at Logan Terminal E was a breast feeding/pumping pod, which felt ironic and a little like adding insult to injury. The code to get in was 80085 though (BOOBS) which I found funny at least. Also in case you’re curious, needles and syringes are totally fine to pack in your carryon. We had a note from the doctor that they were medically necessary, but no one gave us a hard time about it. The 2am shots in London weren’t actually as bad as we thought they might be. The nice part was that we were always back in our room and not out-and-about doing tourist-y things. We just prepped everything before we went to bed, set a phone alarm for 2am, and when it went off, sleepily drew up the injection and administered it.

We had a fantastic time in London. It was a great way to distract myself from constantly wondering if the transfer had worked or not. We flew back to Boston on a Sunday evening and my pregnancy test was scheduled for early Tuesday morning. Monday morning I woke up around 3am to pee and probably a bit due to jetlag. Since I was up and going anyway, I decided to take a home test, fully expecting it to be negative so I could brace myself for the next day’s blood test. I think you could have knocked me over with a feather when two dark lines showed up almost immediately. Once I convinced myself I wasn’t actually dreaming, I ran back into the bedroom to wake Matt up and make him look at the test. He was definitely still very much asleep but similarly excited to see our first ever positive pregnancy test.

My HCG level on Tuesday was around 1500. They scheduled another draw for two days later to make sure the levels were rising appropriately. That one came back at 2800, which the nurse described as “perfect”. A final draw a week later came back at almost 16,000 which pretty much meant that I was definitely pregnant and it was looking viable. Slow rising or dropping HCG levels can indicated a chemical pregnancy, where the embryo implants but fails to grow shortly after, or an ectopic pregnancy where the embryo manages to find its way out of the uterus and implant somewhere it shouldn’t. They’d have me in for an ultrasound to confirm placement two weeks later. Those two weeks CRAWLED by. Like I said… lots and lots of anxious waiting in this process!

Our ultrasound was scheduled for when I was 7 weeks and 6 days pregnant and our little embryo measured exactly on track with a strong heartbeat. At that point we were released from the fertility clinic and were transferred to an OB for standard prenatal care. That was obviously the good news. The bad news was I was still required to continue the PIO injections and would need to keep doing them until I was 10 weeks pregnant.

Looking back, my “symptoms” while we were in London could have been due to the progesterone or the time change, but I was exhausted. Especially towards the end of the trip, I couldn’t keep my eyes open. I thought my sense of smell on the plane home was a bit more sensitive than usual, and I completely lost my taste for wine. We planned a little wine tasting with our friends one of the last evenings there where we bought a few nice bottles and wanted to taste them side by side and compare notes. Every glass tasted awful to me. I was completely disinterested in drinking any sort of wine, which is very unusual for me!

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Posted in: Lifestyle Tagged: fertility, fet, frozen embryo transfer, infertility, ivf, pregnancy

The IVF Process Part III: Fresh Transfer and the Two Week Wait

September 23, 2018 by Alina Avery Leave a Comment

Right after retrieval we were told that they had managed to collect 24 eggs. This seemed like a great number to me, and we expected to get a good haul as I was young and had responded to the medication well. Twenty-four seems like a huge number, and comparably it is, but during each stage of development, you can expect  about 30% drop off. So from our 24 retrieved, not all would fertilize, and not all of those would develop, and not all of those would reach the 5-day blastocyst stage which is what’s required for transfer.

The next 24 hours were very anxious for me as I waited to hear how many eggs had managed to fertilize normally. I got the call fairly early the next day — we had 16 embryos! Off to a good start, and pretty spot on for the 30% drop off. At this point, I wouldn’t receive any more updates on how many embryos continued to develop until I showed up four days later for the transfer. They prefer to leave them alone in the incubator to grow rather than disturb them. If you didn’t have many to start with or they suspected the embryos might not reach day-5, they sometimes check them early and schedule a day-3 transfer. The philosophy being that the embryos will do better in their natural environment rather than in a lab. But since we still had a good amount growing, I wouldn’t hear anything for 4 more days. I thought those were the longest 4 days… turns out there would be a lot more waiting and anticipating in this process! I was also instructed to start a combination of estrogen and progesterone supplements in order to prepare my body for the transfer.

A few days later I received a call letting me know what time I should arrive for my fresh transfer and other instructions. Essentially, at this point the uterus is quite small and they use an external ultrasound to help guide the placement of the embryo. They can get a better image if you have a full bladder. You’re told to drink 16 oz or so of water on your way in to the clinic and not to empty your bladder until after the transfer. It’s… uncomfortable.

So Matt and I arrived for the transfer, bladder full (mine, not his!), waited a bit, and then went into a room adjacent to the lab where the embryologists work. I signed some forms, including instructions for what to do and not to do post transfer and when to come back for a pregnancy blood test. I got all situated on the table, and the doctor and nurse came in. The doctor explained that we had a great looking embryo that day to transfer, graded a 5AA, and several more that they would be able to freeze. I would get an email the next morning with the exact number, but it was at least 5 so I was feeling pretty relieved about that after 5 days in the dark. The embryologist brought in the embryo in a petri dish and matched it to my wristband to make sure they had the right one. Once they were sure they had the right embryo, they gave me a little picture of it to keep, and we got started. The procedure is very similar to a pap smear. There’s a speculum involved, which is also uncomfortable of course, and then the doctor inserts a larger guiding catheter while the nurse (or maybe a technician?) guides the placement with an ultrasound. Once the outer catheter is in place, the embryologist brings back in the embryo, this time along with some fluid in a smaller catheter. The small tube gets inserted into the larger one and gets “flushed” into the uterus. Matt held my hand the whole time and we watched as much as we could on the ultrasound screen. You can’t really see anything much except the outline of the uterus and a little flash of white traveling through to tube and into the uterus. That’s the fluid surrounding the embryo, the embryo itself is far to tiny to discern.

And that’s about it. After that, I could go pee (FINALLY), get dressed, and go home. I told to take it easy for a bit, but no bed rest or anything like that. Just no super heavy lifting or strenuous exercise. I was still on exercise limitations since my ovaries were still enlarged from the retrieval process, so nothing really changed there.

The next morning, I got the email that we ended up having 6 more embryos to freeze. On average, 1 in 3 embryos will result in an ongoing pregnancy, so we’re pretty confident we won’t have to go through the entire retrieval cycle again in order to complete our family. If we do though, insurance won’t allow us to do another cycle until we’ve transferred all of our frozen embryos. So if we do decide we still want to grow our family, it will be a while before we go through this again. And I’ll be even older so the chances of success will be lower. We do have the option of paying out of pocket in order to “bank” more embryos if that’s what we decide to do.

Another step we opted out of was genetic testing for our embryos. Instead of doing a fresh transfer, we could have done a freeze-all cycle. On day 5 when the embryos reached blastocyst stage, they would have been biopsied and frozen. The biopsies would then be sent off to a lab for analysis. They look at the cells for signs of genetic aneuploidy, meaning the embryo is chromosomally abnormal. Many times, abnormal embryos won’t develop to the blastocyst stage, but some do and this helps filter them out and theoretically leads to better transfer success rates. This technology is relatively knew and inexact however, and since we aren’t carriers for any genetic diseases and are young enough to be low-risk, we didn’t choose to do any testing. It also would not have been covered by insurance and would run us about $2500, so we decided it wasn’t worth the cost.

A note about embryo grading as well. Our embryo was 5AA, meaning the size and arrangement of cells was looking really good, but embryo grading is also not super exact and doesn’t always have any correlation to whether or not the transfer will be successful. Some doctors won’t even tell you the grade of the embryo, just that it was good enough to freeze or good enough to transfer.

After the transfer, I continued taking estrogen and progesterone supplements until the day of the pregnancy test, which was scheduled for 10 days later. For those 10 days, I was the most pregnant I had ever been. I was also probably the craziest. It was a brutal wait. Wondering if it had worked, if it hadn’t, compulsively googling possible symptoms and chances of success and anecdotal evidence. It was a very emotional and nerve wracking time. I ended up taking an at-home pregnancy test a few days before I was scheduled for the blood test. I wanted to know as soon as possible, knowing that it wouldn’t change the outcome of course, and brace myself for bad news if it was coming. That test was negative. Unfortunately, my blood test a few days later was also negative. I was told that I could stop all medication and schedule a follow up visit with our doctor in order to talk about what our next steps were.

The negative blood test was difficult. We’d gone through so much and it felt like we were so close and then yet again, nothing. I couldn’t help but think that they had given me a perfect embryo and I had failed it. There are lots of reasons a transfer can fail though, and almost none of them are anything that someone could have prevented. On top of it being an emotional time, I was also coming off several synthetic hormones as my body recovered from the retrieval and I stopped the medication from the transfer. We’d been through a lot physically and emotionally. Looking back, I’m a bit relieved that that first transfer was ultimately unsuccessful, as it did give us some time to process and recover, and for me to take back control of my body which had just been pushed to limits it had not experienced before. We had a few weeks before our follow up appointment, which meant that we’d be taking at least one cycle off for sure, so I got back in the gym and focused on myself for a bit.

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Posted in: Lifestyle, Other Tagged: embryo, fertility, ivf, transfer
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