Let It Go

Let me preface this post with the fact that I'm on a very high dose of estradiol, which is making me quite irritable, and more than a little nauseous (which makes me a little more irritable). No amount of Elsa singing 'Let It Go' will help, although I have the sudden urge to build a snowman. Admit it, you're still in mid-verse "the cold never bothered me anyway!" But I digress: Today's post is more introspective and less hearts and flowers than some of the others. I'm sure that the humor and whimsy will return soon, but today, my thoughts are about the tedious, unproductive nature of worry while trying to conceive.

Stop worrying. Stop thinking about it. Don't let it get to you. Ignore it. It will be what it will be. You can't change it by worrying. It's out of your control. Let it go. I've heard and said each of these things to myself many times, and yet, I find the advice hard to follow. While it's 100% true, I find no comfort in it. Somewhere deep down, I truly believe that if I work harder, try more, wish harder, hope more, and do something different than the next person, I will achieve greater success than they have. In most things in life, this really does hold true. Pregnancy, however, is not one of those things. If you could harness the power all of the hoping and wishing and praying of all of the women that have ever tried to get pregnant for more than one cycle, you could move mountains with it.

But there's a dark side to all of that hoping and wishing and praying: When the one thing that those women had their hopes and dreams set on doesn't happen, doesn't work, or happens and then tauntingly fades away, there's an emotional crash on the backside. Trying to conceive is often a very private adventure full of enthusiasm and excitement. Women daydream about what the positive test will look like, how they'll tell their partner, how their partner will react, how they'll tell their parents, whether or not they'll find out the gender, on and on. And while they're spending a great deal of time getting lost in the joy and visions of what it will be like when baby gets here, nobody entertains what it will be like when the test comes up negative or the doctor shows them an ultrasound with no heartbeat. I mean, who can blame them? You don't want to invite such terrible things to happen. Yet, a majority of the time, those things do happen.

For women trying to get pregnant in their 20s with no fertility issues, the chances of a successful pregnancy are 25%. In other words, they are 3 times more likely to see a stark, one-line negative test than the two lines they've been dreaming of. In their 30s, the likelihood drops to 20% each cycle, and by 40, there's only a 5% chance of successful pregnancy. Of the pregnancies that are achieved, about 1 in 5 will end in miscarriage in the first trimester. The odds are staggeringly pitiful.

So what makes us so punch drunk with visions of onsies and pacifiers and bottles and diaper bags? Certainly there's biology; an internal drive to procreate. But it also seems like the most bitingly painful casino game ever played. You might win big the first time you play - 'hey, my best friend did, so I probably will too.' The random reward schedule keeps you pulling that lever over and over again - 'I've lost so many times, this time HAS to be the winning one.' For women out there like me, we have somehow convinced ourselves that if we "try" hard enough, we'll overcome the odds and find success. I've beat my head against that wall 9 times in trying to conceive my own children. Come to find out, I'm totally normal - statistically speaking. But overachievers don't generally care for 'normal', thus all of the headache and heartache of my unsuccessful cycles.

When I came to the decision to be a stork, however, I was determined to leave the stress and worry to the parents. I wanted to know what it was like to just enjoy the experience of being pregnant. I am still certain that a worry-free pregnancy would be one of the greatest adventures in life, and look forward to it when it happens. Somewhere in the chaos of the hormones and the embryo transfer in August, I slipped back into the overachiever. I wished and I hoped and I tried(?) until the crash. As we embark on our second transfer next week, I am consciously aware that 'it will be what it will be', 'it's out of my control', and I need to 'stop worrying'.

While I know that I'm in a better place to handle whatever result of may come of this next transfer, I also know that it has come at a price. I haven't emailed or Skyped Ellie and Matt as much in the past three weeks as we did leading up to the first transfer. I know that they are excited and nervous, joyful and anxious, and a bundle of all of the emotions that build up in each cycle. While I'm cheering for them in the background, I recognize that I can't ride this roller-coaster with them. This isn't my trying-to-conceive road to walk anymore, and somehow, in watching their journey, I've found my way to letting it go.

Hormones and Needles and Tests - Oh My!

We've put another six weeks of the stork adventure under our belt, which was full of injections, pills, and anxious waiting. Of all of the parts of the process to date, this has been the most active in a day-to-day sense. From they day we left off of the last post, I've been on a constantly changing regimen of leuprorelin (Lupron), estradiol (Estrace), and progesterone in oil (PIO).

Now I'll be the first to admit that I can be a little OCD sometimes, and I take far too much pride in accurately following directions and doing a good job. But this ever-changing menagerie of dosages and drug combinations over a 4-week period is enough to make my head spin, and my subconscious constantly wonder if I took the right medications at the right time. To calm my inner Monica Geller, I found this nifty little pill organizer on Amazon, filled it with my oral medications for the upcoming week, then put dummy markers in each appropriate slot to remind me to do an injection on that day and time. The over-achiever in me beamed with pride.

It's probably time to address the elephant in the room: "How bad are the injections... really?" The Lupron was in a small insulin syringe with a tiny little needle (the small one in the picture). As long as the needle isn't dull in any way, you really don't feel it going in, and I really didn't feel the Lupron dispersing for the most part. The tough part about the Lupron injections is watching myself stab it into the skin. Even in the last few days of doing those, I would catch myself hesitating, hovering over the pinched skin, and have to talk myself into it. So all in all, the Lupron injections weren't terrible. The Lupron side-effects, on the other hand, were not as kind. I started with 10 units per day, and within a few days I had hot flashes and a slight headache. After a week, I was in a full-on battle against the INSANE weight gain, and I was noticeably slower in my thought processes. Lupron seriously made me dumber. By the time I stepped down to 5 units, I was in a hate-hate relationship with the drug, and threw myself a little party on the last day that I had to take it. That happened to also be the first day that I took the infamous PIO.

PIO gets a bad rap in the IVF world because it comes with (comparatively) HUGE needles, has to be delivered deep into the muscle, and is in oil - not a great solution for dispersion into the muscle. I read some great tips online from other IVFers before attempting any of the PIOs, and my dear, sweet husband, Scott, watched some very helpful YouTube videos with some professional tips. As most people recommend, I warmed the oil in the syringe to help it disperse once it's injected.

Buzzy Injection Pain Blocker

I also applied ice and vibration to the injection site for about 15 minutes. Ellie and Matt purchased a Buzzy for me to help with this part, for which I love them dearly! The rest of the work is Scott's to deal with. I place myself face down, he finds the right spot on my tush/hip, delivers the medication and does a wonderful job of massaging the area with the heating pad afterward. I've concluded that this is true love; someone that is happy and willing to rub my bum to keep it from hurting me the next day. What a catch. :)

Not all injections go according to plan, or with the luxuries of home, however. Shortly after starting the PIO, Scott and I had to attend an evening dinner party out of town, and we didn't have time to stop at the hotel to do the PIO injection first. Instead, I found myself with my pants dropped in the backseat of his pickup, because, well, you gotta do what you gotta do. While slightly more painful without ice or heat, Scott still did a great job, and I didn't end up with a bruise or a lump afterward. In fact, the only lump and bruise that I've gotten from the PIO injections came at the hands of our IVF nurse immediately following the transfer. Scott wasn't able to go with me, so she did the injection before I left the clinic that night. I knew it was going badly when I felt her pinch the skin instead of pulling it taut, and again at the end when she said "Wait here and hold very still. It's bleeding quite a bit, so I'm going to grab some tissue and a band-aid." I was thinking "BLEEDING??? Scott never makes me bleed!?" As I type, some 15 days later, I can still feel the distinct lump from that injection. If ever in that situation again, I think I'll take my chances and do the PIO on myself.

Did someone say "transfer"?? Ah yes, there was that exciting little event stuck in there in addition to all of the medication fun. :)  In fact, Matt and Ellie flew into town early in August to prepare for Ellie's egg retrieval. As we went through August, she had multiple visits to the clinic to check on her egg production progress, and I had two visits to ensure that the oven was fully pre-heated and ready to bake a sweet little bun. All of our appointments went great, and by the day of Ellie's retrieval, we were getting good news left and right. The RE ended up retrieving 9 eggs, 8 of which were mature, and all 8 fertilized into embryos through intracytoplasmic sperm injection (ICSI). We continued to be encouraged by day 3 when we learned that 6 of the 8 were still doing well.

On day 5 there were 5 excellent embryos, so Matt and Ellie decided to do preimplantation genetic diagnosis (PGD), and we pushed the transfer back a day to allow results to come in. On day 6, I traveled to the clinic in my lucky green shirt and my shamrock socks. I arrived with a full bladder as instructed, and was informed that the PGD results were not in yet. So I settled into the waiting room, only to find that the other woman in the waiting room was also a gestational carrier waiting for PGD results in order to transfer. We struck up quite a conversation over the 2 hours that we waited, trying to ignore the pain of the bladders that were ready to explode. Finally the results came in, showing that Matt and Ellie had 2 normal embryos from the 5 tested; 1 boy and 1 girl. We proceeded with the transfer of the best looking embryo of the two, and froze the other one. Thus began our intense wait.

Four days after the transfer I took a home pregnancy test, but nothing showed up. I retested on the fifth day after transfer and there was a faint second line - woohoo! Ellie and Matt were very encouraged to hear the news, while I was working hard to hold down my breakfast each day. Day 6 post-transfer brought the same faint second line, which made me a bit nervous. I was expecting it to get darker, but, as you all know, patience isn't my forte, so I chalked it up to being over-anxious to see progress. I tested again the next day, knowing that on the 8th day after the transfer we would have our first beta HCG blood test. The line was exactly the same as the previous two days, and as the day wore on, I felt less nausea than I had in over a week. I reported everything I knew to Ellie and Matt, so we were all cautiously optimistic going into the blood test. When the clinic called with the results of the blood test, it was only 2 mIU/ml, which is barely pregnant. If the pregnancy was viable, it should be have been above the single digits, so the clinic told me to stop all medications and allow my body to reset for a new cycle. Of course, Ellie and Matt were heartbroken, and I found myself in a combination of sad and mad at no one in particular. I was mad that we had all done so much work, did everything "right", received great news at every check point, and transferred a PGD normal embryo, only to have a failure on our hands. How does that happen!?!? The question is rhetorical of course, but that was the level of frustration that I had reached. I went home to tuck all of my medications and IVF supplies away in the closet, and found that Scott had brought me sushi, my favorite amber ale, and espresso ice cream to help me feel better. Have I mentioned that he's quite a catch? So Matt, Ellie, and I decided to Skype a few days later to discuss what happened and start to plan our next step. Based on our clinic's schedule, our options will be to transfer the one remaining frozen embryo in early October or mid-December. Regardless of which date is chosen, may the fertility odds be ever in our favor.