All in: Thoughts on a 7th embryo transfer

Just back from the transfer and resting comfortably on my hotel bed while Will whips up a nice lunch for us. Bed rest has commenced and will end on Saturday morning. Kind of nice to have an imposed rest.

I did acupuncture before and after transfer, which I think helped relax me (along with the 10mg of valium they give you). I was so relaxed, I actually fell asleep during the hour-long lie down following the transfer (Will says I even snored a little). This transfer was much more comfortable than the last one because they didn't make me overfill my bladder. I explained how uncomfortable I was last time and how I can't seem to use a bed pan (all those years of practicing not peeing on myself lying down as a kid, I guess). So the tech actually let me get up and partially empty my bladder twice before the transfer. This made all the difference.

We decided to transfer three blastocysts back. I had six total frozen (five chromosomally normal ones and one no result), so we figured we'd use half on me and save half in the case I need to move forward with the woman who has so generously offered to be a carrier.

For those into the details, the three embryos transferred were of the following qualities:

1. A Day 6 3AB
2. A Day 7 4AB
3. An invitro matured day 7 4AA (was immature at retrieval and so fertilized a day late. Technically this one then is a day 6)

These are all three confirmed chromosomally normal...So with my amateur embryologist hat on, I rate these as seemingly one that looks pretty good (the straight up day 6) and two that are more wild cards (the day 7 and invitro matured one)...

we shall see...

Two survived the thaw 100% and were re-expanded. One survived 98% and hadn't fully expanded, but they said it was on its way. Here's what they looked like up on the screen just prior to transfer (I have highest hopes for the one on the bottom right).

Now to just rest as much as possible and hope that at least one of these guys decides to burrow in to the nice lining I've been working on developing over here...

I can't believe this is my 7th embryo transfer! Please please please let this one be the one.

Mo

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Regret management is expensive

Despite the ongoing silence, we are continuing to prepare for the frozen embryo transfer in Denver this Thursday - I'm in the midst of a whirlwind of preparations:

• Two months of Depot Lupron to quiet endometriosis and improve endometrial receptivity? Check
• Consult with reproductive psychiatrist (double boarded in OB/GYN and psychiatry) after crazy mood downturn on Depot Lupron? Check
• Eliminate all caffeine, decaffeinated products, alcohol, and chocolate since New Years? Check
• Start boatload of multivitamins, vitamin D, folate at New Years? Check
• Endometrial biopsy to improve growth factors in endometrium lining last month? Check
• Electro-acupuncture twice a week for past month to improve uterine blood flow? Check
• Lining checks and hormone bloodwork? Check
• Consult with reproductive immunologist to discuss immunological plan for this transfer? Check
• ...leading to prednisone on board past two weeks? Check
• Baby aspirin? Check
• Four hour infusion of IVIG last week to quiet NK cell activity? Check
• Lovenox syringes ready to go? Check
• Denver anti-miscarriage protocol of Pepcid and Claritin ready to begin? Check

So all systems are go from a practical standpoint. I'm still feeling pretty checked out emotionally. All these steps have become entirely disconnected from the possibility of actually having a real live baby. Hence, partially, the lack of posting. If I post, I have to acknowledge we are actually doing this...and I *know* we are, but it still feels very abstract in many ways.

We've really pulled out all the stops for this transfer, doing all the things we usually do, plus doing IVIG for the first time ever. And strangely, pulling out all the stops is not about thinking it will actually make a difference, because that is just too hard for me to fathom. All of these steps are in place mainly for regret management. I don't want to look back later (quiet thought after this has failed) thinking that if only I had done X, Y, or Z, we would have succeeded. I am trying to be thoughtful in that way to make sure we don't accumulate any extra suffering on top of how unpleasant this whole endeavor already inherently is.

But seriously, folks, regret management is expensive. Both monetarily and otherwise - the IVIG in particular. The treatment took four hours of my life, and a ridiculous sum of money. Add to that that the night of and the next day, I had a horrendous headache and chest pain. The doctor had mentioned headache could be a potential side effect but would be less likely to happen if I drank a lot of water. And so I drank a ton - liters and liters. This headache I had post IVIG treatment? It redefined headache for me. I kept thinking, well now I understand the term "splitting" headache. I felt as though my head might actually burst open. It was terrible. Didn't help that I couldn't take any time off and in fact had to speak for two and a half hours at a workshop the day after. Ugh. Fortunately, by two days out, I was feeling significantly better. I hope that treatment served some purpose in addition to its regret management function, but either way, it is behind us now.

So we are close to take off...hard to believe, and yet here we are.

Thank you all for your continued thoughts and encouragement. Even though I've been quiet over here of late, it has meant the world to us.

Mo (and Will)



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Gearing up

Sorry for the silence. Not sure what's accounting for it...I've been very busy, but that's no excuse. I think I've been a bit down in the dumps with a birthday ending in zero earlier this month that really funked me out. I survived (helped by Will lovingly whisking me away to Miami Beach that weekend - thank you, Will). Life goes on.

Although my heart really isn't in it, we made the decision to proceed with a frozen embryo transfer, so that I didn't waste the Depot Lupron I'd taken for two months thinking we were headed for a donor cycle. So I'm in the midst of daily Lupron and estrogen patches and acupuncture. I'm off ALL caffeine, including chocolate, caffeine-free sodas, and decaffeinated products (God help me). We even went back to the reproductive immunologist and so I'm on baby aspirin and I'll be starting lovenox and prednisone soon. As well as doing my first infusion of IVIG. In addition to the Denver recommendation for folks with recurrent miscarriage of pepcid and claritin. So no shortage of drugs to try to make things work.

In the meantime, we've got two lovely potential egg donors in the midst of testing. So far things look promising for both of them, but we'll see...

Frozen embryo transfer is scheduled in Denver for Thursday, Feb. 9. I wish I felt more optimistic, but maybe that would be crazy. This is my ninth transfer, after all, and still no kids. But you never know, right?

I thought it would feel better than it does to be doing something. But yeah, well...not really. Still, maybe it would feel worse not to be moving forward with something? Probably.

More to come, maybe even some hope if I can drum it up.

Mo

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FET #1: Beta #1: 9dp5dt: We couldn't wait!

We decided not to wait until tomorrow.

My husband Will thought of a creative way for me to get my beta drawn today at the hospital that didn't involve the ER. So we decided to give his idea a go. Ultimately, if you can believe it, Will ended up drawing my blood himself (he was on call) and hand delivering it to the central lab. Despite me not being an inpatient, they graciously ran the results. I was a little nervous that Will doing the venipuncture could turn into a train wreck with the combination of me having chemo-scarred veins that make me a difficult stick plus being on lovenox and Will not drawing blood all that often (or really, at all since his residency), but he did great and got a vein on the first try. Go Will!

So we have the results. And you guys were right, there was a second line. I am (a little bit) pregnant!

The numbers are lowish, which is not unexpected given the faintness of the lines.

My beta is 26.8

progesterone is 4.87

I'm taking steps immediately to remedy the low progesterone - upping my suppositories and adding oral progesterone until tomorrow, when I'll be picking up PIO (progesterone in ethyl oleate) for an every other day injection.

I spoke to the nurse in Denver and she said they like to see the HCG at 50 at this point, so 26.8 is lower than optimal. We will recheck beta on Tuesday morning, which will be off a bit in timing, since today's beta wasn't drawn until about 3:00PM. But we'll see where we are at at that point.

I asked the nurse if a number like this ever turns out ok and she said she has seen betas as low as 12 turn out to be real live babies, so that was good to hear.

Honestly, I was expecting a lower number than we got, so I was pleasantly surprised. (I guess there is a silver lining for having rock bottom expectations?) I even thought I might have imagined the lines, or that they were evaporation lines, so was half expecting the beta to be 0. In that context, 26.8 sounds pretty good!

We know that whatever embryo took is chromosomally normal (can't imagine there is more than one with a number like this). We also know they biopsied the trophectoderm (which forms the placenta) to do the FISH and microarray analysis. So I'm imagining that there were many fewer cells there maybe to form this connection to my blood supply and that there is a lot of catch up hopefully going on now and in the next little while. Plus FETs are slower, according to you guys. These are my optimistic thoughts at least.

Grow little embryo, grow and firmly attach!

Oh, God, here's hoping.

Would love to hear specific low beta success stories at this point. Got one to share? I'm all ears.

Mo

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It's all in my uterus's hands. Except my uterus doesn't HAVE hands!

Today we are at 5dp5dt and symptoms continue. The meaning of said symptoms continues to be confounding. As of yesterday afternoon, I have the following to report:

Cramping for hours, followed by no cramping, followed by cramping? Check

"Pulling" uterine sensations? (have felt this when pregnant in past sometimes) Not really

Rapid heart rate/shortness of breath? (a typical early pregnancy symptom for me) Check

Indigestion/Queasiness? Check

Fatigue? Check

Sore breasts? Somewhat

Bloating? Check

Spotting? No. Gosh darnit

Who knows. But I'm thinking maybe, just maybe. Am allowing myself to hope, which scares me.

So now there is the question of when to POAS. Sigh. The Denver nurse said to consider my embryos day 5, even though they are day 6 and 7. So no extra speedy testing for that reason.

I'll be honest with you guys. I HAVE actually peed on a stick the past two days. But I haven't looked, because I don't want to be disappointed/upset erroneously. It has taken enormous impulse control, but I have succeeded. This will sound crazy, but I opened the tests, labeled them, used them, and then immediately (without looking) sealed them into envelopes. Some of you who are longtime readers may remember that Will bought me a huge batch of HPTs during the two week wait from IVF #4 (boy that seems like a long time ago), so it's not like I have a shortage of tests. Later, if I'm getting positives, I will want to find out when I first started testing positive, but on the other hand, I know I will lose hope if I see a negative - even if it's early. If we ARE pregnant, I will immediately be wondering with how many...because...hey, we transferred three chromosomally normal blasts, and I theoretically could test positive quite early. Since two of the three blasts looked like shriveled raisins after the thaw, it's seeming more like we transferred one viable one and two dead(ish) ones, so I'm more worried that we are going to get nada than that we are going to get three. But who knows.

So the question is, when to start looking at the tests? Just to be on the safe side in terms of sensitivity, I bought two First Response Early Result Pregnancy Tests today (which I think measures down to 15 mIU hcg versus my other tests' sensitivity of 25 mIU hcg). Am thinking I might possibly POAS (and look) tomorrow. Or I might wait until Friday. According to the Early Response leaflet, "one study" (sample size annoyingly not reported) showed that all pregnant women tested positive four days before their missed period. Which I think would be tomorrow, since I'll be 6dp5dt. Am I counting right?

Egads. There is so much riding on this cycle emotionally. Feeling enormous internal pressure here (and it's not just the bloating).

What do you guys think? When should I start testing (and looking)? Tomorrow? Friday?

Hoping. Hoping. Hoping.

Mo

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Two week wait symptom watch: 3dp5dt

Yesterday, I spent the morning in quiet despair that the cycle was over. Just because it felt that way, which is, well, not a good way to reason at all. Whenever my attention strayed to my abdomen region, I had a sinking feeling, because I was continuing to feel nothing going on down there. And feeling nothing has never been a good sign for me.

My mood began to brighten considerably in the afternoon when I started getting crampy. Yay, crampy!! Very menstrual feeling!! Not feeling anything in breasts so much, but the cramping (Cramping!!) lasted for about three hours and this may sound strange, but I luxuriated in it, masochist that I am. Of course, I also had the tiny nagging fear that these cramps could just signal that my period is coming. Because during the two week wait you can't win really - symptoms or no symptoms, you can twist things around in your head to be a potentially ominous sign no matter what. But mostly I was relieved to be feeling uncomfortable uterine feelings. Thrilled even.

So, I've been telling myself that if I could only feel some physical signs of reassurance, I'd calm down and be, well, reassured. And what actually happened? My relieved and mostly happy feelings lasted just until the cramps stopped, around 9 last night. At which point, I promptly ratcheted up the worry again whenever my mind drifted to my midsection. Cramps gone again? Embryos must be kaput. Strength of belief? 100% (sigh. No learning seems to be occurring here).

Today is 4dp5dt. And my uterus has gone back into hibernation. It's way too early to test, so I'm not even going to torture myself (or you) with that at this point.

I will post soon about some of the Denver clinic's recommendations/cocktails/prohibitions, in response to some of you asking. Promise.

For now, will attempt to distract self with my more than full-time job and class schedule. I can try at least.

Mo

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Home again, home again...2dp5dt

...or really 2 days post 6 and 7 day frozen embryo transfer, but who's counting?

And I am feeling...NOTHING.

The cramping I had yesterday, off to the left side, seems to be gone. So thoroughly gone that it is hard to believe it was there at all (but it was).

Been mashing my hand against my chest to check for tenderness and it is possible that there is the slightest tenderness, but if it is there, it is so so slight that it is difficult to tell. My breasts do seem rather full. But that could be the progesterone.

I'm feeling discouraged. Already thoughts trickling in about when we could transfer again and wondering if I would have to do two more months of the dreaded depot lupron to prepare, which just sounds awful (don't think either Will or I is ready for a gestational carrier yet).

Need to unpack my talisman necklace and re-center, but gosh it would be easier if I felt something going on in my abdomen. I've been pregnant five times and I think I know what it feels like for me.

Although, on the other hand, I don't have detailed records, so I can't remember what day I felt what. And this is an FET, so it's different. And when I've gotten pregnant naturally, I didn't feel implantation at all, or notice any spotting, so what exactly am I thinking I'm going to feel? Sigh.

Last night I dreamt that the nurse called and my estrogen had dropped. She had called to tell me it was OVER. I was stunned. Even in the dream I knew I hadn't had my blood drawn. How could our chances be so thoroughly over so fast?

I also dreamt I accidently drank a caffeinated beverage and was midway through the beverage - a yummy diet coke - when I realized. Akkkkk!!!! (This one will only make sense to other CCRM'ers. The Denver clinic is so obsessive about these things and I am abiding by all of their rules - including no caffeine and no decaf either. Sigh.)

So in response to all of these thoughts and dreams, and the absence of physical reassurance, I am duly trying to say to myself, "Shhh, Mo. Have patience. It's going to be ok no matter what happens. Nothing more you can do now. Simmer down. Find the middle path where a good outcome is a possibility and let some time pass."

Easier said than done, but I am trying.

One thing is for sure. It is good to be home. Telling myself that whatever will be will be.

Mo

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Bedresting twinges

I've been flat on my back since yesterday, completely taking it easy, and wanted to report I'm feeling something.

I'm definitely not imagining it. There's an on and off crampy feeling in my lower abdomen, on the left side. Started overnight. Still going on, with increasing sensation. It's not gas. It feels a bit like ovulation pain, but that can't be, can it? I was thinking it couldn't be implantation yet, because it's too soon...

But then I remembered a couple of things:

1. Two of our three transferred embryos had completely hatched by the time of the biopsy, so they were ready to go before even being frozen.

2. Our embryos are old and advanced, folks. In fact, I was trying to think how to write the abbreviation of where we are at today. For two of them it would be 1dp6dt. And our third embryo is 1dp7dt. So developmentally two are at day 7 and one is at day 8. Day 8 being around the time implantation occurs on average.

So given those facts, it is possible that I'm feeling something as I lie here (not obsessing, but attentive) on bedrest. And that that something is real and not just in my head.

You know what this feels like? It feels like hope.

Mo

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Transfer day

Thank you all so much for your good thoughts and well-wishes. They mean more than we can say.

Transfer complete, but not without a few hair-raising moments. First we received a call from the nurse yesterday that the transfer might be cancelled because I potentially misunderstood (still unclear to me) and took the first dose of progesterone a few hours early. Dr. Schl. ended up saying a few hours makes no difference, but it was a real panic situation for about 30 minutes that basically ended up seeming like needless drama from the nurse. That imaginary crisis averted, all systems were again go.

This morning, we were scheduled to arrive at the clinic at 11AM but received a call at 7:30AM to "put on my pants and just get there asap" - apparently all of Dr. Schl's transfers got moved up this morning by several hours. So we hightailed it over there and I had acupuncture and then the standard 10 mg of valium they give to relax you. Mmmmm.

They thawed three CCS and FISH chromosomally normal embryos:

Embryo #5 from June - a 6BA

Embryo #14 from June - a 4BB

and Embryo #6 from March - a 6BB

All survived, with 100% cell survival for two of them and 98% cell survival for the third. One of the three completely re-expanded, and the other two moderately and minimally (but the third one was thawed last in our race to the new transfer time this morning, and so may catch up). The lack of re-expansion on the two (see pic below) scares the bejeezus out of me, but I'm trying to just accept it and hope for the best. Not sure how critical it is. Any of you know?

After spending much time post-transfer trying to pee in a bedpan (boy that was difficult!) and getting a second round of acupuncture, I'm back at hotel and on bed rest until Sunday - planning to snooze a lot after very little sleep last night (nerves) and watch multiple episodes of Mad Men for entertainment. Love that show. Will is as usual being a champ and helping me do everything I need. Such a good husband!

I'm not feeling too hopeful, more just terrified, which is maybe what hope looks and feels like at this stage of the game? Talisman necklace clutched tightly in hand, prayers on my lips. Hoping to find a zen place to settle my mind in soon, but so far somewhat failing.

Here are the Mo and Will threesome below, if you're curious.

Any thoughts on the lack/slowness of re-expansion and what it portends? Any of you btdt with vitrified blasts and had a good or not-good outcome?

More to come soon...

Mo

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