IVF#2: Embryo Development Day 2

(Image from: http://www.advancedfertility.com/4cell.htm )
On day 2 of development, embryos should have 4 cells. The grading of them depends on the level of fragmentation.

Of our 13 fertilized embryos:
7 have 4-5 cells, and are graded as good
5 have 4-5 cells, and are graded as average
1 has 2 cells, but is still alive and could catch up

I asked the embryologist to give us daily updates, which they don’t normally do. I am so grateful that she is doing this for us, and appreciate the time she takes to answer our questions.

OHSS watch:
Weight: up 0.2 of a pound
Waist measurement: up 1 cm

How I’m feeling: Ovaries are still sore, especially with movement, peeing and pooping. The Dostinex is still making me super nauseous despite taking it at night and with food. DW made me a great breakfast in bed: GF grilled cheese and soft boiled eggs, with a side of Gravol.

Today, I start all of my embryo transfer meds:
– prednisone 10mg
– endometrin (progesterone suppositories)- 100mg x 3 times a day
– prometrium (progesterone orally)- 300m at bedtime
– Fragmin injections

*TMI Warning*
Shoving the Endometrin in my vagina was a real treat this morning (not!). My vagina is clearly still in the early stages of healing after all the egg retrieval punctures. I couldn’t get the suppository more than two inches inside, because everything was clenched and hurt.

I’m a little worried about the Prednisone, because last time (failed FET) it caused major comfort food cravings, as well as water retention. This time, I’m trying to stave off OHSS, and the last thing I need is to crave bad food and retain water. However, a nice therapeutic effect of the prednisone is that it made my digestive issues go away. Honestly, my usual IBS and Celiac issues seem to go away when I’m on the Prednisone, which is wonderful.

FET#4: Protocol

There are a lot of meds involved in our FET this round, and I thought that I’d like to document it, both for myself, but also to help anyone else who is also going through this. The days refer to cycle day, and non-medical supplementation is in brackets (Chinese Medicine herbs).

Days 3-16: Estrace 6mg daily

Days 3+: ASA 81mg daily

Day 13: Intralipids

Day 17+:
7:30am: Prednisone 10mg, Estrace 2mg, Pink PregVit, 100mg Endometrin, (1000IU Vitamin D, Yuan Support Formula- 4 tablets)
3:30pm: Endometrin 100mg, (Yuan Support Formula)
Dinner time: ASA 81mg, Blue PregVit Folic 5
11:30pm: 5000IU Fragmin, 2mg Estrace, 300mg Prometrium, 100mg Endometrin, levothyroxine 25mcg, (omega 3 fish oils, Yuan Support Formula)

Day 21: Frozen Embryo Transfer

Day 31: HCG beta test

Day 33: Repeat HCG beta test

Sometime after Day 33: Intralipids

Tips:

– Set time alarms on your phone so that you take your meds at the proper times.

– But a pill schedule case like this to organize yourself:

– inject the Fragmin super slowly

– protect your underpants from leaky Endometrin using long and wide, but super thin panty liners. Better yet- make your own cloth ones, they are so much more comfortable

– clean your lady parts after Endometrin messes, or else it seems to burn down there

I just started the huge combo of meds today, and let me tell you, the Fragmin burns like a B$&@H! I was perfectly fine with the Lupron, Follistim, and Ovidrel injects during my stimulation phase, but this needle would not break the skin without significant force, and while I plunged very very slowly, the medication itself causes a strong burning sensation. I had DW hold my fat roll for me because I needed two hands to steadily depress the plunger, and it felt like she was pinching me as tightly as she could with fingernails (she wasn’t- that’s just what the Fragmin felt like going in). Anyway, I will find a way to make it work, as it needs to be done daily, but right now it is a not-so-distant unpleasant memory. Some advice: have someone else inject it for you, inject the drug very slowly, stop and catch your breath after the burning feeling, inject some more, and so on.

We also keep a stash of homemade organic tea tree and witch hazel wet naps by the toilet to help me “wipe up” any nasty Endometrin leakage (vaginal suppository). I am back to wearing large Cadillac-sized panty liners again too (so as to not ruin my underwear), so the wipes help to prevent some of the chaffing I experienced last pregnancy.

Happiness Cycle Day 14: Downtown

DW took the day off work today, as we had a day of medical appointments, in town and out of town. She has also been so busy and overworked so far this semester that she really needed a “mental health” day as well.

I must mention that I finally had a good sleep last night, after almost a week of terrible anxiety-induced insomnia.

This morning DW made me a decaf coffee (such a nice treat to be served coffee in the morning), we gave the dogs got some consolation pats on the head, and we were on our way.

Our first stop was the fertility clinic’s satellite clinic, which is in our city. I needed to have my blood work and ultrasound monitoring again. Things are on track, with my uterine lining measuring 9.4 today, up from 8.7 of two days ago. I also got a “present” from one of the receptionists, who wasn’t working today, but had mentioned last time I was in that “she’d give me a troll to put down my pants”. I wasn’t sure what she meant by that, but she meant Treasure Trolls, those dolls from the 80’s, for good luck. We joked about for a bit- especially the part about putting one down my pants. Anyway, today, the phlebotomist nurse gave me this on behalf of the receptionist:

So thoughtful and sweet!

After that, we headed downtown, to see my family doctor. I was really nervous and stressed about this appointment, not knowing how to describe and explain the overwhelming emotions and feelings that I have been experiencing since the miscarriage. When we got there, my family doctor was super attentive, gave me room to talk, listened patiently and compassionately, and gave some good advice. I shared with her how depressed and anxious I have been feeling, how it has continued to affect my sleep and made me weary of socializing with friends who aren’t aware of our situation. She had me complete some forms: a depression questionnaire, an anxiety questionnaire, and a survey on the impact of my feelings on my activities of daily living. It was the first time that I had taken inventory of various aspects of my depression and anxiety, and how it has been affecting me beyond just my feelings and sense of hope for the future. This whole time I’ve been so consumed and obsessed with our miscarriage(s) and getting back to making babies that I completely lost sight of how I have been doing as a person. I mean, I knew that I was depressed, and I knew that I had an anxiety problem, but I had always placed them under the context of the miscarriage, and not really that they themselves are focal points that need to be addressed.

I have battled depression before, and had reached a nice homeostasis with Wellbutrin for years. When I first met DW, I had already been on it for many years, but like most people with mental health issues, because I felt better, I thought “why not, let’s try life anti-depressant free!”. That was a couple of years ago, and for the entire time, I have been fine. However, with the fertility challenges and heartbreak of three miscarriages, I think my dear friend depression has snuck back into my life, and has brought his asshole friend anxiety along as back-up.

I have mentioned my emotional struggles on my blog many times, but didn’t realize how bad it has gotten until I answered those questionnaires, and saw and felt the true concern in DW’s and my family doctor’s feedback on how I seem, and have been behaving. I guess this is sort of what an intervention feels like. I’ve been so caught up in my own head, and needed to hear what other people are observing. My depression and anxiety are a big concern right now, and my family doctor is concerned enough about it to suggest that I start some medications right away. She suggested Cipralex, which is an SSRI, and is effective for both depression and anxiety. I would love feedback from anyone who has taken it before. She says that it is safe before, during, and after pregnancy, even though Dr. Google claims otherwise. But I am convinced that you can search anything and find support for it in the form of a online support forum. This I have learned from the all-consuming world of TTC.

She wants me to double check with the RE that he Cipralex won’t interfere/interact with all of the other stuff that I will be on: estrace, prometrium/endometrin, aspirin, fragmin, prednisone, intralipids. I’ve emailed the RE’s nurse, so hopefully I will hear back soon.

I have mixed feelings about taking the Cipralex. On one hand I think that it would be better for me to just tough it out, that it’s normal to have feelings of sadness and despair, or constant worry, given what I’ve been through. On the other hand, it is becoming more and more apparent to me that my depression and anxiety levels are abnormally high, and the culmination of evidence is that that can negatively impact our potential pregnancy even more than the small risk of cardiovascular defects and autism that have been reported but not confirmed. I look at DW, and some of you who seem “recovered” from your miscarriages, and wonder why I’m still stuck in this destructive loop of depression and anxiety. I realize now that it’s because I am struggling with an extra layer of mental illness.

Work has been harassing me again as well. In the past seven days, the person in charge of leaves has called me three times and emailed me once. This is after talking to her already the first time. She didn’t have anything new to discuss the subsequent times, but rather has been very negative and pushy in her tone. DW says that if she calls me again, that we should complain to the union. The last thing you want to do when you have an employee suffering from a mental health challenge is harass them.

Anyway, after my doctor’s appointment we went out for lunch at our favourite Vietnamese place.

Then grabbed some baked treats down the street at this great little bakery we found by accident one day the last time we were here. I got a gluten-free chèvre cheesecake, and DW got “the best butter tart ever”, as well as a pear almond tort-like thing that has a fancy French name that I don’t remember.

We then went shopping at our favourite outdoor store: Mountain Equipment Co-op, where we caught up on some much needed shopping, and bought a couple of early Christmas presents (me mostly).

We also got a call from our primary nurse today. I am supposed to start my long list of meds on Saturday, in preparation for our embryo transfer on Wednesday morning!

I hope that time moves fast, as I’m anxious for our last embryo to come home, but I also feel like I need some time to process everything that has happened today. The good, and the bad new.

Embryo Transfer #2 = Miscarriage

(From http://community.fertilityflower.com/blog-home/pregnancy-loss-art/attachment/mabith-miscarriage-quilt-version-2-2010-3/)

I have a difficult time trying to describe how we feel, not because I’m lacking in words, but rather because I am overwhelmed with such intense feelings. It’s like there is a Wordle in my heart, dense and under high pressure, weighing me down. Each day a new emotion is added to the list.

This round of FET was particularly frustrating because the nursing team at the fertility clinic FUCKED up on two accounts:

1. Dating of DW’s beta – no big deal but if they are messing that up, what other time-sensitive stuff did they also mess up?

2. Her medication. DW had major irritation from the Endometrin (vaginal progesterone suppository), and so they instructed her to replace the 300mg of Endometrin with 300mg of oral Prometrium. I had a weird feeling about it because often specialists instruct patients to take the prometrium vaginally rather than orally because of absorption issues. I had her call them again to confirm that the dosage and route was equivalent to the 300mg of Endometrin. They confirmed it and she followed as they had instructed. A few days later, she started spotting, which is sometimes normal, except that the spotting became red blood and then a full period-like bleed. At about the same time, the intense nausea that she had disappeared and she started having cramps. Really intense cramps.

Trying to make sense of all of this, I found this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695240/#__abstractid1101714title

Which finds that oral Prometrium will test in expected concentrations in the blood, but very little of it actually makes it to the endometrium of the uterus, which is where it is needed.

A lack of progesterone will make your uterine lining shed.

Now, I’m not sure if there is a threshold amount of progesterone that is required and if we were okay in that respect anyway, but 300mg of oral Prometrium actually is like 30mg of usable Progesterone and is no where close to the 300mg of Endometrin which absorbs almost completely into the uterus.

Anyway, we’re in a strange place right now. Part grieving, part blaming (ourselves and the clinic), part next steps.

IVF and FET have a much greater chance of success than the IUIs we were doing last year.

DW wants another go at it (FET), because she feels like she won’t be a stakeholder in these babies (if they ever become real), but two miscarriages in a row necessitates more investigation into why she isn’t keeping the pregnancies. At the same time, we only have 3 embryos left, and my womb hasn’t had a try yet.

What to do?

Right now my daily life is very difficult to navigate through. I teach at a really rough school, where the kids are extremely disrespectful to teachers and administration. I was successful in transferring to a different school for September, but I still need to ride out the last month and a bit of this year.

On a daily basis, I have extreme moments of stress because of my job. In addition to that, everyone around me is pregnant or having babies. A friend/colleague of mine just found out she is having twins, and is griping about it. All I want is a piece of that, and I feel like with each failed attempt, my image of having children gets blurrier.

I am struggling with a lot of emotions and expectations and I feel like my own needs aren’t being met. The problem is, that I am so far down each of these holes that I can’t even find a way to climb out.

Back in the Game FET #2

I haven’t been blogging much for a couple of reasons:

1. Work is kind of hellish right now, and my grandma once said to me: if you’ve got nothing nice to say, don’t say anything at all.
2. Ball hockey season has begun, and between weekend tournaments and twice weekly games, I have zero extra time.
3. Nothing has been really happening in terms of our Gayby-making agenda…. Til now.

2014 has consisted of a whole lot of waiting so far. In fact, almost half a year of waiting. First, it was waiting for DW to have two menstrual cycles after her miscarriage, then it was waiting for her weird post-car-accident bleeding to pass, and then another period. Well, 5 months later, here we are.

DW finally bled on April 23rd, started Estrace 3x per day on April 25th, and adds prometrium and endometrin 3x per day as of tomorrow May 8th.

Finally, our 5-day blastocysts move in on Monday, May 12th.

We are very excited, but a little guarded about our emotions.

You’ll probably hear more from me soon!