Monday, July 31, 2017

Our Infertility Story - Part 2 (IVF)

Sorry it's taken me so long to finish part 2 of our infertility story. I started the post in the final days of my pregnancy, but didn't get a chance to finish before our baby girl decided to make her entrance into the world. The past 3 months have been a whirlwind and I'm finally starting to find sometime to finish up.

Once we were advised that our best option to conceive would be IVF I began researching a clinic that would best fit our needs. I think this was probably one of the hardest decisions for us to make. With so many IVF clinics in the bay area I found it extremely difficult to navigate all the different options. It was such an important decision and with pricing and protocols at each clinic widely varying it wasn't like you could just yelp the best IVF clinic. In the end we decided to go with Dr. Polansky and his team at Bay IVF. I liked that they offered a variety of IVF options (ie: traditional IVF and soft IVF), PGD (preimplantation genetic diagnosis), and a 3 cycle treatment plan that would refund us a portion of our investment if we got pregnant before the 3rd cycle. Most of all I liked that they were a small clinic which made me hopeful that we would get more personalized attention.

Before we were able to start an IVF cycle the doctor performed an initial physical exam and blood work followed by a sonohystogram to determine whether or not I had any uterine abnormalities. The procedure was reminiscent of the HSG I had previously done, but instead of injecting dye and using X-ray imaging they injected saline via a catheter and used a transvaginal ultrasound for the imaging. Similar to the HSG it was pretty uncomfortable with some cramping as the saline was injected into my uterus. After all was said and done they provided us with our probability for a success starting at 27% given a single cycle and 60% given up to 3 cycles. I remember being so optimistic about the statistics at first...after all 60% was better than a 50:50 chance, right?

By the end of January 2015 we were off to the races and began our first egg retrieval cycle. I was started on birth control which seemed weird given that I was trying to have a baby, but the doctor reassured me that it would to help prime my ovaries for the upcoming egg retrieval. The doctor highly suggested that while we were attempting IVF that I should cut gluten from my diet. Cut gluten??? But that's my favorite food group! To be honest I was very skeptical about how much cutting gluten out of my diet would instead I opted for moderation instead. I was also given Lupron (LH) and Follistim (FSH) injections to rev up the production and maturation of my follicles. I was honestly terrified of having to give myself daily injections and wasn't sure if I could do it. To my surprise the injections were pretty much painless and I was able to get over my fears quickly. I was lucky enough to get away with almost no side effects from the Lupron and biggest complaint were hot flashes that would come when I was stressed at work or wake me in the middle of the night. While on the injections I had to make multiple trips to the clinic each week to monitor my estrogen and progesterone levels as well as check the development of my follicles via ultrasound. When we first started IVF I had no idea that I'd have to be monitored so closely and I was lucky to have so many co-workers who were willing to swap shifts with me so that I could make it all of my necessary appointments. Once the majority of my follicles looked to be the ideal size I was instructed to administer my Novarel (hCG) injection which would stimulate my ovaries to release the mature eggs from my follicles. Unlike my Lupron and Follistim the Novarel injection stung quite a bit and even left a bruise on my tummy. Again I was lucky to get away with almost no side effects from the Novarel except for some extreme breast tenderness. 36 hours after my Novarel injection I returned to the clinic for my egg retrieval. I was super nervous for the procedure as I had read online forums about how painful it could be. Before the procedure started I was given a cocktail of IV medications that relaxed and numbed me throughout the entire procedure. I honestly couldn't tell you anything about what the actual procedure was like. Once the procedure was complete I was left to recover and let the medications wear off before I was sent home. Before we left the clinic we were told that they were able to retrieve 10 eggs. I was happy with the least we were in the double digits. However, after fertilization on day 6 we were told that we only had 5 eggs that had fertilized and matured into blastocysts. Our 5 embryos were frozen and biopsied samples of each were sent to the PGD lab for testing. It was disappointing to say the least to hear that we had lost half of the eggs that had been retrieved. Nonetheless we were still hopeful...we just needed a few good embryos to carry us through several rounds of implantation. Unfortnately we weren't so lucky, of the 5 embryos there was 1 embryo deemed normal. The news was shocking and heartbreaking for us, how could we have gone from 10 retrieved eggs to only 1 normal embryo? Worst of all we got the news while we were vacationing in New York...what a way to ruin a day. I remember going back to our hotel room and crying in the arms of hubs after receiving the devastating news. I had been so hopeful that IVF would be a quick fix for our infertility problems, but reality hit me like a ton of bricks.

Disappointed in the results of our first round of egg retrieval, we were eager to start our next round in May. The procedure was generally the same...birth control, Lupron, and Follistim...however this time there were concerns about my extremely high levels of estrogen which put me at high risk for developing OHSS (ovarian hyperstimulation syndrome). Hubs and I had worked this egg retrieval around a trip back to Hawaii for one of my best friend's weddings. The clinic warned that I would have to be closely monitored after the egg retrieval to make sure my OHSS did not become life threatening and would absolutely not be allowed to travel during this time period. Again, I was devastated...I was left with the choice of canceling this round and losing all the time and money we had already invested or canceling our trip to Hawaii and missing one of my best friend's wedding. In the end we decided to cancel this round of egg retrieval. After having to make such a difficult decision we were extremely lucky that the clinic said that they wouldn't count this as one of our 3 rounds and would provide us with samples of the more expensive medications for the next round to help us recoup some the money we had essentially lost due to having to cancel our egg retrieval.

Once we returned from our trip to Hawaii we were ready to jump into another egg retrieval. Due to the clinics protocol I had to repeat my sonohystogram since it had been over 6 months since my original procedure before starting our 3rd round of retrieval. At the beginning of August we got the go ahead to start the egg retrieval procedure, again with birth control, Lupron, Follistim, and Novarel. This retrieval resulted in 12 eggs. I was excited that we had been able to retrieve more eggs than our 1st round, but given the end results of our 1st round we were much more reserved in our hopefulness. And rightfully so, because 6 days after fertilization we only had 3 embryos that had matured into blastocysts to be frozen and biopsied for PGD lab testing. The results of our PGD testing showed that of the 3 embryos, only 1 of them was deemed genetically normal. Again we were disappointed, but at least now we were ready to do a our first FET (frozen embryo transfer).

At the end of September we were excited to finally start our FET. We decided to transfer a single embryo so that we could avoid the possibility of having multiples. The FET protocol called for more Lupron in combination with estradiol patches and high dose progesterone suppositories. Again I had be closely monitored to evaluate my estrogen and progesterone levels as well as check the thickness of my uterine wall. Our embryo was thawed and transferred at the beginning of November. The embryo transfer was much faster and easier than the egg retrieval. Our embryo was implanted into my uterine wall via catheter and the actual procedure only took a few minutes. The doctor assured us that it was as perfect a transfer as he could have asked for and we were sent on our way. Given what the doctor had said about the success of the transfer and the fact that I had a very healthy uterus we were so hopeful that this was going to be it! I continued with the estrogen patches and progesterone suppositories and giddily googled all the possible signs of pregnancy that I was experiencing. We had to wait 10 torturous days before I returned to the clinic for a pregnancy test. Surprisingly I was able to muster all my self-control and I never took a home pregnancy test before returning to the clinic for my pregnancy test. The day of my pregnancy test we excitedly waited on pins and needles for the clinic to call us with our results. When they called to deliver the bad news that our embryo hadn't taken we were devastated. We'd been so hopeful that this would the happy ending to our journey that the news was absolutely crushing. With the holidays fast approaching we decided to take a step back and give our minds and hearts a little break from IVF.

At the beginning of the year with renewed hope we started another round of egg retrievals. As with the previous rounds I started with birth control, Lupron, and Follistim; then finished off with a trigger shot of Novarel. We were able to get a whopping 14 eggs from this retrieval which made us hopeful. When the embryologist called to let us know that 7 days after fertilization we only had 1 embryo that had matured into a blastocyst I was absolutely beside myself. I had prepared myself to lose over half the fertilized embryos, but to be left with only 1 felt incomprehensible. To add insult to injury the embryologist needed to know ASAP whether or not we wanted to send a sample of our embryo for PGD testing which was a costly investment for just a single embryo. Luckily, in the end the lab that did our PGD testing generously offered to test our embryo free of charge. The results of the PGD testing showed that our single embryo was genetically abnormal and we were back at square one.

After 4 egg retrievals and 1 failed FET we felt utterly defeated and scheduled a phone consultation with Dr. Polansky to see how we should move forward. During our consult he admitted that we had been one of his top 5 toughest cases in his entire career. Although this news was discouraging, it also felt like a relief to validate our frustrations. We discussed whether or not the use of a donor egg would be more likely to yield a successful pregnancy. And while he agreed that our chance for a successful pregnancy would be greatly increased with a high quality donor egg, due to my young age he typically wouldn't recommend that route. He said that typically after 3 unsuccessful rounds he usually refers his patients to another clinic, as a different approach may be more successful. However, he said he wanted to give our case one more shot and left it up to us as to how we wanted to proceed. We spent the next few days discussing our options. Still feeling disheartened by all of our failures I agreed to try 1 more time, but told my husband this would be the last time. I didn't think my body and heart could take much more of this.

With a heavy heart we started our 5th egg retrieval cycle in March. Dr. Polansky switched our protocol to a soft IVF protocol in hopes that my body would respond better. This protocol still used Lupron, Follistim, and Novarel; but included Clomid (clomiphine) as well. We were able to retrieve and fertilize 10 eggs; 6 days after fertilization we had a whopping 7 blastocysts to send for PGD testing. It was the largest number of embryos we had ever been able to send for testing, but I knew better than to get my hopes up. The results from the PGD testing showed that 1 out of the 7 embryos was genetically normal. Before our FET I underwent yet another sonohystogram to make sure my endometrial lining was healthy. We followed the same FET protocol as last time, but this time I also underwent a laminaria tent procedure, where a tiny piece of dried seaweed is inserted to dilate the cervix to make the embryo transfer easier. Again, our doctor assured us that the transfer had gone smoothly and all there was left to do was wait.

I had been so defeated by the whole IVF process that I had little to no hope of receiving positive news. In fact, I remember calling my husband during a particularly difficult day at work crying and telling him that I was absolutely sure I wasn't pregnant this time. After the "10 day wait" I went in for the pregnancy test and we waited to hear the results from the clinic. I was still sure that I wasn't pregnant so I asked them to email the results of the pregnancy test instead of calling us because I didn't want to cry over the phone with them. Once we had mustered up the courage to open the email we were both shocked to see that the pregnancy test was positive. My husband and I cried tears of joy much of that day, but we knew we weren't out of the woods yet. I still continue my estradiol patches and progesterone suppositories to maintain the pregnancy until my body's own hormones caught on to the fact that I was indeed pregnant. We were scheduled for an ultrasound about 2 weeks later where they would check for a heartbeat, at which there was a 90%+ chance that I would go on to a successful pregnancy. We were cautiously joyful and shared the news with only our parents since we knew there was still a chance of miscarriage at this point. We were so nervous going into our ultrasound...I was absolutely terrified that they wouldn't find a heartbeat since I had let my hopes soar once we received the news of our positive pregnancy test. When our doctor showed us our tiny little baby on the ultrasound and we heard her heartbeat we both cried tears of relief and joy. I couldn't believe that at a time where I had almost given up hope we were finally gifted the pregnancy we had dreamed of for so long.

Going through infertility and IVF has been one of the most difficult things I've ever had to endure...the misery of being on medications that made me sick, hundreds of injections, painful procedures, and heartbreaking failures. In hindsight as I look at my baby girl's chubby cheeks and smiling face I'd do it all again in a heartbeat.

I hope that anyone reading this that's going through infertility will be given hope, and that those who know someone going through infertility will better understand the difficult journey their loved one is going through.