Monday, February 2, 2015

Our Experience with Infertility: Part VII - IVF #2

For those that are new to this blog or who don't know me personally, we attempted our 1st IVF back in August of 2012. This gorgeous little boy was the fantastic result. He's a super social child who always wants to interact with others, so we are eager to give him a sibling to play with as soon as possible.

In January 2014 I went in for a consultation with my doctor to ask her if I was able to conceive again. Although my menstrual cycles had returned a few months earlier, they were much less intense than they used to be. Ty had stopped needing to nurse at night, but since he was still nursing several times a day, I thought it might be preventing me from having my normal cycles. Before having Tyler I would consistently get incapacitating cramps, bad enough that I often missed school or had to call in sick to work. I didn't believe these super light, painless periods could actually mean I was ovulating normally again, but my doctor assured me I was. She said the biggest sign of ovulation is the regularity of your cycles, that menstrual cycles often change for better or for worse after having a baby, and that I just happened to be one of the lucky ones it had improved for. I also asked her about women that are able to conceive naturally following a successful IVF, but she didn't think that was likely to happen for me. She said most women she knows in that situation became pregnant again very quickly due to the fertility rush that often follows immediately after giving birth. Since my issues are unexplained and don't appear to be caused by physical infertility, a post-labor fertility rush was unlikely to fix things for me. There was still a chance, though, so she advised we attempt to conceive on our own for 6 months after my menstrual cycle returned before attempting another IVF. I also asked about the mini-IVF I'd heard about, but since the standard IVF had been successful the first time around and we had equivalent insurance coverage for both procedures, she thought it best to stick with what we knew had worked rather than experimenting with something new. We did have an additional embryo stored and frozen from our previous cycle, but since I was almost 32 years old and only had a few more years of high fertility, she advised we take that route. Fertility declines with age starting around 32, more so at 35 and significantly so by 37, so if I was going to attempt another fresh cycle, now was the best time to do it. If for some reason I didn't stimulate well and we ended up without any viable embryos to transfer, we could always use that extra embryo instead.

I then contacted my nurse at Accolade, our go-between with our insurance company, told her about my doctor's visit and recommendations, and asked if there was anything else I needed to do. She said all I needed was to get whatever updated testing my fertility clinic required, so in April I was about to start birth control in anticipation of a May IVF cycle when my insurance sent me a letter saying they would not approve coverage yet. Because so many women are able to conceive naturally following a successful IVF, Premera basically required we prove to them that we were still infertile. We had to attempt to conceive naturally for a year after my menstrual cycle had returned before we could request coverage again.

Although the requirement makes sense and I wasn't surprised by it, I was a bit annoyed that I'd requested that sort of information in January and didn't get it until I was just about to start the cycle in April. I told my nurse about it, who apologized for giving me incorrect information and told me my email had stumped her. That requirement wasn't in any of the materials provided to her, and she had to consult a specialist at Premera to find out all the specifics for me. Apparently it doesn't happen very often. Usually when patients use their 2nd or 3rd covered IVF attempts, it's because their first attempts weren't successful, so they certainly wouldn't need to establish their infertility status again. Also, most of the women doing IVF are 35 or over, which is when the definition of "infertile" changes from one year of trying to conceive down to 6 months. And then there are all the women that are able to conceive on their own after an IVF pregnancy or who for other reasons decide not to attempt IVF again. It's just more evidence of our uniqueness, I guess ;)

I was happy to learn, though, that I wouldn't have to stop nursing Tyler before he was ready for it. I'd read that 44% of women won't ovulate until they've stopped breastfeeding entirely while about 33% will start ovulating once the baby stops nursing at night. I'd considered switching to formula if my period hadn't returned by 6 months post-partum, so I was actually quite thrilled when it did return at 5 months. Later when we started planning for a May IVF, the doctor advised me to cut down one feeding a month, but it wasn't working out too well. Even as Ty increased the amount of solids he ate, he still wanted to nurse just as much. When we learned that we wouldn't be able to attempt the IVF until December, it at least allowed Ty to set his own pace. I'd originally intended to wean him at a year, but since he wouldn't drink enough fluid on his own at that point, it was just easier to continue nursing him than to start bottle feeding him cow milk. By 14 months he'd mastered using a sippy cup and drinking for hydration, so I knew I could wean him without needing to supplement with a bottle. He never turned down nursing when it was offered, but for the most part he stopped asking for it, and when he did he'd only nurse for a minute, roll himself off the boppy, then come back for more 5 minutes later. Once I'd become the equivalent of a sippy cup to him, I decided to lead the weaning. I couldn't just stop, though, since that would have been very uncomfortable for me, so I dropped him down to 1 feeding a day, then once every 2 days. I tried for once every 3 days, but by then I was producing so little that he'd drain me quickly and cry for more. That was the day we stopped, though I was a bit disappointed that his final nursing session ended up being so unpleasant for him. He weaned completely by 15 months, 3 months before I was required to stop for the December IVF.

And so it was another 8 months before we could get try to get pregnant. My insurance gave me coverage to try IUI as often as we wanted to, and we did do 3 attempts, but as expected, they were unsuccessful. This gave me bit of closure, though, since I'd read that about 70% of couples will have conceived by the 6th IUI. The 3 more we attempted put us at 6 attempts total, so now I'll never have to wonder if that would have applied to us. Even though I didn't have much hope for the IUIs, they at least helped me feel like I was doing something. I couldn't do what I wanted to do, but I was doing everything I could do.

On a side note, one extremely common thing for people to say when you're struggling to conceive is something along the lines of "don't stress about getting pregnant. Just relax and it will happen. You're worrying about it too much." Unfortunately it's one of the worst things you can say because it's based on a misunderstanding of how stress affects fertility. Though it may be well intended and we've all heard conception stories from people who swear that it's true, it ultimately does more harm than good. Because this "just relax and you'll get pregnant" myth is so widely accepted, it demotivates those with serious fertility issues from seeking out the help they need out of fear that their natural concerns are actually causing their own infertility. Since fertility declines significantly for women over 35, many end up wasting their most fertile years futilely waiting for a baby that was never going to arrive without medical assistance. There are many couples that wait 10-15 years before turning to reproductive assistant techniques, and by the time they do their chances of success are less than half what they would have been if they'd gone in after only 2 years.

While sudden excessive stress can disrupt the brain and in turn prevent normal ovulation, common everyday stress will not cause long term infertility. Even if you work and live in a highly stressful environment, the body is extremely good at adapting to stressful situations and healthy ovulation will return within a few months. Serious post-traumatic stress like coping with the loss of a loved one could contribute to years of infertility, but certainly not the standard stress of trying to conceive. So basically, if you've been trying to conceive unsuccessfully for a few months and your periods are irregular, then yes, stress might be an issue. But if you've been trying to conceive for a few years and your periods are pretty predictable, stress is not the problem. That's when it's time to consult a fertility specialist.

The reason I mention this is to explain how our 6 IUI's, though unsuccessful, gave us some reassurance that we were doing everything right and that we hadn't missed some necessary step in the conception process. Many common physical factors can prevent pregnancy, and they happen often enough that even healthy fertile couples attempting to conceive only have about a 20% chance of successfully doing so on any given month. These include irregular ovulation, insufficient egg development, poor timing or positioning of intimacy, poor diet, vaginal infections, uterine cysts, and/or not having enough healthy mobile sperm. The nice thing about our IUIs is we now have concrete proof that none of those ordinary concerns can account for our inability to conceive. During IUI they give you drugs to ensure you ovulate regularly and produce at least one high quality egg, they perform vaginal ultrasounds to time the ovulation window perfectly and to observe if there are any potentially hazardous cysts or infections, they position you with fancy tools that place the sperm as close as to your cervix as possible, and a sperm washing and analysis is done to make sure the counts are high enough for the procedure and to cleanse the sample of anything but the highest quality sperm. If we couldn't get pregnant with 6 attempts under medically perfect conception circumstances, then certainly there's nothing else we could have done to get pregnant naturally. Although we don't know what causes our inability to conceive, I have to admit I like knowing what's not causing it, and that the silly things people often suggest; like stress, diet, or my personal favorite "you're not doing it right," are completely bogus.

After our IUI attempts I had one more regular cycle and then finally our year of attempting to conceive was over. I began taking birth control while we requested IVF approval from my insurance. I also had some updated testing. There were blood tests on day 3 of my cycle to confirm my current reproductive potential, and 5 days later I had a uterine evaluation to make sure the pathways looked clear for my eventual embryo transfer. The nurse told me it can change after having a vaginal birth, and in my case it actually made it even easier for them. A few days later there was a suppression check to check for cysts and confirm that the birth control had successfully prevented ovulatory activity. I had a small cyst, but she said that was most likely a harmless ovulation cyst, which was later confirmed post-testing. I was good to go for an upcoming IVF cycle.

Although approval came through for our procedures, there were some issues with the approval for my medicines. For example, the preferred insurance gonadotropin pen was Follistim, but I'd been prescribed Gonal F, the same drug I'd used during our first cycle. The doctor was happy to prescribe the other for me, but my copay for Follistim was significantly higher than it was for Gonal F, so why would the preferred drug cost me more? It took a few days for the proper insurance coverage to get worked out with the Caremark specialty pharmacy (though I would later have issues with them twice again when reordering my progesterone supplement), so I ended up staying on birth control a few days longer than originally scheduled. This now put my egg retrieval and embryo transfer right on the week of Christmas.

Though that wouldn't have been our preferred timing, we were just eager to get it done before 2015. We were within a few hundred dollars of our medical out of pocket annual maximum, so doing the IVF before the start of the new year cut the costs down considerably. We didn't mind sacrificing a bit of our holiday to save the money, but it also meant missing Oscar's sister's wedding in Utah on December 18th. That was unfortunately a terrible time frame for us not only because of our IVF but because that's a super busy time for both of us at work. Essentially if we'd delayed the IVF and gone to her wedding, it would have cost us around $4000 in holiday airfare travel, lost wages, and additional out of pocket costs for our IVF. As much as we would have liked to see her get married, there were just too many factors working against it. :/

In early December we finally received our medicines and were able to get started. Mom was up here for the holidays, which was really nice. Among other things she helped mix and administer the shots and kept an eye on Tyler while I was at my doctor appointments. On December 6th I started on a medicine called microdose lupron. This is a shot administered every 12 hours to prevent your body from ovulating on its own schedule. The doctors, of course, need to be in complete control over when you ovulate in order to time your future egg retrieval. It's a fairly low dose, the needle is small, and since you administer it in the fattest part of your gut, it's definitely the least bothersome. I barely felt these at all.

On day 6 of the cycle I began the egg stimulation drugs - Follistim and Menopur. They were administered together once a day between 7pm and 9pm. Follistim is a medical pen which can be used multiple times. You insert the cartridge and the needle, which act like the ink and the tip in a writing pen. My pen went up to 900 units, but since I only needed 450 per day, I would only use half the pen and refrigerate the rest. This medicine is often used in much smaller doses for natural or IUI cycles, so a 900 unit cartridge could last a couple weeks. For this reason, it comes with about 10 times as many needles than I would end up using. This medicine was relatively easy to administer, though the Gonal F pen I used last time was even less complicated since the cartridge was built into the pen. I could feel this pen more than the lupron shots, but they really weren't too bad.

The other egg stimulation medicine was Menopur. This was my least favorite. You have to dissolve the powder in a vial of liquid, and it always stung when administered. The needle was larger than the others, and mom sometimes had a hard time drawing up the full amount of liquid into the syringe. While I wouldn't say it was badly painful, it was the most noticeable of the three.

We were given a sharps collector container to put all the used needles in. I still need to take it to a pharmacy for proper disposal. Last time it cost me $2.

On the 12th, 15th, and 19th I went into the fertility clinic for ultrasounds and blood draws. The ultrasounds count and measure your follicles to see if they're growing well enough to produce an egg, and the blood draws make sure your hormone levels are normal (they actually hook a condom around this instrument on the right before administering the ultrasounds. I bet the delivery person wonders why they're delivering hundreds of condoms to a fertility clinic. I've also seen condoms used as portable microphone covers during stage performance. They have many uses!). If you aren't stimulating enough they might increase your dosage, and if you're hyperstimulating they might decrease your dosage. I always thought the bigger the follicles the better, but it turns out that's not true. They can get too big and either become cysts or not produce a good quality egg. In a regular cycle you'd have many follicles but only one would develop enough to release a decent egg. In IVF that particular follicle may end up becoming useless since the drugs can easily overstimulate it. Last time my follicles grew pretty slowly while this cycle they were right on track. They counted 8 at the first, 10 at the 2nd, and 13 at the final ultrasound. This was very reassuring for me since I only had 9 total back when Tyler was conceived.

About 5am on the 13th I woke up startled when I realized I'd forgotten to take my medicines the previous night. I called SRM to page the on call doctor, but she wouldn't call back. I kept calling every half hour until 7am, and they kept re-paging her, but still nothing. I knew I should take the medicines as soon as possible, but I didn't know if I should increase the dosage or take them at a specific time. Finally I got a call back about 7:30am, and it turned out they'd been paging the wrong doctor. She eventually called me back too once she got her messages, but by then I'd already heard back from the actual doctor on call. Fortunately since it was early in the cycle there wasn't too much concern that I had accidentally ovulated, so they just instructed me to take the previous evening's dosages that morning and to get back on track with my schedule that evening. After that I set a regular reminder on my phone to make sure I never forgot again. This was too expensive and too crucial to risk making that sort of mistake again.

By the final ultrasound I learned things looked great and that my egg retrieval would be Sunday the 21st, two days sooner than our previous cycle. The column to look at is the 3rd one over. They're hoping to see at least two that measure around 1.8. I had several, so everything was ready to go. Unfortunately this meant I couldn't sing in our ward choir's Christmas program that I had a solo in, but I was glad to be able to go back to work for the 22nd-24th, which are super busy days for us. Originally I thought that meant our embryo transfer would be on Christmas day, but I was counting wrong. Embryo transfer was 5 days from egg retrieval, but egg retrieval is considered day zero, not day one.

That evening I had my final medicine, an HCG shot to trigger ovulation exactly 36 hours before egg retrieval. Unfortunately this was painful for me both cycles. It's a large shot administered in the lower back around your love handles, and it has to be mixed up and dissolved just like the Menopur. When Oscar administered it the first time, he accidentally put the needle straight in and slow when it's supposed to be quick and dart like. When mom did it she had a difficult time drawing up the liquid, which made the needle extra bendy by the time she'd gotten it all in there. It was too flexible after that to be administered quickly, so it was straight in and slow too. It would have been nice to have a spare needle, and even though we had tons, we didn't have any that were the correct size.

HCG is also the hormone your body naturally produces when you're pregnant, so I actually had to take a pregnancy test the next morning to confirm successful absorption of the HCG. It's interesting that the only 2 positive pregnancy tests I've had in my life were when I couldn't have possibly been pregnant. I've still got an extra one sitting around since they were only available in 2 packs.

On egg retrieval day we asked Myla to come keep an eye on Tyler while Oscar, mom, and I took two cars down to the clinic. Last time Oscar just gave his sperm sample then waited for me to wake up from the anesthesia, but we decided to have mom come down too so he could leave earlier and get back home for church. He was also supposed to do a solo with the ward choir, and we didn't want to leave our choir director without 2 soloists. Mom drove me home in her car once I was discharged since I wasn't allowed to drive for 24 hours post-anesthesia. Here's me all ready for surgery signing all the necessary paperwork before they took me back. They then had me use the bathroom, weighed me, and brought me back to the operating room. When I walked into it I said "you guys must have really knocked me out last time because I do not remember this room at all." I thought it had all been done in this original bed they put me in. The actual bed they have you lay in for the procedure isn't the most comfortable thing. It has an opening in the middle, like a toilet bowl, but the anesthesia puts you out quickly, so the discomfort doesn't last long. From what I understand they insert a special needle, the eggs come out along with a bunch of fluids, and they search for them under a microscope.

I felt incredibly well rested after both of my egg retrievals. By this point I was awake but still wanting to fall back into that blissful sleep. Once I was coherent they told me they'd retrieved 8 eggs. Though 8 or 9 is what the nurse at my final ultrasound had predicted, I was a bit disappointed since I'd had 13 follicles. Last time I only had 9 follicles but they retrieved 9 eggs. I've learned that I can't predict one cycle based on what happened at the previous one. They then gave me some apple juice and animal crackers and  kept me there about 30 minutes to make sure I didn't have any adverse reactions to the anesthesia. After they discharged me mom held my arm on the way back to the car since I was still a little dizzy and off balance.

We then drove up to the church and watched the end of the Christmas program. Although I couldn't sing in it, I still wanted to see it. Then mom took me and Tyler home and we both got a nice nap. My balance had more or less returned, but I stayed incredibly loopy and kept napping throughout the day. I thought that might make it hard to sleep that night, but nope, I slept perfectly then too. I wish I could always get such refreshing sleep!
Here's where I get a bit religious and philosophical. The next day we got a call that 5 of our 8 eggs had fertilized. Again, I was a bit disappointed since last time we'd had 8 out of 9, but the average is 70%, and 5 of 8 is close to that. It's expected that about 1/4 of those embryos will become viable, so that left us with an expectation of 1.25, meaning we'd likely get one and would be lucky to get another one. During Tyler's cycle we actually implanted 2 embryos, but one of those never developed a fetus while the other became Tyler. Viability in embryos is no guarantee of pregnancy. Because of that previous experience, having only 5 embryos worried me that we might not end up with a baby at all. Last time I hadn't known all these statistics and expectations. Since we had 8 embryos to begin with, I was convinced we were getting at least one if not several babies, so this anxiety was new to me. I began praying fervently for my little embryos, but I wasn't exactly sure what to pray for. I felt kind of stupid asking God to "please let my embryos divide and develop properly," but I also didn't feel I could personalize them. In nature as well as IVF, the vast majority of embryos will stop developing before a fetus is even formed, so for that reason I've never believed the spirit entered the body from the very moment of conception. I've long theorized that it happens around 8 weeks, when the brain starts forming neural pathways in preparation to send messages to the body. If our spirits are intelligences, wouldn't it make sense that they'd enter the body right when the brain starts functioning?

Though I hadn't changed my mind on this particular belief, I had a desire to feel closer to my embryos, to see them as my future children rather than mere balls of cells. My faith teaches of a state of pre-existence, that our spirits come into being and have personalities long before their time on earth, and I wanted to feel some sort of connection to any future babies I had out there. I asked the Lord what I should pray for, and I received a very clear answer - "pray that your embryos will receive spirits to give them life." I have to admit this answer took me aback for a minute. I responded "but God, we're planning on freezing any extra embryos we have. Would you really send a spirit into an embryo just to have it sit in a freezer for several years?" This is when I got totally reprimanded by the Lord. The response I got wasn't sharp, but it was very firm and unquestionable - "When I choose to send my spirits to their MY business." I felt impressed that it wasn't something for me to know right now and that I should just pray for what He'd told me to pray for, even if I couldn't make sense of it in my own head. Once I accepted that, I felt immediate peace and an overwhelming conviction that I would have children as a result of this cycle. Over the next few days I made the prediction that we'd have one viable embryo for transfer, 2 that were questionable, and 2 that had stopped developing.

On the 26th following a wonderful Christmas day, I drove down for my embryo transfer. I wasn't put under anesthesia so I was able to drive myself home without a problem. You come in with a full bladder since it helps them access your uterus more easily. This is uncomfortable but not unbearable, and it was better than last time since back then I'd missed the memo to avoid drinking in the last half hour.

After I'd changed, the embryologist came in to update me on the status of my embryos. My prediction had been spot on, but I didn't know all the specifics. One embryo was recommended for transfer, 2 had not divided past the day 3 stage, and 2 were early stage blastocysts they wanted to continue observing ("extended culture"). Fortunately there are pictures on the walls to help you see what embryos look like in development, which gives you an idea of what that all means. For the first 3 days the cells divide and you can count the number of divisions. They sometimes do day 3 transfers if one embryo's divisions look clearer and more uniform than the others. If there are multiple embryos with clear uniform divisions, they wait until the blastocyst stage when they can observe a bit more about them. Next is the morula stage. This is when the cells start to differentiate and arrange themselves in preparation for the day 5 blastocyst stage. The blastocyst stage has 3 different stages within itself - early, expanded, and hatching. In early stage blastocysts you find the beginnings of 3 distinct parts - the cells that will become the placenta, the cells that will become the fetus, and the fluid those cells are floating in. In the expanded stage you can clearly distinguish the outer cell mass (future placenta) from the inner cell mass (future fetus), and in the hatching stage those cell masses are literally trying to burst out of their shell in order to implant in a uterus. Many reproductive clinics actually perform assisted hatching for their older patients, particularly if they've failed IVF in the past. They place a small hole in the embryo, which certainly comes with its own risks, but has also proven quite effective at increasing rates of pregnancy among poor prognosis patients. It also increases the odds of conceiving identical twins, the only thing in the world that does that.
Our little embryo (or Myrgle, as Oscar has named it) was an AB expanded blastocyst. They give the outer cell mass and the inner cell mass a rating, A being highest and C being lowest, according to how clear and distinct it is. I believe the fetus part was the A and the placenta part was a B, but I'm not completely sure. You can see the little future fetus easily. It's the nice oval shape right in the middle. The embryologist told me, though, that the rating really isn't all that important at this point. Once they've expanded they're all lumped together under "good quality" and there's no difference in pregnancy rates according to their letter grades. I told him how we'd had one embryo implant successfully but not develop during our first cycle even though we were told it was very similar in quality to the first. He explained that's because whether it's going to develop or not is up to its genetics, which is something they can't determine from a microscope. One blog I follow says they've experimented with many ways to test and grade embryos to figure out which will result in pregnancy, but so far, nothing has proven effective.
This new understanding of blastocyst development made me question our embryos from our first cycle. The one on the left was the one they recommended we implant. The other they intended to freeze, but we chose to implant it as well. They said the one on the left was slightly better but that the one on the right was really great too. I'm no embryologist, but from what I can observe, the one on the left looks more than just "slightly better." It's easy to see the inner cell mass in the one on the left. It's like a little brain smack in the middle of the embryo. In the one on the right the inner cell mass is very fuzzy and difficult to distinguish while the outer cell mass is very clear. Maybe that's just an issue with proper focus on the camera, but I've always been able to distinguish the inner cell mass of expanded blastocysts I've seen in pictures, and I cannot see it in this one. There's no way of knowing for sure, of course, but my guess is that embryo #1 became Tyler. Embryo #2 implanted successfully but didn't develop any further because its inner cell mass never fully formed. Its outer cell mass was strong enough to hatch out and implant, but there was never a fetus within it. Though I was initially disappointed to learn we weren't having twins, I can't say I'd felt any particular attachment to embryo #2. I certainly didn't mourn for it the way I would have if I'd miscarried much later, and I don't believe it's a lost soul that's waiting to meet me whenever I make it to the other side. When I described this to my mother in law she said she felt similarly about one of her miscarriages. After everything was cleaned out they found a placenta but no baby. I wonder if hers was a similar embryo but with an even stronger outer cell mass.

For this cycle I did not want to implant two embryos and risk having twins again. Oscar tried to convince me to do two, figuring if it wasn't going to make it we'd have saved money by not paying for a separate embryo transfer, and if it did make it we'd get two babies for the price of one. Though it has some logic to it, I was not interested in having twins while I'm busy chasing around a toddler, and I wanted to give my babies their best possible chance for survival and development. We hear about healthy twins being born all the time, but there are always risks when two babies are growing inside a womb meant for one. I follow a blog by a retired embryologist who says without fail every year they had couples who'd conceived twins have one or both babies die, and my own fertility doctor had told me "the biggest risk to a growing fetus is having to share its space." For that reason I only intended to implant more than one embryo if they were lower in quality and the doctor recommended it. The fact that one particular embryo clearly stood out among the rest also helped decide it for me.

I told the embryologist how I'd predicted our embryo status correctly and that we were hoping one of our remaining embryos would develop enough to be frozen. We had a good laugh when I explained how we named the extra embryo from our first cycle Eglantine and that we'd really like to get a buddy for him/her. We also intended to name it "Buddy" if we got one. He laughed and said both the other two were early blastocysts and that "if one becomes extended, we'll freeze it." He would have known the odds were fairly low that both embryos would become viable (we only had 1 out of 3 make it last cycle when I was 2.5 years younger), which makes me think he intentionally didn't say "one or both embryos" so I wouldn't get my hopes up. I explained to him how nice it was going into the embryo transfer with a more realistic view of what to expect than I had the first time. He was glad to hear it since often people just assume all their embryos have baby potential only to be crushed that most of them don't.
Next the nurse and the doctor come in to examine and test you out in a few positions to see which will be the easiest one to perform the transfer in. The doctor wasn't the same as the one I'd had last time but the nurse was. The doctor said my cervix looked great and that the progesterone supplement was clearly working. This made me happy since I REALLY hate that stuff, so it was good to know that at least it was doing its job. When they were satisfied that we were ready to go, my embryo lit up on the monitor pictured above. I got to watch as it was sucked up through the catheter. I could even see it in the catheter itself. Then the embryologist handed the catheter to the doctor through this window and I was asked to hold as still as possible during the transfer itself. After the catheter was inserted it was handed back to the embryologist who checked to make sure the embryo wasn't still somewhere inside the catheter. He responded very quickly that it'd been a success, which was a bit concerning for me since my embryologist the first time had spent much longer examining the catheter before she announced that the transfer had been successful. The doctor and nurse then left the room after setting a timer and recommending I lie down for about 10 minutes before using the bathroom. This is purely for your own relaxation since you can't accidentally pee out the embryos, and if you really got to go, you are allowed to. I was able to wait, then after using the bathroom I came back and relaxed a bit more before getting dressed and heading back. I appreciated that they had a make-shift skirt for me to put on instead of needing to get fully dressed before using the bathroom. You do have to pee pretty badly at that point.

Throughout the rest of the day I did as instructed and took it easy. I paid attention to my body and noticed some minor cramping. There were also two points when a small part of the left side of my gut started vibrating. My uterus was definitely getting to work. I wondered if that vibration was the embryo actually implanting. I had a HORRIBLE cough that day, so it was very comforting to know I couldn't jostle the embryo out. I'd heard that before but decided to research it more that day purely for a bit of extra comfort. This blogpost explains perfectly why the embryos are not going anywhere no matter how much you shake them up.

The next day I went to to the gym. Technically I was supposed to continue taking it easy, but I felt fine and really wanted to get out of the house. I ended up getting distracted by the workout and forgot that I was expecting a call updating me on the status of our two extended culture embryos. I suddenly remembered and ran to my locker to grab my phone. Lo and behold there was a voicemail and a missed call from Seattle Reproductive Medicine. I started listening to the message "Hello Ms Hunt, we're just calling to inform you of the status of your embryos..." when the message cut off. I wanted to scream out "Noooooooo!" but instead did the logical thing and left the locker room to make the phone call with better reception. I called my voice mail again and fortunately was able to hear the rest of the message "Two of your embryos are extended, and we froze both of them. Call us if you have any questions." Two!!! I was so excited I literally jumped up and down and came sprinting out to the treadmills to tell Oscar. The odds were so low of our having 3 viable embryos out of only 5 that I hadn't even let myself entertain the thought that both extra embryos might become viable. Last time we'd had 3 out of 8 when I was younger with better fertility, and of our three in extended culture, only one ever became viable. I couldn't believe it. A potential family of 5 children! We'd always wanted a big family, and here it was already in the making! And if five isn't enough, we still have another fresh IVF cycle covered by our insurance. It makes me so happy I honestly am holding back the tears writing about it now more than 6 weeks later.

In the following days I did a little research on early embryos and learned something new - boy embryos tend to develop quicker than girls and are thus more likely to be selected by embryologists for transfer. Although about as many boys as girls are conceived with IVF, you're 57% likely to give birth to a boy. Here's an example of why - let's say a woman has an IVF cycle with one boy embryo that develops into an expanded blastocyst on day 5 and a girl embryo that develops into one of equal quality on day 6. The boy would get implanted on day 5 while the girl would get frozen. Women are often able to get pregnant on their own following a successful IVF cycle, or they never freeze their extra embryos for personal reasons, so many of those late bloomer girls never end up being implanted. We very nearly didn't freeze our extra embryo from our first cycle (Eglantine) because our insurance wouldn't cover it. It was $900 to freeze it plus $40 a month to store it, which was more than we'd paid for the entire rest of our cycle. We'd implanted two embryos and been told our chances of twins was extremely high, we had coverage for two more fresh IVF attempts, we weren't sure how many children we'd end up wanting total, and I held on to the hope that we would get pregnant naturally after doing IVF. At the time the chances of needing that extra embryo seemed minimal. As it turned out we did not have twins, our one baby has now made us want as many children as possible, and we've still never conceived naturally, so now I'm extra glad we froze our embryos. And based on what I now know about early embryo development, I'm predicting that this pregnancy is another boy and at least 2 of our frozen embryos are girls.

Since we'd had more than one extra embryo, we decided to give them names other than Buddy 1 and Buddy 2. I like Egglebert and Egglinda, but Oscar prefers Egglanjot and Egglantittle. It's still up for debate.

What's interesting is that boys may develop faster as early embryos, but at birth, girls are actually more physically developed than boys. I find this absolutely hilarious and very telling of gender differences right from the moment of conception. Here's how I picture it.

Boy Embryo: Wahoo! Let's do this thing! Let's be the biggest, strongest, fastest embryo ever! I'm gonna implant in that uterus so hard, she won't know what hit her. Yeah! Rock on!!!
Girl Embryo: We're here, but there's no need to rush or take any unnecessary risks. Let's be as efficient as possible and make sure everything is developing properly.
Boy Fetus: (whining) I'm tired...This is hard! How am I supposed to grow when I'm so cramped in here?
Girl Fetus: (pleased) Excellent! Everything's in place the way it should be. I even had enough extra time to form all the eggs I'll ever need. Look how much hard work, patience, and persistence can do!

Sometimes people abandon their embryos, meaning they stop paying for their storage fees and the fertility clinic can't get in contact with them to find out what they'd like done with them. For this reason they have you state in writing what your preferences are in the case of embryo abandonment. You can have them discarded, donated to stem cell research, or donated to other couples. We picked donated to other couples first, then stem cell research, then discarded. If there ever comes a time that we decide not to have any more children, we intend to donate any extra embryos to other couples, but having a baby has made us want a large family, so we think we'll end up using them all. What might change our mind is if a doctor told me I shouldn't carry any more children for health reasons or if we miraculously start being able to conceive on our own.

For the next couple weeks we waited to find out if the embryo we'd transferred had resulted in pregnancy, but I was already convinced that it had been successful. The minor cramps happened often enough that I could tell my uterus was getting to work, and I also had the early pregnancy fatigue as a result of hormone production. It was nice to know the signs to look for now that I'd been through pregnancy once before. Although my scheduled blood draw wasn't until January 4th, the fact that my period hadn't come by the 3rd convinced me I was pregnant. I'd also had to take an HCG trigger shot for all 6 failed IUIs, and it keeps me incredibly regular. When pregnancy doesn't occur, my period returns exactly 14 days from when the shot was administered. I knew if I wasn't pregnant and all those symptoms were simply the aftereffects of ovarian stimulation, I would have had my period on January 2nd. I went in for my pregnancy test at 9am on Sunday the 4th pretty much knowing there would be a positive result.

It was about 3pm when I got my results the first time around, so I never expected the call to come at 11:20am this time. I guess since it was a Sunday they had less blood tests to analyze, so they were able to get back to me sooner. For that reason I didn't have my phone near me when they called, and I wasn't able to get to it before it went to my voicemail. The nurse said "if you'd like to hear the results from us directly, call us back, but if you're happy to hear it're pregnant! You're HCG level is 265." They'd explained to me the first time that they're looking for at least 50, so at 265, there was no doubt. It's actually higher than what it was with Tyler. I was 232 then, and I'd started off with two implanted embryos.

Since then things have been going fine, but this pregnancy's definitely been more difficult than the last. I didn't have any nausea before while now I feel queasy pretty regularly. I also have quite a bit of mild cramping, I get side pains if I do anything more than low intensity exercise, and I'm tired all the time. With Tyler I really only had the fatigue, some difficulty exercising, and a tiny bit of cramping. I'm also having an aversion to meat, particularly chicken. I had it to beef at the beginning, but that quickly went away. I can eat beef again but in smaller quantities than I used to. I normally love those whole roast chickens you can get at the store, and now just the thought of one makes me want to vomit. However I was able to eat one spicy chicken wing at a sample booth at Costco the other day, and I ate ham and turkey deli meat today during our superbowl party, so I think it's slowly improving. I'm also having cravings for pulpy orange juice like last time, and cereals like Corn Flakes and Chex really hit the spot these days.

I went in for the 7 week ultrasound last week and so far everything's looking good. I told the doctor about my extra symptoms, and she said it's likely the result of my ovaries still being a bit enlarged. Everything is just working extra hard fighting for space! It didn't happen last time, but it's not uncommon after IVF stimulation, and it's nothing to be concerned about.

The baby's only about the size of a blueberry, so they can't get much of a view of him/her, but their measurements and heartbeat look normal. I'm hoping for another healthy pregnancy!

For more about our journey see:

Our Experience with Infertility Part I - Pre-diagnosis

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